NAME OF CANDIDATE :- DR.

MADHURA MADHUSUDAN

DEODHAR

NAME OF COLLEGE :- DR. M.L.DHAWALE MEMORIAL

HOMOEOPATHIC INSTITUE.

:-

NAME OF GUIDE DR. NITYANAND L. TIWARI

NAME OF COURSE :- M.D. (HOMOEOPATHY)

NAME OF SUBJECT :- PSYCHIATRY

ADMISSION :- 2009-2012

YEAR/ACADEMIC YEAR

TOPIC :- STUDYING THE INFUENCE OF PHYSICIAN’S PERSONALITY

TYPE ON PERCEPTION OF PATIENT.

NAME OF COURSE :- M.D. (HOMOEOPATHY)

NAME OF SUBJECT :- PSYCHIATRY

ADMISSION :- 2009-2012

YEAR/ACADEMIC YEAR

TOPIC :- STUDYING THE INFUENCE OF PHYSICIAN’S PERSONALITY

TYPE ON PERCEPTION OF PATIENT.

 DECLARATION

I, hereby declare that the dissertation entitled “STUDYING THE INFLUENCE

OF PHYSICIAN’S PERSONALITY TYPE ON PERCEPTION OF PATIENT” has been

prepared by me under the guidance and supervision of DR. NITYANAND L. TIWARI in the

partial fulfillment of the regulations for the award of the degree of DOCTOR OF MEDICINE

(HOMOEOPATHY) in PSYCHIATRY of Maharashtra university of health sciences, Nashik and

has not been submitted previously for the award of any diploma or degree from any university.

Date:

Place: PALGHAR

DR. MADHURA MADHUSUDAN DEODHAR

 INDEX

SR.NO. CONTENTS PAGE NO.

1. INTRODUCTION 1

2. AIMS AND OBJECTIVES 5

3. REVIEW OF LITERATURE 7

4. MATERIALS AND METHODS 29

5. CASE RECORDS 33

6. OBSERVATIONS AND ANALYSIS 272

7. DISCUSSION 288

8. SUMMARY AND CONCLUSIONS 294

9. RECOMMENDATIONS 301

10. BIBLIOGRAPHY 304

11. ABBREVIATIONS 307

12. ACKNOWLEDGEMENT 309

13. ANNEXURES 312

14. MASTER TABLE 320

 1

INTRODUCTION
 2

INTRODUCTION

I remember how enthusiastically I had started my internship

when I was for the first time exposed to the practice of Homoeopathy and its

principles which till then were just learnt in theory. But soon the initial

enthusiasm got unknowingly and gradually transformed into kind of frustration!

The frustration being on self, because I was realizing that no matter how

much ever I was good with my theoretical knowledge I was lacking a great

deal in applying it into practice. This was clearly evident through the cases

which I would take up. I was able to arrive at perfect clinical diagnosis but

when it came to understanding patient and his remedy it was always a mess. I

still remember an incidence in my internship where I took case of a patient to

the consultant. When I had taken that case patient had wept a lot regarding

her disappointment in love. I being very sensitive by nature immediately had

got affected by this and felt sympathetic for her and considered her to be mild,

dependent weepy female neglecting the other aspects which she had shared..

But when I discussed it with consultant the understanding of patient came out

to be opposite i.e. sentimental, irritable, brooding, and female. This

understanding evolved through the same data which I had taken but didn‟t

feel it important to be considered. And my initial impression of Pulsatilla for

that patient then turned out be Natrum Mur! And this would happen many

times. Every time I would realize that there are certain aspects of „me‟ as an

„individual‟ which make me sensitive for some experiences or insensitive for

some. And those aspects affect my perceptual processes involuntarily

irrespective of any experiences, training or teaching. It would always make me

wonder from where does these individual perceptual processes originate

 3

leading to such drastic differences in our perception?? Rather, if we shift our

focus slightly away from homoeopathy then we will understand that this kind

of situations arise very commonly in our day to day life also. E.g. imagine two

people meeting a well dressed, well mannered gentleman for first time. One is

highly impressed and says,‟ oh! What a nice person he is, see the way he

speaks, behaves , seems to be a good chap.‟ While other says,‟ true but still I

didn‟t feel comfortable with him… may be he not as good as he at least

appears to be..‟We all know that no two individuals are alike and hence it is

obvious to have such differences in perception of world around us. So first

question that comes up is that have we really thought how important it is to

understand the genesis and consequences of these kinds of differences? Not

really! In our day to day life we may dismiss it or may consider it depending on

circumstances. So then next question is it justified to have this attitude when

we are practicing as a Homoeopath? Certainly not! Study of the individual in a

holistic way forms the back bone of homoeopathic practice. It has been known

since ages that controversy always arises when different physicians try to

understand same patient with no two homoeopaths arriving at same

constitutional remedy. The remedy of the patient will determine the fate of the

patient in terms of recovery. So when we see different views arising for same

patient we can‟t afford to neglect it. As an MD student in the Dr. M. L.

Dhawale Memorial Homoeopathic Institute, I came across a novel concept of

Primary physician and observer together going for case taking with the

underlying concept of observer being a KEY FACTOR in bringing a physician

face to face with his prejudices and vice a versa by discussing their individual

perception of patient, remedial understanding, evaluating self and each other

 4

in different parameter. Thus my prior quest and this scenario motivated me to

explore this phenomenon in depth so as to understand from where, how these

differences arise and in what aspects they influence our perception of patient.

The differences in the perception are considered to be due to

prejudices as rightly said by Dr. Hahnemann which in turn is product of our

upbringing, past experiences & value system etc. but isn‟t it likely that another

factor is probably playing a crucial role? The innate psychological personality

type may be such a factor. One can go beyond our upbringing and

indoctrinations but not our heritage. So with this thinking in mind, I went

through different personality theories and eventually found the Psychological

Personality Types by Carl Jung to be the most interesting, and very

fundamental. I found his work to be insightful & a sensible integration of both

Eastern as well as Western Psycho-spiritual concept of life. Carl Jung‟s basic

personality types are Extravert and Introvert. The life experience of an

Introvert with respect to Extravert is diagonally opposite. To understand

other‟s experience, one needs a paradigm shift in orientation. This is only

possible if primary awareness of own personality type is there. Along with this

the journey will be equally interesting with awareness of own Personality Type

while functioning as Physician, for this is an important path in realizing the

dream of becoming an unprejudiced observer.

It is said that, every one of us has in him continent of undiscovered character,

blessed is he who acts the Columbus to his own Soul. (Anonymous).

This study would also serve as an opportunity to the involved physicians to

become the Columbus who is set to discover self!

 5

AIMS AND

OBJECTIVES
 6

AIMS AND OBJECTIVES

AIMS

Every individual is gifted with his own innate personality. In Homoeopathy, this

is termed as disposition. It determines the perception of the individual and

perception is different for each. Most important and fundamental step in

homoeopathic practice is Case taking in an unprejudiced manner.

Homeopathic case taking is all about perceiving dynamics at the level of the

mind & body in a patient. Thus the aim is to study the personality type or

disposition of the physician and how the differences in personality types of

different physician‟s influences the perception of the patient.

OBJECTIVES:

1) To study the physician‟s personality type

2) To study how the type influences case taking & processing in terms of:

a) Nature of Doctor–patient relationship formulated during clinical interview.

b) Life areas explored.

c) Usage of technical skills during the interview.

d) Perceiving the patient‟s disposition, attributes & his mental state.

e) Final totality formation.

f) Similarities and differences that may or may not arise in perception.

 7

REVIEW OF

LITERATURE
 8

REVIEW OF LITERATURE

Homoeopathy is an intricate science and art. We all homoeopathic physicians

are ordinary human beings who through our knowledge, training and

experience developed an understanding of the intricacies of the human mind,

body, its function in health, and its dysfunction in disease. Just as each

patient has their own unique personality, each physician also has their own

unique personality or Disposition as we say in Homoeopathy. Hence

perceiving of a Human mind has never been standardized and cannot be

standardized. Practice of Homoeopathy requires Physicians to understand

and perceive every individual Human being in unprejudiced manner the way it

travels from health to disease. Many stalwarts in Homoeopathy too have

attempted to understand man in health and disease in their own fashion

depending on their own disposition or Personality type as we would say in

terms of Psychology. But if we understand process of perceiving and how our

own personality influences our perception, then it can help us to identify how,

when and where do we get prejudiced and how our personality serves as an

asset or liability. This truly is first step in journey to evolve as an unprejudiced

observer.

UNDERSTANDING PERCEIVING A PROCESS:

 Definition:

PERCEIVE: Apprehend especially through the sight, observe

apprehend with the mind, understand, see or regard.

PERCEPTION: Act or faculty of perceiving, intuitive recognition of

truth, aesthetic quality, way of seeing or understanding.

 9

Perceiving is most essential function with which human being is endowed

with. Perceiving evolves with the passage of time. It seeks meanings into

experiences. Meanings appear to the mind‟s eye and hence bear

characteristic stamp that identifies us primarily. Perceiving changes with the

observer, his position, as well as his attitude. Information reception in

humans is perception. Perception is a dynamic conflict between the attempts

of an outer world to impose an actuality on us and our efforts to transform this

actuality into a self-centered perspective. Perception is a confrontation

between an inward directed vector of external reality compelling awareness

and an outward-directed vector of physiological, cultural, and psychological

transformation. Where these vectors clash, where they balance each other, is

what we perceive.

 Types of Perceptual processes:

Lower level Perceptual process: The physical receipt of information about a

state or situation occurring elsewhere. Perception, often understood to be a

biological phenomena, may involve a substantial amount of processing by

neural networks. Visual perceptions, for example, involve the sensing of light

and dark images by rods in the back of the eye. These sensors are linked

through complex networks to portions of the brain.

Higher level perceptual process: involve cognitive processing and require

memory. For example, the detection of motion obviously requires that one

remember the previous position of the object if one is to detect a change in

position. Similarly, detecting the presence of a particular shape (e.g., a

square) requires the ability to recognize a set of individual retinal points

 10

representing a square as being a square despite the variations in sizes for

squares and the different orientations (e.g., rotation) in the visual field that a

square may take.

 Process of Perceiving:

An entity may be said to perceive another entity when a process or chain of

processes receives ``input," that is, something at the ``causal" end of the

process changes, and a representative output is physically produced by the

perceiver. The processes that take physical events to human sense organs

are often unaffected by higher level cognitive processes as well as by other

human biases. On the other hand, empirical evidence strongly supports the

notion that human background and experience strongly determine the nature

of what is observed by humans. The ``biased" nature of information

processing by humans is such that all processing, whether of observations of

the outside world or ``thought process" running from rumination to formal

deductions are likely to be biased.

PERSONALITY THEORIES AND PERCEPTION:

Personality-Definition: 'Personality is that pattern of characteristic thoughts,

feelings, and behaviors that distinguishes one person from another and that

persists over time and situation'. It is the sum of biologically based and learnt

behavior which forms the person's unique responses to environmental stimuli.

Our profile--our personality--stands in dialectical relationship to perception.

What we are as a personality, our motives, goals, temperaments, and so on,

influence what we perceive as a situation; and this. Perception itself will

 11

influence our personality. Nonetheless, personality and will on the one hand

and perceived situation on the other are clearly distinct. A person is likely to

behave differently depending on whether he is among friends or strangers,

with his family or at work, or talking to a man or woman, adult or child, boss or

subordinate. Situations, such as those associated with occupation or family,

often recur and are common to many people. Regardless of similar situations

and roles, however, people still differ in their behavioral tend. This has been

attribute individual personalities. Throughout the centuries, personality has

been described and measured by a range of theories and models. The study

of personality has a broad and varied history in psychology, with an

abundance of theoretical traditions. The major theories include dispositional

(trait) perspective, psychodynamic, humanistic, biological, behaviorist and

social learning perspective. Some theories (such as those of Freud, and

Jung,) seek to explain the dynamics of personality as a whole.

CONCEPT AND EVOLUTION OF CARL JUNG PERSONALITY TYPES:

One of the basic concepts of Freud's theories is the notion of different levels

of consciousness. We are aware of the phenomena on the conscious level,

able to reach the phenomena on the preconscious level but unaware of the

issues on the unconscious level. Our personality and reactions are influenced

by all these three levels. Jung's work on himself and his patients convinced

him that life has a spiritual purpose beyond material goals. Our main task, he

believed, is to discover and fulfill our deep-innate potential, much as the acorn

contains the potential to become the oak, or the caterpillar to become the

butterfly. Based on his study of Christianity, Hinduism, Buddhism, Gnosticism,

 12

Taoism, and other traditions, Jung perceived that this journey of

transformation is at the mystical heart of all religions. It is a journey to meet

the self and at the same time to meet the Divine. Unlike Sigmund Freud, Jung

thought spiritual experience was essential to our well-being. When asked

during a 1959 BBC interview if he believed in the existence of God, Jung

replied, "I don't believe-I know".

Jung's primary disagreement with Freud stemmed from their differing

concepts of the unconscious. Jung saw Freud's theory of the unconscious as

incomplete and unnecessarily negative. According to Jung (though not

according to Freud), Freud conceived the unconscious solely as a repository

of repressed emotions and desires. Jung believed that the unconscious also

had a creative capacity, that the collective unconscious of archetypes and

images which made up the human psyche was processed and renewed within

the unconscious. Jung‟s Personality types also come up from how the psychic

process at subconscious level behave.

Carl Jung gives us the concept of Psychological Personality types.

TYPES are classes, groups of people with similar reaction pattern, typical

attitudes that constitute an essential bias which conditions the whole psychic

process, establishes the habitual reactions, and thus determines not only the

style of behavior, but also the nature of subjective experience. These

psychological types are based on conscious direction of psychic energies and

subject-object orientation and not just that but it also denotes the kind of

compensatory activity of unconscious which we may expect to find. According

to Jung, type is a characteristic specimen of a general attitude occurring in

many individual forms. The function types to which he has arrived to are
 13

Thinking, feeling, sensation, intuition. All these basic types belong to the two

classes which Jung has divided which are based on predominant trend of

movement of libido; namely INTROVERSION & EXTRAVERSION.

The concept of libido for Jung is not just about sexual drives but it also

incorporates biological drives with spiritual urges. The terms

EXTRAVERSION AND INTRAVERSION both are used to describe opposite

movements of libido. Thus these are two modes of psychic reaction which can

be observed in same individual. Such psychic reactions can be observed in

both pathological conditions of mind such as in Hysteria and Schizophrenia

respectively and as well as in normal human types who are distinguished by

the predominance of one or the other two mechanisms. If we try to

understand these phenomena in terms of homoeopathic practice then the

physician is the subject and his patient becomes the object. Now depending

upon his own personality type his psychic energy will get directed externally

towards the object or may get directed more internally. This will affect the

manner in which he would relate to his patient. It is going to be a key factor in

the type of relationship formed between them, the case taking done till

formation of totality of his patient.

So we see that basically Jung Understands a personality in view of

1) ATTITUDE TYPES FUNCTION TYPES

1) EXTRAVERSION 1. SENSATION

2) INTROVERSION 2. INTUITION

3. THINKING

4. FEELING
 14

 Influence Of Carl Jung’s Personality Types On Perception:

An interesting experiment conducted by Sommer and Hall in 1959.

The study was devised as an initial attempt to investigate the relationship

between a personality dimension and personal space. Extraversion-

introversion was chosen as a suitable personality variable because, as

described by Jung (1923, 1953), it clearly involves subject-object relations.

The extravert is pictured as moving towards objects in the environment, and

the introvert as moving away from them (Jung, 1923, p. 11). For the purposes

of this study it was hypothesized that extraverts would prefer to be physically

closer to people with whom they were interacting than would introverts. The

overall results were inconsistent in relation to the hypothesis that extraverts

would prefer to interact at shorter distances than would introverts. But

subjectively the feelings came up were introverts more frequently said they

would feel "self-conscious" when others were too close while extraverts

tended to indicate "irritated" would better describe their feelings. This is a

clear indication that under these circumstances extraverts tend to have

feelings associated with behaviors that move aggressively towards the

environment while the introverts retreat into thought or behavioral withdrawal.

This is consistent with Jung's description of the extravert as moving towards

environmental objects while the introvert moves away from them (Jung,

1923). The results of the present study suggest that the extraverts and

introverts do not differ in terms of social distance but do differ in terms of

individual distance, the extraverts allowing people to approach them more

closely than do the introverts.

 15

 ATTITUDE TYPES

Extroversion / Introversion

The fundamental choice of personality determines your orientation or attitude

to the world. Are you going to move towards it or away from it? Are you going

to be an extrovert or an introvert? This choice may be related to

temperament. These two attitudes may be biologically influenced. They are

initially observed as differences in temperaments that can be seen from birth.

Among siblings it may be noted that one child has a higher activity level. One

is more oriented to the outer environment. Another child is less active and

more self absorbed. Such basic temperamental differences can be the

starting point for introversion and extroversion, especially if the family system

reinforces and supports the natural temperament. The critical difference

between the two attitudes is that extroverts are oriented to the outer world of

people, places, and things while introverts are oriented to the inner world of

thoughts, ideas, and concepts.

1) Extroverts

Extroverts are motivated from "without" and their attention is directed

outward. They are people who are sociable, friendly, self-confident and

outgoing. They appear relaxed and confident. Extroverts have trouble

understanding life until they have lived it. When extroverts are feeling

bad, low in energy, or stressed, they are likely to look outside

themselves for relief. They might go shopping, call friends to come

over, or arrange a party. They are energized from without, and they

look for meaning outside of themselves. Extroverts make up about 75%

of the American population.

 16

2) Introverts

Introverts are motivated from "within" and they are oriented towards the

inner world of ideas, imagery, and reflection. Introverts get their energy

from within rather than from the outside world. An introvert values quiet

time alone for thinking while an extrovert wants time with others for

action. Introverts believe that they cannot live life until they have

understood it. They are seen as reserved, quiet, shy, aloof, and distant.

When an introvert is tired, stressed or feels bad he is likely to withdraw

to a quiet place and engage in reflective activity. Introverts look to the

inner world for energy and meaning. Approximately 25% of the

American population is introverted.

Differences in introversion and extroversion can result in interpersonal

conflict. If an introvert and an extrovert in a relationship are both under stress

each will use a different strategy of coping. The extrovert will want to go out to

a party or shopping while the introvert will want quietness and solitude. As

they interact with each other the extrovert may feel rejected while the introvert

imposed upon. What reduces stress for one will not for the other? These two

people are caught in a type difference but may only see the other person as

being demanding or resistive. Learning to understand the type difference can

be helpful and open a door to understanding and cooperation.

 17

Attitudes: The Orientation to Life

Extroversion Introversion

Energized by the outer world Energized by the inner world

Outgoing Inward

Talkative Quiet

Acts first. Thinks later. Thinks and may act.

Values breadth of experience Values depth of experience

Once an orientation to the world is adopted we must take in information from

our surroundings and eventually use this information to make decisions. We

are aided in this process by the perceptive and judging functions of

personality. The perceptive functions are Sensing and Intuition. The judging

functions are Thinking and Feeling.

 PERCEPTIVE FUNCTION

1) Sensing:

Sensing gathers information through the five senses and is concerned

with details and facts. People operating from the sensory function are

acutely aware of the specifics and particularity of the environment. If

such a person attends a party then she is attentive to the sights,

sounds and other sensory information and would be able to remember

 18

and describe the decor of the house and what people wore. About 75%

of the American populations are in the sensory dimension.

2) Intuition

The intuitive function refers to perception that is indirect and not overly

tied to sensory data. Intuition is concerned with connections and

possibilities that go beyond the data. It is an indirect process that Jung

described as perception by the unconscious. This perceptive function is

stimulated by the sensory information but quickly goes past the data

through unconscious associations to new possibilities and hunches.

Intuitive are interested in the big picture and will overlook details. In

America 25% percent or less of the population make up the intuitive

dimension.

Judgmental Functions:

Thinking and feeling are the two dimensions of the judgmental function. They

are the rational functions and are so designated because they make decisions

or judgments about the information provided by the perceiving functions.

Thinking and feeling make decisions in very different ways.

1) Thinking

Thinking approaches decision making through a logical, sequential

process of analyzing data to arrive at a conclusion. Thinking is directed

towards an impersonal finding. It is a "true-false" approach to decision

making. Thinking employs principles and laws. It is most appropriate

for handling problems that are of an impersonal nature. Thinking is

 19

objective and critical. This is the predominate Western mode of making

decisions and it underlies the scientific model. About 50% of the

American populations are Thinkers. By gender 60% of men and 40% of

women are thinkers.

2) Feeling

Feeling reaches a decision in a very different manner through a deep

valuing process. Feeling, as discussed by Jung, does not refer to

emotion in the sense of emotional reasoning. It is not emotional in a

shallow manner of being angry, fearful or joyful and using this as a

basis for decision. Rather feeling refers to a deep process of a "gut-

like" recognition of the worth or value of something. Feeling recognizes

beauty, value, or significance but not through an analytical process.

Feeling is the experience of just knowing at an instinctive level what is

valuable and what needs to be done. It is most useful in situations involving

relationships. Feeling involves passion rather than logic. It is a process of

appreciation and is interested in harmony. Feeling is not impersonal and

includes a subjective element. For example, in regard to assessing a work of

art, thinking can evaluate it according to a critical analysis of technique and

decide if it has worth as well as explain why it has worth. Feeling can

immediately recognize the true beauty or worth of the artwork but not explain

why it is so. Feeling just recognizes and knows. About 50% of the American

population is Feelers. By gender 40% of men and 60% of women are Feelers.

Jung theorized that the dominant function characterizes consciousness, while

its opposite is repressed and characterizes unconscious behavior. Generally,

 20

we tend to favor our most developed, dominant function, while we can

broaden our personality by developing the others. Related to this, Jung noted

that the unconscious often tends to reveal itself most easily through a

person's least developed, inferior function. The encounter with the

unconscious and development of the underdeveloped functions thus tend to

progress together. When the unconscious, inferior functions fail to develop,

imbalance results.

Thus we see that innate personality type is highly responsible for the manner

in which one perceives the world around him.

PERCEIVING IN HOMOEOPATHIC PRACTICE:

 Role of unprejudiced observer in perceiving:

The Practice of Homoeopathic system of medicine is definitely more difficult

than any other system of medicine as it deals with the person as a whole.

Rather it deals with Perception of man in health and then subsequently in

disease. "It is the man in the disease that is to be treated and not the disease

in the man". Homoeopathic practice hence requires understanding the patient

as a person. But, is it easy to understand a person? Or even to understand

oneself, for that matter? The way in which a Homoeopathic physician

understands a patient (his totality) will depend on the way he approaches,

analyses and evaluates the patient. So here we see that a homoeopathic

physician himself becomes most important in the practice of this system. We

all have different dispositions, upbringing, values, experiences which

determine our perception of model of man. But these differences give rise to
 21

prejudices affecting our perception. Hence Dr. Hahnemann stresses that one

has to get rid of his prejudices for accurate perception.

Dr. Hahnemann: Dr. Hahnemann thus gives prime importance to

homoeopathic physician and enumerates all qualities that he should have in

aph.3 and aph.6 of 6th edition of Organon of medicine. Out of all these he

gives prime importance to the fact that a homoeopathic physician has to be an

„Unprejudiced observer‟.

§ 6: The Unprejudiced observer- well aware of the futility of transcendental

Speculations which can receive no confirmation from experience – be his

powers of, penetration ever so great, takes note of nothing in every individual

disease, except the changes in the health of the body and of the mind (morbid

phenomena, accidents, Symptoms which can be perceived externally by

means of the senses; that is to say, he notices only the deviation from the

former healthy state of the now diseased individual, which are felt by the

patient himself, remarked by those around him and observed by the

physician. All these perceptible signs represent the disease in its whole

extent, that Is, together they form the true and only conceivable portrait of the

disease. Dr. Hahnemann further elaborates this concept of unprejudiced

observer in “THE MEDICAL OBSERVER” in his lesser writings as

follows:

Well observation requires the capacity and habit of noticing carefully and

correctly in Natural and morbid states artificially excited by medicine when

they tested on healthy Human being and describe them in the most

appropriate and natural expressions.

1) Accurate perceiving what is to be observed in patient.

 22

2) Physician applying his own thoughts which comes from his mind with

power of concentration upon patient„s feeling and thinking but it is nothing

actually present. Physician can find out subjective feeling of patient by using

senses.

3) Poetic fancy (imaginative), fantastic wit (a strange ability to think quickly

and make good decisions), speculation (a theory without firm evidence based)

must be suspend for a while.

4) Overstrained reasoning, forced interpretation and tendency to explain away

things must be suppressing.

5) Duty of the observer is only to take notice of the phenomena (a fact or

situation observed to exist or happen) and their course.

6) What he observes is understood exactly as it is.

7) This capability of observing accurately is never inborn, but chiefly acquired

by practice by regulating the perceptions of the senses. It means, by

exercising a severe criticism in regard to the rapid impression obtain about

external objects and at the same time the necessary coolness, calmness and

firmness of judgment must be preserved together with a constant distrust of

our own powers of apprehension.

8) Physician should use his energies of body and mind towards the

observation with patience supported by the power of will until the completion

of observation.

9) Thinking and feelings should be expressed directly in appropriate way and

simplicity of expressing physician„s sensations.

10) Art of drawing from nature is also useful, as it sharpens and practices our

eyes and there by other senses, teaching us to form a true conception of

 23

objects, and to represent what we observe, truly and purely, without any

addition from the fancy.

11) Drug proving on our self is the best opportunity for exercising and

perfecting our

Observations. Observe and correctly record the altered state of mind and

body with

Wakeful senses.

Prejudice essentially is an Emotional state which produces in the person

either a favorable or an unfavorable Reaction to the situation that obtains.

Before one can get rid of it, one has to become aware of it. This awareness

of one„s shortcomings is difficult to attain unaided.

 Influence of personality on understanding concept of man

It is evident even from glorious history of Homoeopathy that different schools

of homoeopathy have evolved through different stalwarts trying to perceive

man in health and disease. The manner in which they have tried to perceive

model of man has been being highly dependent on their own thinking

determined by their individual Personality.E.g

1. Dr. J.T. Kent: He was influenced by the philosopher Swedenborg, also

gave the highest importance to psycho-spiritual concept of mind.

According to him, Man consists of Mind, Body & Spirit, known through

his actions. The Mind is further being analyzed at three levels, viz, Will,

Emotion, & Intellect, each being different in different individuals. To

perceive these differences, one needs to be unprejudiced because

even law will deceive man of a prejudiced mind as he then misreads

Law & Doctrine.

 24

2. Dr. H.A. Robert: He recognizes life as trinity of Mind, Body & Spirit. In

this trinity flows the vital energy. But this vital energy differs in each

individual. Each possesses a special personality, special psycho-

physical construction which is determined by interplay of hereditary

tendencies & environmental factors.

3. Dr. Stuart Close: The vital phenomenon in health and disease are

caused by reaction of Vital Substantial Power of the organism to

external stimuli. With this he also says that homeopath must be

efficient enough to perceive this vital phenomenon. Efficiency in

homoeopathy implies and involves native ability, acquired technical

proficiency and logical consistency in the application of its principles.

Every problem in homoeopathy must be approached from a particular

and a definite mental standpoint. The student or practitioner of

homoeopathy must not only know what this point of view is, but he

must acquire it and act from it in each case. This might be called the

personal side of homoeopathy; for in the last analysis, homoeopathy,

from a psychological standpoint, is essentially a state of mind existent

in the person of its representative. In this sense personality or the sum

of all the essential attributes and qualities of individual is a condition

precedent to professional success.

4. Dr. M. L. Dhawale: He speaks of Homoeopathy as a science which

deals with man. This demands that the physician be an integrated,

cultured individual who has learnt, through his contact with the patients

to take a total view of man from anthropological, evolutionary as well as

teleological point of view. A physician can develop exact judgments in

 25

respect of his patients only when he himself evolves in that manner. It

is absolutely necessary that a homoeopathic physician, realizing his

human individuality, obtains a clear vision of the essential reality of the

human being. He also mentions that observer has to move from

subjectivity to objectivity so that the accuracy is maintained in terms of

reporting and interpretations. Dr. M.L. Dhawale says that in field of

Psycho- analysis , “Know Thyself” Becomes the sine qua non of the

training. One observes what one expects to see. The expectations in

turn are determined by the attitudes that are developed. These

attitudes are determined largely by the training one has received in

developing the concepts of reality – the theories we hold about the

nature of the things and their interrelationship. Even the bare facts are

tinged by these attitudes. Interpretation, will, therefore, be colored by

our previous state of knowledge. All new discoveries and new

inventions leading to progress have been possible because at times a

human mind has been able to liberate itself from the tyranny of the

accepted reality. As a result of this liberation, new facts were unearthed

and a rational interpretation and explanation helped to modify our

concept of reality in that particular field. Homoeopathic practice hence

requires understanding the patient as a person, as an individual.

5. C. J Wansbrough: He opines that, the world is basically a mirror

image or a reflection of our own desires, possibilities and perceptions

and these alone will influence the outcome of our patient's progress

towards the state of health. The perception of the remedy is embedded

within the context of the practitioner's ontological state thereby leading

 26

to a similimum which will be a reflection of the practitioner's own ability

to perceive his own state of his mind. Different aspects of the whole will

appear to different practitioners, each reflecting an aspect of their own

belief structures. This therefore focuses attention on just how, our

model of healing (based on our own beliefs), becomes crucial to the

entire process of homeopathy. Such a model must at least possess

three aspects to consider itself a role model for wholeness. The first

must be a sense of the infinite possibilities of self-healing; the second,

a sense of perception which is grounded in the numinous, and thirdly a

sense of penetration, by this he means the ability to penetrate and

realize different dimensions of our own personality.

From the above review of literature we can see that the individual

personality of all stalwarts have dominated the way they have thought,

perceived and integrated the concept of man. E.g, Kent, has been

philosopher a strong believer in spirituality which lead him in

understanding man in terms of evil deeds, will intellect etc. Whereas

Boenninghausen has been a lawyer by profession, highly analytical,

critical and evidence based which has highly influenced his concept of

totality where prima facie he gives importance to modalities‟ and

concomitants that are visible as he feels it is always difficult to fathom

mind. Dr. Stuart Close also emphasizes hence that one has to be aware of

one‟s own individuality. Dr. Hahnemann has given us clear guidelines as

to what qualities a homoeopathic physician requires to evolve as an

unprejudiced observer. But one can evolve as an unprejudiced observer

 27

only when one is aware of his own prejudices. Prejudices arise from how

one perceives and internalizes his experiences with life. Dr. Hahnemann

also says that our prejudices are products of our upbringing,

circumstances etc, and one must understand prejudices result from how

an individual acts, reacts, embeds, learns and grows in given time, place

and environment and this fundamentally depending on our basic

personality types. This again is highly determined by personality or in other

words disposition of an individual. Hence knowledge of one‟s own

disposition is most essential.

The way in which a Homoeopathic physician understands a patient (his

totality) will depend on the way he analyses and evaluates the patient. The

evaluation has to be done against the patient's background i.e. his mode of

living, as stated in the § 5. Each Homoeopathic physician will thus evaluate

the patient on the basis of his understanding of the various knowledge and

experience of life, the way he conducts his life own life i.e. according to his

Functional-Fundamental-Standard, or his concept of man. His functional

fundamental standard is highly dependent on his Disposition or in other words

his personality. Every individual is gifted with his unique innate personality

type. In our day to day life depending on situations different dispositions

perceive and react to the situations differently. They a person perceives and

reacts is highly determined by the disposition. The outcome may be at times

beneficial or at time harmful for the individual, same applies for the

homoeopathic physician. One‟s own personality thus can be an asset or a

liability depending on the circumstances. Hence it becomes very much

 28

necessary to understand how and what parameter of one‟s own personality

influences his perception and subsequently his reaction. Insight about

becoming aware of own personality, and the strengths and weakness of the

same would be first and most essential step in journey towards achieving

state of unprejudiced. This awareness will lead to development of balance

and poise in an individual. Internal equilibrium will lead to rational and

unprejudiced perception of external environment. The ICR methodology

believes in this concept and hence has devised a specific system of training of

homoeopathic physician. In a case Primary physician (PP) is always

accompanied with an observer. The Primary physician and the observer are

then to understand each other‟s prejudices, disposition how it affects case

taking through CSEF and later overcoming the same while processing the

case etc.

From further case records an attempt is made to understand PP‟s personality

through Eysenck‟s Personality Inventory and CSEF and how his personality

influences his perception.

 29

MATERIALS & METHODS

 30

MATERIALS AND METHODS

TYPE OF STUDY: Analytical Study.

SOURCE OF DATA:

Patients and M.D. Students from M. L. Dhawale Memorial Homoeopathic

Institute. (M.L.DMHI)

STUDY DESIGN:

It is going to be Cause Effect study, hence is a COHORT study.

Sample:

A) Size of sample: 30 physicians from MLDMHI

B) Sampling method: Random sampling from population of Post

graduation students from MLDMHI. who will volunteer for the study.

METHOD OF COLLECTION OF DATA:

Selecting 30 cases randomly out of which 15 would be by defined by

Extroverted Physicians and 15 by introverted physicians.

