“I Feel Cheated, Hurt, Trapped, Sucked Inside” A Case Оf Clinical Depression By Dr. Atul Patwardhan

This is a case of a 50 year old lady who came to me on 29/12/2013 diagnosed with clinical depression and was taking psychiatric medicines and consulting a counselor. Her issues with her Husband led to divorce and she went into depression. This is how her story unfolded

PASSIVE CASE TAKING

Dr: Feel free, I just want to know you…say whatever you can

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P: I am separated from my husband more than 10 yrs ago, because of his behavior. He used to drink a lot and do many other bad things. Gradually I did not feel anything…. that hurt started coming lower and lower. I have a daughter who is 14 years old now

He was a drunkard and he used to emotionally blackmail me, many years he kept saying that our daughter is alone, not going to school etc. so you come back. That time I was working in Mumbai, so I took a transfer and came back to Pune for the sake of my daughter. I did not have any relationship with my husband at that time besides that we used to stay in the same room. That time I realized that things have gone worse, he is lying and stealing money and my daughter was fine. She was already used to the fact that Mom is not around. Yes, emotionally any child will feel bad, but seeing us fight for even worse for her. She used to cry, she used to try and protect me.

After that I left that house for good and never really went back. I used to go whenever I used to come to Pune. Only for her I used to go there. Well that’s about it, all that ended but that hurt was already gone out of my system by then. There was no hurt regarding him just anger. There was no sign of resentment, there was only anger.

In all these years when I was struggling practically for everything my parents never thought of helping me. My mother remarried as I lost my father. One day her husband told me we have a flat there in Airoli if you want you can stay there. That was the time when I came to know that my husband and my brother used to spend a lot of time together. My husband used to tell my brother a lot of nonsense about me, and my brother believed it. I used to think that my brother is supporting me but he was not. Even today he will be doing the same. I felt very cheated and I can’t trust anymore . Specially men!

AS A CHILD

My father as well used to hit me a lot, he was a strict man. He never tried to understand me as a child and what I was trying to tell him. I never liked him. Then it came to my husband, and then it came to my brother…then gradually friends also, so there is nothing that I can trust anymore.

Now I have been alone for many years, even if I have a very good friend I can’t trust her like she will be there for me if I need her. Trust is completely gone, and then I feel lonely.

FRIENDS:
My likings are different, I like to listen to music, sit by myself or may be in a room, talk to people. That’s not how they are. This is how I have been even at the age of 17, it is not that now I have turned to listening to music, I would like to sit and relax. This I was doing when I was 17 also yet I had a huge set of friends then. I don’t know I mean is there something wrong with me? I feel very lonely. I know that I have tried to commit suicide earlier and I get scared that I should not fall in that trap once again.

I have not been doing anything. People have plans ahead, like my friends if they are married they have plans ahead, they might be having a house, having kids…there is nothing of that sort in my life. I think nobody is bothered about me. Because when I got married that time they asked me to sign some papers and like a fool I went and signed the papers, it’s all trust…..I am feeling cheated now but they were my parents, I went and signed. I don’t have any house. I felt cheated again.

What will happen later in life? May be my parents have already decided that we will give Sheetal this house. May be they have decided but I don’t know then how can I trust? I can’t trust. Tomorrow again they will say sign on this paper. Can’t trust…!

Like if I am a motorcycle and I am travelling, I travel a lot alone, that time we might not even know where we are going but I trust myself that I will find a hotel somewhere. I even trust that hotel manager, I can sleep a peaceful night in that hotel there I can trust but these people I don’t trust.

I cannot express also now even if I have to talk about anything emotional I will tell may be 85% the rest 15% even if it is very important I cannot tell, I want to express I can’t express. May be that hurt locker is still locked.