Specific Tools to be used in the Study:

Eysenck‟s Personality Inventory (EPI )

Clinical Session Evaluation Form (CSEF)

Life Space

For Sample:

Inclusion Criteria:

1. Post graduation students from M.L.DMHI of both the sexes.

2. Students who volunteer for the study and who display adequate

enthusiasm and commitment to follow the protocols during the study.

 31

Exclusion Criteria:

1. Post Graduate students with any history of or present complaints

suggestive of a psychiatric illness (Axis I diagnosis as per DSM-IV

TR)

For Cases:

Inclusion criteria

1. 30 cases of both genders, above 18yrs of age.

2. Cases with adequate psycho-social data in life-space.

3. Cases which can be managed at OPD basis.

Exclusion criteria

1. No cooperative patient with psychiatric illness.

Method of study:

1) From all volunteers identifying extrovert physicians and introvert

physicians.

2) Considering the cases defined by them.(15 cases by each type)

3) Processing the cases based on following points:

CSEF (to be filled immediately after case taking)

Life Areas explored

Perceiving patient‟s attributes, mental state

Approach taken for totality formulation

Final totality formulation.

1) Analysis of 15 cases defined by extroverts and 15 cases defined by

introverts on above mentioned points.

 32

2) Comparing the results of this analysis so as to understand how these

two different personality types receive, perceive and understand the

patients.

3) Points of analysis are as follows:

All points given in CSEF.

Nonverbal communications.

Any specific feeling states.

Life space-Areas explored.

Perception of mental state.

Approach taken for totality formation.

Final totality formation.

 33

Case records
 34

CASE 1

Preliminary data: O.P.D. Regno. P/4552/11

Name: RJY Age: 26yrs Sex: Female

Education: illiterate Occupation: Housewife Status married

Cast: Hindu Spouse: Mr. Jy Occupation: Truck driver

Fa: 80yrs Mo: 75yrs. Expired CA stomach Children: 2 sons

Chief Complaints:

No. Location Sensation Modalities Concomitants

1. R.S

Bronchi 1 Dry cough Weakness 2+

year 2 episodes of <Rainy

1 month breathlessness grade (I) <season

O– but now no c/o <Morning

sudden breathlessness <8-9 p.m.

I – mild No expectoration >warm water

F– No fever/Coryza drinking

Variable

In July 2010 - 1st episode lasted for 2 days > with medicine

Few days after - 2nd episode lasted for 1 hour > with medicine

Patient as a person:

Appearance: lean, thin Tongue: Clean & Moist

Perspiration: partial All over body – mod – only in summer

Digestion: appetite: No Aversions & cravings: Not any

 35

Stool/Urine: normal Menstrual function:Menses: Regular Cycle: 28 – 30

days Sexual function:Desire: Normal

Patient‟s obstetric history: G4 P2 A2 L2: IUFDS L2:FTND

Life – space investigation:Patient is a lean, thin, wheatish complexioned

lady. She was wearing saree with Ghunghat and her face, head was covered

by it. Patient is basically from UP, Since Sept. 2010 she is staying at Boisar ,

when screening was done, patient sat in front of me with Ghunghat on face

looking down, not responding properly – because of timidity/shyness. During

interview she sat frankly in front of me and started talking. Patient is illiterate.

She has 3 brothers & 4 sisters. But patient was never put into school. Her

father was doing farming. Patient has good relation with all siblings.

Sometimes used to go to farm with mother and work there. She got married at

very young age. She even does not remember about her marriage with

Gauna. She was in maiden family for 7 – 8 years and then marriage occurred.

In in-laws family, her husband is youngest. As she is youngest DIL, she is not

given much importance by other members of family. Everyone listens to

eldest DIL. Whenever eldest DIL shouts on her or scolds her, patient feels

bad, gets angry also, but can‟t do anything. She has to suppress her anger.

She does not like to fight actually. She thinks that if I fight, what other people

will say about me. They will say that this lady is quarrelsome. This may spoil

the name of husband, and mother father. Anger is short lasting. If she has

any complaints regarding any family member, she takes it to husband, does

not go and speak to that person. Her IPR with husband is very good. Husband

takes care of her a lot, takes care of children also. Sometimes makes food for

all. Now almost past 1 year she has Complaints & has taken lots of medicine.
 36

Her MIL is calling her back but . for proper treatment, she has come to Boisar.

She had 2 IUFD – 2nd & 3rd pregnancies. When this happened with 2nd

pregnancy, patient felt so bad that she did not take food for 4 – 5 days, was

weeping continuously. Then her MIL & SIL convinced her. M. When this

happened with 3rd pregnancy, she did not feel bad. She felt that atleast she

has 1 child and her health is normal. Patient is image conscious. She does

not like to fight even though she is angry. She thinks that „zagda karne se

meri nak kat jaegi. Log kya bolenge mere mummy papa ko. Wo to bolenge ki

ye aurat zagdalu hai‟. Her neighbours are say that her disease is incurable

and this makes her more anxious.

Observations: She will constantly keep on asking whether she will get

alright.Says „Mar gayi to baccho ko kaun sambhalega‟

ANALYSIS :

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is female. EPI analysis shows that this physician is basically happy go

Extrovert lucky, likes cracking jokes creating a friendly atmosphere around, is lively

Score: and an easy going person. She is a person who may not really plan out the

E-14/24 things but would just do or say whatever might come to head first.

N-11/24

L-3/9

Observer Observer is also female. EPI analysis shows this observer also to be

Extrovert extroverted type. Again basically of happy go lucky nature but score wise the

Score: observer has more predominant Extroverted attitude. Observer is a believer

E-17/24 in planning, as opposed to PP and has more patience because she believes
 37

N-8/24 that things do come right at the end somehow.

L-4/9

2. CSEF:

Points Analysis

History PP had screened the patient & found her to be shy with ghunghat. Hence

evaluation PP had anticipated that it would be difficult to open her and there could be

a language problem. Hence an alternative plan thought was to create a

friendly environment.

Interview According to the PP, the interview did not go as she had thought & felt it to

be inadequate because she was not able to reach the feeling state. She

concluded the patient to be image conscious. On the contrary, the

observer felt it to be adequate and found the person to be even anxious,

fearful and irritable.

Doctor- PP not able to identify what happened to her and the nature of the

patient relationship formed. But according to the observer a friendly relationship

relationship was formed between PP and patient.

Sensitivity PP was irritated because patient was telling her something else while she

& was asking something else. This was due to language problem &

Sensibility. according to observer PP did get confused. This was due to language

problem which was expected by PP yet she was not able to avoid those

emotions. But the situation was handled somehow by asking other

questions.

Technical Mainly Questioning, at times listening, Silence were mainly used by the

skills & PP. Language barrier resulting in irritation was the PP‟s block observer

Blocks also identified the same block & recommends PP to deal with such illiterate
 38

patients in more detail e.g. by explaining them more etc.i.e by dealing with

such situations more patiently.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas Childhood- Situation is described. But effect on the patient & reactions are

Explored not explored.

The IPR with in laws and husband- Situation described well and IPR

problems with her in laws and her reactions of keeping quiet etc were

explored. Her relationship with husband also explored but superficially.

Health related anxiety: As was evident from patient‟s behavior these were

well noted.

Reactions of patient: PP mentions directly in life space that patient doesn‟t

fight because she feels people will go and tell her parents that she is

quarrelsome and hence considers her to be image conscious.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Image conscious Chilly PP not sure about any specific approach

Suppressed anger <rainy season3 Remedial understanding superficially

High value system <morning3 derived by considering only the symptoms

Anxious about health >warm Fear mentioned. Observer also sees almost the

<water2 same totality but she arrives at it through

Impression-(PP)Silicea her other observations during case taking.

Observer- totality- almost same

Remedy- Observer- Silicea

 39

CONCLUSION:

This PP is predominantly of an extroverted type. This gets reflected in case

taking specifically in several areas where she goes by only external evidence

of the patient wearing ghunghat, talking less & hence considering her to be

reserved. A solution could be creating a friendly environment which is a part

of the PP‟s personality. She does identify possible difficulty due to language

problem but a strong alternative is not thought of. Since this was not

considered in the planning, it lead her into problem and hence caused

irritation and confusion. Patient could connect to patient only in a friendly

way`. While processing, the physician considers things as they are e.g

considering patient to be mainly image conscious and neglecting to explore

other possible feeling states in the same situation. Totality formulation reflects

the difficulty of the PP in being able to understand and derive the portrait and

arrive at the core due to absence of in-depth understanding and consideration

of symptoms on its face value. Now the observer has a more predominant

extroverted attitude and this makes things simpler for her and she is able to

clearly see what is the fact based on her observations and hence able to tell

the kind of relationship formed between the PP and the patient and is also

able to see the attributes of patient, with less confusion as compared to the

PP.

This is how we see that PP‟s Extroverted nature greatly influenced the way

PP has approached the case, defined it and perceived the totality.

Final remedy: Patient was given Silicea 200

 40

Sr. Core perceived Reasons

No

Physician Observer

1) Image conscious and Anxious, Fearful, Irritable, PP not able to

high value system with but thinks that with this connect to the patient

anxiety. patient PP must be more due to irritation,

sensitive. hence could not feel

other emotions.only

superficial friendly

relations formed.

Level of Similarity: Similar

Follow ups:

Sr. Date Follow up Action

no

1) 12/6/11 Weakness++, mild cough , Silicea 200 1 dose and

breathelessenss++ placebo for 1 week.

Generals normal

2) 19/6/11 Weakness improved2+, no Placebo for 2 weeks

cough or breathelessness

Generals – normal

Further follow-ups awaited.

 41

CASE 2

Preliminary data: O.P.D. Reg. No. P/2532/11

Name: Mr.M.A.A Occupation: Welder Fa: Akbar Ali Mo: 48yrs

Age:24 yrs/Male Status: Single Brother: 21 yrs navy Sisters: 2

Education: 12th pass Religion: muslim Address: DN

Chief Complaint:

Sr.no Location Sensation Modalities Concomitants

1) G.I.T

Hypochondriac Pain

O;Sudden Vomiting

D: Since 1yr Bilious, mucus, <morning Headache.

P: Started as with nauseatic ,11am to

severe pain now sensation 12pm

reduced in Distension and

intensity. sour eructations.

2) F: Everyday No

R.S Cough with modality

Throat since 1yr expectoration

occ

Patient as a person:

Appearance : lean wound healing normal Perspiration-right abdomen

Hunger can‟t tolerate Stool/Urine- normal Craving- Salad2, spicy2

Aversion-sour3 Thermal-chilly sleep- Disturbed due to anxiety

Pa/H- Nothing specific Fa/H- nothing specific

 42

Life Space: Patient is 24 yrs old male came for case definition appearing

anxious and hurried. He is the 3rd child in family and has 2 elder sisters and 1

younger brother who is in the navy. He has good IPRs in the family.

Childhood was spent in village. He was average in studies and desired to go

to military school because there was a trend in his village that most of them

went in military. He gave a try but was not selected. Later, he decided to do

an ITI course for which he had to stay at his paternal aunty‟s house. He

stayed there but his aunt‟s behavior changed. She would not talk with the

patient‟s father. He slowly realized her arrogance when he once asked for a

sweater and she refused. He started feeling uncomfortable and hence left her

house and came home but on father‟s insistence did not leave the course and

cut it short to 1year from 3years. Again tried to join military school but was not

selected due to age bar and abdominal pain. Hence decided to come to

Boisar to do some job and stay with sister. At workplace he talks to everyone

but does not have close friends due to his past experience that people first

come close and then you do everything and one day they leave you for no

reason. He feels that if people say something then he listens to him and he

doesn‟t feel bad but when he does say same joke they feel bad and cannot

tolerate hence it is better to stay away from them. His nature is of speaking

openly whatever it is and doesn‟t care what the opposite person may feel.

Now since 2 years he has lost interest in many things. He stopped exercising,

keeping fast in Ramzan and doesn‟t even want to marry. He denied his

marriage proposal due to his complaint. He has fear of heights. Observations:

patient was anxious, did not want to reveal the problem with aunt. Anxious

about his body structure and investigations.

 43

ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is female and is predominantly extroverted but also has a fairly high

Extrovert score on the N scale. EPI analysis shows that she is lively, likes mixing with

Score: people, does believe in taking daring decisions but at the same time is not a

E-20/24 planner, hence often gets stuck up while doing things, gets listless, and

N-15/24 makes up mind too late.

L-3/9

Observer Observer is a male and is predominantly extroverted in nature. At the same

Extrovert time he scores very low on his N score. Observer is friendly and happy go

Score: lucky, but is a strong believer in planning, focused, mostly keeps things to

E-11/24 himself, and does things confidently.

N-5/24

L-5/9

2. CSEF:

Points Analysis

History Both PP and observer did not find any specific data to arrive at a Problem

evaluation definition and planning an interview except for properly evaluating the

chief complaint and then following SCR pattern of Case definition.

Interview Interview was conducted as decided prior in a routinistic way. PP found it

to be average and observer found it to be inadequate as regards to

receiving the patient.

PP found the patient in general anxious and fearful as regards to his

complaints. But PP has not noticed agitation, hurriedness, impatience

 44

which were evident externally from the patient‟s behavior. PP‟s focus was

gathering evidences from life space, whereas her observer gave a lot of

importance to his behavior during case taking.

Doctor- PP was unable to exactly identify the kind of relationship except that she

patient had formed a superficial relation. According to observer, PP was like a

relationship partial friend. PP was somehow uncomfortable with the patient right from

the start with the way he talked or behaved. She also says that it was not

about gender but still internally had a rejection.

Sensitivity According to the observer, the PP was highly involved in the issue of IPRs

& with the paternal aunty and was focused only on exploration of the same.

Sensibility. PP too agrees that she was not otherwise comfortable with the patient so

she decided to understand the patient through exploration of IPRs and

other life space situations where PP said that his aunt was arrogant in

nature. PP was somehow irritated with this patient.

Technical According to both, the PP and observer, PP was not able to handle her

skills & discomfort since she was not able to realize from where it came thus

Blocks leading to formation of a superficial and a Professional relationship

between them.

PP mainly used the skill of questioning too much but did not receive the

patient. PP did realize this because patient was trying to go into different

situations but she was adamant on her areas as also pointed out by the

observer. According to him the patient spoke a lot through nonverbal

communication and behavior which the PP did not notice. Exploration and

questioning was needed but at some point it was of no help where a lot of

receiving was required but not done. PP was blocked mainly at this point
 45

where she was not able to overcome her internal feeling states and

confusion.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas Areas tried to be mainly explored by PP were of childhood, ambition of

Explored joining military, IPR with paternal aunt. But all areas were superficially

explored and PP has not been able to arrive at an understanding of the

reaction pattern and feeling state precisely although could get a few

attributes.

4) TOTALITY ANALYSIS:

Approach – Kent‟s approach Analysis

Totality: In totality formation again, PP

Mind, ambition loss of cr. Spices has not considered the obvious

Mind, Impulsive cr. salads expressions which observer

Mind restlessness, anxious av. sour has considered.

Mind, fear falling off Hunger >

According to observer, additions:

Hurried, Impatient, control lack of, Anxiety

out of proportion, Impulsivity, fear

misfortune of.

Remedy (PP): Lycopodium

Remedy (Observer): Argentum Nitricum.

 46

CONCLUSION:

This PP is predominantly of an extroverted type according to EPI analysis. But

EPI analysis also shows that PP has a high N score. The Extroverted attitude

gets reflected during the interview where PP is highly evidence based trying to

be analytical, critical, and fixed hence using questioning and exploration most

of the times. But one sees that inspite of PP being mainly extroverted as per

EPI analysis in this case PP‟s Introverted nature has dominated. PP

developed unnecessary discomfort which was due to her inner feeling state

this was probably due to the fact that she is also quiet anxious in nature. This

has made PP to always keep a distance from the patient ending into a

superficial relationship between both. As a result PP has not received the

patient. PP is clear about the fact that it is not about gender difference or age

of patient because she has interviewed patients of such type without

experiencing such problem. PP is not basically a planner and rather gets at

times stuck up. This is basically a part of her Extroverted attitude. This caused

a problem to deal with this block. Hence PP was able to partially understand

her patient.

Observer, according to EPI analysis, has a low N score and is predominantly

Extroverted type. He also was not only able to perceive all attributes which PP

has identified but also was able to give value to all observations, non verbal

communication due to his strong analytical and focused nature. Hence we are

able to see that although both PP and observer have been predominantly of

extroverted type, in this case PP‟s introverted attitude which is also equally

strong dominated her. Thus it is not necessary that a particular personality

 47

type will always behave in the same way. Rather a predominance may

change at some situations.

Final Remedy (Consultant)- Argentum Nitricum,

Sr. Core perceived Reasons

No.

Physician Observer

1) Impulsive, Restless, Hurried, Impatient and PP was

without any ambition. anxiety out of proportion. uncomfortable and

was dominated by

patient, hence she

had rejected the

patient and was not

able to see the other

obvious features.

Level Of similarity: Different

Follow ups:

Date Complaints Action

20/6/11 Abdominal pain ++Eructations++ Argentum Nitricum 200 1

Itching right side abdomen++ Anxiety ++ dose

Placebo 2 weeks

4/7/2011 Abdominal pain >+ no eructations anxiety>+ Ct. all 2weeks

itching >+

18/7/11 No abdominal pain. Mild fullness of abdomen. Ct. All 2 weeks

No anxiety. Itching occasional

 48

8/8/11 Anxiety+ no other complaints Ct. all 2 weeks

22/8/11 No complaints. Generals normal Patient given placebo for

2 weeks
 49

CASE 3

Preliminary data: O.P.D. Reg. No. P/2532/11

Name: Mrs.MAC Occupation: house wife Sister-1 younger

Age: 66yrs female Status: Married 14yrs. Brother: 2 younger

Education: 7th std Religion: Hindu Address: DN

Chief Complaint:

Sr. Location Sensation Modalities Concomitants

no

1) GIT Sour

Abdomen eructations <milk2+ Thirst

Since 10years Burning <Sour2+ reduced2+

Pain <spicy2+ Headache2+

Heaviness <empty

Distension stomach2+

Nausea >cold drinks2+

2) M.S.S Pain3+

Lumbar spine Stiffness <bending2+

Since 30years Tingling <night2+

Heaviness <Lifting weight2+

>lying back2+

3) Endocrines Lethargy,

Since 5-6 years weight loss >tab Eltroxin

Heaviness <after sleep

Facial edema
 50

Diagnosis: APD with Hypothyroidism

Patient as a person:

Appearance : lean,thin, well dressed wound healing normal

Perspiration-face,palms, moderate Hunger cannot tolerate

Stool/Urine- normal Craving- warm food2+, sour2

Thermal-chilly O/H- G2P2A0L2 no complaints.

Menses-stain fast, dark red, big clots, profuse, Pain in abdomen during>hot

fomentation.

Pa/H- Nothing specific Fa/H- nothing specific

Life Space: Patient is 66yrs old female accompanied by her son for Case

definition. She stays with her 2 sons and their wives and their children. Her

husband expired 14yrs back due to TB and alcoholism. He describes him to

be of a loving nature but when he would be drunk he was out of control.

Initially patient would react to him later become indifferent. He had a

transferable job. This would cause problem to her children and their

education. So she decided to stay separately and husband would visit them.

Financial support was only from her husband. But later her husband took VRS

and he became even more addicted to alcohol and his misbehavior increased.

Patient too then becomes indifferent. Hence when her husband she did not

really feel bad. Says it was her destiny to tolerate. Patient would get angry on

her sons when they would not study, or they didn‟t listen to he and she would

beat them in anger but then love them. Patient during the interview was not in

a sharing state. She would use two mechanisms of escaping,i.e she would

say that she doesn‟t think about it or no problems. Patient was not

complaining about anything except that, the work she has to do till her DIL
 51

comes from job. Due to disputes between her 2 DILs her two sons stay

separately, in same bungalow on separate floors. Occasionally there are

quarrels which get settled on its own. Patient‟s nature has changed after

joining Om Shanti Om group in which there are series lectures. She changed

her diet, from veg to non veg. She became very particular about her utensils

to be kept separate wants her place to be neat and clean and in order. This is

her disposition right from beginning. After joining Om Shanti Om she is able to

control her anger. Earlier used to express it much and would speak out but

does‟nt do it now. Now has become more religious. According to son she has

become more irritable now a days. She complaints of various things probably

because she is not keeping well. She always wants cleanliness, will help her

DIL even if they don‟t ask for help. Observations- tried to avoid certain issues

sits erect calm and quiet. Answers only when asked. Husband was bed ridden

for more than one month and she did all for him considering it as her duty.

ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is male and is predominantly extroverted but also has fairly high score on

Extrovert N scale. EPI analysis shows that PP is lively, likes mixing with people, does

Score: believe in taking daring decisions but at the same time is not a planner,

E-20/24 hence often gets stuck up while doing things, gets listless, and makes up

N-15/24 mind too late.

L-3/9

Observer Observer is female and is predominantly extroverted in nature. At the same

Extrovert time he scores very low on his N score. Observer is friendly and happy go
 52

Score: lucky, but is strong believer in planning, focused, mostly keeps things to

E-11/24 himself, and does things confidently.

N-5/24

L-5/9

2. CSEF:

Points Analysis

History Both PP and observer did not find any specific data arrive at some

evaluation Problem definition. But clinically problem defined by both PP and observer

i.e. of APD, Hypothyroidism, and hypertension under investigation.

Interview Opening was decided through LSMC. But differences have come up after

the interview. According to PP- interview was inadequate as regard to

relationship with DIL

According to observer interview was adequate and PP had allowed patient

to tell about all areas in her life. PP had faced difficulty in this area and felt

that he has not fully understood.

Doctor- According to observer PP has formed a Son-Mother relationship and

patient created a trust in patient by orienting about homoeopathy through her Om-

relationship shanti-om philosophy.

Sensitivity PP too felt that he had formed mother-son relationship with the patient.

& According to Observer- PP did not have any sensitivity and case taking

Sensibility. was adequate. But PP had taken much time for case taking as explored

some issues such as IPRs twice. According to PP patient was strict and

hiding. PP was sensitized by the issue of old lady who has to work till now,

inspite of doing so much. PP was not able to handle this sensitivity and

tried to explore a lot although patient had said that she has no major
 53

issues with this area.

Technical Open ended questions, and exploration were used most of the times.

skills & According to Observer there were no major blocks. But for PP his block

Blocks was his sensitivity for old people and his concept of life of old people. His

concept made him feel that patient has to work so much at this age and

that she has not got enough love and care.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas If we consider the life space given by PP it is evident that there is no

Explored slightest mention of patient‟s life before marriage, such as childhood,

teenage etc. no exploration was done as regard to these areas.

PP focused more on patient‟s life after marriage and IPRs with husband

and her IPRS with DIL and Sons. PP is not convinced with the fact tasht

there is no major issue for patient in her IPRs with Her DILS. Hence PP

says that patient is trying to „escape‟ from this by saying that there are no

major problems. PP had to interview her son from whom he got the data

that PP patient is dispositional fastidious. Otherwise in interview with

patient physician has hardly been able to arrive at dispositional qualities.

 54

4) TOTALITY ANALYSIS:

Approach – to arrive at the totality PP has Analysis

used the tools of LST and EET and remedial

understanding was made through

structuralization.

Key points identified: The attributes that have been

Fastidious3+, Irritable, anger suppressed, derived through the use of LST

submissive, not complaining of anything, , shows that the derivations

sensitive and attached. Duty conscious3+ made did not have strong

Dreams, dead relatives, Craving sour, evidences to support them, PP

menses staining. has used lot of his own

Group of Remedies: Magnesium group, interpretations. And while

Sepia, Silicea. arriving at a final remedy he

Final remedy: (PP) Silicea gives importance to his feeling

Final remedy-(observer)- Silicea state of her Duty

consciousness and not getting

affected but delivering duty and

hence arrives at a final remedy

Supervisor: Considered the same totality of Silicea.

and perceived the core to be duty conscious

but considering the bone affections remedy

was Aurum

Final Remedy- Aurum Met

 55

CONCLUSION:

According to observer PP was no where sensitized and case went on

smoothly and that PP has formulated a good rapport with patient.

PP is basically of extroverted type, highly critical and analytical which itself

becomes a block. PP has very strong concept of life of old people. Hence due

to this he is not able to accept that patient has no problems for the work that

she has done and has to do because patient is highly conscientious and

considers it to be part of her duty. But PP is not able to understand this and

tries to find conflict which is existent for PP although factually not there in

patient. At the same time because Patient says that there is no problem, PP

perceives it to be Hiding and escape from questions. Hence it is evident that

PP has not received the patient although has tried to form Mother-son

relationship. Although he later is able to see that patient is definitely duty

conscious.This attitude of being highly evidenced based and obstinacy

reflected in non motility from his own concepts lead to non observation as well

as mal observation. Hence PP explored areas of DIL, and Husband twice and

hardly explored any other area. Moreover considered Patient‟s „no problem

and non complaining state and delivering duties‟ made him to arrive at final

remedy Silicea.

Final Remedy (Consultant)- Aurum Metallicum

 56

Sr. No. Core perceived Reasons

Physician Observer/Supervisor

1) Irritable, with anger Duty conscious, PP is too fixed with his own

suppressed and not reserved concept & is analytical in

complaining of nature and hence was

anything but seeking for evidences, but

delivering duty due to this missed out on

other subtle aspects which

were obvious and was not

able to believe that patient

is actually without any

problem.

Level Of Similarity: Similar

Follow ups:

Sr.No. Date Follow Up Action

1) 21/7/11 Back pain ++, GIT burming Aurum Met 200 1 dose, with

retrosternal ++ Generals- placebo 1 week.

normal

2) 28/7/11 Back pain SQ, Retrosternal Aurum met 200 1 dose with

burning reduced 2+ placebo 1 week

Generals normal
 57

CASE 4

Preliminary Data: O.P.D reg no :495

Name: Mrs. BSC Education: 10th pass Occupation: Housewife

Age: 23 yrs/F Status: married since 2yrs Caste: Hindu

Brothers: 1(26yrs) Sisters: 1(20 yrs) Children: 1 son(1yr)

Address: MJH

Chief Complaint:

Location Sensation Modalities Concomitants

1)Mind Spasm of all the A/F- Fear that

2nd episode- limbs. With husband gave her

11.00 a.m. clenching of teeth abortive pills -

1st Episode with heaviness in suspicion

January 2011( chest. A/F-MIL scolder her

both episodes Similar episode

similar) In milder form

2)R.S Coryza – Thin A/F. Cold drink Thirst –

Nose watery with < Night Remained for

Throat sneezing nose > Sitting large quantity

Larynx block <Solids Taste-Insipid

Pain >Liquids warm

Patient as a Person:

Appearance: fair well-built average heighted

Perspiration: partial: palms soles, forehead, Excessive, odors (+) staining:

colour blackish.
 58

Digestion: acidity – (+) hunger<+ gases

Av- Sweets, Milk Cr.- Eggs, Spicy

Stools/Urine- Normal Urine occasional burning.

Menstrual function: menses: irregular cycle: 15 – 25 days duration 6 -7

days, quantity: 8-10 pads/day colour: red clots: small stain – colour – dark but

dellible, earlier – regular – 5 days 28-30 days

before menses 1-2 days – back and lower abdomen – has to have bed rest

Sexual functions- abdominal pain, coition during.

O/H- G3 P3 A2 L1 1induced abortion and 1 spontaneous abortion. Morning

sickness for 9 months.

Sleep: Position – On back with hands on chest .

Dreams – Funerals her everybody attending – Pleasant outings – Snakes

(before marriage) – Religious gods – Waterfall < Sun: Headache2+ Themal:

chilly

Life – Space: A 23 years old female admitted with c/o conversion reaction at

the time of interview – patient was wearing a kundan worked sari and a red

bindi with a kiddish smile on her face. She belongs to a small village near

Bihar staying with brother/father/ mother/younger sister. Father/Mother–good

in nature. Father was short tempered and would not tolerate anything against

him but did not ever said anything to patient, as patient was also short

tempered. She would not listen to anybody for any matter. She was very

obstinate as to what she wants is she wants. She would cry and lock herself

up – would not eat for days together. She has locked up her mother/sister

once for not listening to her. Once had locked her sister who did not listen to

her. Then she opened the door when she was exhausted crying and said
 59

sorry. So her parents would not dare say anything to her. They were also

equally short tempered. Would throw things and go away from house, if not

listened to. Patient was very much fond of brother, even she would not eat

food without him; and would sleep only after he goes to sleep. Father was

working as a LIC agent and mother earlier was an LIC agent but later did

household work and looked after children. Patient did not have any other fear

other than dark. Would fear dark due to the frightful dreams she gets. She

would scream and wake up from sleep with palpitations. During her school

days, there was stage fear – palpitation before going on stage – whether

some mistake happen but never before exams/studies or in front of teachers.

Patient was a leader in school. She was once a monitor. Teacher had asked

one question. Patient answered and when other student (boy) was asked, he

could not answer. So teacher asked patient to slap him. She slapped him very

tight. Later when school was over, the boy pursued her and held her. Patient

asked all her friends to take out their sandal and beat him. At that time patient

was not feared and was describing the incident by laughing and she

described her childhood as very good and said she would not forget anything.

During childhood she has many times told this and went out with friends as

well. All siblings have also gone for swimming and then only patient has

slapped brother. Brother did not eat for 7 days and patient had warned

mother/father if anything happens to my brother, I would not leave you.

Patient was good in studies and scored good marks. After 10 th std. patient

wanted to study medicine but her marriage was getting fixed. So her parents

pacified her saying that she can study after marriage. But the one she had

seen (an LLB fellow) asked her to become a teacher, which patient did not
 60

want to be, so she rejected that proposal (above he had asked for a lot for

dowry). Then this proposal. She accepted as the dowry they asked was less.

After marriage for 1 year patient was at maiden family and in between had

episode of allergy reaction of penicillin and was admitted in a hospital for 8

days. Then later 1 year back she came to her in-laws place at village. She got

pregnant and delivered a baby boy. When baby was 5 months old, mother

said 1st food will be done at her place but in-laws opposed and patient was

brought to in-laws place and she did not liked it that way. During that period

patient felt she is pregnant and husband gave her abortifying agents next day.

She had an attack of conversion. Sisters came to her place and started

blaming in-laws for the happenings. Then onwards there were clashes

between the two families. Patient feels bad for it. And now, anything told to

her, she feels angry and locks herself up in a room and cries. Patient gets

angry on admonition and then does not feel like working. Main aggression is

towards mother in law and likes the maiden family. Now the scenario is that

the in-laws are convinced that she is doing drama and so nobody is ready to

keep her with them. Husband is very supportive, as he is sandwiched

between them. He is not able to decide what to do.

ANALYSIS :

1. PERONALITY ANALYSIS :

Type Analysis
Physician Physician is female with predominant extroverted type according to EPI. But

Extrovert she also has fairly high N score. She is very much outgoing, very friendly,

Score: easy going, hardly plans her things, usually casual in her attitude. She is

E-17/29 moody and often gets conscious in front of supervisors.

 61

N-15/24

L-2/9

Observer Observer is Male by gender. EPI analysis shows that this PP is

Introvert predominantly of Introverted type. PP doesn‟t like to be with mixing with

Score: people. He is nervous and anxious in nature and is touchy.

E-8/24

N-12/24

L-1/9

2. CSEF:

Points Analysis
History Patient was directly defined in the IPD. Hence not much data available for

evaluation analysis.

Interview

Doctor- Both PP and observer had found patient to be communicative and hence

Patient did not find any difficulties. According to both PP and observer both had

relationship felt that interview with patient was inadequate because she was giving very

childish answers and was also not giving proper answers to their

questions. And hence felt the need to interview with the husband.

Sensitivity According to PP initially friendly relationship was created between both of

and them. Later it was more like an elder sister/mother- daughter relationship.

sensibility According to the observer it was like a Montessori school teacher, being

like a kid to talk with a kid.

PP had got very angry when she was interviewing the patient as she was

very much disturbed by the fact that patient was not taking care of her

children not doing routine work properly etc, because PP felt that how
 62

could a girl do like this. Hence PP had rejected the patient right from the

start possibly because she had formed a close relation and felt how could

she be this, even after interview with her husband rejection towards the

patient still continued. PP tried to handle her sensitivity by controlling her

anger as she wanted to understand the evolution. But was not that

successful as patient did not fully open up with her. PP did realize that due

to her anger she was not able to understand the patient‟s feelings and why

she was behaving like this. Observer too had rejected this patient and felt

that patient was a moron. So he too was not able to understand that

patient also hence did not open up with them.

Technical Probably due to this kind of relationship most of the times confrontation

skills and was done. Exploration was also done. PP‟s major block identified by both

Block the PP and the observer were their rejection and hatred for the patient.

3) LIFESPACE ANALYSIS:

Points Analysis
Areas Most of the areas such as childhood, IPRs with inlaws, Husband etc were

explored explored. Her reactive patterns are not available everywhere and also her

feeling states were not completely explored.

4) TOTALITY ANALYSIS:
Totality –Approach and remedy Analysis

Approach- Kent‟s approach

According to PP: PP considered this totality and with the

A/F- Admonition3+ Cr-spicy2+ help of PDF which was well covered by

Anger trifles3+ Cr-sour2+ phos, PP arrived at the remedy Calc phos.

Indolent , aversion to work Cr-eggs2+ But PP even though in her totality

 63

Obstinate Av-sweets2+ considers, anger pattern, she doesn‟t

Weeping anger after Av-milk2+ attempt to differentiate other remedies,

Travel desire to Sun<2headache such as natrum mur and purely goes by

Getting wet <2+ numerical totality. She did not consider the

Group of remedies: Calc carb, Phos, hard data of menses, abortions, morning

Sulph, Puls., Natrum Mur. sickness, coition pain, perspiration, hunger

PDF- Dreams- murdered of being, dreams- aggravation etc.

animals. According to observer he has based his

Final remedy(PP)- Calc. phos. understanding completely on face value

Final remedy(observer)- Calc carb and interpretations.

Final remedy(supervisor)- Natrum Mur. But these aspects of her anger patterns,

reactivity and then the physical generals

were considered by the Supervisor and

hence she arrived at the remedial

understanding of Natrum Mur.

CONCLUSION:

PP is dispositionally extrovert but also has a high N score. At the same time

she has the extroverted qualities of mixing easily with people and making

friends and is quiet casual in her attitude and not very focused and analytical.

In this case it is evident that PP had initially formed close relations but then

she could not take the fact that patient is kiddish and hence went into rejecting

the patient this rejection has continued till the final totality formation. She did

not realize that her prejudice and sensitivity both are hampering her analytical

faculties and hence missed out even the hard data. Her sensitivity influenced
 64

even her interpretations and although her personality type is an extroverted

type which is believed to be more evidence based she seems to be lacking

this in this case. This could probably be attributed to her equally high N score.

Observer being totally in rejection state, has been absolutely interpretative

and gave importance to the mind that he perceived i.e. of lazy, dull, averse to

work etc. has been interpretative and neglected the other hard data

completely.

Sr. No. Core perceived Reasons

Physician Observer
1) Indolent, Obstinacy, PP and observer both are of similar

moronic and averse to personality type. But PP was somehow

obstinate work. developed negative emotions towards

patient which can be attributed to her high N

score. Observer also was on similar totality

but supervisor on different totality.

Level Of similarity: Similar

Follow ups- After the definition patient had been getting acutes for which she

had been treated with the acutes and Constitutional remedy Natrum Mur 200

was given weekly for 8 weeks as patient was going to village. Follow ups

awaited.
 65

CASE 5

Preliminary Data: O.P.D. Reg no. 1329

Name: Mrs. NSK Age: 17yrs/Female Occupation: Student

Religion: Muslim 3 Sisters Address: BNM

Chief Complaints:

Location Sensations Modalities Concomitants

Mind 1st episode Suicidal thought

yesterday night followed by suicidal

attempt by ingestion of

all out liquid mosquito

followed by nausea &

vomiting. Feeling of self

worth decreased with

feeling that would not be

able to do anything in < during

life. Despair. H/O parent‟s fights.

Suicidal thoughts <suppressed

Sensorium Giddiness would fall. No anger.

3 episodes till GTC, No convulsive < before and

now.lasting for episodes, No tongue during exams.

few minutes bite, no frothing, no < seeing fights

UROEB

Patient As A Person:

Appearance: Fair complexion, curly hair. Hunger<2+

Cr.-Sweets2+, Curd2+, cold drinks2+ Av.: Milk2, Boiled eggs, apples2+

 66

Stool/Urine-Normal Riding<3+

Menstrual function: Cycle-regular duration7-8days, quantity-increased.

Bodyache,2+ and abdominal pain3+ before and during menses.

Sleep: refreshing, dreams: unremembered. Thermals- Hot

Life- Space: A 17 years of female admitted to the ICU for suicidal attempt all

out liquidator as she received less percentage than expected. During the

evaluation, patient was crying and saying,„How could I get less marks, I had

studied well, everybody was expecting good marks from me‟. Patient came to

know about her percentage 2 weeks ago, when she felt shocked, was at

Thane at her cousin‟s place. She did not receive any phones of her friend as

she was feeling ashamed of her marks. She was not going out of her house,

as she was feeling bad to meet the teacher and Principal. Yesterday morning,

on insistence of father she went to leave her younger sister to school, but left

her till gate came back, father saw this and shouted at her and also because

yesterday she got her mark list and felt bad as she received less marks in

expected subject ( Science & maths). At night, when father shouted at her,

she was crying, when mother went to console her, she asked her to leave and

took the poison & slept then she had one episode of vomiting and her sister

came to know and she called everybody. Basically, born at Malad and after 5

years of age came to Boisar with mother & father. Patient has 3 more sisters

younger to her. Father having a Vada-Pav stall where mother also works.

Earlier, father was at Dubai working there for about 5 years and then came to

Malad. Meanwhile, they had a shop at Masjid Bandar but it had to be sold

then – they came here. Father by nature is a bit irritable on trifles and gets

angry and throws things here and there. Everyday, there were fights with
 67

mother, seeing this patient gets irritable, she says- I can‟t tolerate these fights,

please don‟t fight‟. Earlier, mother used to answer back to father ,but later,

seeing patient‟s condition, she would now not speak, she would just keep

quite. Patient gets angry when contradicted but does not express, keep quiet

and goes to room, weeps or goes out with friends and then comes home.

Even when she sees the fights – she sits in her room when mother goes to

console her – pulls her hair and bangs hands on her head. So mother does

not go near her. This behavior does not happen in front of father. Patient fears

father. Mother says she is moody, if she is in good mood, and he would play

music, play with kids and do all the work but when not in mood, just go to the

room and do her work. Patient‟s rapport with her immediate younger sister is

not that good. Patient because of her father had developed a kind of dislike to

males. Also she has been very moody, and not really bothered about doing

household work.

Interview with father: Father is a Vada-Pav vendor and earlier would work in

Dubai and before that, he was at Manish Market having 2 nd No. work. Now, he

has changed and running a small Vada-Pav stall where he is earning and

working day-night to livelihood of his family. Mother who is of nagging nature,

does not understand the severity of the socio-economic condition and works

accordingly for it. So, father has constant verbal arguments with her which

patient does not like and suppresses her anger. Even father says, patient is

moody. Sometimes would do all the work and sometimes would not even

touch anything. Father compares her with younger sisters who is in that way

co-operative which patient does not like.

 68

ANALYSIS :

1. PERONALITY ANALYSIS :

Type Analysis

Physician Physician is female with predominant extroverted type according to EPI.

Extrovert But she also has fairly high N score. She is very much outgoing, very

Score: friendly, easy going, hardly plans her things, usually casual in her attitude.

E-17/29 She is moody and often gets conscious in front of supervisors emotionally

N-15/24 unstable.

L-2/9

Observer Observer is also female with interesting scores on EPI. i.e nearly equal

Score: scores but with one point predominance of N-score. Hence her personality

Introvert has shades of both anxiety and confidence, likes mixing with people, and

E-16/24 at the same time is equally reserved. She doesn‟t like much of excitement

N-18/24 around, but would rather prefer to go stay back home rather than going out

L-2/9 for a party. She usually is spontaneous and has ready answers for

everything, gets anxious before any performance and in front of

supervisors.

2. CSEF:

Points Analysis

History PP had got some history from father and mother. Patient had previous

evaluation history of suicidal attempt. According to PP she felt that observer was

probably moody, highly irritable and ha slot of expectations. PP was

highly bothered about maintaining cause of fights between mother and

father.

Interview The difficulty anticipated by the PP was that about opening of the patient
 69

and that she may revolve only around her chief complaint. Hence PP had

decided that she would counsel the patient first and then open up her first.

PP started as per her plan, but right from the start she had to ask lots of

questions first as patient was not opening up at all. But the interview as

per PP was adequate. But according to Observer PP had done lot of

confrontation in the interview. PP did not have patience and was putting

words in Patient‟s mouth. The information was adequate for diagnosis but

understanding was not enough and the suicide issue was inadequately

explored. After the interview the person diagnosis arrived by PP was that

of moody, irritable, easily angered after contradiction. And aggravated

after consolation.

Doctor- According to PP she had taken a role of a elder sister and PP identified

Patient herself with patient‟s current state of exam results. According to observer

relationship PP striked a very superficial relationship with the patient this was because

of the way the PP had confronted and was giving words in patient‟s

mouth.

Sensitivity PP was highly sensitized by the issue of the fights between her mother

and and father. She mostly remained focused on that area to the extent that

sensibility she forgot even to explore the current suicide issue in details. PP feels

that she was not able to handle this sensitivity as repeatedly she would

ask same question as what patient feels about those fights. Observer

says that PP had lot of identification in with patient at various issues. Due

to this PP got highly sensitised and observer felt that the manner in which

Technical PP was questioning it gave a feel that she was trying to find answers from

skills and the patient for her own conflicts.

 70

Block Predominantly Questioning and Probing were the skills used. According to

PP patient was crying due to home issues due to this PP was getting

blocked as did not knew how to proceed further. According to observer

PP was quite confused and was not able to understand how and what she

was to explore.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas Only two areas were predominantly focused. First was about

explored circumstances leading to suicide. Second was the fights between mother

and father. Evolution since childhood and other dispositional qualities

were not explored. Also exact emotional state leading to suicide was also

not understood well.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

According to PP; PP considered Kentian approach in this

Ailments from- Anger suppressed case. The PDF consists of hard data but

Consolation<2+ the important data of thermal state being

Contradiction intolerance to2+ hot was not considered.other closely

Thermals- hot related remedy covering the hard data as

Hunger aggravation2+ well as mental state strongly was Natrum

Riding aggravation2+ mur. But PP for finer differentiation gave

Sweets craving2+ importance to her interpretations of state

PDF: Milk aversion2+, eggs aversion2+, the patient as dislike for males, or not

menses before and during aggravation2+ doing work and being moody which she
 71

Final remedy(PP): Sepia. considered it to be Indifference. This was

not considered for remedy differentiation.

According to Observer: Hostility toward According to observer the remedy was

the parents, mood swings, sensitivity Natrum Mur as she was more integrative in

towards the family issues and Suppressed her approach and hence considered the

anger. hard data as well as thermals and current

Final remedy(observer): Natrum Mur. state of vexation but again an

interpretation.

CONCLUSION:

PP is dispositionally extrovert but also has a high N score. She hence again

has more chance of connecting with the patient and get into conflict. At the

same time she has the extroverted qualities of mixing easily with people and

making friends and is quiet casual in her attitude and not very focused and

analytical. In this case her introverted qualities seem to have dominated

where she has got connected deeply with the patient and has identified with

her, especially in the issue of her mother and father fights. She was trying to

find answers for her conflicts. Moreover she was confused and was not able

to understand that how was she to handle the crying patient. This gets

reflected in the lifespace and areas explored. PP was not able to distinguish

between disposition and state as eliciting this would mean being highly

analytical and evidence based. In the totality formation PP was not able to

give justice to even the hard data and went by numerical ranking of remedy in

the repertorial totality and PDF without being analytical and holistic approach.

Observer too has been interpretative but was able to understand the state and
 72

then integrating it with the hard data she came to the phasic remedy as

Natrum Mur.

Sr. No. Core perceived Reasons

Physician Observer/Supervisor

1) Anger suppression, Mood swings, Totality percieved was

contradiction Hostility, suppressed similar but PP had

aggravation, vexation anger, vexation become too sensitive

and hostility but with the state which

dispositional qualities blocked her from

not perceived arriving at exact

disposition

Level Of Perception: Different

Follow ups:

Date. Follow up Action

28/6/11 Case defined Natrum Mur 1M I dose given

5/7/11 No suicidal thoughts, anger Placebo given for 2 weeks

reduced, good sleep,

Further follow ups awaited.

 73

CASE 6

Preliminary data: O.P.D. Reg No.- 524

Name: Mr. AKT Occupation: farmer Fa and Mo Expired 1year back.

Age: 60yrs male married since 34yrs 2 brothers and 1 sister

Education: 11th caste: Hindu 3 children Add.: WDF

Chief Complaint:

Location Sensation Modalities concomitants

1)R.S A/F- mo.‟s death

Since 1yr Sneezing+3 and getting wet

Nose White, sticky <cold

2-3 days Discharge. food/drinks3

Throat Cough- yellowish

Pain with

Odynophagia

2)M.S.S Pain2+

Upper back Stiffness2+ <riding bike2+

Cervical region No tingling, <hot

no numbness, application2+

no h/o trauma >massaging2+

3)G.I.T Burning2+

Since 5-6yrs Nausea2+

retrosternal <1 hr after eating

region <over eating2+

<spicy2+

<oily2+
 74

4)Soles Burning >Cold milk2+

since 7-8yrs. Cracks, pain2+ < whisky2+

>Oil

application2+

<winter2+

<walking2+

>soft footwear2+

Patient As A Person:

Appearance- round face noise aggravation2+

Perspiration-Scanty3+ Thermals Chilly

Hunger< in general Av- mutton2+

Cr-Chicken+3, Fish3+, Warm food3+

Life – space investigation.: A 60 year old male, well built, well dressed

came for his complaints of Recurrent URTI. Patient came alone and had to

wait for a long time before he was attended. He gave a smile to the physician

as soon as he was attended and was ready to give more time for the interview

happily. Interaction during the interview was fluent especially from his side. He

did not require any question to answer, shared himself. Patient was narrating

about many other topics while discussing one and was loquacious in that

sense. Starting from the childhood, patient lived in a joint family with 2 uncles

and grandparents etc. Patient was eldest boy among his siblings and was

favourite of his grandfather. Grandfather was in construction line. Patient

used to go with him on his work area and says, learned how to talk with

people and others from him. Patient was not interested in studies and was an
 75

average student. Father was calm by nature and was a farmer. While mother

was very loving and was a house wife. Patient was very much attached to 2

people i.e. mother and grandfather. Grandfather gave major business work to

his 2nd son who was literate and gave farming and land to patient‟s father.

Patient was furious and so were his parents which got separated and were

short of finance. Patient failed in his 2nd standard. The same year stopped his

communications with that uncle. Patient decided to quit studies and work.

During separation patient‟s family got farm, animals and a small shop of cold-

drinks. Patient started selling milk daily, did work on that shop, got it updated

to breakfast centre along with other work. Patient says, he a did lot of hard

work at that time and made the foundation for the future. Working for 10 years

in the shop, patient gave the responsibility to his younger brother who was

alcoholic. He used to drink a lot (Brother) and was not attentive on work. So

patient shifted the responsibility to his youngest brother and gave the

alcoholic brother responsibility of the farm. Patient himself started with

construction and contract work. He along with labourers formed a group of

contract led by him recognized by Government. Patient says managing

people at different levels was his skill and adjust very fast, how to talk to

seniors (high authority) authority he knew very well. How to get work done

and look for new contracts was his duty. During this period he travelled a lot

on bike and used to have Back Pain (Upper). He worked for many years in

this field and now past 3 years he left it giving responsibility to his uncle‟s son.

Patient is also a senior member of Lions Club and was President of his area.

Patient does lot of social work being in this club. Says if he helps someone

and then that person even progresses more than him then he feels no
 76

jealousy, feels good. Patient‟s just younger brother is an alcoholic and not

taken much responsibilities of his family. Patient says, all the responsibilities

was taken by him regarding studies / marriage. Patient says, his brother

should atleast work a bit and look towards his family. Patient does a lot to help

to his brother to come out of alcohol and feels, if his brother drinks alcohol

and doesn‟t maintain social standards then his name and image in the society

ultimately goes down. I.P.R. at home is good with everyone. The patient has

sent his son to his aunt‟s place for further education as there was a good

environment and teachers for studies. Patient wants that his children should

study hard. All decisions at home are taken after asking him and says, even

patient‟s father is scared of him as dad knows that, everything is done by

patient. He has made everyone stand on their feet he says this with very pride

and also talks of his deeds and achievements with pride. Patient says, he

does not gets angry but on the contrary gives history of anger on alcoholic

brother and had even beat him and now has decided to ask him to stay

separate. Patient likes to play with his grandson and is very much attached to

him and narrates incidence of him whistling and grandson responding with

much enthuasium. A year back, patient‟s mother expired. Patient was / is very

much attached to his mother and during the cremation process patient got wet

in rain since then his complaint started. During interview patient has moist

eyes while narrating this.

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ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis
Physician PP is male and is predominantly extroverted but also has fairly high score

Extrovert on N scale. EPI analysis shows that PP is lively, likes mixing with people,

Score: does believe in taking daring decisions but at the same time is not a

E-20/24 planner, hence often gets stuck up while doing things, gets listless, and

N-15/24 makes up mind too late.

L-3/9

Observer Observer is female and is predominantly extroverted in nature. At the same

Extrovert time she scores very low on his N score. Observer is friendly and happy go

Score: lucky, but is strong believer in planning, focused, mostly keeps things to

E-11/24 himself, and does things confidently.

N-9/24

L-5/9

2. CSEF:

Points Analysis
History PP felt that patient is possibly egoistic and dominating. According to

evaluation observer Patient probably was calm, cooperative as seen from his

behavior.

Interview PP had planned to start with LSMC and then generals. But PP was finding

it difficult to apply his plan as patient was very much talkative and would go

on into lifespace and PP would try to bring him back into LSMC. PP

realized this and then decided to give space to the patient and then
 78

allowed him to express his sensitivities in brother‟s issue. After interview

PP felt that patient is Image conscious, manipulative, diplomatic and

dominating. Observer also felt that patient was very talkative, diplomatic,

and egoistic.

Doctor- PP felt that he tried to maintain doctor-patient relationship as patient was

patient too talkative and dominating and he was not sure of the kind of

relationship relationship. Moreover felt that any relationship would not have helped.

Observer felt that PP was like a son and a friend to whom patient was

saying everything.

Sensitivity PP got sensitive in the issue of mother‟s issue. But was able to handle his

& sensitivity and did explore emotional states. According to observer there

Sensibility were no major sensitive issues.

Technical Predominantly receiving was used and at times exploring was used. This

skills & talkative nature of patient frequently changing the topics was a major

Blocks difficulty. PP was not able to block patient.

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3) LIFESPACE ANALYSIS:

Points Analysis
Areas PP had done minimal exploration. He had mostly received and listened.
Explored
Due to this many different areas have been mentioned but all the emotional

states were not explored. The life space is like a narration. But many

dispositional qualities are evident in life space.

4) TOTALITY ANALYSIS:
Approach and totality: Analysis:

No specific approach. Structuralization was PP did not take up any specific

used for remedial understanding . approach. In this case could

Responsible3+ Cr. Fish3+, chicken3+ have been Boenninghausen‟s

Hard working3+ warm food3+ approach due to presence of

Dominating2+ Av.Mutton2+ characteristic modalities. There

Attachment2+ Perspiration-scanty2+ were no qualified mental

Image conscious2+ noise <2+ symptoms in the case. While

Irritable2+ Thermals: chilly. arriving at the remedy both PP

Remedy: PP- Lycopodium, D/D Nux and observer have been on an

vomica interpretative level, not being

Remedy: Observer- Lycopodium. analytical.

CONCLUSION:

According to observer PP was no where sensitized and case went on

smoothly and that PP has formulated a good rapport with patient.

PP is basically of extroverted type and dispositionally tends to get stuck up,

same happened in this case. PP was stuck up due to excessive data and

hence decided to stop enquiry and completely became passive. His

 80

perception completely was based on the data that was received from the

patient. Observer was impressed by the patient and hence hardly felt the

need to cross questioning. PP and observer both were extroverted and for

them they both perceived patient to be more of responsible but manipulative

and image conscious. They did not do justice to the hard data. They gave

more importance to the face value and were too interpretative which was

carried on till they arrived at a remedial understanding. According to the

supervisor, the remedy is Calcarea Fluor.

Final Remedy- Calcarea Fluor.

Sr. Core perceived Reasons

No.
Physician Observer/Supervisor
1) Dominating and Supervisor perceived PP in this case case has

irritable but hard patient to be dominating considered whatever has

working person but equally tough money been directly available and

but hardly oriented and ambitious. has not gone to

considered the Observer had perceived interpretations much unlike

hard data. the same totality. the supervisor

Level Of Similarity: Similar

Follow ups: Constitutional treatment yet to be started and follow-ups are

awaited.
 81

CASE 7

Preliminary data: O.P.D. Reg. No. P/2532/11

Name: Mr. BHN Occupation: Kirana store Age: 43yrs/male

Status: Married 18yrs. Education: 9th std Religion: Hindu Brahmin

Address: DN

Chief Complaint:

Location Sensation Modalities Concomitants

1)Back Pain throbbing Pricking A/F- fall from height

Lumbar region Radiating stiffness No 3-4 years back.

O-gradual D-6-7 h/o fever/redness/swelling <rainy seasons3+

years Now since along with pain. <bending forward

10-15 days <changing position

at night2+

<morning2+

<first motion2+

>massage2+

2) Lower Abdomen Pain stitching2+, >hot fomentation2+

inguinal region B/L Pricking2+ No swelling, no

O- Sudden redness at that part <Standing2+

D- Since 15yrs < movement2+

F-2-3 times/yr > rest2+

3)Skin Itching, Blackish

since 10 yrs right discolouration. No swelling, <evening2+

forearm, left warmth, redness < rainy season2+

forearm, thighs, < scratching2+

 82

occiput >warm water2+

Patient as a person:

Appearance: Thin average height, wound healing normal.

Perspiration-scanty, scalp3+

Cr- Sweets3+ Salts3+ Flatulence occasional. Stools/Urine-Normal.

Sexual history- Normal Sleep- Refreshing

Dreams- Flying in aeroplane and falling on earth and dying.

Thermals- Chilly.

Pa/H- H/O Piles? Fissures? Fa/H- Mother- Fibroid uterus. Son T.B

Life Space:

Patient is male well dressed, average height and wheatish complexion

laughing in between definition. Patient brought up at village in Udaipur in a

joint family. Father‟s nature is irritable but had never hit patient. Patient is also

irritable like his father especially when wrong thing is going on. When patient

was small, uncle cheated father due to land distribution. Then patient is

irritable whenever anything wrong thing occurs with him. Now, father is in

unstable mental state, anytime scolds mother and patient not like this. Mother

is calm by nature. Patient is very much attached to brother and his wife.

Brother is teacher at village. Brother is very supportive to patient and helped

in educating his children. Patient becomes irritable when anyone does wrong

thing with him, can‟t bear others obstinacy. In anger abuses people and also

beats if opposite person beats him. Once there was fight due to money

matter. Opposite person has abused and beat him so he also abused badly

and beat that person. Anger remains for half to one hour and feels heat in his
 83

head, feels tension when anyone does not return his money. In his early days

of marriage had beaten wife 2 to 3 times as wife would not understand him.

He was average in study and not interested in studies although all are well

educated in his family. He had seen many people in village who come back

with lot of money. He also desired to go to city to earn money. He never likes

people talking on back. He never does this. Whenever he finds something

wrong is done by any people, he speaks on the face, that is, the reason

people don‟t like him. He came in Kelva for business and started a small

shop. Though father told him to study more but patient not followed father and

came to city as has to earn money. Here even Brahmin people eat non-veg

and even drink alcohol which is against religion but when patient sees people

doing such things he feels very bad, becomes irritable and speaks on face of

people that they are not doing good things and after words never talks to that

people even not goes to their house and breaks relations with that person.

Even after coming here he is selling black jaggery which is to prepare alcohol

, but he has to do as he has to earn money. He thinks, if he will not sell this,

there will not be much benefits in business. He is taking all sins of doing bad

work so that his family can become happy. He wants his both daughters to

learn so that they can earn name. Both daughters are also interested in study.

If they study well then they can get good husband. He got married in 1993 in

village by his will, but done by parent arrange marriage. His wife is illiterate.

Even due to illiteracy even not able to teach children. He feels that, if he had

married to literate girl, she would be also able to help in earning him. She has

not mixed with his father and hence patient also not goes to her home. Once

he made friendship with a person, who is doing also business, that fellow had
 84

taken money about 60 thousand and he did not return. When patient went

there to collect money he abused him so patient also abused, then people

had started beating him. Thus, in anger patient also started beating. He feels

that, relationship maintenance in business only leads to loss. Thus, he never

then dared to make and maintain any relationship. He, in free time remains in

home only and very rarely attends social function. He wants that he will do

marriage of daughters with their own choice but in their cast only. If they do

love marriage in inter cast, he will die, as he is doing everything for his

daughters. He will not allow their daughters to do such things and he is

confident also, that they will never take such steps. If they do inter cast

marriage then he fees it would destroy his image in society. He also returns

other‟s money on time, if delay occurs he gets tensed due to fear of fight. He

doesn‟t have any of his relatives here and hence keeps quiet but says that if

he would have been in his village with his own people he would have even

fought and would not have even returned anybody‟s money. He does pooja

only when he feels his bodyand mind are pure. When he feels that there is

impurity then that day he does not do pooja. Once when his father was here,

during early days of business and abused him for black jaggery selling, he

become very irritable and pushed father on floor but stopped himself to beat

his father.

ANALYSIS:
1. PERONALITY ANALYSIS :

Type Analysis
Physician PP is female and is predominantly extroverted in nature. At the same time

Extrovert he scores very low on his N score. PP is friendly and easy going, mixes well

Score: with people, but is strong believer in planning, focused, mostly keeps things
 85

E-17/24 to himself, and does things confidently.

N-8/24

L-4/9

Observer Observer is female. She is a lively person who likes to mix with people and

Extrovert is a very easy going kind of person but doesn‟t believe in planning, Gets

Score: nervous in front of her superiors, gets anxious before any important occasion

E-14/24 usually first to make friends.

N-11/24

L-3/9

2. CSEF:

Points Analysis

History Patient was overall appearing to be calm and cooperative from his external

evaluation behavior and hence PP or observer both did not anticipate any difficulties.

Clinically patient was diagnosed to have probably lumbar spondylosis.

Interview plan decided was to start case with with LSMC of chief
Interview
complaint, physical generals, and then the life space as PP wanted clarify

the clinical diagnosis. According to Observer case overall went smoothly

and as per plan and was adequate

After the interview: Observer‟s perception- patient is honest3+,

Religious2+, Image conscious, straight forward, attached. She felt so

because of the manner he was talking, he sounded to be honest,

confident. Hence she was impressed by patient‟s external manner of

presenting himself.

PP‟s perception: Likes to remain alone, money bounded obstinate,

 86

irritable. She too found patient to be appearing confident but she arrived at

this understanding by focusing on the content of his speech. But based on

same interview when this case was discussed the consultant perceived the

patient to be more of a booster, dominating and basically anxious and

fearful and hence he had a talk with the patient and confronted him which

proved his probability right, thus changing further remedial understanding.

Doctor- According to Observer: good rapport was developed and PP took location

patient of patient‟s daughter. According to PP also a good relation was formed but

relationship it was more of a friendly relationship. As a result of this there was lot of
listening, receiving, but hardly any confrontation.

According to observer she did not feel any sensitive points in the case.

Sensitivity According to PP rather than sensitive points she felt that Patient was giving

& „general‟ answers to the questions. Hence was unable to understand how

Sensibility. to go about with the case taking. PP was overall impressed by the patient.

PP‟s above dilemma itself became a block for her. The technical skills

used were that of questioning most of the times and otherwise listening.
Technical
But Patient was not answering her questions precisely. At that time PP
skills &
was not able to understand how is she supposed to go ahead but
Blocks
according to observer PP did not have any block.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas Life space mentions of lots of aspects of patient‟s irritability. But the

Explored incidences have been not explored and understood completely. Childhood

evolution of such irritable disposition is absent. He has subtle aspects of

 87

anxiety, image consciousness, domination which have been mentioned and

are evident especially in IPR with his daughters but again not explored. He

has problematic IPR with his wife which is also not understood. Overall life

space appears to be like a story as narrated by patient without much of

understanding the different issues but just accepting them as they were

told. Few confronting questions by the supervisor then lead to clarity in

these issues.

4) TOTALITY ANALYSIS:

Approach – PP has taken Kent‟s approach Analysis

Anger violence with2+ Perspiration Scanty PP has considered Kent‟s

Abusive when angry2+ on scalp2+ approach. But a possible

Fear of loss of money Cr. Sweets3+ approach could have been

Fear of fights+2 Cr. Salt3+ Boenninghausen‟s approach

dreams of flying Thermals- Chilly was more suitable as the case

in aeroplane3+ has significant number of

Dreams amorous2+ characteristic modalities.

Dreams of Devils2+ Observer could not arrive at

Disposition- Obstinate3+, attachment to single remedy due to

money2+ confusion.

Remedy(PP)- Calc. Fluor Supervisor considered this

Remedy(observer)- calc. Fluor. totality and with that his

Remedy(Supervisor)- Lycopodium perception of Boasting,

dominating nature was taken

up for differentiation.
 88

CONCLUSION:

Both PP an Observer are predominantly extrovert types with observer having

a high N score as compared to PP. Significant differences were found in

perception of this patient which are as follows. Both of them were impressed

by the manner in which the patient has presented himself. Hence they did not

anticipate any difficulty at the start. But as the case progressed PP got his

picture to be a very irritated and money bounded fellow and was finding

difficulty in eliciting precise feeling states as patient was giving very general

answers. This can be attributed to focused and analytical nature of PP but her

disposition to mix well with forming friends easily lead her into formation of

friendly relationship which created how to now get the data from this „friend‟

as it would mean confronting and blocking him. Ultimately PP‟s relationship

with the patient dominated the interview and she relied only on patient‟s

narration and her perception. This is evident from the final totality and the

remedial understanding which was Calc Flour. Observer: Observer is a

person who gets very easily connected to patients, and has low self

confidence. Probably due to this nature she was impressed from start just like

PP but remained impressed throughout. She considered patient to be

straightforward, honest, conscientious. But she was able to arrive at the

understanding of image consciousness which PP wasn‟t able to identify.

Inspite of this she was confused as to exactly what the patient is and was not

able to arrive at a remedial understanding. Overall both of them were

perceiving the patient but not in all parameters as their innate qualities

determined their point of view. Hence were not able to arrive at the core. But

both of them perceived the totality in similar manner

 89

Supervisor: Supervisor dispositionally is very critical and analytical in nature

relying always on facts and is highly evidence based in his approach usually.

He had a short talk with patient he directly asked patient few confrontative

questions especially regarding the fights and quarrels etc, where then patient

said that he never goes and fights alone, he always goes with many people to

support him and the core of the patient was understood to be basically fearful

and image conscious but boasting and trying to dominating and confident

externally. But he too has not shown a very evidence based attitude, and still

relied more on interpretations for arriving at the remedy.The final remedy

hence decided was LYCOPODIUM. Thus supervisor, who is analytical went

on interpretative level rather than relying on hard facts.

Sr. No Core perceived Reasons

Physician Observer/Supervisor
1) Angry, Supervisor understood the PP‟s friendly relationship made her

abusive same qualities as that to be completely in receiving

with perceived by the PP the core mode. Same was with the observer

money identified was basic who too on the face value was

oriented dominating, boastful nature. impressed. Hence the core which

attitude. Observer had perceived the was perceived by the supervisor

same way as had the PP after confrontation was not

perceived by the PP.

Level Of Similarity: Similar

Follow ups: Patient is yet to come for follow up after 1st dose of Lycopodium.
 90

CASE 8

Preliminary Data: O.P.D. reg. no.-2824

Name: Mrs. PPM Age: 22yrs/Female Education: 10th std

Occupation: news reporter Married since 10 months Religion: Bhandari

Fa: 51 yrs, Mo: 46yrs Sisters:2, Brothers:1 Address: ACV

Chief Complaint:

Location Sensation Modalities Concomitants

1)Abdomen& Pain3+, cutting <2-3 days before

F.G.U.T type, with nausea menses

Hypogastrium, and waterbrash. < exertion2+

lumbar >hot

fomentation2+

D-5-6days Menses delayed,

Clots+

2)M.S.S

Lower extremities Tingling,

Since 6-7 months numbness. No

radiating from pain no stiffness.

ankle upto knee

joint

3) Head Pain with feeling <continuous work

frontal to bang head. No >Pressing3+

nausea no >Balm

vomiting application3+
 91

Patient as a Person:

Appearance- average heighted, wheatish complexion.

Perspiration- scanty, offensive, stains blackish

Cr.- Salty3+, sour3+ Av.-sweets3+, green vegetables3+

Stool/urine- normal. Menses: see chief complaint Sexual desire- reduced

Bus- Vomiting2+ Thermals: hot Sun< 3+

Life space:

A 22 years old female who came in the OPD was lean, thin, short. She has

spent her childhood at Tarapur with her mother, father, 2 sisters and 1

brother. She is the 2nd sibling amongst them. She learnt only upto 10th

standard. Her financial status was good. Mother was housewife and father

was doing job in a company. Her IPR with all her family members was good.