Another thing what I have realized is when I become emotional I start shivering very badly. It gets very embarrassing. This also happens when I drink. I drink, but I don’t drink everyday! But while working I could not drink at all as I had to get up in the morning. If I am happy only then I can drink, if I am angry or if I am upset or down I cannot drink. I drink to enjoy, I listen to nice music. Only when I am happy I can drink, but people feel no she a problem in her life, so she drinks. But I don’t even drink every day. I try to tell people but opposite only happens. It is a cycle I think. I feel lonely, I try to get out of it….same thing. Then I feel cheated, then I come back, again I feel lonely. Cheated, lonely, cheated lonely…..and in between commit suicide.

Dr: Anything else about you nature?

P: I cannot tolerate anyone lying to me. I cannot tolerate people stealing. Anybody telling me the worst of things as well it will be difficult for me to take it, but if someone lies to me I feel very angry, very upset. Again same thing….cheated…! I can’t…… I lose that person, I lose myself and trust…I don’t know what to say….I can see only black then. If someone lies to me I feel black, I feel all walls are closed (HG) I feel everything is closed in front of me. Somebody lies….the wind, everything just goes off.

Everything seems black. At that moment I just go down, I just crash….I need to sit. (HG) it is all darkness around me. I can’t hear anything, I can’t see anything, I don’t want to talk, my heart….something happens!

Pause…….

I get very angry with people behaving in a wrong way. The other day when I was riding a bike, I was standing at a signal. Signal went green, I left with everybody and there was a guy who broke the signal from the left hand side and came and banged into me. When I recovered I saw him, he was speeding….he was panicked. I decided I will catch him. I drove for quite a few kilometers and I caught him. That time also it was anger. He hit me and he ran, I dint do anything to him as such. I took away his phone, I said you come to the police station right now but he didn’t come. So I took away his phone, then he called me, started crying and shouting outside my house. He said I will pay for your damages. He paid me. I said he would have killed me. It was a hit and run case. I spoke to him nicely. I asked him, what made you hit me and go? He said there was an emergency. I said you will put me in the emergency room and go away? Obviously I shouted at him. I think that was fair enough. Took away his phone so that he calls me back, which he did otherwise why would he? I don’t think I am mad.

The other day one rickshaw driver was charging a girl more than what the fare and I was passing by so I asked what happened? She said he is cheating me, taking 10/- extra. I could not stand that, so I spoke to the rickshaw driver, spoke to him very nicely and made him return that 10/- to the girl. I did not catch him by the collar.

Earlier I used to get angry on my child. It was afternoon time and I was trying to put her to sleep and she was crying and she did not want to sleep. Then she said how much time you want me to sleep and I said precisely 45 minutes. Then she said let me see the time right now….I said you are not trusting me? She said no you show me the time and I got so angry that I took the watch and banged it on the wall…

But I think I have control my anger otherwise would have held that rickshaw driver by his collar or I would have slapped that guy who slapped me. I think I am better now. That fellow who had stolen my cassette and I ran after him I don’t do it right now.

It is wrong for them to do something like that. So I reacted. But people think that it is because I get very angry. What I feel is earlier I used to get very angry but now I try to control it. If somebody lies then I don’t know, I cannot control…may be even I don’t want to control if somebody lies to me

Focus of the case:

• Cheated / No trust / cannot tolerate lies

Level of experience:

• Delusion

Hand Gesture: Sometimes aligned with the description

ACTIVE CWP (with focus)

Dr: What happens to you when someone lies to you, cheats you, breaks your trust? What exactly do you experience?

P: I feel like sitting down, a lot of air that comes out, I cannot sleep, I try to run away from people, I try to be alone I cannot face I cannot talk. Then I dwell on those things. I try to remember what all happened, what she did, what I did…then I think this happened so that happened….I go in the past and torture myself only.

Dr: Not what you think, what you experience inside you?