She failed in 9th standard and wanted to appear for 10th exam. In that situation

every one told her for not to appear for 10 th but as she was very much

obstinate she did it against her parent‟s wish. She had done the beautician‟s

course and when she failed in 9th Std, that time parents didn‟t give her money

to study. She did a job in beauty parlor and simultaneously in a company and

got all her books and studied, given her exam and got pass through that

exam. At childhood she was very much irritable and obstinate by nature as

compared now. One day, when she was in 7th Std., she was asking for new

school shoes, that time her father was going to some other place for the

purpose of some work. So he refused that time. At that time, patient got so

much irritable that she broke the front mirror of her father‟s car with the stone.

That time her father had beat her badly but patient did not feel anything and

after 2 days her father again started pampering her. She is the most
 92

pampered child in the house. She got married 10 months back. Her marriage

is love marriage. During their affair also she had undergone many conflicts.

That boy did not belonging to her cast. They both used to meet frequently.

Boy‟s family was against their affair still they used to meet. One day patient

and her boy friend meet with each other and that boy‟s mother and younger

sister saw them. That time his mother and sister started beating the patient

and that time boy has protected the patient. One day that boy‟s mother

brought 10-15 people at patient‟s house and had blackmailed the patient‟s

father and she also had insulted the patient‟s father. Patient felt very much

bad about that. For that matter she still considered herself to be responsible

for the insult of her parents. Due to all these things, she got frustrated.

Meanwhile, her parents started searching a guy for her. She used to tell each

and every guy that, she is engaged and finally she went to Pune for a

change. Due to the big insult of her parents, she was feeling very guilty about

herself. And got very much angry with her boy friend. Because, she was

thinking that he should tell his parents to not to do that, but her boy friend was

not at all telling anything to his parents and keeping all these things in mind,

she got ready to break this relationship and ready to marry with some other

boy. Her parents selected a guy for her with whom she got ready to marry.

But one day suddenly her boy friend came to Pune with a bond paper with

him and he blackmailed the patient to marry him otherwise he will commit

suicide. In that fear patient has did Court marriage. After this incidence her

parents stopped talking with her. She felt very bad about. Now slowly her

parents started talking with her. Due to all these incidences she has lost her
 93

interest about her life, marriage, etc. She is disinterested in staying with him.

There are always quarrels in their house.

ANALYSIS :

1. PERONALITY ANALYSIS :

Type Analysis

Physician EPI analysis shows this PP also to be extroverted type. Again basically of

Extrovert happy go lucky nature but score wise the observer has more predominant

Score: Extroverted attitude.. She is a person who may not really plan out the things

E-15/24 but would just do or say whatever might come to head first. She is nervous

N-13/24 and gets conscious in front of her supervisors.

L-3/9

Observer Observer is male. EPI analysis shows that this observer is basically happy

Extrovert go lucky, likes cracking jokes creating a friendly atmosphere around, is lively

Score: and an easy going person. Observer is a believer in planning, as opposed to

E-18/24 PP and has more patience because he believes that things do come right at

N-12/24 the end somehow

L-4/9

2. CSEF:

Points Analysis

History No data as such available prior to the definition.

evaluation

Interview According to the PP interview went on smoothly and was able to formulate

good rapport with the patient. She found patient to be anxious, and highly

irritable and obstinate in nature. According to observer also PP had

formulated a good rapport and he found the patient to be anxious, very

 94

talkative and highly irritable by nature.

Doctor- According to the PP she became a good friend of patient. Observer also

patient felt that PP had developed a very friendly relationship with the patient. But

relationship at the same time patient was also so much talkative and PP was almost

dominated by the patient. PP was only receiving the patient.

Sensitivity According to PP the areas where patient was sensitive was regarding her

& love affair. Observer also felt that PP was sensitized by the same issue as

Sensibility. there were many aspects in this event which needed confrontation,

exploration but PP did not confront at all.

Technical PP mostly was receiving and at times, exploring.

skills & According to the PP her block was that she was sensitized by patient‟s

Blocks love affair and she could not block or confront patient. According to

observer PP was blocked due to various things such as her basic anxious

nature due to which patient almost dominated the PP and her sensitivity

due to which PP throughout only received the case.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not Her childhood- reasons for the aggressive behavior, IPRs with mother,

explored. IPRs with mother, her current relationship with her maiden family.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

PP-Kent‟s approach PP was able to arrive at this totality

Anger3+ violent, throws things but She was not able to integrate the
 95

Irritable3+ Thermals-hot totality and hence not able to arrive at

Contradiction3+ Cr-Sour3+ the remedial understanding of the

Guilt3+ Cr-Salty2+ patient. According to observer the

Obstinate3+ Av-sweet2+ main remedies were Natrum Mur,

Anxiety anticipating3+ Sun<3+ Sepia. But then he relied more on the

Motion<3+ mind symptoms such as despair and

Observer-Kent‟s Approach irritability coition during and hence felt

In addition to above totality observer that possible remedy correspondence

also considered the following is Sepia. But the thermal state is hot

symptoms which is not considered by the

Irritabilty, coition during, Despair of Observer.

life, lack of sensitivity.

Remedy- Sepia

Final Remedy- Sepia

CONCLUSION:

In this case both PP and observer have been extrovert by nature according to

EPI Analysis. But PP has a high N score as compared to her Observer and

lower E score as compared to her observer. In this case PP has been anxious

and very sensitive. She was completely dominated by the patient to the extent

that she was not able to confront or the block and had became very sensitive

with the issue of her love affair and hence was not able to arrive at a

comprehensive understanding of the patient. This could be probably attributed

to her high N score. Observer was able to arrive at a comprehensive

 96

understanding, but for final remedy differentiation he went more on

interpretative level.

Sr. Core perceived Level of Reasons

No. similarity

Physician Observer

1) Anger, irritability Anger, irritability with Different PP due to her

despair of life. sensitivity and

anxiety was not

able arrive at

clear totality

formation.

Follow Up:

Constitutional yet to be released and further follow ups awaited.

 97

CASE 9

Preliminary Data: O.P.D Reg No.-1339

Name: Mrs. AMS Age:18yrs female Education- 8th std

Status- Single. 3 brothers, 2 sisters, Religion- Hindu

Address- EGT

Chief Complaint:

Location Sensation Modalities Concomitants

1)R.S Cough < getting wet2+ Irritability3+

Since childhood Thick, yellowish, < Draft of air2+ Anger violence2+

D-1 to 2 weeks sticky, non < Taking cold2+ Wants to be

F- once in 6 offensive. < Night2+ alone2+

months <exertion3+ Bitter taste in

D- after 2-3 days Coryza with thin mouth2+

watery discharge,

2)F.R.S Irregular menses >medicine Wants to be

Profuse bleeding < lying on back3+ alone3+

Offensive

Dark red clots

Pain in abdomen

Patient as a Person:

Appearance- Lean, average heighted.

Wound healing delayed Stool/Urine- Normal.

Perspiration- Moderate on face and forehead Cr-salty3+ Av-Sweets3+,

Apples3+, Bananas3+ Sleep- Normal, refreshing

Sun<3 Headache Thermals- Chilly

 98

Life Space: An 18 years old lady of average built and wheatish complexion

came in OPD with anxiety and nervousness on her face. She stayed in Boisar

with her father, mother and 3 brothers and 2 sisters. She is the 4th sibling

among them. She has elder sister and 2 elder brothers. One younger sister

and younger brother. She does not have good IPR with her brothers and

sisters. She thinks that everyone gets jealous upon her. She remains quite for

whole day in the home. Don't talk to anybody., in the house, rather she

doesn't like to talk with her family members. As she remains quite for whole

day, heir elder brother & sister scolds her about her behaviour. They always

asks her why you are sitting like this, why you behave like this? And they

always laugh at her. That's why, she thinks that they all get jealous on her.

She is very much afraid of her father. She has learned only upto 8th std. She

wanted to learn further also, but her father did not allow her to learn. That time

also she felt very bad about it, but didn't express emotions. Previously she

was staying at her village and there and had taken her education, then one

day she came to Boiser at her home. That time her father did not allow her to

go back again. Now she manage all the household work. She used to go for

the sewing classes also. But her father made her to stop that also. She was

having interest in that, but she again did not express anything. Even if she

wanted to go out of the house, she could not go because her mother and

brother scold her and if she stays at home & remains quite that time also they

laugh at her, so she also does not know what to do? She is having constant

feeling that somebody will beat her, because, when she was at village, that

time one day she was playing with her uncle‟s daughter, and she was sitting

on. Uncle asked her not to play but she did not listen to him, so he took a
 99

bucket and hit her with that bucket. And since that time she is having great

fear, that her family members will beat her if she will not listen,to them. When

she scolded her younger sister that time also her younger sister & her mother

scolds her. Now, she don't like to talk to her family members..having anger

about them in her mind, she is attached to her mother, shares sometimes with

her.

ANALYSIS :

1. PERONALITY ANALYSIS :

Type Analysis

Physician EPI analysis shows this PP also to be extroverted type. Again basically of

Extrovert happy go lucky nature but score wise the observer has more predominant

Score: Extroverted attitude.. She is a person who may not really plan out the things

E-15/24 but would just do or say whatever might come to head first. She is nervous

N-13/24 and gets conscious in front of her supervisors.

L-3/9

Observer EPI analysis shows that this physician is basically happy go lucky, likes

Extrovert cracking jokes creating a friendly atmosphere around, is lively and an easy

Score: going person. Observer is a believer in planning, as opposed to PP and has

E-18/24 more patience because he/she believes that things do come right at the end

N-12/24 somehow

L-4/9

2. CSEF:

Points Analysis

History No data as such available prior to the definition.

evaluation
 100

Interview According to the PP interview went on smoothly and was able to

formulate good rapport with the patient. She found patient to be very

fearful, reserved, irritable in nature. According to observer also PP had

formulated a good rapport and he found the patient to be anxious, very

talkative and highly irritable by nature. According to observer PP tried

hard to establish good rapport but patient was too reserved and was not

even maintaining eye to eye contact. So PP seemed to be irritated.

Doctor- According to the PP it was only a professional doctor-patient relationship.

patient Inspite of all her attempts she did not open up. Observer also felt that PP

relationship was not able to form any relationship. Patient was giving only short

answers to whatever PP would ask her.

Sensitivity & PP although was not able to form a very good rapport, was sensitized and

Sensibility. got very much sympathetic to patient after hearing the situations in which

she has been brought up till now. Due to this PP also stopped too much of

probing in later part and to some extent was also irritated as patient was

not opening up as she wanted.

Technical Questioning, Exploration. Major blocks were PP‟s sympathetic feeling and

skills & patient‟s reserved nature due to which PP landed up in irritability.

Blocks

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not All the situations have come up in the case but her reactions and

explored. feeling states are missing

 101

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach: PP went on with Kent‟s approach.

Anger long lasting2+ Chilly But the mentals that have been

Aversion to company2+ Cr-Salty2+ considered are highly

Fear of getting beaten Av- Apples2+ interpretative. Due to lack of

by others2+ Av-Sweets3+ further data PP not able to

Suppressed emotion2+ Sun<3+ conclude on the remedy.

Getting wet <3+ Observer did not take up any

Group of remedies- Natrum Mur, Sepia, specific approach. And

Phos, Calc. Carb considering mainly the symptoms

Observer- Totality mentioned arrived at the remedial

Fear of approaching3+ understanding of Arnica which

Sibling rivalry was also based mainly on

Childhood Asthma interpretation.

Severe Dysmenorrhea

Bleeding from nose, when coryza.

Observer - remedy- Arnica

CONCLUSION:

In this case both PP and observer have been extrovert by nature according to

EPI Analysis. Patient was reserved by nature and did not open up inspite of

efforts from the physician. Also PP got sympathetic as well as irritated as

patient was not opening up as she wanted, because she wanted to elicit

proper data and evidences. Both of them relied more on the mentals which
 102

were not very clear and did not consider the hard data which was evident in

the case in totality formation.

Sr. No. Core perceived Reasons

Physician Observer

1) Fearful and Fearful and PP has not realized the

reserved reserved, with sibling possible aspect of sibling

rivalry. rivalry which was considered

by her observer. This was

because PP was sympathetic

and got irritated when she did

not get the data she wanted.

Level of similarity: Similar

Follow ups awaited.

 103

CASE 10

Preliminary Data: O.P.D. Reg no. 349

Name- Mrs. SMR Age/Sex-25yrs Education-10th std

Religion- Hindu Occupation- Housewife Status- Married

Spouse- 30yrs, supervisor 1 Brother, 1 Sister Add- GHJ

Chief Complaint:

Location Sensation Modalities Concomitants

1)Endocrines

O- Sudden, since Weakness+ <overwork2+

3 years >rest2+

2)F.G.U.T Menses dark red. < before

O-since 3 years Clots, pain2+ menses2+

Diagnosed as

hypothyroidism

Started tab.

Eltroxin 1 OD

Infertility

H/O

amenorrhoea

Patient as a person:

Appearance- lean thin, fair complexion Wound healing normal.

Perspiration- scanty, but profuse on palms3+, Sole3+, Back

Appetite- reduced. Cr- Fish2+, Sour2+, Cr-sweets3+ Av- Milk3+

Stools/Urine-Normal
 104

Menstrual Function- Regular after taking treatment for primary amenorrhea,

monthly cycle, large clots, dark red, with abdominal pain in the beginning.

Sexual function- 2-3/weeks, normal. O/H- G1P0A1L0 missed abortion

Thermals- chilly. Pa/h- nothing specific

Fa/H- Mo- operated for benign breast tumour

Life space: A 23 yrs old female lean thin came to the OPD with fair

complexion, came for the case definition for secondary infertility and drug

induced hyperthyroidism. She was brought up at uncle‟s house at Dahisar as

parents were too poor to give her a good upbringing. She lived with her

grandparents, uncle, aunty, and her elder brother. She studied upto 10 th and

then uncle stopped her studies and she did not argue with her uncle. She later

learnt the sewing but did not go for any work outside as no one had guided

her to do the work. Her uncle‟s nature is good. Aunty is also good in nature.

She has good IPRs with all. Patient was average in studies , would take part

in all drawing competitions, but not in elocution competitions due to stage

fear, would feel whether she would remember or she would forget everything

etc. Even now she has fears. She got married at the age of 19yrs., to the boy

chosen by her uncle, and she is happy with him. Her mother in law is calm by

nature and but her father in law is irritable and patient also gets irritable by

nature when her father in law shouts at her mother in law although her mother

in law is concerned about him. Husband‟s nature in general is good but,

husband shouts at her when she does something wrong, or she forgets to do

certain things. When anyone angry on her she weeps, and will not speak with

anyone, feels better if someone consoles her. When angry patient gets

palpitations and perspiration on chest. She conceived 1 year after her

 105

marriage but later found that there was no growth of the child and it was

amissed abortion and then got a D&C done. She then started with an anxiety

that whether she will be able to conceive again or not. She feels bad when

she sees children and other couples in village who were married after them.

As such she doesn‟t have any pressures from her family. She mixes well with

all her neighbours, has good IPRS with all. She does all her household work

and has got well adjusted in new family. Brother in law is unmarried and has

good IPRs with him.

ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is female and is predominantly extroverted in nature. At the same time

Extrovert he scores very low on his N score. Observer is friendly and happy go lucky,

Score: but is strong believer in planning, focused, mostly keeps things to himself,

E-11/24 and does things confidently.

N-5/24

L-5/9

Observer Observer is male and is predominantly extroverted but also has fairly high

Extrovert score on N scale. EPI analysis shows that PP is lively, likes mixing with

Score: people, does believe in taking daring decisions but at the same time is not a

E-20/24 planner, hence often gets stuck up while doing things, gets listless, and

N-15/24 makes up mind too late.

L-3/9
 106

2. CSEF:

Points Analysis

History PP had anticipated only language difficulties and had decided to focus first

evaluation on the eliciting properly the LSMC and understand the clinical cause of

secondary infertility.

Interview After the interview PP felt that interview went as per her plan and was

overall adequate. But according to the Observer, PP was jumping from one

issue to the other and appeared to be confused. Observer felt that data

collected was adequate but the way it was collected was not proper.

Observer also felt that complaint diagnosis was not achieved. According to

the PP Patient is anxious, irritable, sensitive and family oriented. PP also

felt that patient is anxious and irritable in nature.

Doctor- PP felt that initially no relationship was formed but later a very good

patient rapport was formed almost like sisters. Observer felt that relationship

relationship between them was like that of sisters and Patient opened up very well and

lot of sharing was done.

Sensitivity According to the PP there were no major areas where she became

& sensitive. But according to the observer death of child (abortion) and now

Sensibility. the secondary infertility were 2 major issues where PP appeared to be

sensitized. Observer felt this because although patient seemed to have

accepted this but PP had not. This is because PP was trying to go into

depths and tried to elicit emotional state of patient although nothing

significant was coming up. Hence observer felt that PP was too sensitive,

even more than patient for these issues, and was not able to handle her

sensitivity.
 107

Technical Exploration, listening were predominantly used. Blocks according to PP

skills & were inability to understand the clinical state. PP also felt the same. This

Blocks was due to lack of knowledge and that of technical skills.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not Childhood, as to what she feels about not staying with parents, Feeling

Explored state when father in law shouts at her mother in law.

4) TOTALITY ANALYSIS:

Approach: Kent‟s approach. Analysis

Totality- PP Due to presence of many

Fear with palpitation2+ Cr- Fish2+, Sweets2+ qualified mentals as well

Fear stage2+ Cr-sour2+, Av-Milk2+ as characteristic physical

Fear sudden noise2+ Menses dark red clotted generals, PP has taken

Fear of dogbite2+ Perspiration- Palms2+ up this approach which

Fear of snakes2+ Perspiration- Soles2+ seems to be appropriate.

Dreams snakes2+ Thermals- Chilly

Anger with palpitation2+ Abortion- 3rd month

Remedy(PP)- Calc. Carb D/D- Silicea

Remedy(observer)- Calc. Carb

CONCLUSION:

PP in the interview was able to gather adequate data as she formed a very

good friendly relation almost like a sister as felt by the observer. This was

probably due to the nature of the PP being outgoing and easily making

friends. PP being highly focused by nature was more focused on assessing

the clinical state, but was not able to asses it due to lack of knowledge.
 108

Similarly PP stressed a lot on the issue of abortion and infertility because of

her nature to be too evidence based as she did not wanted to apply her

standard of the emotions. But this was taken up to be as sensitivity by the

observer who was equally sensitized by this issue. But PP has not explored

the childhood and relationship with the parents. In totality formation PP has

used Kent‟s approach for totality formation. But she has based herself on

directly obtained data and has not been able to integrate it and arrive at the

core. Based on the hard data and directly available mental symptoms PP

arrived at the remedy Calc. Carb. This has been done by her supervisor who

has arrived at the core, through interpretations based on hard data. Observer

and PP had arrived at almost the same remedy i.e calc carb

According to PP considering the core as high sensitivity to reprimamds as to

what will people will think of her etc. and hence remedy given was silica.

Final remedy- Silicea

Sr. No. Core perceived Reasons

Physician Observer/Supervisor

1) Basicallly Sensitivity to what This is because PP goes on only

fearful people will think of symptoms as they are directly

anxious. her and hence the available and she does not become

anxiety interpretative hence not able to

arrive at the core at which the

observer has.

Level Of Similarity: Similar

Follow ups-

Constitutional remedy yet to be released and further follow ups awaited.

 109

CASE 11
Preliminary Data: O.P.D Reg. No.- 3340

Name- Mr. JAP Age/Sex- 46yrs/male Education- 9th standard

Status- Married Religion- Hindu Occupation-

Farming/electrician

Spouse- Housewife, 1 son, 2 daughters, Fa- expired Add- GHJ

Chief Complaint:

Location Sensation Modalities Concomitants

M.S.S Mild Pain, no A/F- Overexertion

O-sudden swelling, no <walking3+

D- since 2years radiation, no <standing3+

P-gradual stiffness, no <sour food3+

crepitation. >rest3+

No tingling >winter3+

numbness, no >massage3+

H/O trauma. >warm

application3+

2)R.S Difficulty in <night3+

O-Sudden breathing <winter3+

D-since birth Restlessness, <cold food3+

Till age of 15-16 crackling sound <cold drink3+

years during breathing. >warm water

F- as soon as H/O bronchial application3+

precipitating asthma

factor comes up.

 110

Patient as Person:

Appearance- Short heighted, average weight, dark complexion.

Wound healing- normal Sleep- normal

Perspiration- Scanty2+, face2+

Cr- fried food2+ Av- Sour2+

Stool/urine- normal Sexual function- normal

Thermals- Chilly Dreams- daily events2+

Fa/H- Fa- bronchial Asthma, M.I. expired suddenly.

Pa/H- diagnosed as Hansen‟s in 1985

Life Space: Patient was born and brought up in navali and his family

consisted of Father, mother, younger brother and 3 sisters. IPRs with all is

good, but patient did not like his mother as she was irritable in nature. Patient

was more attaché dto his father who is good natured and teaches everything

to them. He has learned many things from his father. Father also helped

everybody to settle even after marriage. Father retired and died 16yrs back

due to MI. Patient very bad as he felt he lost his strong support. His younger

brother works in company and supports him. In childhood patient felt that it

would had been better if would have died as he was not able to do many

things due to childhood due to his asthma. Once was admitted to hospital and

was put on O2 for asthmatic complaint, whenever he has to face exams he

gets asthmatic attack. It occurs due to fear of exams. Due to his illness he had

leave his school after 9th standard although was interested in studies. After

that he never thought of studying and started working in company. There he

had to do the job of packing but left it as there was no new learning. Later he

started driving autorickshaw and did this for 7-8 months but then again started
 111

with asthmatic attacks. Hence was advised by the G.P to leave the job and

hence he changed it to Salesman but again felt that there was not much of a

learning and hence now since 5-6 years he is doing the job of electrician. He

always likes to do something new and now is happy with this job. But since

few years, he is facing difficulty to do his work as there is pain in his knees.

But he likes doing work and then he does attends all calls is particular about

doing his work. Apart from the electrical work he is doing farming but not

much developed due to other job. Now since few years, he is slowly

developing it with new techniques and learning from it.

Patient is married since 1995 and has good IPRS with his wife. He has 1 son

and 2 daughters and he believes in inculcating good values in them. He feels

they must understand what is right and wrong.

Sister‟s interview:

During interview patient did not share about his behavior and sister told that

patient becomes angry on trifles and becomes impulsive but does not do any

harm to anyone. Becomes angry when anyone tells him anything to do

repeatedly.

To leave first company was his own descision as there is difference when we

work under someone and when it is our own business. In private work there is

no time boundary to get up early and no one would tell you something.

ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician Observer is female and is predominantly extroverted in nature. At the same

Extrovert time he scores very low on his N score. Observer is friendly and happy go
 112

Score: lucky, but is strong believer in planning, focused, mostly keeps things to

E-11/24 himself, and does things confidently.

N-5/24

L-5/9

Observer PP is male and is predominantly extroverted but also has fairly high score on

Extrovert N scale. EPI analysis shows that PP is lively, likes mixing with people, does

Score: believe in taking daring decisions but at the same time is not a planner,

E-20/24 hence often gets stuck up while doing things, gets listless, and makes up

N-15/24 mind too late.

L-3/9

2. CSEF:

Points Analysis

History Both PP and observer did not find any specific data arrive at some

evaluation Problem definition. But clinically problem defined by both PP and observer

i.e. of OA knee. Opening was decided through LSMC. But differences have

come up after the interview.

Interview Interview went as per plan but in all areas PP and observer both felt that

patient was answering but was not clear and not giving all the details.

According to both PP and observer interview was inadequate as regard to

many physical generals as well as lifespace. According to PP after

interview she was not able to arrive at a person understanding because

she did not get clear evidences to arrive at any definitive patient

understanding. According to observer he felt that patient is anxious,

sympathetic and reserved.

Doctor- According to PP initially was not able to form any particular relationship
 113

patient and took lot of time to create a rapport at the end there was a friendly

relationship relationship but it was still superficial and patient did not open up

completely according to PP. According to the observer PP tried to form a

Sensitivity daughter- father relationship. But he too felt that patient did not open up.

& As such there were no major sensitive issues in the case.

Sensibility

Technical PP was predominantly using questioning and exploring. Major block faced

skills & by the PP was that patient was not talking much and was not telling

Blocks properly. She had got confused as to how to go about. But then went on to

explore hard data and would come again to same point and start exploring,

it did help her top some extent but not completely.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas Most of the areas have been attempted to explore but all the areas

Explored mentioned lack expressions of the patient and hence difficult to understand

the attributes.

4) TOTALITY ANALYSIS:

Approach: Boenninghausen‟s approach. Analysis

Totality(PP)- Due to lack of qualified

Fear< exams during >warm application3+ mentals and characteristic

Irritability<trifles Cr- Fried3+ physical generals Kent‟s

<sour3+ Cr- Sour3+ approach is not suitable.

<winter3+ Hence PP has preferred

<cold food/drinks3+ Boenninghausen‟s approach

Group of remedies- Arsenic alb, nux vomica, as the case has good number
 114

phos., silicea of characteristic modalities.

PDF:

Thermals- Chilly, reserved

Sense of responsibility but at the same time

fearful and

Final remedy(PP)- Silicea

Totality(observer)- Same as that of the PP

Remedy(Observer)- Silicea.

CONCLUSION:

Both PP and observer both are extroverted type according to EPI analysis.

But PP has a lower N score and is more analytical as compared to the

observer. Hence probably in the interview when did not get exact data on

which she can rely upon. But then she went on to explore the physical

generals and as regards to be more confirm about the mentals she preferred

to collect the information even from the relatives. Due to the lack of evidences

and proper expressions in the case both PP and observer preferred to go by

evidence based approach i.e. Boenninghausen‟s approach. Both of them felt

that patient is duty conscious and reserved.

Final Remedy (Consultant)- Silicea.

Sr. No. Core perceived Reasons

Physician Observer/Supervisor

1) Duty Duty conscious, It was directly evident that patient

conscious reserved and was reserved as was not opening

and reserved anxious up easily, and duty conscious as

but fearful at was evident from his work pattern

 115

the same time but other aspects were not

as is desirous explored as PP was trying to be to

of support. analytical and hence was not able

to develop a relationship with the

patient.

Level Of Similarity: Similar

Follow ups:

Sr.No. Date Follow Up Action

1) 11/7/11 Bilateral knee joint pain +, Silicea 200 1 dose, with

Crepitations nil placebo 1 week.

Cold aggravation+

2) 18/7/11 Bilateral knee pain Silicea 200 1 dose weekly,

amelioration 25% placebo 2 weeks.

3) 2/8/11 Bilateral knee pain Silicea 200 weekly dose

ameliorated 50% no new placebo 2 weeks.

complaints
 116

CASE 12

Preliminary Data: O.P.D Reg. No- 6785

Name- Mrs. ARF Age- 42 years/female Education- 10th pass

Religion- Muslim Status-divorce since 6yrs Occupation-Housewife

Fa- Died, Mother- 65yrs Children- 1 son Address- JKL

Chief Complaint:

Location Sensation Modalities Concomitants

G.I.T Nausea <sitting2+ Thirst reduced2+

O- since 4-5 days Vomiting >lying on the Dryness of

Sudden Fullness2+ back2+ mouth2+

Abdomen Pain2+ >allopathic Low mood,

injection weeping2+

2)Mind Low mood++ A/F- Vexation3+

Since 2003 Irritability2+ <contradiction2+

O-gradual Weeping2+ >consolation2+

P-slow Socialization >company2+

Continuous reduced2+ >sleeping Pills2+

No interest in

work

Suicidal

Attempts2+

3)M.S.S Sleep reduced2+ <lying2+

Since 7-8years Pain2+ <winter2+

Gradual Morning stiffness >hot

fomentation2+
 117

4) L.S Spine No specific

4-6 months Pain2+ modalities

5) G.I.T Morning stiffness

Retrosternal Pain, Burning,

region Nausea, Sour

eructations,

Flatulence2+ <Tension2+

6)Head, fronto- Pain2+ <Anger2+

parietal

Since many years

Patient as a person:

Appearance- Medium built, Depressed look, weepy.

Perspiration- Profuse2+, stainig white, offensive odours.

Hunger<2+ Cr- fish3+, sour2+

Sun < headache2+ Riding <3+

Thermals- Chilly Sour<3+

Menstrual Function- regular cycle, dark red black clots, offensive++, mild

backache and abdominal pain before menses.

Sexual function- now normal.

Sleep- reduced++, dreams- nothing specific.

O/H- G1P1A0L1, FTND, Morning Sickness for 3 months, unable to do any

work

Pa/H- Nothing specific Fa/H- Father- suicide attempt.

 118

Life Space: A 42 year female admitted for abdominal pain and nausea in

hospital, she is having medium built with wheatish complexion, tearful mood,.

She was accompanied with her mother and son, She is born and brought up

at small village near Hyderabad where her father having business in

partnership with one of their relative. She told that her mother wanted male

child, when she born, hence mother did not give love to her. Father was good

by nature but there are frequent fights between mother & feather. Father

committed suicide when patient was 5 years old but does not remember

much. Then all family shifted to Umargaon, where her maternal grand mother

stayed. Then she grown up in Umargaon. Childhood many difficulties related

to money, no one to love and care. She taken education till 10th but failed in

l0th standard, At that time her mother used to take tutions for daily needs, she

is having 1 elderbrother and one younger brother and sister. IPR with all is O.

K., but she told, mother loved all siblings but not loved her at all. when she

was 17-18 years old, she married with person who was having business, but

after few months of marriage her husband told her that she is not much

attractive and he wants to marry her friend, and then he gave her divorce &

married with her friend. After that he cutoff relations with husband but

relations with friend continued till date. She talks with her when she meets

her.Then after 1-2 years her family decided her second marriage with

relations (cousin brother), who was handicapped. He was having tailoring

business, they lived for 5 to 6 years and patient was very much attached with

him but her son was 5 years old. He started extramarital affairs. One day she

caught them in their home doing physical relations and patient become so

much angry and beat that lady very much. But later on, patients-husband did
 119

not support patient and told clearly that I will not love you, I only love that

lady.Then after this incidence it got very much disturbed and started with

depression, anger outburst with head baging suicidal attempt. Then she

decided to live only for son.

Before six to seven years her family members again convinced her for

marriage. She married with divorcee husband who also had one son. Patient

was there one to two months but they used to beat and torture patient and her

son very much. Her father-in-law wanted to does have physical relationship

with her. Then she told it, to husband but he did not give attention and

husband told her once, that he married & brought her for his father only. After

that she left her house and started again to live with mother. Now a days, they

have many financial problems and patient does not want to sympathy and

help from other. Previously she was working outside for 5to 6 years but all

people ware friendly and then would try to sexsually abuse and she left the

job. Now her brother fulfil there demand of daily need. Her son now doing first

year B. Com. and given C. A. entrance also, but failed hence she started

much anxiety-GHABARAT. Now, after becoming healthy, she wants to join

new work for earning bread and butter. Actually she is much dissatisfied with

life and wants to die but because of son, she is living. During narrating she

was continuously weeping and look somewhat relieved after listening

complaint but giddiness and headache aggravated after case defination.

According to son-she is very much anxious & and attached with son. She is

very independent, does not like to be helped by others. According to mother-

very irritable, weeping always. Takes sleeping pills, only does household work

but good in that. Creebing and always dissatisfied. Very often anger outburst
 120

with and abuse sometime. When got irritated ocassionly, only beats son, but

loves him very much.

Observation :- She is very much concerned about son & son is also having

attached with her. Mother was very irritable and always blaming to patient.

Patient doesnot seem very comfortable and attached with mother. At the time

of case defination mother become restless.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician: PP is male and EPI Analysis shows that observer is predominantly

Extrovert Extroverted in nature. EPI analysis shows that he is basically happy go

Score: lucky, likes cracking jokes, is lively and an easy going person. But at the

E-18/24 same time he is organized and analytical.

N-12/24

L-2/9

Observer: PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP like to be with mix with people. He is nervous and

Score: anxious in nature and is touchy, often find difficult to express what he

E-13/24 feels into words, gets lost in thoughts.

N-16/24

L-4/9

2. CSEF:

Points Analysis

History Patient was defined in IPD not much data available for history evaluation.

evaluation PP had planned to start with the Chief complaint and then physical
 121

generals and then life space.

Interview But the interview did not went in same way rather most of the times patient

was coming up with her own tension and would weep. After the interview

PP felt that overall it was adequate and observer also felt the same. PP

after the interview felt that patient has suffered a lot in her life hence

irritable but has been a fighter and many people have cheated her and she

has never got love. Observer also felt the same and felt that due to this

she has landed up in indifferent state except for her son whom she is very

much attached.

Doctor- According to PP he had taken up the role of younger brother. But

patient according to observer PP maintained a doctor patient relationship and did

relationship not form any as deeper relationship. But definitely a good rapport was

formed between both PP and the Patient.

Sensitivity According to the observer PP did not get sensitive because he felt that PP

& did not believe patient completely and was not receiving he was trying to

Sensibility. cross check many things. Observer had become very much emotional and

sympathetic. PP too had become emotional and sympathetic after hearing

such multiple tragedies in her life and hence was in receiving mode for

certain period but at the same time was conscious that he need to

understand the issues not just from patient‟s perspective but wanted to

examine other side of the coin and hence went into further enquiry and

also collected the data from relatives.

Technical Most of the times it was exploring, and questioning and receiving when it

skills & was needed. PP‟s sympathy was a block but only for some time and he

Blocks was able to overcome it to some extent but his observer was not able he
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was highly sensitized throughout the case.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not Most of the areas have been adequately explored. But few aspects such

explored has she being abused at work place everytime and that she is independent

and doesn‟t like being helped etc then why does she accept help even from

brother and mother etc are not very clearly explored.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Boenninghausen‟s Approach. Due to presence of many

Totality: mental modalities, and physical

A/F- Vexation <noise general modalities PP

<contradiction <hunger considered Boenninghausen‟s

<company <motion approach.

>consolation <before and after Observer has been highly

menses affected by the physician‟s

Cr- fish <sour emotional state and considered

Cr- Sour Headache anger after. mainly her severe vexation and

Group of remedies: currently perceives her to be in

Pulsatilla, Natrum Mur, Lycopodium, an indifferent state.

Bryonia, Sepia, Phosphorous, Nux Vomica,

Kali carb.

PDF: Thermals- chilly

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Disatissfied and vexed, Fighter,

Independent.

Differentiated Natrum Mur, on the basis of

reactivity and consolation amelioration.

Final Remedy(PP)- Sepia.

Observer: Also perceived in same way but

felt that patient has been very much vexed

and now has been into indifference for

everyone in family members.

Final remedy- Sepia.

CONCLUSION:

PP is of extroverted type and observer is introverted type. The case was

having multiple issues and both PP and observer were highly sensitized and

became very much sympathetic. But PP was able to overcome his emotions

and tried to understand all all these issues and all her reactive patterns in

different perspective and hence from receiving mode he went into probing and

exploring mode. But his observer who is of introverted type and emotionally

unstable basically was completely sympathetic and hence felt that PP was not

sensitive although it was not the fact and patient too responded well to PP‟s

exploration and probing. Both of them arrived at a same remedy. But PP took

a more evidence based approach i.e. Boenninghausen‟s approach however

observer interpreted as indifference and arrived at the remedy Sepia.

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Sr. Core perceived Reasons

No.

Physician Observer

1) Independent, Patient has suffered PP being analytical did not

Fighter, irritable a lot, vexation3+ with interpret the consequence of long

and vexed, with that now term vexation but observer being

that recently indifference. very emotional by nature

developed considered vexation as main

anxiety due to issue and interpreted it till level of

financial issues indifference.

Level Of Similarity: Similar

Follow ups:

Sr. Date Follow ups Action

No

1) 23/4/11 Case defined and first dose given Sepia 1M 1 dose

HS

Placebo for 1week

2) 3/5/11 Mood improved, irritability reduced, Sepia 1M 1 dose

no socialization Sleep disturbed ++, HS Placebo for 1

Anxiety SQ week

3) 10/5/11 Mood improved, irritability, weeping Sepia 1M 1 dose

once, sleep improved3+, Anxiety SQ HS placebo for

1week.
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CASE 13

Preliminary Data: O.P.D Reg no:3310

Name- Mrs. SHP Age- 38yrs/Female Religion- Hindu

Occupation- Doctor Status- married Education- B.A.M.S

1 brother, 3 sisters, Husband- physician 1 son, 1 daughter Address- MNJ

Chief Complaints:

Location Sensation Modalities Concomitants

1)Right hand Cramps while

Finger writing,Cannot <writing 2-3

Since 7th std write, pain pages.

Could not

complete paper

Currently Difficulty in Loss of

signing <physical work confidence

cannot write in

2)Mind Lack of front of others.

Since 3.5 yrs. enthusiasm <tension

Irritability <disappointment

Helplessness

Sleeplessness

headache <noise

Patient as a person:

Skin- Cracks on feet, dry Perspiration- Scanty

Hunger aggravation Stool- dysentery<tension

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Cr- Sour2+, Sweets2+ Urine- <tension2+

Menses- regular, colour-dark red. Occ. Bodyache.

Thermals- Chilly. Sun<abdominal pain

Sleep- normal, dreams- nothing specific.

Fa/h- DM- father, mother- hypertension.

Life Space: The medical couple had seen ASN sir 3 months ago,and were

advised Psychiatric consultant. They took their own time to act. After a short

interview they were asked to report today. Patient came with a half written

history form and was advised to complete it sitting outside which she did. A

short stature lady with anxious look was born and brought up in interior village

in Nanded district. Her mother was second wife of school teacher, the first

wife being abandoned due to want of son. But there were no conflicts due to

this in the family. Her father was a communist and was a social worker and

never had any excess money. He was short tempered.They belong to NT

community. Patient was a bright student since childhood and got admission

on her own merit in local ayurvedic college. She developed anxiety while

appearing for exams. She was not able to complete her papers. This took the

form of the writer‟s cramps. In the meantime certain incidents occurred in her

life. Her elder sister married a good for nothing fellow and was brought back

by her father to stay with them. Then another sister of her married some other

out of community fellow. In the mid of her 2 nd BAMS her father expired and

this was a great shock to all and her mother took over the responsibility of the

family. She arranged for patient‟s education. Her cramps increased in the

meantime. At the same time, relatives were anxious abot marriage of other

girls in the family. Hence patient was married to some distant relative of her
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mother. The guy wad also BAMS. She had never seen him before marriage.

After marriage they both set up their practice in village for nearly 10years. But

education facilities were very poor there. So they had to keep their son with

mother which patient had to accept. Her husband who did not settle there

wanted to leave that place.

They shifted to Boisar and one benefit that the patient got was she was now

able to stay with her son. Her husband got settled here. She did locums for an

year and then decided to devote all her time to her family. Currently there

were few issues that made him really anxious. One was when her son got

meningitis and had to be referred to Nair. She was extremely anxious. Later

her son completely came out of this problem. But now her daughter is having

some hip problem for which she is being investigated. That is also a cause of

worry. Her husband is short tempered and ambitious, now wants to earn

money from business rather than taking care of her domestic matters which

bothers her a lot. But now she has accepted this and wants to start her

practice by doing few modifications in the school. Her current phase of anxiety

is sporadic and periodic. Sensitivity to noise is one of the prominent features.

Patient does not keep relations with her elder sister who married out of the

caste. Overall she appeared to be very anxious, who is getting exhausted

easily who recovers with a short nap. She was unable to give full satisfactory

explanation for changes in her mental state. She is torn between her need to

care for children and her wishes to do things in professional life.

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ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is male and is predominantly extroverted but also has fairly high score on

Extrovert N scale. EPI analysis shows that PP doesn‟t like mixing with people, does

Score: believe in taking daring decisions he is emotionally stable believes in

E-10/24 planning things is not a planner, he usually doesn‟t get stuck up and in not a

N-4/24 very easy going person.

L-3/9

Observer Observer is male and is predominantly extroverted in nature. Observer also

Extrovert is a believer in planning, likes to mix with people but emotionally is unstable

Score: as is moody and touchy. He gets anxious in front of his seniors.

E-13/24

N-8/24

L-5/9

2. CSEF:

Points Analysis

History PP arrived at the clinical diagnosis of writers cramps, with anxiety

evaluation depressed state after stopping of practice. According to observer patient

was probably irritable, angry, sensitive, gets tensed easily.

Interview PP had anticipated the difficulty that patient has poor reflections on

psychological reasons because she had taken long time to see a

psychiatrist inspite of being a doctor herself and being told to see a

psychiatrist. Possible remedial correspondences thought of by the PP was

Kali Carb.
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PP had planned to start the definition with the preliminary data then

background information to create the rapport and to give insight to the

problem. PP started the interview as per plan, and felt that interview was

adequate in terms of exploration of multiple issues. Observer also felt that

interview was adequate and PP explored all suspected areas which might

have given rise to her problems. After interview according to the PP patient

is basically an anxious female with her anxiety increased when she has to

cope up with the demands and perform. All anxieties basically aggravated

after father‟s death. According to the observer patient is anxious, highly

sensitive and attached. Still has grief of father.

Doctor- According to observer PP had established a professional relationship.

patient According to the PP the doctor-patient relationship was adequately

relationship developed as patient was comfortable in sharing her feeling state and her

current dilemma.

Sensitivity PP had become sensitive to the life patient had spent in the hinterland and

& the orthodox family. Observer more specifically felt that PP was sensitive

Sensibility in the area of sister‟s intercaste marriage. PP was able to handle his

sensitivity well and went ahead to explore the other areas.

Technical Exploring and listening were the skills predominantly used by the PP

skills & according to the observer.

Blocks According to the PP his block was death of father and the unresolved

conflict that had entailed. PP feels that he could have handled this issue

differently. He also felt that it is important to take a certain call from the

patient when patient expresses it through her tears instead of words, which

he was able to do.

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3) LIFESPACE ANALYSIS:

Points Analysis

Areas not Life space written by the PP shows that PP has explored the issues with

Explored expressions of the patient. But PP has not mentioned exactly the feeling

state of patient as regards to her father‟s death. Apart from that her IPRs

with husband have not been mentioned especially when she is undergoing

such stressful situations through which she is going.

4) TOTALITY ANALYSIS:

Approach and totality: Analysis:

Approach(PP)- structuralisation PP has taken structuralisation

Totality: Irritable2+ Cr- Sour2+ to arrive at person

Attached2+ Cr- Sweets2+ understanding and remedial

Anxious about health2+ Thermals- understanding.

chilly PP considers Dispositonal

Worries2+ leading Sun<2+ qualities more and their

To sleeplessness expressions at the somatic

PDF- Anxious person with bladder and level.

rectum affection But he has not considered all

Attachment with the family++, Worries the physical generals which

leading to easy exhaustion >rest after. have been considered by his

Locations+Situations pointing to Kali Phos observer. Observer has

Final remedy-(PP)- Kali phos. considered the causation i.e.

Approach (Observer)- Kent‟s approach. Ailments from grief, vexation

According to Observer- which have not been

A/F- Anxiety3+, Vexation3+ considered by the PP in his

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Anxiety disease about2+ totality. At the same time PP

Anxiety children illness about2+ considers easy exhaustion and

<contradiction2+ hence arrives at the

<hunger2+ understanding of Phos element

<sun exposure2+ in the patient.

<change of weather2+ Observer has not considered

Group of remedies- Phos, Calcarea, this physical symptom. Hence

Sulphur, Sepia, Lycopodium, Kali carb he arrives at the remedy Kali

PDF- Attachment3+ with the family carb. But it is evident from the

Thermals- Chilly totality of both PP and observer

Diarrhea, urination, trembling anxiety due to. that both have understood the

Final remedy(observer)- Kali carb. core of the patient to be

Anxiety and attachment with

the family.

CONCLUSION:

Both PP and observer are of extroverted type. But the N score of the PP is

much lower as compared to the N score of the observer. PP is more stable

emotionally which is evident through the case as PP did not get stuck up

where the patient had tears in her eyes, and could deal with the situation and

move ahead along with the patient. Although PP feels that he could have

tackled the situation in a better way. His relationship was balanced without

any excessive sentimentalities but warm enough which enabled the patient to

share her feeling state and most of the conflicts. Observer who is also of

predominant extroverted type took up Kent‟s approach and arrived almost at

the same core remedy.

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Sr. Core perceived Reasons

No.

Physician Observer

1) Basically Anxious and PP and observer both of similar

anxious and irritable female personality type but PP emotionally

attached with lot of more stable and hence probably did

female who is family not got too much affected by the grief

getting attachement and vexation aspect unlike observer

somatic with long and considered the anxiety aspect

complaints lasting grief which was directly evident rather

with easy and vexation than being interpretative about other

exhaustion emotions.

Level of Similarity Similar

Follow ups:

Sr. Date Followups Action

No.

1) 6/5/11 Case defined Placebo for 1 week

2) 13/5/11 Cramps SQ, Anxiety SQ, Kali phos 200 1 dose

feeling of weekness SQ placebo for 3 weeks

Further follow ups awaited.

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CASE 14
Preliminary Data: O.P.D. Reg. No.:2348

Name: Mrs. LAP. Age: 53 yrs female. Status: Married

Religion: Hindu Education: 5th std Occupation: tailoring

2 Sons, 2 Daughters Fa-expired,Mo-70yrs. Add: WEK

Chief Complaints:

Location Sensation Modalities Concomitants

1)General, whole Heat sensation++ <summer3+ Appetite reduced.

body. Burning, >cold water

O- sudden weakness. application2+

D-since 4yrs

F-every summer Pain,

2)M.S.S bilateral everyday.no <standing2+

knees radiation, <climbing

D-4yrs cracking sound, stairs2+

F-everyday Heaviness of <massage2+

limbs, no tingling <lifting heavy

, no numbness. weight2+

>rest2+

>lying down2+

2)R.S Started with >tight

O-sudden coryza, nose banadage2+

D-2-3months block+nasal <night2+

discharge, thick >balm

yellowish, application2+
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greenish followed >after

by cough, dry discharge2+

with pain, itching >warm water2+

in throat. >warm water

gargles.2+

<sleep during.2+

Patient as a Person:

Appearance: obese, wheatish complexion. Wound healing- normal

Gum bleed occasionally. Heat palms+ Perspiration: Face2+ back.

Perspiration: staining white easily washed off.

Cr.-Spicy3+, sweets2+, warm food2+

Stool/Urine-normal.

Menstrual Function: menopausal since 6yrs. Dark red menses, clots-large,

quantity-profuse, cycle, monthly28-30 days.

Sexual function: suppressed as husband living separately.

Sleep: refreshing Sun<3, headache, vertigo. Thermals: Hot.

Dreams: frightful of husband beating her2+, meeting friends, going in big dark

places.2+ O/H- G4P4A0L4 All FTNDS Pedal oedema2+ in all pregnancies.

Life space:

A 52 years female, residing in Bhapyapada along with young daughter &

young son . Elder daughter is married residing at village . Elder son is

married, lives separately. Patient born and broughtup in Bihar. She was third

sibling of mother, who is 3rd wife of father. Mother's age 18 years when

married to 60 years old father. Father married third time as previous two wife
 135

has no children. She resided with father, mother,2brothers,3 sisters. Good

IPRS with all. As father was old, mother thought to do marriage all children

before father's death thus due to early marriage at the age of 11 years patient

was unable to study and not much interested in studies. Then at the age of

the 14 years went to the husband's house. Till that time she had done tailoring

work on her own, never had taken training. At 15years gave birth to lst

daughter. There she was living with mother-in-law, father-in-law,husband,

elder brother-in-law and his wife, two younger brother-in-laws & their wife.

Mother-in- law is irritable and would not give daily required things-oil, soap,

ete. Patient has to use carefully what comes from her house. Father-in-law is

also irritable. She would do all household work and in free time either sleeps

or do some tailoring work. Elder brother-in-laws wife is also of same nature as

mother-in-law. Husband's nature is good in starting days & also gives money

to her, but after lst child birth, he started drinking, occasionally, which then

after 2nd child‟s birth increased and then never gave money to family. He

came to Dahanu road for work but patient and four children were in Bihar.

Husband helped in studying lst two children but for third and fourth child did

not give money and patient by tailoring work managed expenses of them for

education. After husband started drinking, he used to beat patient, but patient

was too young to understand good/bad. She cried a lot and developed fear of

husband. Her elder son also would fear his father but younger son , when he

started understanding, would not let father to beat patient. Whenever father

would beats, he would come in between and scolds and beat his drunkard

father, and patient would feel very proud as she believed that there is no one

to help her, but younger son helped her. He started earning at 14 years of age
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and would give all his salary to his mother. Patient was known of place where

husband was working ,but never had seen it. Elder daughter got married and

resides in village. Elder son is also married, and lives separately with wife and

children. He also started drinking. Younger son along with sister and mother

and with other friends came in Boisar and started working in company . Sister

also works in company, both of them earn 6000/-individually. Patient does

tailoring work and earns Rs. 500/- month. Now there is no problem.

Occasionally, husband comes to home with under influence of alcohol abuses

patient. She fears when husband comes home, but 2nd son has told her,

whenever he comes you call me and I will come. Son beats father & elder

son, when they came to home. Thus both of them fear's of 2 nd son and never

comes when he is at home. Patient feels bad about elder son, but has very

irritation from husband. She becomes angry on husband, feels that he must

be punished with her but when 2nd son beats him,(father),she stops son.

When angry, anger remains for four to five days and she beats the person,

then only feels relieved from anger. "Maraneke bad hi Dilko shanti milati hai.

Atma Ko Acha Lagta hai, marneke bad Anand milta hi.” She mixes well with

neighbours and also helps them . But if anyone comes and talks with her,

when her work is remained, she never likes it. She wants everything perfectly

done. If she knows that some person is having bad habit/ company, she not

goes to change him/ her, but leaves that person and then doesn‟t keep any

relations. When husband beats, she feels that I am born with such bad luck,

that I have to tolerate, but younger son gave me some freedom, feels very

proud of him. When becomes angry on anyone, she would not talk till he/she
 137

approaches. She feel if they have some work, then they have to talk 1st why

should I approach?

ANALYSIS :

1. PERONALITY ANALYSIS :

Type Analysis

Physician EPI analysis shows this observer also to be extroverted type. Again

Extrovert basically of happy go lucky nature but score wise the observer has more

Score: predominant Extroverted attitude. Observer is a believer in planning, as

E-14/24 opposed to PP and has more patience because he/she believes that things

N-11/24 do come right at the end somehow.

L-3/9

Observer EPI analysis shows that this physician is basically happy go lucky, likes

Extrovert cracking jokes creating a friendly atmosphere around, is lively and an easy

Score: going person. She is a person who may not really plan out the things but

E-17/24 would just do or say whatever might come to head first.

N-8/24

L-4/9

2. CSEF:

Points Analysis

History Prior to the definition it was felt by the observer that PP is irritable and

evaluation straightforward, and has lot of issues with her elder son and husband. PP

had decided to start with the chief complaint and then explore lifespace.

PP had felt that the patient is very much talkative and only difficulty

anticipated was to block the patient.

Interview According to the observer PP did well at her level but was not able to
 138

reach the in depth emotions of patient and hence was not able to arrive at

the core. PP also felt that interview was in certain areas inadequate.

According to PP it was a mother-daughter relationship right from the start.

Doctor- According to the observer it was a friendly relationship and rapport created

patient was very good as patient even wept in front of the PP. There was lot of

relationship transference from patient‟s side.

Sensitivity According to PP she got sensitized when she came to know that patient‟s

& husband used to beat her since her age of 15yrs. Observer did not feel any

Sensibility. major issues on which PP might had got sensitized. PP had got sensitized

with it but after some time, handled it by making herself understand that

this is in general state of their community and went ahead with other areas.

Technical Skills mainly used were Questioning and listening and to some extent

skills & counseling. PP was not able to block the patient where as observer felt

Blocks that PP should do listening more and must improve her skill of handling the

sensitive areas.

3) LIFESPACE ANALYSIS:

Points Analysis

Childhood This area has been partially explored as after her marriage in childhood

her sufferings have got a lot of mention.

IPRS with Rather than IPRs it has been mentioned about her sufferings, the

Husband aspect when husband was good and cooperative and the IPRs then

are not explored. Her aspect of anger, her aggression where she feels

beating people etc, has not been adequately understood.

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4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s approach PP considered Kent‟s approach

Anger, irritability, violent Sun<2+ for the case as the case has many

Mind, hatred sleep during<2+ qualified mentals and

Mind, Loquacity Cr-Spicy2+ characteristic physical generals.

Mind, Dreams, Friends Cr-Sweets2+ Observer also felt that patient has

Perspiration-scanty2+, Cr-warm food2+ lots of anger and irritability and

Face2+ perceived the same totality, the

Menses dark, clotted, large. remedy was same i.e Natrum Mur.

Final remedy (PP)- Natrum Mur

Final remedy (observer)- Natrum Mur

CONCLUSION:

PP and observer are both of similar personality types. But there is slight

difference in them with the point that the PP is more integrated and focused in

nature as compared to his observer. In the case PP got sensitive for certain

issues but was able to handle her state and was able to handle it and move

ahead with the interview. Considering the anger and rage which were clearly

evident in the case PP considered it to be more of a vexed female with lot

hatredness and with other physical general she arrived at the remedy Natrum

Mur. But in the interview observer felt that PP should have received the

patient more as PP was more into seeking evidences and hence was

probably more often asking questions.

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Sr. No. Core perceived Reasons

Physician Observer

1) Basically Angry, vexed PP and observer both of similar

angry female with lot personality type but PP emotionally

and vexed of hatred still in more stable and hence probably did

female her. not got too much affected by the grief

who is and vexation aspect unlike observer

attached and considered the anxiety aspect

to her which was directly evident rather

children. than being interpretative about other

emotions.

Level of Similarity Similar

Final remedy: Case yet to be discussed and remedy to be released. Hence

follow ups awaited.

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CASE 15

Preliminary Data: O.P.D. Reg no: 1501

Name- Ms. AHY Age/Sex- 16yrs, female Education- 8th std.

Religion- Hindu Status- Single Occupation- Student

3 sisters, Fa- driver, Mo- housewife Address- njm

Chief complaint:

Location Sensation Modalities Concomitants

1)M.S.S Pain3+ <pressure3+ Cries hits anyone

Since 2-3 years Bursting type of <rubbing2+ who approaches.

Upper extremity pain <massaging2+

Lower extremity Tingling in upper

On and off extremities

Once in a week No fever

No stiffness

Pain

2)Shoulder No edema

bilateral pain Menses delayed

3)F.R.S missed in may

Patient as person:

Appearance- lean thin

Perspiration- upper lips3+ Stool/urine- normal.

Cr- spicy3+, milk3+,eggs3+ Av- sweets3+, non veg2+

Menses- dark red, lasting for 4 days, stains dellible, F.M.P- 13yrs

Pain in abdomen, back2+ before menses.

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Thermals- chilly

Sun<2+, headache Sleep- normal.

Dreams- snakes3+, ghosts3+, murder2+

Pa/H- nothing specific

Fa/H- nothing specific

Life space: A good looking well dressed female giving a coy smile, born and

brought up in Azamgad in a lower middle class family. Father works in Boisar

.He is at autodriver, mother is housewife. Patient lives with uncle and aunty at

Azamgad . She has 3 sisters and two elder and one younger, She is afraid of

father, friendly with mother. Her inter personal relationship with 2nd sister is

erratic. She does not like sharing her things with her sister. Hits her when she

takes her things without asking her. She is currently in eight standard, but has

come to Boiser for vacation which may last till May 2012, She has come

Boiser with her parents, She is not very serious about studies. She does not

have any exam-tension, says she does not miss even a single daily soap

even on the day of the exam. She never skips meals her aunty scolds her for

the same. She says that there is no freedom in village. She likes to get well

dressed up, wear long, attractive earings, roam about but all this is not

possible in the village. Her uncle, aunty are good by nature but she does not/

cannot ask much from them. She does not know what to do in the future, has

no further plan, neither serious about anything, nor worried about future. She

has got very low threshold for pain, starts weeping and shouting, requires

pain killers to settle the pain.She gets very irritable when in pain. she feels

that her pains could not subsides, she has got some disease because of

which she is having so much pain.She does not share her feelings with
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anyone, if angry or otherwise as well. She likes to sit alone when angry and

does not like anyone approaching her at that time but then her anger does not

last for long. She fears dark, does not go to dark places alone, has got

marked fear of snakes, she fears to stay alone. She becomes very conscious

when asked to do something in front of elders. Even the act of getting tea tray

in front of them makes her conscious.

She fears the dark, does not go to dark places alone and she has got marked

fear of snakes. She fears to share above. She becomes very conscious when

she is asked to do anything in front of the elders. Even the act of getting tea

tray for elders makes her conscious / fearful and she starts shivering.

ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is female and is predominantly extroverted but also has a fairly high

Extrovert score on the N scale. EPI analysis shows that she is lively, likes mixing with

Score: people, does believe in taking daring decisions but at the same time is not a

E-20/24 planner, hence often gets stuck up while doing things, gets listless, and

N-15/24 makes up mind too late.

L-3/9

Observer Observer is a male and is predominantly extroverted in nature. At the same

Extrovert time he scores very low on his N score. Observer is friendly and happy go

Score: lucky, but is a strong believer in planning, focused, mostly keeps things to

E-11/24 himself, and does things confidently.

N-5/24

L-5/9
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2. CSEF:

Points Analysis

History Not much of the data available as to arrive at some concrete

evaluation understanding. But PP was of the opinion from the screening that the

patient might be having functional complaints which needs to be first

evaluated.

Interview According to PP interview was overall adequate and tried to evaluate the

complaints clinically and found that it was more of functional complaints.

According to observer the interview was inadequate as regards to

exploring exactly the sensations and feelings. After the interview PP felt

that patient is carefree, childish, low threshold for pain, and very much

fearful. According to the observer patient is a restricted person with lot of

aggression due to which there is lot of sensitivity.

Doctor- According to PP it was a doctor-patient relationship. PP felt hat she had

patient already got prejudiced, that patient is not having any pathological

relationship complaint and hence there are not much issues in the case and hence PP

had only a doctor-patient relationship.

Sensitivity No sensitive issues as such but PP was very much irritated as she felt that

& everything is functional and patient does not have any complaints as such

Sensibility. as. Observer also felt that PP was angry with the patient, but then he felt

that it was not a problem as it was not reflected anywhere in the case

taking and PP was able to control her anger.

Technical Questioning was predominantly the technique used. Blocks was PP‟s own

skills & irritation and but PP was successful in not getting reflected the state in the

Blocks interview.
 145

3) LIFESPACE ANALYSIS:

Points Analysis

Areas PP has not mentioned about the reasons for erratic IPRS with her sister and

not her feeling towards her. Areas of IPRS in her school/college, with parents not

Explore explored. Academic Performance in school not enquired.

4) TOTALITY ANALYSIS:

Approach – Kent‟s approach Analysis

Totality: (PP) PP has considered kent‟s

Oversensitive3+ Thermals-chilly approach due to the presence

Reserved3+ Perspiration-upperlips2+ of qualified mentals and

Fear of dark3+ Av-sweets3+ characteristic physicals. PP

Fear of snakes3+ Cr-spicy3+ has went only by

Fear of staying alone3+ Cr-milk3+ rep[ertorisation and arrived at

Dreams- snakes3+ Cr-eggs3+ the remedy Pulsatilla, but has

Dreams of murder3+ Menses-dark red3+ not attempted to differentiate

Sun< headache2+ other remedies like, Phos,

Hunger<2+ Calc.carb Natrum Mur etc.

Remedy (PP): Pulsatilla Observer has not considered

Totality (Observer): Internal aggression- not any specific approach but

expressed, doesn‟t share her feelings,

sensitivity++ with physical generals

Remedy(Observer): Natrum Mur

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CONCLUSION:

This PP is predominantly of an extroverted type according to EPI analysis. But

EPI analysis also shows that PP has a high N score. The Extroverted attitude

gets reflected during the interview where PP is highly evidence based trying to

be analytical, critical, and fixed hence using questioning and exploration most

of the times. But one sees that inspite of PP being mainly extroverted as per

EPI analysis in this case PP‟s Introverted nature has dominated. PP

developed unnecessary discomfort which was due to her inner feeling state

this was probably due to the fact that she is also quiet anxious in nature. This

has made PP to always keep a distance from the patient ending into a

superficial relationship between both. As a result PP has not received the

patient. PP is clear about the fact that it is not about gender difference or age

of patient because she has interviewed patients of such type without

experiencing such problem. PP is not basically a planner and rather gets at

times stuck up. This is basically a part of her Extroverted attitude. This caused

a problem to deal with this block. Hence PP was able to partially understand

her patient.

Observer, according to EPI analysis, has a low N score and is predominantly

Extroverted type. He also was not only able to perceive all attributes which PP

has identified but also was able to give value to all observations, non verbal

communication due to his strong analytical and focused nature. Hence we are

able to see that although both PP and observer have been predominantly of

extroverted type, in this case PP‟s introverted attitude which is also equally

strong dominated her. Thus it is not necessary that a particular personality

 147

type will always behave in the same way. Rather a predominance may

change at some situations.

Final Remedy (Consultant)- Argentum Nitricum,

Sr. No. Core perceived Reasons

Physician Observer

1) Impulsive, Hurried, Impatient PP was uncomfortable and was

Restless, and anxiety out of dominated by patient, hence she

without any proportion had rejected the patient and was

ambition. not able to see the other obvious

features.

Level of Similarity: Different

Follow ups:

Date Complaints Action

20/6/11 Abdominal pain ++Eructations++ Argentum Nitricum 200 1

Itching right side abdomen++ Anxiety ++ dose

Placebo 2 weeks

4/7/2011 Abdominal pain >+ no eructations anxiety>+ Ct. all 2weeks

itching >+

18/7/11 No abdominal pain. Mild fullness of abdomen. Ct. All 2 weeks

No anxiety. Itching occasional

8/8/11 Anxiety+ no other complaints Ct. all 2 weeks

22/8/11 No complaints. Generals normal Patient given placebo for

2 weeks
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CASE 16

Preliminary data: O.P.D Reg no. 897

Name: Mr. DBN Religion: Hindu Brahmin Education: BSC Dip

Age: 36 years Status: Married since 2001 Address: KBU

Sex: male Occupation: Engineer Children: 1son 1 daughter.

Chief complaints:

Location Sensation Modalities Concomitants

1)GIT Burning A/F-after leaving alcohol Anxiety

Since 10 Sour eructations <oily food health3+

years Heaviness,Rumbling <tea, biscuits Laziness2+

Increased Stools <Before stools Unrefreshed

since 5-6yrs hard,Unsatisfactory < 2-3 hrs after eating feeling

No diarrhea >After stools App.

Easy satiety Reduced

2)Mind Ghabrahat, Uneasiness A/F since the time

Since 18 yrs. Different sensations in diagnosed as TB

O:sudden body <Loss of sleep

D:few hours Pain here and there <when increase in GIT

F: on and off Dizziness2+, complaints

Increased Papitations2+ < thinking of disease

since 2-3 yrs Suffocation, <seeing something bad

Perspiration+2 <lying on left side

<long sitting
 149

3)Bronchi on Cough yellowish green <Winter2+

7 off expectoration >summer2+

of unconsciousness with >movement2+

coldness of body >warmth.

diagnosed as

hypotensive episode

4)M.S.S. Dull aching pain

Lumbosacral Stiffness2+

region Radiculopathy2+

Left lower Pain2+ Numbness+2

extremity No tingling

Especially

hamstrings

Patient as person:

Appearance- wheatish premature graying of hair

Facial configuration & expression- oval, happy go lucky. Suppuration+

Perspiration- moderate, palms+, odours- offensive, stain- white powdery

Hunger<2+ Cravings- Spicy2+, meat2+, fish2+, sweets2+

Stools/urine-normal sexual function-N frequency-1-2/month

Diet and daily routine: Shifts as per work- 7.30am wakes up, then breakfast,

works till 8pm, for lunch has roti and sabji Dinner roti sabji nonveg 1-2/week

Life Space: Patient is wheatish to fair, little stocky came for interview in a well

dressed way. Presently staying in Boisar, with his family, since 1998.

Originally belongs to Uttaranchal where he would stay with his entire family.

For studies Family shifted to Kanpur. Father was in Armed forces and so was
 150

always away from home visiting once in 6 months. Hence he never had any

interaction with him. Mother was very strict and disciplined. She would hit if

kids wouldn‟t listen to her and was a perfectionist. From her all 3 kids also

developed same attitude. Since early days patient was highly fastidious would

not tolerate if things not in proper place. He would get angry and will go and

keep things himself at place. He likes neatness2+, tidyness2+. During school

days he was average in studies. He liked being with friends, but had very few

close friends. He was choosy and mixed with few people only. He studied

B.SC and also did diploma in software. He got a job in village which did not

give him more money so through friends he came to Boisar & is working in

same company since 1998. Initially he was a worker and as time passed he

was promoted. He was sincere and hardworking. His perfection in work got

him promotion. Patient was always meticulous. If workers under him don‟t

listen he would shout but at times suppress his anger as it is not always good

to shout at them especially in professional environment. If things are wrong

then he would not mind even to shout at boss but till now only few such

occasions have come up. Patient also has good IPRS with wife who is also

strict and disciplinary but not so much like patient. At times there are small

fights but nothing major has happened usually patient gives up. He has one

son and daughter with whom he is always loving and caring. As a person he

is very jolly by nature.(He appeared happy-go-lucky in interview and did not

seem that there so many deep anxieties hidden deep inside him.) He gets

angry when contradicted and then shouts at opposite person. Anger is short

lasting and without repentance or brooding. He has fear of lightening, fear of

being alone, dogs, of crowded places, lot of noise makes him feel uneasy. He
 151

was bitten by dog and since then has fear of dogs. He has anticipatory anxiety

for health of self and others. He keeps thinking about disease when he will be

okay etc.When kids are sick he takes more tension makes frequent calls to

his wife whether doctor has been called etc then in anxiety gets palpitations,

perspirations. He is obstinate by nature and would do whatever he feels and

pleases him. He gets dreams of snakes and ghosts. Dreams are frightful

where somebody has fallen from height. Lost in jungle. Searching for him etc.