P: That black. This all is black; I cannot see….it is all black… (HG: Hand covering the face, and eyes closed)

Dr: be with it and try to describe it with as much detail as you can. Just that experience, no thoughts, no emotions

P: I can see only black, just black. And air coming out of me. I am also black and everything around me also black. Nothing is there. Even if I am standing in the sunlight it will all be black. I cannot see anything else but black. If I try to picture myself in my room that time also everything is black. Like the body is stiff. And the heart beats are on. Too much of pressure on the brain and I am crying, but it is not crying-crying but just the tears flow. And head hurts a lot. And that shivering thing, I feel cold. I don’t know if the body becomes stiff because I feel cold…but it just becomes stiff.

Dr: Be with all this experience and describe it more, black, 4 wall, shivering…

P: Ya, it is like completely black, it is like a box, it is like you are in a jail or something, there is no sunlight and everything is black. Like a cell.

Dr: just be with it

P: My body goes down like this. If I sit also I will sit like this. If there is nothing to sit I will bend in my knees, I will bend in my back. (HG: Open left hand making a fist, pulls it down and at the same time expires and bends down)

If I am breathing I feel as if the breath is not actually coming and going….it is just going inside. I feel like everything is just going inside . Even that breath, when it goes inside it just goes inside, when it comes out it just comes out. It is not like normal breathing, it is like focused breathing. When I take it in it comes in, I don’t have to breath that’s how I feel, when it comes in it goes somewhere inside my body. But sometimes when the breath comes out I understand the breath coming out. I feel like everything is shut. I am in a zone of myself….like this hurt….like whatever has happened….this experience…this hurt….god I remembered this was a year ago see this….breathing….

ACTIVE_ACTIVE CASE WITNESSING (towards the whole inner pattern and source)

Dr: What is the experience? Just be with this experience deep inside you…?

P: I feel that my lungs and everything is going inside... (HG: Both the hands move from mouth down towards the stomach, palms facing down)

Dr: Describe that inside, this HG that you are doing?

P: it is like my throat, my tongue everything is going in…where down I don’t know; I don’t know where it ends…it goes in. like my tongue is going in, my throat is getting pulled inside. It is like how sand goes in? One by one..! Like if this is sand….the top part goes in, and then the inner….like that from here till here (throat till stomach) one by one everything goes inside.

Dr: Just describe in general these words…..Pulled inside, in general…whatever comes up to you talk about these words, pulled inside.

P: It is sinking. Drawn inside, sucked...(Same HG as above)

P: A man is standing on quick sand and that man is going in...in...in... might try to come out but it is not possible. Once the sand goes in it goes in. You cannot hold on to the sand, even if he tries to hold on to the sand, the sand will come in the hand but the hand will go down with the sand. He will go inside. (HG: Open fingers of left hand closes to make a fist at the same time pulls down)

Dr: More about these words, pulled in…sucked in…give me one more different example, completely different example…pulled in, sucked in. might try to come out but cannot come out

P: like in water….I have never seen such things but since you are asking this is the first time that this is coming to my mind…..in water there are these plants / flowers…they wait there. There is a fish going, they are very attractive and pretty…there is a fish going…he will go past like this, then he will go like this and when he comes right here it will close…..it will close and that fish will be inside that. It will be trying to come out but it can’t come out of that. He is there inside right….now what happens is that….these tentacles suck his blood out and it dies or they suck the entire fish inside. They suck the entire fish inside. That is the sucked in. it cannot come out….it is trapped.

Dr: In the sense?

P: like…that flower is there, when that fish goes inside…it traps the fish….now when that man is going inside and the sand comes over him and he is trapped inside…like that when it happens to me my breath goes inside…actually it does not happen but what I feel is like when that sinking is happening, my tongue is going in…in...In…that time I feel my breath is trapped inside…its going inside…inside.

Dr: you were talking about some plant? Describe that to me.

P: those plants are there…they are nice and attractive. Those tiny fish who are swimming around they go there because these are nice plants and those plants are like that…stationary….they don’t move….the fish goes here, here, and suddenly they close.

Dr: Suddenly they close?

P: Ya…(HG) suddenly they close so the fish is trapped and that’s their meal.