His complaints have started since the time he was diagnosed a T.B. Patient

was deeply affected by it. He said „us din bahut ajeeb laga‟. He felt that he

had got some incurable disease like cancer.He took treatment but thought

always was in his mind that this would again happen in future.Even today he

gets any disease he thinks a lot about it. At tis time he also started drinking

alcohol but after 2 years of his marriage he stopped drinking as felt it would

have a bad impression on his kids. In history form he had written a lot about

his anxieties related to his diseases. He had wrote that his mind keeps

thinking about body and can‟t get rid of it.If he sees others in pain he feels bad

about it and thinks a lot. „uska pain feel hota hai‟.

1. ANALYSIS: PERONALITY ANALYSIS OF THE PHYSICIAN AND

OBSERVER:

Type Analysis

Physician: PP is Male by gender. EPI analysis shows that this PP is predominantly

Introvert of Introverted type. PP doesn‟t like to be with mixing with people. He is

Score: nervous and anxious in nature and is touchy.

E-8/24

N-12/24
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L-1/9

Observer: Observer is Female by gender EPI Analysis shows that observer is

Extrovert predominantly Extroverted in nature. EPI analysis shows that she is

Score: basically happy go lucky, likes cracking jokes, is lively and an easy going

E-18/24 person. She is a person who may not really plan out the things.

N-12/24

L-2/9

2. CSEF:

Points Analysis

History PP anticipates from H/F that patient is anxious and is very much worried

evaluation and also feels that could be arrogant, but observer in addition to this feels

that patient also is systematic which was directly evident from the way

history form was written. PP anticipated that only difficulty could come up

was patient being too talkative and would have to block the patient.

Interview According to observer the interview went smoothly but lot of questioning

was done. PP too felt that unnecessary questioning was done even at

times where patient was opening up spontaneously. PP did not explore

some important physical generals which the observer felt that it could

have been due to the fact that PP was too much engrossed in exploring

Life space and that too specifically lot of focus was given on Anxiety part.

Doctor- According to observer she felt that a professional relationship was formed.

patient But actually PP had identified with patient as his elder brother. This had

relationship completely dominated the PP which the observer has failed to recognize.

This identification probably was the reason why PP was focused on life

space and anxiety areas.

 153

Sensitivity PP was highly sensitized by anxieties of patient because he had identified

& with his brother and constantly tried to evaluate why his brother could have

Sensibility. suffered from anxiety through constantly questioning patient. Observer too

could identify this point but not able to identify the reason behind this. This

was because the sensitivity of observer was at a different level. Observer

was just PP was also realizing that something is not in its place & hence

tried to cover-up but still was not able to resist it and would again end up in

exploring the same area.

Technical Lot of confronting, done even in instances where it was not at all required.

skills &

Blocks

3) LIFESPACE ANALYSIS:

Points Analysis

Childhood PP has well explored situation in childhood, strict upbringing, making

Marriage evolving patient as a perfectionist and anxious person.

and children. PP has very superficially explored IPRS with his wife, children.

Work and In work place area PP goes into his anger and perfection but later again

society focuses more on anxieties and fear.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Approach-Kent‟s approach Here Kent‟s approach was

Anger, contradiction 2+ Cr. Meat3+ taken by PP. But presence of

Anxiety health about 2+ Cr. Fish2+ characteristic modalities and

Anxiety anticipation2+ Cr. Spices2+ Physicals means

Fear alone2+ Hunger <2+ Boenninghausen approach

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Cr.sweets2+ Perspiration- offensive could have been more suited.

Fear crowd2+ PP relied on Mentals which he

Fear, dogs2+ has not really understood in

Riding<2+ depth, and again missed out on

Dreams snake, ghosts,2+ important physicals in case.

Remedy(PP)- Nux vomica The remedies coming up were

Totality (observer)- all above mentioned Natrum mur, Lycopodium,

anxieties and all other symptoms with Duty Phos,Silicea, Arsenic alb etc.

consciousness. But PP appeared to be in

Remedy(observer)- Silicea confusion while differentiation

Totality (Supervisor) and was not able to stand on

Duty conscious, fastidious and anxiety etc any proper grounds for

with the above totality. differentiation and based on

Remedy(Supervisor)- Silicea. anxiety with fastidiousness

arrived at Nux Vomica.

Considering the same data

observer was on the remedy

Silicea.

CONCLUSION:

PP according to EPI analysis is predominantly Introverted in nature. PP and

his observer both have equal N score i.e. 12 but observer‟s E score is very

high as compared to PP. This has made a lot of difference as to how they

have approached and felt about the patient. PP right from start has focused

on the anxiety issue, because somewhere his predominance of Introverted

 155

attitude has started getting internally connected to patient. He has identified

patient as his brother, and has paved a way for counter transference. This has

lead to lot of unnecessary probing. But PP was realizing this and hence was

trying to use his extrovert faculty and be critical hence could atleast

understand patient in other parameters to achieve fair balance but failed to do

so. Observer on the other side has been very much dependant on external

evidences and facts. So she could perceive patient only through what was

seen during interview and could not experience the dynamics again leading to

a superficial understanding of patient. But she was crucial in reminding the PP

to explore the hard data. Thus in this case the predominant personality type

has influenced perception of patient in both PP and observer differently, but

the conclusion is too much dominance in case of both observer and PP

proved it as a liability.

PP has been very much sensitive, confused, In totality formation although PP

considered all symptoms he was again dominated by his internal issue of

anxiety with fastidiousness hence remedies for him were Lycopodium, and

Nux vomica, final selection being Nuxvomica. He was not able to integrate the

data in holistic aspect, In this case where the mind was inadequately explored

but Physical generals were prominent, Consultant was able to work on this

and utilize mind and sector for finer remedial understanding and remedy

given was Silicea.

Sr. Core perceived Level of Reasons

No. similarity

Physician Observer/Supervisor

1) anxiety with anxiety, similar pp being highly

 156

irritability and fastidiousness but perception sensitized and

fastidiousness. integrated it with of mind, identified with

physical generals but the patient‟s

Observer and difference conflicts did not

supervisor both in consider

perceived same integration physicals at all.

patient

understanding.

follow ups:

Date Symptoms Actions.

8/9/11 Anxiety + Ghabrahat, dizziness+ Silicea 200 1st dose

Abdominal pain , rumbling> after diet 1Dose weekly placebo

modification, back pain + for 3 weeks.

29/9/11 Abdominal complaints increased but Silicea 200 weekly 1

anxiety > dose and placebo for 2

Back pain same. weeks.

13/10/11 No abdominal complaints. Few episodes Silicea 200 weekly one

of Ghabrahat. Back pain reduced dose with placebo for 2

weeks.
 157

CASE 17
Preliminary Data: OPD Reg no.: P/118/11

Name: Mr. RPS Education: B.A Occupation: Retired teacher

Age: 71yrs Status: married Children: 1son, 3 daughters

Sex: Male Religion: Vanjari Address:K

Chief Complaints:

Location Sensation Modalities Concomitants

1)Metabolism <night3+

Endocrines K/C/O DM <walking+3

C.N.S Tingling2+ >massage+2

Nerves Numbness2+ >warm water+2

Bilateral lower limbs Cannot keep feet on

ground

2)Soles bilateral Pulling pain+2 <night3+

Wrists, Bilateral Burning+2 >movement3+

>warm water3+

3)M.S.S >movement2+

Left ankle Tingling2+

Numbness2+

Swelling2+

Warmth2+

Redness2+

Patient as person:

Physical Appearance: fair, wearing spectacles, confident look, obese, tall.

Perspiration: Profuse general all over
Craving:spicy2+, salty2+ Aversion: Sweets3+
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Stools- unsatisfactory,Hard most of the times

Sexual function: Normal 1/15 days.
Thermal- Hot Sun- <headache3+
Sleep- Disturbed, thoughts2+, Starts2+ Dreams-Unremembered
Pa/H-Depression, Acid peptic disease

Fa/H- Paralysis-mo, Infarct- brother

Life Space: Patient came to the OPD for definition alone. In interview he

appeared to be confident, but his lower extremities were constant fidgety. He

stays with his wife. He stayed with his parents and had 5 siblings. Father was

a government servant and financially were okay. Patient studied upto BA and

then got government job. During school days he was average in studies, but

was sincere, He would have anxiety about stage shows and would even

forget, perspire and tremble. He married 47yrs back and was an arrange

marriage. But patient keeps fighting with his wife. They both are hot tempered

and both would stop talking to each other. And depending on situation either

of them initiate talking. Patient was good at work and he liked his work. He

shared good IPRs with all his colleagues. But he had only superficial

relationships. He had good IPRs with authorities .Would never worry to say if

anything is wrong. Since beginning he has very few friends. He mixes with

everyone but share only with close associates. He liked working but took

tensions easily and due to stress had gone into depression. Patient earlier

stayed with his parents and was eldest and took responsibility. After few years

they all were separated. He doesn‟t have any contacts with his brothers.(while

talking about this he was trying to avoid and did not go much deep into it.) He

feels that inspite of doing so much and loving them they don‟t have much

feelings for him. They never come to meet him even if he is sick. But patient
 159

says that he is satisfied because all his 3 daughters have studied well and are

well settled. All his sons in law are hard working and from scratch they have

build up their empires. His son was also good and intelligent and got

admission in good college. But then he got in bad company and left studies.

Patient used to take lot of tensions, because his son also became an

alcoholic. But later his middle son in law took him in factory and now his son is

also well settled. During interview patient talked a lot about his personal

experiences. He broods a lot about his past and also becomes sleepless. He

gets angry if anything happens against his wish and shouts or either would

keep quiet and brood. Never had any specific or general fears.

ANALYSIS :
1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:
Type Analysis
Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. She is nervous and anxious in nature and is touchy, worries

Score: for a long time and gets easily conscious. Doesn‟t like hustle-bustle around,

E-8/24 gets fed up easily, but at the same time is not moody and likes mixing with

N-12/24 people.

L-1/9

Observer: Observer is Female by gender EPI Analysis shows that observer is

Extrovert predominantly Extroverted in nature. EPI analysis shows that she is

Score: basically happy go lucky, likes cracking jokes, is lively and an easy going

E-18/24 person. She is a person who may not really plan out the things.

N-12/24

L-2/9
 160

2. CSEF:

History Clinically proper diagnosis was done i.e. of DM with Nephropathy.

evaluation From H/F PP considered patient to be systematic. The same was also

considered by observer although having different personality type.

Interview PP did not anticipate any difficulties as circumstances did not appear such.

Again trusted on external evidences. Observer too had not anticipated any

difficulties. Interview was felt to be adequate and post interview PP found

patient to be Irritable, sentimental, anxious, but here quality of patient

being well organized gets neglected which was considered prior.

Doctor- According to PP Dynamic relation of Father- son formed. PP became

patient almost like a son to his patient. This made PP vulnerable. On the contrary

relationship observer felt that They had a professional relationship i.e. only a doctor –

patient relationship.

Sensitivity Vulnerable PP got sensitized by issue of hard work and success, got highly

& impressed so was completely at the receiving end unable to come out of

Sensibility. the relationship formed neither was PP able to even block the patient. But

according to observer PP was properly going with the case taking and felt

that there were no major issues of sensitivity but definitely felt that PP was

silent and more at the receiving end.

Technical PP used receiving for most of the time with minimum of questioning and

skills & exploration. PP realized that he could have blocked the patient but didn‟t

Blocks understand how and when.

 161

3. LIFESPACE ANALYSIS:

Points Analysis

Childhood Only environment is considered but no reaction of patient have been

Marriage explored

and Patient has narrated situations which have been put down but

children. exploration is not done.IPRS with wife also just mentioned.

IPRs with Patient has been sensitive regarding his Son in law and son which is

siblings. described well

Social area. This was the sensitive issue for patient which is described well

Not explored

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach.-PP Mentals given prime

Totality: importance

anger<contradiction3 Cr. Salty2, spicy2 Other approach such as

Anxiety<anticipation3 Av.Sweets Boennighausen could have

Anxiety trembling with2 been better suited as the

Perspiration,Profuse case was rich even in

Anxiety perspiration with2 Sun <3 modalities.

Sleep disturbed thoughts due to2

Differential remedies: Grounds of differentiation:

Natrum Mur., Lycopodium primary usage of mentals.

Ground of further differentiation: Sector being considered

-Sentimentality superficially.
 162

-Brooding

-Reserved Final remedy (PP)-Natrum

-Affinity of Natrum in reducing sugars. mur.

And sectors being covered. Final remedy (consultant):

Observer- similar totality and same remedy Natrum mur.

CONCLUSION:

PP of this case is basically of introverted type, and observer being extroverted

type. After case definition also Observer in his CSEF says that person

according to him is well organized and well educated but PP connects to this

patient at an different level and also feels patient to be sentimental, anxious

irritable etc. PP throughout the interview becomes very receptive and passive

due to both transference and counter-transference occurring between patient

and PP, for which observer feels that it is PP‟s way of handling a 70 year old

man, but is not able to identify the deeper dynamics occurred father son

relationship. This dynamics itself becomes a block for this introverted PP on

the other hand observer feels that there was no block. Because of this kind of

relationship PP was not able to even explore where needed. These

fundamental opposite perceptions have occurred because of their own

different personality. One being internally connected and other believing only

on what is visible externally. Further PP‟s this attitude is reflected in resolution

because due to the kind of dynamics that is established PP gets anxious even

to given basic advises feeling that it could create a mistrust. In totality

formation PP gives importance to all mentals that he has derived and

interpreted without any evidences and although while differentiating the

 163

remedies he does try to be more factual i.e giving consideration to generals,

pathology etc but is not able to give full justice to it and again uses his

interpretations such as sentimentality etc. and again arrives at a remedy

which is also basically introverted in nature i.e Natrum Mur.

Remedy (consultant)- Natrum Mur.

Sr. Core perceived Reasons

No.

Physician Observer/Supervisor

1) Reserved, Brooding with PP had became very receptive

Brooding with reserved nature and and there was lot of

anxiety anxiety transference from patient‟s

side, patient shared a lot and

hence data was nearly

adequate. Therefore totality

perception is nearly same.

Level of similarity- similar

Follow ups- awaited.

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CASE 18

Preliminary Data: O.P.D Reg no.1190

Name: Mrs.AMG Fa: Expired Occupation: School teacher

Age:22yrs female Mo: 45yrs caste-muslim

Education:D.Ed Brother-25yrs Status: Divorced since 5yrs Add:

XYZ

Chief complaint:

Location Sensation Modalities Concomitants

1) Mind Anxiety about future A/F after divorce

Since 5 yrs Persistence thoughts <when alone2+

Almost daily about divorce and <watching

present state. marriage of

Sleep disturbed due others2+

to thoughts >when

Irritability2+ occupied2+

Once suicidal thought > when people

Anger2+ point on life

Thoughts of killing situation

husband. >consolation

2) R.S Dryness2+cough2++ >allopathic

O-since No expectoration treatment.

childhood Fever for 1 day

Throat No breathlessness

Hoarseness of voice
 165

Patient as a person:

Fair complexion, lean, wound healing normal, dandruff on and off.

Perspiration scanty. since 5-6 months profuse all over body

Hunger aggravation3+ Cr.-salty2+ Av.Sweets3+, milk2+ Milk aggravation2+

Stools -unsatisfactory on and off. Urine- normal

Menstrual Function: Menarche 15yrs. Cycle 30 days, Duration-2-3 days, Flow-

moderate. Stains dellible odors- fishy.

H/O sticky white, offensive leaving powdery stains on and off.

Sexual desire- Aversion2+ Lack of desire.

Life space: A young divorcee came for case definition , well dressed but sad

expression on her face waited for case definition. Patient is born and brought

up in Boisar, in a small family, belonging to Muslim Community. She was the

only daughter in the family, and has one elder brother. Her father was a

rickshaw driver. Economically they were average. Family got support from

Maternal Grandparents for finances. She was more attached to her father

than mother would follow his advice always. Patient had many friends since

childhood and many of them were boys and many of them would come home

and her family members would doubt in terms of having her affair. She was

very specific with having relation of just being friends. Never accepted any

proposal. She knew that she would not be able to go against her family and

impossible to marry on her own. She completed her education till D.Ed. She

was very much interested in teaching profession. At school she was a

performer and would take part in any competition. She would always perform

well and gain appreciation. If she would not be able to perform well then she

would feel bad momentarily because did not like to hear bad comments from
 166

anyone. After some time will make up her own mind and and do same work

well again. Then she will feel better. She will not leave anything half done. 5

years back one night her father suddenly expired due to CVA. It was a shock

to her and her mother. Slowly they came out from this state and her family

immediately planned for her marriage. Patient actually wanted to do job but

then did not go against her family‟s wish and everybody‟s opinion regarding

the boy was good. At 18years of age patient got married to this boy. The boy

is basically from Kolhapur and work here in some company. Patient had

spoken o the boy on phone once or twice. Her family gifted her flat and all

essential things as a dowry. At the day of her marriage patient and her

husband were left at Mira road home all alone and all relatives went. That

night patient waited for long but her husband did not arrive even next day.

She tried to call him but he did not receive her call and hence she called her

inlaws but did not tell in her maiden family. Her in laws called her to Kolhapur,

she went there but there she was badly treated, was made to work. She came

to know that her husband was not interested in marriage and had some affair.

She told her in laws but they were not bothered and when her husband would

call them but they would not allow her to talk to him. Gradually patient realized

that nothing is going to be fruitful. She left all her jewellery there and came

back to Mira road. She totally lost hope in husband and started taking tuitions

for children and joined school. At work place she never had any bad

experiences. She always did her work well. She has good IPRS with all. But

when away from work place she again starts getting all thoughts about her

failed marriage. After some days patient‟s brother came to know of reality and

was shocked. When her brother visited her patient made an excuse that her
 167

husband has gone out and will take time to come. But when brother waited for

long she had to disclose everything to him. She said that she was worried

about her mother and hence had hidden everything. Brother took her home

and hunted for her husband but was not successful and hence filed for

divorce. On the day of divorce too her husband had not come. Finally they got

divorced. Patient developed immense hatred and anger and with a desire to

kill her husband. She feels he had no right to spoil anybody‟s life. She was

always genuine from her side. She cannot forget and forgive him. When

people around her try to convince and console her she feels very bad but then

tries to understand their concern. She has now lost interest in marriage. She

wants to come out of this mental state, stabilize herself then think of marriage.

Family has given her freedom to take this decision. She is not willing to take

any action presently.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is female. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP doesn‟t like to be with mixing with people. He is

Score: nervous and anxious in nature and is touchy.

E-11/24

N-15/24

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Observer: Observer is male and EPI Analysis shows that observer is predominantly

Extrovert Extroverted in nature. EPI analysis shows that he is basically happy go

Score: lucky, likes cracking jokes, is lively and an easy going person. But at the
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E-18/24 same time he is organized

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2. CSEF:

Points Analysis

History Not much of the data available and hence only probable clinical diagnosis

evaluation of? Anxiety disorder ? Dysthymia was thought of by PP as well as observer

Interview No specific plan was made. According to PP she was going to follow

pattern of LSMC then Physical generals and as Chief complaint itself

belonged to mind area, probably she would enter in the lifespace from that

point itself. According to PP interview was adequate and according to

observer interview was adequate as regards to clinical and homoeopathic

data. PP felt that she was a female with shaky confidence. But according

to observer she was a conscientious and a responsible.

Doctor- According to both PP and observer, PP had formed a relationship of Friend

patient and Sister.

relationship

Sensitivity PP was very much sensitized by the issue of patient‟s marriage where her

& husband had left her immediately after marriage, never to return. This was

Sensibility. a total deceitful action. According to observer PP was not just sensitized in

this area but in many other areas of family such as father‟s death,

responsibility, decision of marriage in forceful situation etc. As a result of

this PP has flown in these areas making interview too prolonged. Observer

felt that PP herself lacked clarity about concept of marriage, Relationships,

and feels that PP has her own conflicts in these areas, which she should
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handle first. When PP got to know about her husband, she was silent for

first few seconds, but then came back to normal state. According to

observer PP was not able to control her sensitivity and become totally

receptive and went as patient went in these areas.

Technical According to both PP and observer, PP has predominantly used skills such

skills & as , receiving mainly, questioning and confrontation at few times.

Blocks According to observer PP also allowed patient to ventilate and tried to give

insight through interview. According to PP blocks felt were regarding

concept of marriage, reciprocation, relationships. According to PP it was

mainly her own feeling state of anger which developed after hearing about

patient‟s husband.

3) LIFESPACE ANALYSIS:

Points Analysis

Childhood The area chiefly explored is only about performance in school and her

Marriage attachment with father. But the importance of father, reason for attachment

with him, upbringing, values at the backdrop of Muslim community are left

unexplored. In CSEF PP mentions of lack of knowledge of Muslim

community and culture. In that case probably PP should have explored

that area thoroughly to understand this patient from such community. But

that was not done. Rather entire Life space focuses on marriage and post

marriage event that too description of Divorce her stay at inlaws and not

telling her maiden family etc situations have not been clarified and have

Work area been received as said by patient.

It has been explored to some extent also her performance in school.

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4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach. Mentals given prime

Totality: importance

A/F- Disappointment Sun<2+ Other approach such as

A/F-Grief Noise<2+ Boennighausen could have

Fear of crowd Crowd<2+ been better suited as the case

Fear of dark Hunger<3+ was rich even in modalities.

<when alone Getting wet <2+

<when thinking Sexual desire Grounds of differentiation:

Aversion Current state of patient. i.e,

Menses- offensive, clots. better by occupation diversion,

PDF: from dependency state in

From above totality PP considers following childhood to indifference now.

as PDF Symptoms.:

Av-Milk, Av –Sweets, Sun<, Hunger<, Final remedy (PP)-Sepia

Getting wet<, Noise< with a kind of Final remedy (observer)-

indifference for the things that have Natrum phos.

happened.

CONCLUSION:

PP of this case is basically of introverted type, and observer being extroverted

type. PP was highly sensitized by the issue of patient‟s husband. Although

PP‟s anger was momentary, she was persistently revolving around the same

issue. Her counseling was also based on that. According to observer PP

 171

needs to clear her own concepts and conflicts. She being highly sensitized

and identified with the patient. Hence based on her this she perceived and

gave importance mainly to the state due to husband that is anger followed

now indifference and hence her remedial understanding was sepia. But her

observer who is an extrovert and mainly analytical in nature gave importance

to other hard data and direct observations such as different fears,

aggravations and amelioration built of the patient and patient‟s behavior

hence according to him his remedial understanding was Natrum Phos.

Sr. No. Core perceived Reasons

Physician Observer/Supervisor

1) Grief and Basically fearful PP was highly sensitized

Disappointment with disposition, social by the current state and

fearful disposition outgoing, angry for husband, gave

and current state of And other physicals with more importance to the

indifference. suppressed anger. state and neglected the

disposition

Level of similarity- Different

Follow ups: Remedy yet to be released and follow ups awaited.

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CASE 19

Preliminary data: O.P.D. Reg. no.- 3457

Name: Mr. RSN Occupation: manager Address: WSD

Age: 32 yrs Male Education: M.Sc Fa-Expired 1yr back

Married since 5yrs Daughter: 1, 3.5 yrs. Caste: Hindu

Chief Complaint:

Location Sensation modalities Concomitants

1)Mind

Since 4-5 yrs Trembling <tension2+ Headache2+

Gradual Palpitation <shouting2+ Breathlessness2+

Almost daily <contradiction.2+

2)Nose Macule >allopathic

Since 1year Papule treatment.

On and off Pustule

Pain3+, redness

Pus-yellowish

discharge.

3)Mouth Whitish ulcers <spicy food

4)Extremities Pain, dull aching < motion

>rest

<cold

Petient as a Person:

Appearance: lean, fair, male type of baldness.

Craving: Milk, Buttermilk2+ Spicy3+ Urine/stool- normal

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Aversion: Sugar2+ Sexual functions: normal

Riding aggravation in childhood. Thermals: chilly

Life space:

A 32 year old male patient fair, lean, thin, male pattern baldness, eyes

protruded & big, well dressed. He born and brought up in Village. His father

was farmer and mother is also helping in farm work. Economical condition of

family was very poor. Father was only man in family who is earning by

working on farms but it was too less to provide daily needs to family. Patient

was elder in family. He has 3 young sisters. Patient was very much interested

in education and he was very good in studies. His mother wanted to educate

patient but father was not interested as family economical conditions was too

poor. Father told patient to work on tea-stall when he was 8 years old. Patient

also decided to do work. So in morning he would go to school and in

afternoon do work on tea stall. Patient was good in studies so teacher would

also help him in studies and given concessions. After some days he started

selling vegetables. They were financially so poor that in lunch they used to

have bread and tea. Patient was always felt that if he would not study, his

condition also would become like father, as father was illiterate. Mother

always appreciated patient in studies which would motivate him. Patient

passed in 10th standard and then 12th with a 1st class. He wanted to get

admission in engineering but they don't have money even to get admission.

Patient felt very sad. But he took admission in B.Sc. got first class. & joined

M.Sc. He failed in first year but later passed as he was ill during exams. in

first attempt. After Msc, he got a good job in pharmaceutical Co. He told, he

has many responsibilities like sister‟s education / marriage. He has two

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sister‟s marriage left and third sister is studying in Nagpur. Father was ill and

he has to look after their hospital and medicines. Father died four years back.

He was Assistant Manager in that Co. (Daund). He was taking all decisions

about quality control of drugs and verybody would trust him and he was also

satisfied with his work. He met a Brahmin girl. Both liked each other and

decided to marry but parents of girl opposed for marriage due to difference in

caste. So both of them decided to marry without informing anybody. Patient

told, he felt guilty of separating his wife from his father by not doing marriage

with their permission. But after marriage, father of patient's wife‟s parents

accepted marriage & married life is going happily. At work he helped many

people to come up (promotion) according to their capability. After one and half

year patient changed his company and started working in Tarapur. He is

manager in company. He is in quality control dept. 8-to10 people work under

him. He has to look after quality of drugs prepared. Above him only G. M. is

there. In this company he told, work done by him not does get proper

valuation,so he is dissatisfied. Before 15 days, 3-4 workers in company not

doing work properly, as patient is in quality control any mistake in preparing

drug will leads to harmful effects. Patient shouted on them for their work, that

time patient started trembling and palptation. Then onwards, patient becomes

anxious about work. He doesn‟t get any cooperation from workers then he has

to look after each and everything, it is not possible. Workers are not Co-

Operating this gives more tension about work. If anybody does things against

his wish then he become irritable and starts with trembling. If he shouts on

somebody then also he starts trembling. In this company work done by him

and suggestion given by him are not appreciated but management finally
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does the things what he has suggested. This leads to dissatisfaction that

patient never gets the credit for his work. He is anxious about family he is the

only man in family taking all responsibility. If anything happens to him then

nobody will look after his family. His wife also doing job in an another

company. Patient has anxiety about her. He told she is very mild by nature

and any one can misuse her and he is very much caring for her and

suspicious about her collegues that they will misuse her. He told he is very

helping nature, he helps needy persons.

ANALYSIS:

1. PERONALITY ANALYSIS :

Type Analysis

Physician PP is male basically introvert. PP likes to be with people and gets anxious

Introvert easily. He is moody, stays behind in parties, often sulks, makes up his mind

Score: late, gets easily conscious , gets fed up often.

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Observer Observer is male and predominantly extroverted by nature according to EPI

Extrovert analysis, He is of a happy go lucky and mixes easily with people. But is not

Score: very focused and gets conscious especially in front of his seniors.

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2. CSEF:

Points Analysis

History History form was available. PP perceived patient to be probably

evaluation aggressive on slightest trifles, suspicious, caring and, responsible.

Interview According to observer patient was responsible, suspicious, angry and

dissatisfied with his life. Prognosis was thought to be good by both

physicians. PP did not anticipate any difficulty in interview as patient had

mentioned most of the events of his life and PP felt that he had to enquire

into details of each. Pp did not think of any remedies as preferred to think

over it after eliciting the life space. Observer thought probable remedies

could be Silicea and Kali carb. PP was anxious before case taking as he

usually becomes for any other case.

According to both PP and observer was adequate. Person understood by

PP after the interview was, responsible, and hardworking.

According to observer patient was, mature, responsible and had many

expectations from his collegues, he worked so much and he desires

appreciation.

Doctor- According to PP it was a purely patient-physician relationship. According

patient to observer it was a friendly relationship.

relationship

Sensitivity & According to observer there were no areas of sensitivity. But he felt that

Sensibility. PP should have focused on certain aspects and words which were

sensitive areas of patient and should have explored them. PP was highly

sensitized by the the issue of patient‟s mother‟s hardwork and also of that

of the patient and did not explore futher feeling states and emotional
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aspects. He was highly impressed by the patient. With this PP also had

forgot to enquire the aspects which were mentioned in the history form.

Somehow PP was not able to handle his sensitivity and his interview

became a question-answer session.

Technical The skills used were mostly questioning and listening. Blocks as pointed

skills & by observer and both PP was he was unable to elicit the finer emotions

Blocks and other aspects that had come up in history form in details due to his

own anxiety and inability to handle his own state.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas Chiefly his patient‟s environment, his father‟s nature and his work pattern

Explored has been explored. But the emotional feeling state especially as regards to

his mother were not explored.

4) TOTALITY ANALYSIS:

Approach: Kent Analysis

Anxiety trembling with Chilly Both PP and observer give

Anxiety headache with Cr. Spicy3+ importance to mind symptoms, but the

Anger < contradiction Cr. Buttermilk2+ remedies such as Lycopodium,

Responsible, Av. Sugar3+ argentums, Silicea, Carcinosin, Kali

Industrious motion< carb etc were not differentiated. In

Sympathetic Remedy: Phosphorous totality also the characteristic mental

According to observer: modalities were not considered. PP

In addition to above totality following added: lacks clarity in his perception of

Systematic patient and in his totality formation. As

Mature far as observer is considered he has

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Wanting appreciation Remedy: Palladium been on a very interpretative level in

totality formation.

CONCLUSION:

PP and observer both belong to a different personality type according to EPI

analysis. But PP had been anxious before the interview and most of the times

is anxious. During the interview he has been anxious and got sensitized easily

and hence was not able to go in the finer emotional aspects. Hence in the

interview it has been mostly questioning that was done. The observer is of an

extroverted nature he was not sensitized as such by any issue but was highly

impressed by the way the patient had written the history form and overall he

had conducted his life. Both of them went completely on an interpretative level

and arrived at two different remedies.

Sr. No. Core perceived Reasons

Physician Observer/Supervisor

1) Basically Systematic and PP was anxious himself before the

anxious and mature, but anxious interview because he is not

duty conscious and always desirous comfortable with handling multiple

in nature. But of appreciation emotional issues and was sensitized

emotional state with the hardwork that patient has

IPRs with done and impressed with him. So

mother not was not able to understand the

explored. aspect of want of appreciation.

Level of Similarity: Different

Follow ups: awaited.

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CASE 20

Preliminary Data: O.P.D Reg no: 1238

Name: Mrs. HAM Age:36yrs/female Education: Diploma

Status: Married since 1yr Religion: Muslim Occupation: Advertising

Fa: expired 2003, Mo: Expired 1997, Spouse: done engineering.

Chief Complaints:

Location Sensation Modalities Concomitants.

1)M.S.S Pain++ < sitting without

back since 3 No radiation no support2+

months tingling , no <more on left side2+

Lumbosacral. numbness, no >lying on left

Centre to left stiffness. side.2+

side. >lying straight2+

D-continuous >local sprays,

F-daily painkillers.

< allopathic Rx

2)G.I.T,stomach Vomiting2+, >cold milk2+

On and off since burning2+

2003 No retrosternal

burning. A/F: sleep

3)Head Pain disturbed.

One-sided(rt) No aura. No >Pain killer.

Since 11-12 yrs refractory error.

of age < winter3+

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4)Skin, Face Dryness3+, >Moisturizer

since 5yrs itching2+, cream

scratching2+,

Black

pigmentation

Patient as a Person:

Appearance: stocky. Stool: unsatisfactory, hard,

straining+2

Delayed wound healing. Urine: on and off burning.

Perspiration: dimished3+ Menses: NAD

Hunger tolerates+ Sexual functions: extramarital+

Cr: Spicy3+, junk food2+, cold water2+ Thermals: chilly

Av: leafy vegetables2+ Riding aggravation: vomiting.

Pa/H: Renal calculi Fa/H: Fa- Hypertension, Perforation

(intestine)

Life Space: Patient is a 30 years old female divorcee came to the OPD for

C/O back ache partially better with acute. Then case was planned for

definition. On the day of definition she was waiting outside the OPD and was

bit hurry to complete fast. She was well dressed. Wearing jeans with full

cotton full sleeves kurta and a –round neck. Before case definition, she was

made to sit in the cabin, she was occupied with mirror and make up. Case

was started. Patient gave information to whatever questions asked and

certain aspects were not well disclosed. Patient is born and brought up at

Mumbai. Family of 6 siblings. Patient is the 4th child. She completed her

diploma in I.T. and started doing job. While in job, she got committed to one of
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the boy who had done B.Sc. Computers, working as a developer in his field.