Dr: Tell more about it

P: the fish is nice and colorful. Yellow, black, they are also nice and colorful, they are very pretty…and there are plenty of those. The fish goes to one flower. When they close, these things…the petals or whatever it is…the fish is trapped. The inside is red, the fish dies…the flower it sucks out everything , blood or whatever is there is sucked out. When it open the fish is dead…it falls.

Dr: You visualize this entire thing under water?

P: Yes IT IS UNDER WATER …….But these flowers this is what they eat. They are meant for that, that’s their food. But in real life people cheat….they have business to do, other things to do…they can’t cheat somebody and live the life like that. Be it money, be it faith you can’t cheat. Or like my husband how he cheated on me, or my brother cheated.

Dr: So you are saying that it suddenly closes…

P: Yes…because it has to catch….if it closes slowly the fish will go away. So it has to suddenly close so the fish is trapped.

Dr: Anything else you want to say?

P: NO.

Follow up: 1 month

She developed a very severe upper respiratory infection 5 days after I started the treatment. 102 degree fever, cough, cold and swollen tonsils. I asked her to take the constitutional medicine in water dilution for 2 days and the episode subsided. Later on she started feeling gradually better. When she met me after a month she was much more energetic and looking happy. She said she went a for a bike ride and is feeling happy about it.

Plan: Continue S.L.

Follow up: 3 months (Skype follow up)

Dr: Hi, how are you doing?

P: I am much better doctor. I haven’t felt so good in a long time. All these 3 months I have been steadily progressing. I have stopped my anti-depressants. I am no more feeling that trapped.

Dr: What you mean?

P: I used to feel used and cheated, and there was a strong feeling of being deceived. Now I don’t bother about others and somehow I am not affected because of the people or their comments.

Dr: Any dreams you had?

P: Nothing much, only dreams related by day in office and routine stuff.

Follow up: 6 months (Phone call)

P: Hello doctor, I am pretty well, I am going to join a new bikers organization hence I am not able to come and see you. I am doing very well. I have been meeting my daughter regularly. Sometime again the hurt feeling is bothering as I have to interact with my husband during my visit but I am managing it well. Could you send me some me medicine which will help me reduce my anxiety which I feel during the days when I meet my husband?

Dr: What do you feel that time?

P: I feel that shivering within my body and difficulty in breathing….somewhat similar kind of feeling which we discussed.

PLAN: S.L. for 2 months and few powder doses of her constitutional medicine just in case she feels the sensation is again surfacing. The dose to be taken at bedtime!

Doctor: She kept on coming to me for follow ups every 2-3 months. We would either meet on skype or she used to message me about her condition and I used to courier the medicine as she lives in Mumbai. She reported feeling better gradually on all levels and now it has been more than 3 years she continues to be better. She has stopped treatment but whenever she comes to Pune she talks to me, meets me. It feel so good and satisfying as a doctor to see her doing well and leading a well deserved happy and beautiful life.

P.S. All her follow ups as well as the case is video/audio recorded.

ANALYSIS OF THE CASE:

Word / Expressions / Gestures those were peculiar and repetitive in passive case taking:

• hurt was already gone out of my system
• I felt cheated and I can’t trust anymore .
• Trust is completely gone, and then I feel lonely
• I know that I have tried to commit suicide earlier and I get scared that I should not fall in that trap once again.
• Because when I got married that time they asked me to sign some papers and like a fool I went and signed the papers, it’s all trust…..I am feeling cheated now but they were my parents, I went and signed. I don’t have any house. I felt cheated again.
• May be that hurt locker is still locked.
• Another thing what I have realized is when I become emotional I start shivering very badly.
• I try to tell people but opposite only happens. It is a cycle I think. I feel lonely, I try to get out of it….same thing. Then I feel cheated, then I come back, again I feel lonely. Cheated, lonely, cheated lonely…..and in between commit suicide.
• I cannot tolerate anyone lying to me. I cannot tolerate people stealing. Anybody telling me the worst of things as well it will be difficult for me to take it, but if someone lies to me I feel very angry, very upset. Again same thing….cheated…! I can’t……
• I lose that person, I lose myself and trust…I don’t know what to say….I can see only black then. If someone lies to me I feel black, I feel all walls are closed (HG) I feel everything is closed in front of me. Somebody lies….the wind, everything just goes off. Completely