She liked him. Had an affair for one year. Both the family members came to

know about it. The boy‟s side was totally against the marriage. They did not

like this proposal. Then with mutual consent, both of them did Court

Registered marriage. Patient did not like in laws, who are staying at

Aurangadad. So stayed separately with husband at Mumbra and continued

working. Her disliking towards in laws because of their nature and expectation

from patient. Patient says they are abusive and bad humoured. Patient can‟t

tolerate such things. They also restricted patient not to go for job, go out of

home to wear nakab as per muslim tradition. These conditions were not

acceptable by patient she clearly told to her husband regarding these rules

before marriage that, she will not follow. Even at her maiden family home all

sisters wear Nakab. She is the one who does not like it. and never followed.

There was a consistent conflict regarding these issues between patient –

husband – in laws. The marriage life continued for 5- 6 years with such

conflicts. During the 1st year of married life she conceived she aborted (MTP)

as she felt she had not planned for and not settled. Gradually, patient‟s

husband also talking towards his mother‟s side. Started telling patient to stay

with mother in law and follow what she says. Patient denied completely. She

also came to know that, at in laws place they are planning for 2 nd marriage for

her husband amongst the family. Meanwhile, patient got transferred to

Banglore. Patient considering this, asked for divorce. They initially stayed

away and got divorce 2 years back. Patient‟s family accepted her after

divorce. She is now staying with her brother‟s family at Dahanu. Daily she

commutes up and down to Mumbai for her job. Presently working in

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advertising department at Andheri and as a teaching faculty. Previously doing

same job associated with web designing. Now also doing some short term

course. She is not bother about anything which had happened in her marriage

life just looking forward in her carrier. She has too many friends at working

place and at personal life. Spends time with them but share her problems to

only few. Has good relation with all. She get easily angry when bad words are

spoken. She will not talk to that person, this to avoid them. If the problem

between herself and other is small, she will forget and get together. But once,

if the problem seem to big she will come out of it and avoid having relation

with the respective person and will not talk to third person. She does not like

weeping and brooding and so will not do it. Does not get deeply involved in

emotion, likes to be alone.

Observation after CD outside OPD: Patient was accompanied by a person

who is her boyfriend. She is into relation with him for last 1 and ½ year. They

both are planning to get married. They are also involved in physical

relationship. The boy is also defined and the above details were given by the

patient who defined the boy.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is female. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP doesn‟t like to be with mixing with people. She is

Score: nervous and anxious in nature and is touchy.

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Observer: Observer is male and EPI Analysis shows that observer is predominantly

Extrovert Extroverted in nature. EPI analysis shows that he is basically happy go

Score: lucky, likes cracking jokes, is lively and an easy going person. But at the

E-18/24 same time he is organized.

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2. CSEF:

Points Analysis

History Mainly focus was on understanding first the clinical diagnosis. As such no

evaluation data otherwise available for any other interpretations

Interview PP‟s before beginning the case was not having any feeling state. But

during the interview PP got a severe rejection towards the patient. Hence

the interview did not go as per her plan i.e. of eliciting the chief complaints,

physical generals, and mentals. Hence the interview was inadequate in all

terms. Observer also noticed that there was severe rejection for the patient

from PP‟s side. On the other hand observer did not at all have such

feelings. Although it was not in accordance to even his value system he

was able to guard himself from going into hatred for the patient. After the

interview the first hand impression of the patient was Immoral, no value

system, independent, conscious about self image, blaming others.

According to observer his impression was that patient was goal oriented,

clear of her life, rebellious, straight forward.

Doctor- PP had taken location of patient‟s husband and had became judgemental

patient about everything and was almost in a firing mood, to the extent that PP
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relationship had taken an interview almost like an enemy as the PP puts it in her

CSEF. According to the observer PP had been doing almost a police

enquiry.

Sensitivity PP became very sensitive with the fact that patient had a love marriage

& and just for sake of some rituals which the patient did not wanted to follow

Sensibility. she broke the marriage. PP took it very seriously and was not able to

accept it at all. PP was not at all able to handle her sensitivity.

Technical PP either had blockedthe patient most of the times or just confronted her.

skills & According to observer it was almost like a police enquiry.

Blocks PP‟s biggest block was her anger for the patient that resulted due to her

own upbringings and value system.

3) LIFESPACE ANALYSIS:

Points Analysis

Mainly The whole life space revolves around her post marriage IPRs with inlaws

Marriage and her husband which later culminated into a divorce. PP hardly did listen

and to patient, PP also did not attempt to explore and was most of the times

divorce. confronting hence the life space is inadequate in most of the areas.
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4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach. Mentals given prime

Totality: importance

Chilly Other approach such as

Av-sour3+ Scanty perspiration Boennighausen could have

Cr-spicy3+ Fear animals2+ been better suited as the case

Sun<3+ Dreams-snakes2+ was rich even in modalities.

Riding <2+ Grounds of differentiation:

PDF: Current state of patient. i.e,

Irritablility3+ independence, irritability,

Sexual Suppression Sexual suppression

Determined All symptoms based on sexual

Independent suppression.

Observer- Totality- for observer he has not Final remedy (PP)-Sepia

been able to arrive at one single remedy as Final remedy (observer)- was

he felt he had understood one aspect of not able to conclude on the

her‟s that is of independence and rebel. remedy.

Totality –Supervisor Final remedy(Supervisor)-

Intolerant to abusive behavior Chilly Natrum Phos.

Reacts, speaks out Av-sour2+

Sociable but yet reserved Cr-spicy

Dreams snakes, dead bodies3+ Sun<2+

Sector- Jaundice, Migraine, Back ache

Impression- Natrum Phos.

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CONCLUSION:

PP of this case is basically of introverted type, and observer being extroverted

type. PP was highly sensitized by the issue of patient‟s husband. Her

emotionality for the patient has been very marked. Her most sensitive area

was she was highly affected by the patient‟s conduct and that made her highly

subjective and was not able to overcome her subjectivity till the end. Her

totality was also based on her interpretations and hence the remedy for the

PP was Sepia. Her observer who is extroverted and analytical in nature was

not much sensitized as patient was rather was more focused as to know her

as a person. He was more objective and hence did not want to form a totality

based on subjectivity and interpretations. Supervisor is equally analytical in

nature he considered the direct symptoms of mind without trying to derive any

meaning and integrated it with the hard data of physical generals to arrive at

the remedy Natrum Phos. In this case there were extremes seen i.e. of PP

who due to her sensitivity was very subjective and jumped to conclusions

while the observer who became too analytical and objective was not able to

arrive at any understanding. Thus there own personalities became liability for

both of them.

Final remedy released: Natrum phos

Sr. Core perceived Reasons

No.

Physician Observer

1) Independent, Independent, rebel, PP had become highly subjective

irritable, but Suppressed and due to this she was absolutely

lacking morals emotions interpreting the patient as per her

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standards. Observer was

visualizing patient from perspective

of patient itself and hence was not

that interpretative and was more

objective.

Level Of Similarity: Different

Follow ups:

Sr. no Date Follow up Action

1) 8/7/11 Lumbar Back pain+, Knee Natrum Phos 200 1 dose

joint pain+ Hairfall+ weekly,Placebo for 4 weeks

2) 24/9/11 Complaints of back pain Bryonia 200 4 pills QDS for

and Knee joint pain SQ. 10 days then Natrum Phos

Hairfall improved 200 1 dose weekly for 2

Further follow ups awaited. months.

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CASE 21

Preliminary Data: O.P.D. Reg. no. 609

Name: AFZ Age: 25yrs/Male Occupation- scrap collection

Religion: Muslim Education: 7th std Fa: 85yrs, Mo: 70yrs

3 sisters married Address: MHK Status: Single

Chief Complaint:

Location Sensation Modalities Concomitants

Mind Addiction of Weakness++

O: sudden, since Ganja then

12-13yrs abstinence for 3-

4 yrs

Then alcohol

addiction ½ bottle

daily and

complete

abstinence in

Ramazan no

Since 7-8 years, symptoms of

1-2 packets daily withdrawal.

Cigarette

Since childhood smoking now

daily 10-15 times. stopped since

2) Mind since1-2 years

Till 3-4 years Tobacco chewing

back Multiple self

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infliction of wound

with blade to

scare his

girlfriend.

Increase of

addiction since

then.

Mouth Inability to open

Since 1-2 yrs mouth (due to

fibrosis)

Patient as a person:

Appearance: lean thin person, weight loss since 3-4 years.

Perspiration: chest++, Forehead++, excessive mild offensive, sticky.

Craving: Spicy3+, salty3+, sweets2+

Stools/Urine: normal

Sexual function: Suppressed, no sexual relations with anyone,occ nocturnal

emission.

Diet and Daily routine: not very fixed. Sun <+ Thermals: Chilly.

PA/H- N.S. FA/H: N.S.

Life Space:

Patient was born and brought up in afarmer‟s family in a village near lucknow.

The village that he belonged to had different groups of people. They would

have fights in between them for trivial matters e.g. any animal going from one

field to another. Patient was basically a calm child, but circumstances made

him impulsive, violent and extremely angry. After a small tiff of above
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mentioned character, there was quarrel between the two parties and out of

that quarrel they burnt his house one night. Patient was very small at that time

to remember any other details but says that he had seen all this and since

then driven by a kind of revenge and decided not to get afraid of anyone.

Hence he started beating people, breaking things etc. but then at the same

time lacked the courage to stand. He would runaway and go into the forests,

and would turn up in a few days. On returning back he would get thrashing

from his mother and father, would use to beat him upside down in a jute sack

and with a cane. He had no hard feelings for either of them. The violence,

impulsiveness increased with age, so much so that patient would land up into

fights and would beat up people badly. In an instance where his father was

abused over some trivial matter then he beat up that person very badly with a

bamboo. Another instance of his anger and impulsiveness, was that when he

was around 20 yrs old, he was involved in a group theft, and one of the

partner refused to share the booty and patient got very angry and impulsively

inflicted trauma with a chopper on this person‟s chest. Patient after that fled to

Pune, and later he was caught by the police and was kept in prison for around

19months. His addiction of tobacco and alcohol started at a very early age but

it was infrequent. Ganja addiction went on high when he was disappointed in

a relationship with the girl whom he liked, and wished to marry against his

parent‟s wish. The girl did not wish to marry him, against her parent‟s wish, he

tried to force her by inmflicting wounds himself with a blade, but ultimately the

girl married some other person. He lost interest in marriage. After a couple of

years, another girl had started liking him but patient never paid any heed to

her. After these incidences his Ganja consumption increased and . But his
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impulsiveness and anger reduced and started having feeling of

embarassement and especially when a small child told him that. Patient was a

stigma to the caste and village. Patient has always been changing his

workplace. He first came to Mumbai and then started working as a scrap

collector, earning anything between 7 to 20 thousand. But most of his money

was spent in his addictions. Offlate he has been associated with a girl, whom

he was introduced by his employer. He wishes to marry her now and he feel

that she will bring him on line. Parents doesn‟t have any idea of this as he has

not been to his village since 6yrs. He doesn‟t wish to go due to fear of

embarassement. Patient‟s father and grand father according to patient would

practice some sorcery or witchcraft and says that he would be able to

establish contact with demons, angels etc. His father got his hand paralysed

as he was fighting with the demon. Patient also has a belief that he was under

the possession of talisman, due to which he was not going home. He believes

that he will be out of this addiction because he believs a lot on God and says

if he will consume any such substance then God will automatically punish him

i.e he would get fainting spells, etc.

1. ANALYSIS: PERONALITY ANALYSIS OF THE PHYSICIAN AND

OBSERVER:

Type Analysis

Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP doesn‟t like to be with mixing with people. He is

Score: nervous and anxious in nature and is touchy. He is also moody and tends to

E-8/24 become emotionally unstable often.

N-12/24
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L-1/9

Observer: Observer is Female by gender EPI Analysis shows that observer is

Introvert predominantly Extroverted in nature. EPI analysis shows that she is

Score: basically happy go lucky, likes cracking jokes, is lively and an easy going

E-13/24 person. She is a person who may not really plan out the things.

N-12/24

L-2/9

2. CSEF:

Points Analysis

History Then case was admitted in the IPD for fever with chills but it was realized

evaluation that Patient was having addictions and hence was considered for

definition in psychiatry department. Hence no history available and patient

was also not much ina willing state initially. No significant data available for

history evaluation. For observer through patient‟s external behavior

appeared to be obstinate and irritable. But for PP it was not the case rather

he felt that patient would open up easily.

Interview PP considering the inputs given by the observer first oriented the patient

and then patient also appeared to be a bit comfortable and started with the

case. Plan was to consider the addictions and record its LSMC and then

go routinely with physical generals, observer was very keen that PP should

focus on physical generals as wanted to have hard data so as to facilitate

an accurate prescription. But the interview went very much haywire. PP

was not able to focus on one issue and was changing the things very fast.

Doctor- PP did not form a single stable relationship with the patient and was

patient frequently changing roles, once identified with the patient especially in
 193

relationship areas of disappointment in love and at times was getting impressed with

the patient. According to observer PP seemed to be very much confused.

PP was most of the time asking few questions and leaving that area and at

times when he did not get a proper answer would confront the patient. As

rightly realized by the PP, observer too felt that he was changing his

locations. But the relations were many times that of a brother.

Sensitivity According to observer, PP had identified with the patient and at times was

& also impressed by the patient, due to both of these factors, PP was not

Sensibility. able to focus and explore all areas, and rather had missed on many

important physical generals and other issues. According to PP, he had

identified with the patient and was sensitized by the issues like

disappointment in love. But he feels that he has been able to balance his

external and internal feeling and it did not affect his case taking.

Technical Receiving was predominantly used with that after inputs from observer it

skills & was also listening and questioning etc were used. According to observer in

Blocks addition to all these confrontation was also done couple of time. According

to PP judgement in view of clinical diagnosis faulty. According to observer

the diagnosis was an antisocial personality disorder. PP had missed

diagnosis of personality disorder this was a major block according to

observer as due to this block PP was not able to realize the evolutionary

understanding of this patient and was more exploring only his reactive

patterns.
 194

3) LIFESPACE ANALYSIS:

Areas Analysis

explored

Childhood IPRs with father, childhood upbringing well explored.

Work This area lacks, chronological understanding. Exact reasons,

situations, leading him into antisocial activities not explored.

Love affairs. This area also was not very clear as to why he lost interest after first

IPRS with breakup and now how he is again ready for the marriage etc.

parents These are not at all explored apart from some glimpses about it in

childhood area.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Approach- no specific approach.

Violent anger3+ Forsaken2+ feeling2+ The case has scanty hard

Remorse3+ Perspiration: data such as physical

Anger- trembling with2+ chest2+, sticky2+ generals. Hence totality by

Impulsive2+ Thermals-chilly PP, Observer, or supervisor

Sexual desire- suppressed. was based on a lot on

Final remedy- PP-Merc sol. interpretations. Both PP and

Final remedy-Observer- Merc sol Observer both are introverted

Final remedy-supervisor- remedy from ophidia types but from the

group D/D merc sol. expressions of patient both

could arrive at a similar

 195

patient understanding.

Supervisor gave importance

to the evolution and

processes resulting into such

actions and hence he thought

of ophidian group.

CONCLUSION:

PP according to EPI analysis is predominantly Introverted in nature. PP and

his observer both have equal N score i.e. 12 but observer‟s E score is very

high as compared to PP. PP since the beginning of interview was going

haywire and was not able to explore any areas systematically. This was

because PP was sensitized and identified with the patient, his internal conflict

lead him to the confusion. But observer to some extent was more analytical

and focused and hence could help in proper exploration. Both of them while

totality construction were trying to consider as far as possible the hard data

and directly available expressions ofd mind avoiding to be too interpretative.

The supervisor who is more of extroverted type went into interpretations of the

available expressions and hence arrived at a different remedial understanding

probably from ophidia. But then there was lack of any other adequate hence

supervisor preferred to stay away on analysis based on too many

interpretations and hence he along with PP and observer took the data of

mind as it is and final remedy coming up in repertorisation was considered

which was merc sol.

Final remedy: Merc Sol

 196

Sr. Core perceived Level of Reasons

No. similarity

Physician Observer

1) Violent, highly Violent, impulsive, Similar Both PP and

impulsive and sentimental, observer are

sentimental problematic having similar

upbringing. personality

type, i.e

introvert.

Both have

avoided to be

too

interpretative

and considered

the directly

available data.

Follow ups: patient is yet to come for follow ups.

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CASE 22

Preliminary Data: O.P.D. Reg no.-1238

Name- AMY Age-25yrs/female Education- illiterate

Occupation-housewife Married since 12yrs Religion- hindu

Spouse-30yrs, worker,Father-55yrs, mother-52 yrs, 1son, 2 daughters.

Address:WED

Chief complaint:

Location Sensation Modalities concomitants

1)M.S.S, back, Dull, aching pain A/F-after abortion Irritable2+

B/L hips No stiffness, no <exertion2+ Weakness2+

O-sudden radiation,no joint <walking2+ Appetite

D- since 7-8 yrs. pain. <flexion2+ reduced.2+

P-gradual Sensation as if >pressure2+

F- Daily back would >allopathic

break. medicines

2) Head <pressure2+

O-since Dull pain aching <stress2+

childhood type2+ <bending neck2+

Right parietal, Sensation as if >oil massage2+

radiating to right eyeballs would

side teeth. fall

Continuous, No aura, no

almost daily nausea, no A/F-after last

3)G.U.T vomiting. delivery

Urethra << before, during

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O-sudden since Burning2+ and after

2-2.5 yrs. No haematuria urination2+

D-1 day Dark yellow urine. >drinking water2+

F- occasional. > cold water

application2+

< spicy food2+

Abdomen, >drinking water2+

retrosternal

Since 1-2 months Burning2+

Patient as a person:

Appearance: round face dark complexion., smiling intermittently and with

good eye to eye contact. Thermals-chilly

Perspiration- general profuse3+ Cr.-Spicy3+ Sexual function-

normal

Menses- regular cycles with moderate flow and itching in the genitals after

menses for 2-3 days> warm applications3+.

Riding aggravation3+ Dreams- death2+, snakes2+

O/H- G5P4A2l2, still birth-1, 2 spontaneous, 3rd month abortions.

Pa/H- see obstetric history, no other medical, or surgical illness Fa/ h- N.S

Life space: Patient originally is from UP, presently staying in Boisar ,with

husband and three kids. She appeared friendly by nature, had good eye-

contact. In village, she stayed with her parents & siblings. Father was a calm

person and he worked in electric field in Delhi, Would come home on

occasion and that is when they all met. Mother is good natured female.

Patient had good IPR with all. They were financially sound. In that sense,
 199

she had an uneventful childhood. Was quiet attached to Paternal

Grandmother. Patient‟s grand mother taught her everything. She shared all

things with her. She also taught her magical cures by mantras with the help of

which she was / is able to treat patient with bodyache, and pain etc. Patient

wanted to study ahead. But, being the eldest she had to do all household

works. She regrets about it and feels that it would have been better if she had

studied especially when her kids asks her things regarding studies. Patient

got married in a near Village at an early age. It was an arranged marriage

stayed at home for 3 years then she came to in laws. At in laws everything

was well, she had good IPR with everyone. Never fight with husband, says

that everybody must get such husband. She had not got anything from

mother's place. So, her grand mother sent her all household grocery. She has

3 kids. After first kid a gap of one to one and half year after which she had

abortion at third month. It all happened at night around 9.00 PM when a

scorpion bit her. Her eldest sisterinlaw and others in house gave her

something to smell after that she was better. She had no history of

unconsciousness, fear, due to bite or anything. After 2 hours (11. 00 PM) she

started with profuse bleeding and next day doctor gave some medicine & she

aborted the child. Patient, very causally laughed over the matter, but on

further probing her eyes filled up with tears. She said that, she thinks about

this lost child every time. (broods about this matter). Since this time she also

headache, bodyache, backache. Last time when she went to her village, saw

the place where she had started bleeding and again felt bad. Because of this

reason, she avoids going to village. Her fourth delivery was a stillbirth at 9

months. She saw the child, tried to make him cry, but he did not. This was not
 200

thought of again & again and she came out of it fast. She says that, since few

years she has become very irritable and displaces her anger on kids. She get

angry if people tease her or shout at her. She starts weeping, if people shout

at her, will never talk to the person on whom she gets angry. She mixes easily

with people, but will not talk till that new person comes and talks to her. She

has fear of ghosts. Dreams of death of Known and unknown people, dreams

of weeping fathers and also gets dreams of snakes.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. He is nervous and anxious in nature and is touchy, worries

Score: for a long time and gets easily conscious. Doesn‟t like hustle-bustle around,

E-8/24 gets fed up easily, but at the same time is not moody and likes mixing with

N-12/24 people.

L-1/9

Observer: Observer is Female by gender EPI Analysis shows that observer is

Introvert predominantly introverted in nature. EPI analysis shows that she is

Score: basically moody, and like PP doesn‟t like to mix with people, worries for a

E-5/24 long time , gets anxious, is very much sensitive and touchy.

N-12/24

L-2/9

2. CSEF:

History With the help of the screening PP could arrive at a probable diagnosis of

evaluation nonspecific headache, and abdominal pain , which requires proper

 201

evaluation during case taking.

Interview PP had planned to start from chief complaint then physical generals and

then mentals. Interview went as per the plan but both PP and observer felt

that the interview was inadequate as regards to Person understanding.

According to PP patient is an irritable female who displaces her anger on

her kids, brooding type and very sensitive in nature. According to observer

patient is a sentimental, irritable female with lot of attachments.

Doctor- According to the PP it was a relationship of a friend who was making her

patient realize her problem and encouraging her. According to observer initially it

relationship was a friendly relationship but later observer felt that it culminated into a

relationship of brother and sister.

Sensitivity Observer felt that a good rapport was being created, PP almost was like an

& elder brother to patient but suddenly when the issue of abortion came and

Sensibility. when the patient started weeping PP were abruptly cut that topic and

asked some other question, here observer felt that physician probably

doesn‟t want to reach this area in more depths, for reason best known to

the physician himself. PP also agrees to this that he had become highly

sensitized with the abortion issue. This was because PP had actually

identified with the pathos as his own sister had recently gone through such

incidence and PP was not at all confident of dealing with this situation as

he had not resolved himself first. Somehow he managed to overcome his

sadness by deviating from the issue and focusing on the other areas.

Technical Mostly it was exploring and listening that was used. PP‟s block was only

skills & his own internal unresolved state which influenced his interview.

Blocks
 202

3. LIFESPACE ANALYSIS:

Points Analysis

Childhood Childhood was uneventful. But in general her environment and her

reactions were inadequately explored.

Marriage Her feeling state about early marriage, her tussle with motherinlaw due to

and dowry, which has been mentioned by his observer in life space was also

children. not explored and is not even mentioned in the life space of PP.

Social Her attitude in society again doesn‟t seem to get a mention in life space by

PP, but the life space of the observer shows that these areas were also

somewhat explored by the PP.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s approach

According to PP: PP and observer were both

A/F- Abortion after Cr-Spicy3+ nearly on same totality, but

Irritability his Observer gave importance to

children2+ Perspiration-general her grief and the fact that

Fear-ghosts2+ profuse3+ patient is still brooding. She

Fear-snakes2+ riding<3+ went for interpretation while

Sensitive to reprimands2+ remedy differentiation. PP and

Remedy- Kali carb, D/D- Natrum Mur. the supervisor had been more

PDF: Thermals- Chilly. evidence based and they

Abortion 3rd month considered the hard data

Dreams-snakes2+, Death2+ available for the differentiation.

 203

Morning sickness during pregnancy And hence they arrived at Kali

Sectors- M.S.S, G.I.T, Head. carb.

Final remedy(PP)- Kali carb. But a more evidence based

Final remedy (Observer)- Natrum Mur. approach in this case could

( considered the same totality but for have been Boenninghausen‟s

differentiation considered the Grief aspect) approach as the case was rich

in characteristic modalities.

CONCLUSION:

PP and Observer both in this case are predominantly Introverted types with

an equal N score in EPI analysis and PP having higher E score and Observer

with lower E score as compared to PP. Both PP and observer were highly

sensitized and PP was not able to handle his own sensitivity. Moreover

observer being female also felt that PP was not having enough sensitivity to

understand the pathos of this woman. PP while exploring the life space was

also not able to focus on other areas. But while analyzing PP relied more on

hard data and seemed to be somewhat analytical. But observer even in final

totality formation and patient understanding still was affected by the abortion

and grief of patient and she did not consider the characteristic physical data

which was available for remedy differentiation. These differences seem to

have come up inspite of similar personality type due to the differences in the E

scores. PP who had higher E score is seen to be more evidence based as

compared to observer who has lower E scores.

Final remedy- Kali Carb.

 204

Sr. No. Core perceived Reasons

Physician Observer

1) Anxiety and High sensitivity Grief leading Observer was herself

irritability was to irritability highly affect ted by

predominant core the abortion issue. PP

too was sensitized

but avoided from

taking sensitivity to

perceive the core.

Level of similarity- Different

Follow ups:

Sr. Date Follow ups Action

No.

1) 12/10/2009 Headache++, bodyache++, back Kali Carb 200 1 dose

pain++, Generals-Normal , placebo for 1 week.

Headache 50% better. Body ache- Kali carb 200 1 dose,

nil, Back pain-same. placebo for 1 week.

2) 20/10/2009 No complaints. Stools- Ct. all + diet advice.

unsatisfactory
 205

CASE 23

Preliminary Data: O.P.D Reg no. 2134

Name: Mrs. SKS Age: 46yrs/female Education: 7th std.

Status: Married Religion: Hindu Spouse: truck transport

Fa: Expired Brothers2, sisters:3 Add.:HYJ

Chief Complaints:

Location Sensation Modalities Concomitants

1)Chest,Left side Mild pain <spicy, pungent

O-sudden food2+

Since 1yr

P-gradual

2)G.I.T, Burning2+ <spicy food2+ Appetite reduced.

epigastrium Nausea2+ <meat2+ Thirst reduced

O-gradual No vomiting, no

D-since 7-8yrs flatulence.

P-gradual Eructations2+ <lifting heavy Weakness

3)M.S.S Pain2+,no weight

Lumbar region stiffness, no >oil massage

tingling

4) Head numbness <tension2+

Since 7-8 yrs. Pain2+ <when alone2+

Gradual >when

5)Bilateral legs occupied2+

Since 7-8yrs Pain2+ <walking2+

6)Mind >oil massage2+

 206

Since 7-8yrs No desire for

work2+,Anxiety2+ >scratching2+

Sleep >oil application2+

disturbed2+, >cold water

Skin takes tension application

Plantar aspect of easily.

middle 3 toes. Itching has to

Since 7-8yrs scratch with

stone,

Dryness, scaling

burning.

Patient as a Person:

Appearance- stocky. Wound healing- normal Perspiration-Face-moderate,

offensive

Digestion- Flatulence since 7-8 yrs, Hunger <2+

Cr-Chicken2+, Spicy2+, Sour2+ Av.-Milk2+, Carrots, pumpkin

Stool/Urine-Normal

Menstrual Function- Regular cycle, Duration-2 to 3 days. Moderate flow,

dellible stains. Pain in abdomen before menses.

Sexual Function- Normal

Sleep-Normal Sun,-perspiration2+, Ghabrahat2+ Getting wet aggravation.

Thermals- Ambithermal to chilly.

Life space:

A 46 year old female, referred by MD physician, for Dysthymia. She

presented with multiple somatic complaints started after taking tension. She is
 207

has stocky built with dark complexion and dark circles around eyes. She

started as if complaining about everything. She was born and brought up at

Punjab. Her father was farmer and mother was housewife. She has two

brothers and 3 sisters. She is the third sibiling. Her childhood was fine and

there were no issues as such. Her IPR with parents was good. But her elder

sister was irritable kind of person and she was not adjusting with anyone in

family. Patient would get angry on her. Patient studied upto 7th standard in

Punjabi medium and was average in study, used to play and enjoy her

childhood.

Patient's elder sister had talk with her father and asked about the patient‟s

marriage with her brother-in-law and told him that “The guy eats meat, drinks

also but he is good by nature". The patient got married with that boy in 1984,

and her sister became her elder-sister-in-law. Patient was complaining of

each and every member of family. Her mother in law according to her, is such

a female that she can turn anyone mad in 10 minutes but now that her father

in law is dead mother in law is under her control. Mother-in-law would not take

care of patient. Once patient suffered from Hepatitis and had missed abortion

and mother-in-law used to taunt her that ''She will never have a son but will

have only daughter ''. Now after father-in-law‟s death she does not scold

patient much.." But previously her mother in law was very much jealous would

say anything to anyone. Once, patient's elder son became ill, at that time she

asked her mother-in law to come with her in clinic, but mother-in-law told that,

she has no time, so patient told her, that she has time to roam here and there

on which mother in law said that rather than taunting so much you better get

me some poison on which again patient back answered that I don‟t know
 208

where you get poison else would have definitely brought for you. On hearing

this conversation her husband slapped her, but one relative in family took her

side and settled the fight. According to her, eldest sister-in-law is also not

good as she doesn‟t behave well with her husband, asks for money

constantly, give him alcohol and mutton etc. Her sister who is 2 nd eldest sister

in law is also not good, she is irritable and she says whatever she wants to.

She has 2 younger sister in laws but they are not bothered about anyone,

neither are they much involved in family matters so patient also does not go

much to the. Her husband is in truck transport Business and he has contact

with many people though they may be poor. He gives money to them, offers

them non-veg, drinks etc. in his home. Patient does not like all these things.

She tells husband that she can‟t tolerate all these things and that better he

goes out and does whatever he wants to outside. Husband has bought a

tractor at Punjab. Then patient gets angry & then feels to leave house but

then thinks about her children so then when alone feels very sad cries gets

afraid. But then forgets it and feels better. Her father-in-law was very much

irritable short tempered person, but according to patient he was having good

IPR with patient. He used to scold patient whenever something goes wrong,

but at next moment used to speak mildly also. She is close to her son. Her

elder son is in truck transport and younger son is studying. She wants that her

son should marry now. Her Husband is extravagant and now he wants to go

to his village in Punjab.

 209

Husband's. Interview.-

According to husband patient is very irritable by nature. Gets angry on trifles

and is also anxious for trifles. Her sister is also of same nature. He doesn‟t

have good and stable IPRs with her.

1) ANALYSIS: PERONALITY ANALYSIS OF THE PHYSICIAN AND

OBSERVER:

Type Analysis

Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP like to be with mix with people. He is nervous and

Score: anxious in nature and is touchy, often find difficult to express what he feels

E-11/24 into words, gets lost in thoughts.

N-20/24

L-2/9

Observer: Observer is female and Introvert by nature according to EPI analysis. She is

Introvert very moody, touchy, doesn‟t like to mix with people. She is focused and

Score: knows what she wants to do, can integrate things quickly.

E-5/24

N-12/24

L-2/9

3. CSEF:

Points Analysis

History Through the screening PP had got a fair idea regarding the chief

evaluation complaint being multiple and probably functional which need to be

evaluated during the follow ups. PP had anticipated the difficulty that

patient could be very talkative as she had been even during the screening.
 210

Hence he had anticipated that it might be difficult to block her.

Interview PP had decided to start the interview first with follow up from screening.

And then to elicit LSMC, physical generals and mentals. But the interview

did not go in the way as it was planned by the PP and the difficulty

anticipated by the PP was true. Patient was too very talkative and PP was

not able to block her. Hence PP and observer both felt that interview was

in adequate as regard to patient understanding. Person diagnosis

according to PP was short tempered, brooding, weepy and discontented.

According to observer patient is quarrelsome, complaining about

everything and vexed kind of female.

Doctor- According to PP and observer, PP had formed a very friendly relationship

patient and later on took the location of her son. But PP seemed to be confused

relationship and was in between trying to confront her and block her but he was not

successful.

Sensitivity PP became very sensitive when he heard all sufferings of the patient. He

& had already taken the location of her son so later although he felt that

Sensibility. patient was complaining about everyone and that he need to confront her

and block her he was not able to change his location. Observer hence felt

that he was not able to handle his sensitivity.

Technical Listening was the technical skill that was used most of the times.

skills & According to observer PP‟s relationship with the patient was itself huge

Blocks block due to which PP was not able to confront or block patient.
 211

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not In the life space it is evident that PP has written down whatever patient had

explored. said to him. There was hardly any exploration. Different areas that have

been mentioned are mostly her problematic IPRS with her sisters, inlaws,

husband and many more. Everywhere patient‟s feelings about her relative

are mentioned but exploration of situation and her reactions are lacking.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Approach-Kent‟s approach Here Kent‟s approach was

Suspicious3+ Hunger<3+ taken by PP. But presence of

Wanting appreciation3+ Cr- Chicken2+ characteristic modalities and

Weeping alone when2+ Cr.-Sour2+ Physicals means

Irritable2+ Cr- Spicy2+ Boenninghausen approach

Fear, crowded place.2+ Perspiration- could have been more suited.

face2+, PP relied on Mentals which he

Perspiration-offensive2+ Sun<3+ has not really understood in

depth, and missed out on

Final remedy(PP)- Sepia. important physicals in case.