Focus of the case

• Cheated / No trust / cannot tolerate lies

Word / Expressions / Gestures those were peculiar and repetitive in Active case taking:

• It is all black (Connects to the expression in passive case taking)
• I am also black and everything around me also black. Nothing is there. Even if I am standing in the sunlight it will all be black.
• Like the body is stiff.
• Head hurts a lot.
• Shivering thing, I feel cold.
• Completely black, it is like a box.
• It is like you are in a jail or something, there is no sunlight and everything is black. Like a cell.
• If I am breathing I feel as if the breath is not actually coming and going….
• I am in a zone of myself….like this hurt….like whatever has happened….this experience…this hurt….god I remembered this was a year ago see this….breathing….

During active case taking I also noted that the hand gestures were aligned with the verbal expressions. That was the confirmatory point for me to believe that I am on the right track.

Word / Expressions / Gestures those were peculiar and repetitive in Active-Active case taking:

• everything is going in…
• my throat is getting pulled inside.
• It is like how sand goes in? One by one.….the top part goes in, and then the inner….like that from here till here (throat till stomach) one by one everything goes inside
• A man is standing on quick sand and that man is going in..in..
• In water there are these plants / flowers…they wait there. There is a fish going, they are very attractive and pretty…there is a fish going…he will go past like this, then he will go like this and when he comes right here it will close…..it will close and that fish will be inside that. It will be trying to come out but it can’t come out of that. He is there inside right….now what happens is that….these tentacles suck his blood out and it dies or they suck the entire fish inside. They suck the entire fish inside. That is the sucked in. it cannot come out….it is trapped.(CONNECTS WITH THE SOURCE)

Kingdom: Plant

• Her entire experience was just a sensitivity and a feeling of hurt towards certain aspect
• But we also see a hint of victim aggressor theme
• There is a process that we see in this case. The process of being trapped, sucked in, cheated but nowhere in her description the basic survival instinct of the Animal kingdom appears like “you finish me or I finish you”…In any given situation where there are two people involved she just ends up feeling hurt deep within.....as in, "how could you do this to me?" She is 'sensitive towards such emotions. It does not give rise to a feeling of being small, crushed by a bigger force, competition etc. That is the reason why I thought of a substance which has a basic plant quality but with an animal twist in it.

So I thought of Carnivorous plants.

• Another important delusion which came up was “of being sucked in the land” was a superficial example which explained just the phenomenon of being sucked in. It did not fulfil the entire set of expressions as a whole neither did she show signs of source identification with quick sand the way she did with the flower under water. She personified that example better than the previous one

There are 2 types of plants in this family. Plants with active traps and plants with passive traps! The patient’s entire energy suggests that we have to think of a plant which has the following qualities.

• It closes suddenly
• It sucks out everything
• Most importantly it is under water…….

Sensation of carnivorous plants given in the book “AN INSIGHT INTO PLANTS VOL 3” is as follows

• Trap
• Deceived
• Sticking
• Constricting
• Lancinating
• Strangled
• Suffocated
• Convulsive
• Spasmodic

Passive reaction: cannot trust, weakness, paralyzed

Active reaction: Malicious, deceitful, suspicious, Desire to kill/injure, violent

REMEDY GIVEN:   UTRICULARIA FOLIOSA 1M

What I learned from the case : - The case taught me how to not give importance to words but the whole experience. How it is important to listen patiently to see that non-human specific pop up, I have been passive in this case for over one hour 30 minutes. I had to give her time to release her pent up emotions