Final remedy(observer)- Sepia.

Observer had considered the

same totality and in addition to

this she explored the sexual

data which was missed out and

 212

where it was found that sexual

desire right from start has been

less to nil. With that occupation

amelioration was considered

and hence remedy was Sepia.

CONCLUSION:

Both PP and observer are of predominantly introverted types. But there is

difference in them as regard to the confidence level, spontaneity and ability to

be focused and integrate the things. PP being basically anxious and nervous

got easily sensitized with the sufferings of the patient and later was not able to

block. He forgot to even elicit proper LSMC, sexual data etc. PP and observer

both arrived at the similar totality and patient understanding but PP in his

processing was interpretative whereas observer was more evidence based.

Supervisor is basically extroverted type, and he preferred to prescribe on

physical data as there were lack of qualified mentals.

Final remedy: Sepia

Sr. Core perceived Reasons

No.

Physician Observer

1) Anxiety and irritability Anxiety, and lot of irritability PP and observer both

was predominant core with dissatisfaction with are having similar

aversion to sex and personality type but

occupation amelioration PP is more anxious

and observer is more

analytical hence
 213

observer was not

happy with the

interview but as PP

was on a re4dcieving

end they could get

good data and

evidences so could

arrive at the remedy

Level of similarity Different

Follow ups- awaited.

 214

CASE 24

Preliminary Data: O.P.D. Reg no. 831.

Name- Mast. YAD Age/Sex-14yrs/female Education-9thstd

Occupation- Student Religion-Hindu Status-Single

Add-VBN Fa-Teacher, Mother-Housewife, sister 10th std

Chief Complaint:

Location Sensation Modalities Concomitants

1)Mind Increased Mischieviousness3+

O- Since 4th Throws chalks in the class

Standard Restlessness, cannot stay at

one place

Concentration reduced,

Attention span reduced,

Impulsivity3+, performance

gone down , Spelling mistakes,

Forgetfulness.

Since 2- Twitching of upper eyelids, < while

3yrs oscillatory movement of upper talking with

eyeballs, Repeats words, others3+

sounds, also. <during

studies with

father2+

Sneezing3+, thin watery >occupation

2)R.S coryza, nose block dry cough, with work

O-since Breathlessness, Obstructed <winter2+

 215

childhood sensation, no fever, no throat <dust2+

D-1-2days pain >hot drinks2+

F-3-4times

a month

3) G.I.T White, jelly like mucous

O-since 7th discharge, stools offensive, <before,

std spends much time in toilet during and

after stool.

Patient as a Person:

Appearance- Wheatish complexion with black spots Perspiration- Face2+

Cr-Sweets2+, oily food2+, Spicy2+. Icecreams2+,. Av- Beans2+, Bland

food2+

Stools- Unsatisfactory2+, Consistency normal but straining 2+ Urine- Normal

Birth History- Unwanted pregnancy as only 4 months gap between the 1st

deliveries.

Taken pills and had tried to abort, but attempt had failed. Mother had

depression during ANC period due to some family issues. Had delayed

second stage of labour.

But fullterm normal delivery.

Mile stones- Fairly in normal limits.

Behavior- Hyperactive, during childhood.

Thermals- Hot.

Dreams- pursued by lions. Falling down and gets up.

Life space:
 216

A 14years old boy, came for cased definition, with his, parents, well dressed

wearing a sleeveless T-shirt, and jeans, neatly combed hair and wearing

Specs. Patient is 2nd sibling of the family, he was precise in the answering. He

has one elder sister, father works in BARC, patient is more attached to his

mother and sister and also has fights with his sister, Patient never hits back

as he is afraid of father. Hius father restricts hbim a lot but he has good Iprs

with father. Patient is a bit scared of his father and even then commits

mistakes for which he has been scolded before. Does not feel much about it

and continues the same. Father and mother both are irritable and highly

disciplined in nature, especially patient‟s mother is very much fastidious in

nature. Whereas patient never keeps anything orderly, will throw things here

and there, after coming home from school, and then will search for it. At

school many of the times he is late, teacher also punishes him by asking him

to remain outside, but nothing makes difference to him, he will repeat the

same. Then, in classroom finds it difficult to sit at one place, but tries to

control himself, as teacher scolds him. But then he will keep on throwing

chalks on other students, and disturbs them. The subject in which he is

interested he will study in depth, and ask too many questions, science being

his favorite subject. He wants to become a surgeon, So he wants to put all his

efforts to achieve his goal. He will study in detail from internet etc. He knows

good details of space and biology. He will sleep at boring lectures such as

history, maths. He likes to do lot of experimentation, such as electrolysis,

separate hydrogen, oxygen from water with the help of electrodes. Lit fire,

produce vacuum and he is not scared of such experiments, he will open the

CPU dismantle it and again redo it and learns from this. He has intense fear of
 217

stage performance, and his confidence level goes down, feels confusion and

only once he had done a dance on stage and was very much afraid, and was

feeling that he might fall of, then all his friends would tease. Also feels that he

will be broken down and will not attempt it again. Though such incidences

have not yet happened still he feels insecure about this. He replies to any

questions asked. If 2 or more people would encounter with him then he gets

confused and will not be able to reply. He has very few friends at school, he

does not like to be alone and feels bored. So takes always, atleast one

person, to keep him occupied, but he is not very much attached to friends.

Once had a fight with one of his friend and he hit him, friend got injured. His

principal scolded him a lot in front of everyone, but he felt sorry for his and did

not feel bad. Since beginning patient is a good scorer. When patient was in

5th-6th std, he had fallen in a bad company, would bunk the class, waste time,

and his scoring went down. His friends were selfish and would copy during

exams, and when he would ask they would never help. At that time his

memory became very bad, and started using funny words. Then he himself

realized that he is doing wrong things and remembering his ambition he

changed himself. He got separated from those friends and started focusing

more on his subjects. His interest in science gave him state level prizes on his

projects. He eagerly waits for the holidays to come so that, he is free to do

things whatever he wishes to. During holidays he plays by climbing over the

buildings. He also justifies this by saying that in foreign countries, more

importance is given to sports.

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ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is female. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP doesn‟t like to be with mixing with people. She is

Score: nervous and anxious in nature and is touchy.

E-11/24

N-15/24

L-2/9

Observer: Observer is female. EPI analysis shows that this observer is predominantly

Introvert of Introverted type. Observer doesn‟t like to be with mixing with people. She

Score: is nervous and anxious in nature and is touchy. She gets easily conscious

E-13/24 in front of her supervisors. She usually finds difficulty in focusing on

N-16/24 something, she can put her thoughts into words quickly.

L-4/9

2. CSEF:

Points Analysis

History Observer with the help of history form had arrived at clinical understanding.

evaluation Observer felt that probably patient is of very emotional nature. PP had

anticipated from the complaints that boy might be having antisocial

activities, defiant behavior etc, and PP had anticipated difficulties such as

problems in opening up the patient. Same was the difficulty anticipated by

the observer.

Interview According to PP interview went on smoothly and was adequate. According

to observer, interview was smooth but was not adequate in exploration of

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emotional aspects. According to PP person turned out to be completely

different than what was expected. And rather was happy in the interview as

there were no emotional problems and it was more of an intellectual

problem. According to the PP patient is attached to mother but is very

intellectual and highly and ambitious in nature. PP felt that understanding

the emotional side of this person was lacking.

Doctor- PP was more like an elder sister and friend to patient.

patient

relationship

Sensitivity There were no sensitive areas as such. Observer even felt that PP did not

& have any major issues. According to PP she feels one thing that she is

Sensibility. focused more on the performance area, and overlooked the emotional

area which made an impact on his performance.this was because she was

impressed by the patient.

Technical Listening predominantly, questioning, confronting, etc. No blocks as such.

skills &

Blocks

3) LIFESPACE ANALYSIS:

Points Analysis

Childhood Father and mother‟s nature have been explored but how it impacts the

patient at the emotional level and how he reacts to there nature is not

explored. Similarly, his reactions to the scolding of teachers and way of

dealing with them is not explored.

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4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

structuralisation Mentals given prime

Totality: importance

Mind Anxiety anticipatory <winter2+ Other approach such as

Dreams of falling >hot drinks2+ Boenninghausen could have

Cr- Sweets2+ Stool been better suited as the case

mucus, was rich even in modalities.

Cr-milk2+ slimy white.

Cr- Icecreams2+

Cr-Spices2+

Group of remedies-

Ars, Phos, Sulph, Lyco, Nat. Mur.

Differentiation:

Performance oriented, hard working, goal

oriented, with sector of R.S and G.I.T.

Final remedy- Arg. Nitricum

Observer- Lycopodium

CONCLUSION:

PP is basically is of an introverted type. Observer too is of an introverted type.

But inspite of both being introverted predominantly, in this case we see both

of them vibrating at 2 different levels. PP seems to be not comfortable in

handling any sorts of emotional issues and hence in this case there were no

emotional or IPR issues at the conscious level. Moreover PP was highly

 221

impressed by patient‟s, performance oriented and ambitious nature. This is

probably due to identification at certain level where PP also is ambitious

nature. But PP does realize that more focus was given to this and emotional

aspects were neglected. According to observer the remedy is Lycopodium but

her totality is same.

Sr. No. Core perceived Reasons

Physician Observer

1) Anticipatory Almost same core perceived Both observer and PP

anxiety highly only remedy is different due are of similar

performance to her knowledge of personality type and

oriented and remedies. hence both arrived at

intellectual the similar totality

although both felt that

the emotional aspect

was neglected as

both of them were

impressed by the

patient.

Level of similarity- Similar

Follow ups: Follow ups awaited.

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CASE 25

Preliminary Data: O.P.D Reg.no. 769

Name- Mrs. RKE Age/Sex- 70yrs/Female Education- 4th pass

Religion- Hindu Status- Widow 2 brothers

Address- WET Children-4

Chief complaints:

Location Sensation Modalities Concomitants

1)Mind Sleeplessness3+ <anticipation3+

Since 3-4 months Constant

Almost daily thoughts

Thinks about

God, business <when they come

God, late2+

Anxiety about

children

Fear of alone

being2+

Fear of

something bad

will happen

Fear that her

disease will make

her disable2+

Forgetfulness3+

Sometimes >wearing belts,

 223

weeps2+ >allopathic

treatment.

2)M.S.S Pain, no stiffness

Knee joint, Cramps

Shoulders >OHA

Since 15-16years >Multivitamins

Daily

3)Pancreas DM type II

Since 20yrs Started as

weakness, >anti

tingling, hypedrtensives

numbness,

polydipsia

4)Circulatory Hypertension

System

Since many years

Patient as a person:

Appearance- Obese Wounds- Healthy

Hunger- can‟t tolerate3+ Cr- Salad3+, Spicy3+, Bitter3+

Av- Sweets2+ Urine- Burning on and off

Thermals- Chilly Fa/H- Nothing specific

Pa/ History- TIA, Piles

 224

Life Space: When patient was taken for case definition, she was not able to

tell her chief complaints properly as she was feeling too tired and sleepy. So

information was collected from patient‟s only son and daughter in law. Patient

was born & brought up at Kerala. She has two brothers & four sisters. She

studied upto 4th standard. Her IPR with other siblings were good, she got

married & shifted to Palghar. Patient and her husband dot did not have any

support at Palghar. Husband had a canteen. Patient was strong support for

him, she also started doing small jobs. She managed the financial crisis of the

family. She built a home. Started business of lodging & they got well settled.

She has four children (boys). Both patent and husband struggled so much to

bring up their childrens‟ careers. Now all the four children are well settled with

their profession & family. 1st child is a commando at Indian Air Force, and 2 nd

& 3rd child is at Singapor& Hong-Kong. The 4th son is with the mother &

looking after the business. During that period, she was very bold & dictatorial,

no fear of anything. She like to do administration, maintains all the accounts,

wants people to come & ask money from her. She was able to take her own

decisions & stick to it. Son says, he was a “Hitler” Nobody in the family can

contradict her. She will try to boss and make other listen. At the same time

she was sympethetic too. Helps whenever anyone approach her irrespective

of any relation. Joined hands together with husband in serving poor, in terms

of food and clothing. She helps & also expects from people the credit for her

help. Feels very better if any one says-patient-helped. Patient wants all work

to be done in home. The place should be neat & clean. Things to be arranged

at proper place if not, she will get angry and shout. if she feels people around

her not understanding, then she will weep. But many of the time everything
 225

goes as per her wish. During the marriage of the youngest son, at the

daughters –in –law‟s place(she was of own brother‟s days). It was said if MIL

says sun rises in the north, even then, it is wrong. After the marriage, there

used to be many times conflict between daughter–in –law & Patient. Patient

used to emphasise on her working pattern & time. Comment on it & quarrels

start. Patient always notifies daughters –in –law that she got married, son to

brother‟s daughters , wishing she would take better care of patient & family.

For which patient is dissatisfied & quarrels. Patient is religious since the

beginning. Has belief only on Lord Krishna. Always listen Bhajan & other

religious songs. Also insists others to listen. Provide them CD. & cassette.

Like to visit temple on always on regular basis. Likes to go for a pilgrimage.

Reads Bhagawat Geeta daily. But patient‟s son says that she behaves only as

per her wish. During these periods she develop multiple chronic complaints.

At 2003 patient‟s husband expired due to CA colon. As per patient and her

son, She was able to overcome this grief. It did not affect patient much. But

slowly, her functioning level came down. 3-4 years back, she had change in

her mental status as of now. Taken Treatment was better temporarily. Now, 3-

4 moths, patient is throwing totally opposite features what she before. She

become more attached to the daughter-in-- law, with whom patient used to

always fight. Worried about the children & business, fear ofillness & also

death. Yet desires death. Attach to all around. Religiousness is increased

and helping nature is also increased.

 226

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is female. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP doesn‟t like to be with mixing with people. She is

Score: nervous and anxious in nature and is touchy.

E-11/24

N-15/24

L-2/9

Observer: Observer is male and EPI Analysis shows that observer is predominantly

Extrovert Extroverted in nature. EPI analysis shows that he is basically happy go

Score: lucky, likes cracking jokes, is lively and an easy going person. But at the

E-18/24 same time he is organized.

N-12/24

L-2/9

2. CSEF:

Points Analysis

History Not much of the data available, but it was known that patient is 70 years

evaluation old female and hence PP was in anxiety that whether she would be able to

understand her problems.

Interview Overall case taking went on smoothly. PP and observer felt that there were

no major difficulties. After the interview PP felt that she had received the

case very well. For patient she felt that Patient is basically anxious, fearful

person, attached with the family. Also she is money minded and desirous

of position in society as well as home. According to the observer Patient

 227

was very much attached, sympathetic and at the same time egoistic.

Doctor- Patient had became like a grandmother and PP was a grand daughter to

patient her.

relationship

Sensitivity PP became sensitive momentarily for patient‟s husband‟s death and early

& financial responsibilities that she had to take. But PP did not get stuck up

Sensibility. there and handled her sensitivity very well. And moved ahead further to

explore other issues. Observer also did not feel any major issues where

PP became too sensitive.

Technical Most of the times it was receiving that was done and at times questioning.

skills & No confrontations done and only received the case. Her blocks were

Blocks sensitivity regarding the early responsibilities of the patient. But this block

did not last for longer time as PP consciously kept herself on guard from

going into this.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not PP did not explore anything about the IPRS with husband, Upbring and

explored. childhood IPRs with her parents, If she is so good with work then area of

her education stands important which is not explored.

 228

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach(PP) PP has used kentian approach

Anticipatory anxiety3+ <contradiction2+ as there are few qualified

Attachment for money2+ <insecurity2+ mentals and few characteristic

Attachment for power2+ Thermal- Chilly physical generals, observer too

Cr-spicy2+ Cr- Bitter2+ perceived the similar totality

Av-Sweets2 hunger can‟t tolerate3+ and both of them arrived at the

For differentiation considered her aspect of remedy Causticum

sympathetic and helping poor.

CONCLUSION:

PP is introverted in nature and observer is extroverted according to EPI

analysis. PP was anxious at the start of the interview as patient belonged to

geriatric age group and she was nervous as was not sure as whether she

would be able to understand the problem. But this did not last longer as PP

went ahead with the interview confidently. There were no major blocks that

have hampered the case taking. But there were certain areas which remain

unexplored and this brings difficulty in understanding the dispositional

qualities. But this exploration was not done as PP was in receptive mode due

the relationship formed of grandmother and grand daughter. But inspite of this

PP felt that the understanding she has got about the patient is adequate. In

totality formation PP uses Kent‟s approach and arrives at the remedy

Causticum. But PP not able to differentiate the other remedies such as Kali

carb, Lycopodium which were the other possible remedial correspondences.

 229

The understanding of Causticum in this patient is based on interpretations and

not on any hard data. Observer being extroverted in nature perceives almost

same picture and feels Causticum to the possible remedy again because he

finds her sympathetic. This again is based on interpretation rather than hard

data.

Sr. No. Core perceived Reasons

Physician Observer

1) The core The core perceived PP and observer both were

perceived was sympathetic interpretative in nature, PP has got

was mainly nature with anxiety sensitized and got impressed with

attachment and attachment all the way Patient has lived her life

with the family directed towards and and hence no other exploration

and anxiety of for the family was done.

money with

helpful

behaviour

Level Of Similarity- Similar

Final remedy: Causticum

Follow ups:

Sr. No Date Follow Up Action

1) 20/6/11 Sleeplessness++ Anxiety++ Causticum200 1 dose

Lumbar pain++, Finger and placebo for 1 week.

2) 9/6/11 cramps++ Thuja 200 1 dose

Sleep improve, followed by Causticum

Anxiety/thoughts SQ, lumbar 200 1 dose and placebo

 230

3) 16/6/11 pain SQ, Finger cramps SQ for 1 week

Sleep Normal, Anxious Causticum 1M 1 dose

thoughts reduced2+ Lumbar and placebo for 1 week.

pain and finger cramps

reduced2+
 231

CASE 26

Preliminary data: O.P.D. Reg. no-845

Name- Mr. RCN Age/Sex-56yrs /male Status- Married

Education-HSC ITI Occupation- Operator Religion- Hindu

Spouse- House wife , 2 brothers, 2 sisters, 1 son, 1 daughter.

Chief Complaint:

Location Sensation Modalities Concomitants.

1)G.I.T Retrosternal >after food3+ App reduced

Since 1 month burning2+ <after fasting3+ Thirst reduced

D- infrequent No nausea,

vomiting,

abdominal pain.

Fullness of <after food2+

abdomen >fasting3+

2)Mind Loss of interest in

O-sudden work, lack of

D-whole day motivation feeling

Since many years Lack of any <thinking2+

desire to talk <anticipation of

Forgetfulness2+ future2+

3)M.S.S Pain <walking3+

Heel As if something <pressure2+

Right side going inside

 232

Patient as a person:

Appearance- Black complexioned, with spectatcles, Round face with smiling

expression

Perspiration on face back and abdomen. Wound healing delayed

Av- Chicken2+, fatty food2+, smell of milk2+ Cr- salty2+, seasoned

food2+

Stool/Urine-normal Sexual function- normal

Thermals-chilly Sun <2+- headache.

Sleep- disturbed due to anxiety. Dreams- nothing specific.

Fa/H- Sister- DM, Mo-suicide due to depression Pa/H-N.S.

Life space: Patient is basically from Kerala, settled in Boisar since many

years. He has good IPRs with everyone. His childhood was good. He had

studied upto HSC but after that did not continue his studies as his father did

not give him money. His father would scold the Patient and hence he decided

to work in fields so that he can earn money for his daily expenses. He started

earning and spending for himself and would give some money even to his

mother. Then he came to Mumbai as his uncle works here. He did diploma in

ITI and started working as a welder in initially, then as an operator. He was

satisfied with his work. 1 month before in his company they have appointed a

junior on a senior post. After this incidence patient felt very bad and about this

and he even took a leave for one day and since then started losing his interest

in his work. He felt very angry about this, but he did not express anything from

this. He started getting all his complaints since then. Basically patient is

reserved doesn‟t share anything to others whatever he feels to anyone. He

says if we share what we suffer then others will also suffer. He would keep
 233

thinking for 1-2 days if anything happens bad. He never likes quarrels and did

not speak with anyone even if someone would oppose him. He leaves it as

he fears unnecessary quarrels, so he avoids such situations. He will not talk

with a new person as would think what opposite person would feel about him.

Patient had conflicts with his siblings, as he and his brothers had tiffs

regarding the property issues. So he rarely goes to his native place. His father

expired 3 months back (natural Death), mother expired due to suicide as she

was in depression. He has good relationship with his wife, daughter and son.

But at times there would be some minor tussles with his wife and then his

voice would get raise. But then he would keep quiet. He was worried that his

son doesn‟t listen to him as he took engineering instead of MBA.

Observation- Patient did not have proper eye to eyen contact and was slightly

reluctant.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is female. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP doesn‟t like to be with mixing with people. She is

Score: nervous and anxious in nature and is touchy. She gets easily conscious in

E-13/24 front of her supervisors. She usually finds difficulty in focusing on

N-16/24 something, she can put her thoughts into words quickly.

L-4/9

Observer: Observer is male and EPI Analysis shows that observer is predominantly

Extrovert Extroverted in nature. EPI analysis shows that he is basically happy go

Score: lucky, likes cracking jokes, is lively and an easy going person. But at the
 234

E-18/24 same time he is organized and analytical.

N-12/24

L-2/9

2. CSEF:

Points Analysis

History From the screening available, patient PP arrived at an understanding that

evaluation mainly patient has GI complaints and brooding mood, both needing to be

evaluated.

Interview Both PP and observer did not anticipate any major difficulties. PP had

planned to start from the preliminary data to chief complaints and then to

the life space. PP was not able to explore the life space adequately and

feels that he was not getting any direction as to how and where to proceed.

According to observer PP had adequately explored the chief complaints in

view of clinical diagnosis but many areas in the life space were

inadequately explored.

Doctor- According to PP it was completely a professional relationship. According to

patient observer good rapport was formed but no specific relationship as was

relationship established.

Sensitivity According to observer PP had got sensitized with the childhood which was

& deprived area in patient, but according to PP she was sensitized due to the

Sensibility. fact that she was not able to elicit the data from a non communicative

patient. Her own anxiety due presence of observers and then this patient

made her very sensitive. She was not able to handle her sensitivity well

leaving many areas superficially explored.

 235

Technical Different skills used were listening, exploration, questioning, blocking etc

skills & according to the demands of the case. But since the patient is not very

Blocks much communicative most of the time it was questioning that was used.

The blocks that were felt by the PP was her own anxiety. According to the

observer it was more of sentiments regarding the childhood.

3) LIFESPACE ANALYSIS:
Points Analysis

Childhood Hardly any circumstances and his behavior pattern has been explored.

Work area Work area with respect to current state has been explored but nothing

about his working patterns or his in general interactions with his juniors

and seniors has been explored.

Family His IPRS with his mother and father have not been clearly explored,

impact of their death etc, not mentioned.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach. Mentals given prime importance

Totality: Other approach such as

Egoistic3+ Chilly Boennighausen could have

Brooding3+ Perspiration- white3+ been better suited as the case

Suppressed emotions3+ Av-Milk3+ was rich even in modalities. Lot

Reserved3+ Av- Chicken3+ of Hard Data neglected such as

Timid3+ Cr- warm food3+ wound healing delayed, sleep

Fear of quarrels+ Cr- Spicy food3+ disturbed due to anxious

Sun exposure3+ Winter<3+ thoughts, characteristic

 236

PDF: modalities.

From above totality PP considers following Group of remedies according to

as PDF Symptoms.: PP- Silicea, Calc. carb, Merc,

A/F egotism Sulphur.

Winter <3+ PP had not even thought of

Final Remedy(PP)- Lycopodium. Natrum Mur as a differential

Observer- Totality remedy.

Strict upbringing, Reserved3+, Egoisitc, Final remedy(observer)-

Sensitive to hurts3+, and physical generals Natrum Mur.

covering Natrum Mur, Except thermals Final Remedy(supervisor)-

chilly. But patient too is not outright chilly. Natrum Mur.( Based on

understanding same as that of

the observer) with that also

considering sentimentality and

suppressed emotions.

CONCLUSION:

PP of this case is basically of introverted type, and observer being extroverted

type. PP from the outset itself was anxious and nervous, due to presence of 2

observers and patient being egoistic and reserved adding up to PP‟s

nervousness. As a result of this PP somewhere felt intimidated and this

feeling PP was not able to handle and continued throughout the case taking.

Her totality formation also reflects this where she perceives patient through

only mentals she got influenced with that is Egotism, and feels patient is

avoids quarrels, and that he is conscious about what people thinks. PP gave
 237

prominence to this and without any other supportive data she came upto the

remedy Lycopodium. Observer considers all these symptoms and with that

considers the evolutionary understanding along with physical generals and

hence arrives at an integrated understanding of patient. But he does not

consider the hard data of modalities. Supervisor also considered the same

and both seem to be being more analytical and were not under any influence

or not too sensitized by any issue unlike PP while perceiving the patient.

Sr. Core perceived Reasons

No.
Physician Observer
1) Egoistic but Basically reserved PP by her nature had become

fearful by nature and brooding type very much anxious and that state

with suppressed was persistent missed the

emotions. evolutionary understanding.

Level of Similarity: Different

Follow ups:

Sr. Date Follow ups Action

No

1) 5/11/11 App-good, thirst normal, mood SQ, Natrum Mur. 200 1

Sleep disturbed. Thoughts++ dose placebo for 1

week

2) 12/11/11 App/ Thirst- Normal Sleep improved, Placebo for 2

Thoughts reduced++ Overall looking weeks

cheerful
 238

CASE 27

Preliminary data: O.P.D. No.- 5784

Name- Mrs. BAB Age/Sex- 30yrs/female Education- Illiterate

Status- single Religion- Hindu Occupation- in house

3 brothers, 1 sister, Fa- 75yrs, Mo-70yrs. Address- Satpati

Chief Complaint:

Location Sensation Modalities Concomitant

1)Head Pain2+ A/f- Hitting of Anxiety2+

Occiput to Throbbing glass door on Ghabrahat2+

Shoulder head No desire to eat

<touch2+

<talking2+

<exertion2+

<movement of

2)Back Dull pain head2+

Costal margins <touch2+

1.5yrs <lying down2+

3)Mind Ghabrahet2+ Weakness

Anxiety2+ that <alone2+ Reduced sleep2+

she will become Cannot work due

sick to these thoughts.

Cannot sit alone,

feels as if she will

die.
 239

Patient as a person:

Appearance- Dark, lean, thin, with anxious look.

Wound- healing normal

Perspiration- general- Scanty, more on forehead, back

Cr-sweets2+, spicy2+ Av- Sour2+

Stool/Urine- normal Thermals- Chilly

Menstrual Function- Regular cycles, moderate flow, no odors, pain in

hypogastrium before menses

Leucorrhoea, 2-3 days after menses Sun < headache.

Life Space: 30 yrs old female came for case definition, she is illiterate, living

alone with her mother, 2 brothers. They are basically from fishing community

and belong to Satpati. She has not gone to school as 25yrs back her father

had expired and there were financial problems. Her father and mother are

good in nature and there were no IPR issues. The family financial conditions

were not good but somehow got managed and patient did not have to bear

any direct stressors of this. Her brothers also did not study and elder brothers

and elder sisters have got married by now. Her brothers would do fishing and

would come once in 15 days. She is comparatively pampered in the family

and gets angry on contradiction. She occasionally help in household work,

she does not go out much and does not interact with people. She has anxiety

and going to new places, and meeting new people. She wanted to go to work

but her brothers, first reluctantly said yes and then she joined the company

and worked their for 2 months, during that period she got injured from a

trauma due to falling of a glass, from that incidence she did not go for work.

Her brother also said that she need not go for the work. She started staying
 240

home and mostly started watching T.V, she would hardly do any house work

and would hardly help her mother in any work. She says she wanted to do

work as all her friends of her age go for working and she cannot go because

of her illness. 13 yrs back she had an affair with a boy and he was his

brother‟s friend and the love was both sided. But boy was not ready to talk

with her [arents as he knew that they would say no and his relationship with

her brother may get spoilt. He asked the patient to runaway with her. But

patient was not willing to runaway as then this would mean hurting her people

and if some problem happens in future and she might need their help then

they would not help them. So she said to him that she is not interested in him

and they broke up. But this did not have as such any impact on her. Now she

is having anxiety that something serious might have happenend to her after

her injury and that some vein might have got ruptured inside and hence is

anxious that something might happen to her and she will die. She fears to be

alone and needs company gets angry on contradiction, she has fear of dark

and is religious by nature and gets frightful dreams.

ANALYSIS:

1) PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP likes to be with mix with people. He is nervous and

Score: anxious in nature and is moody, may at times get restless and does not

E-11/24 know exactly what he wants, often find difficult to express what he feels into

N-20/24 words, gets lost in thoughts.

L-2/9
 241

Observer: Observer is female and Introvert by nature according to EPI analysis. She is

Introvert very moody, touchy, doesn‟t like to mix with people. She is very focused

Score: and knows what she wants to do, can integrate things quickly.

E-5/24

N-12/24

L-2/9

2) CSEF:

Points Analysis

History No history form available, to interpret anything.

Evaluation

Interview PP had planned to first to elicit Chief complaint then physical generals and

then the life space. According to the PP the interview went as per the plan,

but it was inadequate as regards to certain areas where PP was not able

to explore her feeling states. Observer also felt that PP was not able to

explore the exact feeling states of the patient. After the interview the

patient understanding according to the observer was that the patient is

submissive and very reserved. PP did not arrive as such on any person

diagnosis as in some areas PP was able to reach the expressions and

feeling states but in some areas was not at all able to reach the feeling

states.

Doctor- According to PP initially patient was formal, but as the interview

patient progressed ahead, PP was able to form a Brother sister relationship.

relationship According to the observer Patient was trying to form a relationship right

from the start but PP somehow was not receptive in that stage.

Sensitivity PP did not have any major sensitive issues but PP had constantly a gut
 242

& feeling that something is hidden inside but was not able to elicit exactly

Sensibility. what it was. PP had got sensitized with the love affair and became anxious

that Patient may not be comfortable to narrate about this. The same was

felt by the observer. PP hence was not able to go into depths of such

Technical issues.

skills & PP used lot of Questioning and did not receive the patient when required.

Blocks PP seemed to be blocked as he was not able to elicit the data he wanted.

This had made the PP anxious. According to observer, PP was trying to

get the data that he wanted, he was not going according to the patient.

Many times same questions were asked again and again. Observer also

felt that PP took a long time in forming relationship with the patient and

hence it later became difficult to elicit the data.

3) LIFESPACE ANALYSIS:

Points Analysis

Areas The area of love affair and the details regarding it mentioned in the life

not space were asked by the observer. PP had not enquired much into it. PP

explored. had not explored into the expressions and feeling states. Similarly the

areas of her marriage was not at all explored.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Approach-Kent‟s approach Here kent‟s approach was

Anger<contradiction2+ Dreams- religious3+ taken by PP. PP relied on

Anxiety <anticipation2+ Dreams- Frightful2+ Mentals which he has not really

Irresolute2+ Cr-Spicy2+ understood in depth, and was

 243

Obstinacy2+ Cr-sweets2+ depending highly on his own

Fear<alone2+ Av-Sour2+ interpretations.

Fear Perspiration-scanty

<impending Disease2+ Observer had considered the

Sensitive reprimands2+ same aspects of physical

Final remedy(PP)- Silicea generals, and arrived at the

Totality- Observer- core of Submissive and fearful

Anxiety, fear of impending disease2+ nature with dependency after

Reserved2+, dependency. exploring certain areas and

Submissive and above mentioned physical hence had got evidences for

generals the same, unlike observer who

Impression- Calc. Carb arrived at the other aspects

such as obstinacy and

irresoluteness which was highly

based on interpretations.

CONCLUSION:

PP is predominantly of an introverted type and observer is of predominantly

extroverted type. PP took a long time to create rapport with the patient.

According to the observer also PP was not in a state to receive the patient

when in the initial part she was trying to share things. This was because PP

was not somehow comfortable in the case and that initially he was more

focused in eliciting the data from the patient which he wanted and was more

focused on recording the data and hence was not in the flow with the patient.

According to the PP also he was not able to elicit the expressions and feeling
 244

states of the patient as he was somehow not able to reach the depths, making

him anxious. In the final understanding of the patient and the totality formation

PP has been very much interpretative especially while deriving attributes such

as irresolute which has hardly any evidences and has taken the Kentian

approach. Observer on the other hand has tried to explore after PP had

finished the interview and then after seeking for evidences PP has arrived at

the understanding of fearful, submissive nature with a sensitivity for

reprimands and hence the remedy Calc. Carb and possible differential

remedy as Calc. Silicata. Supervisor also perceived the similar totality and

hence Final remedy was Calc. Silicata.

Final remedy: Calc. Silicata

Sr. No. Core perceived Reasons

Physician Observer

1) Anxiety Submissive and PP was not able to explore the

with fearful with issues right from the start possibly

irresolutene reservedness and due to his introverted nature. He

ss sensitivity to has been interpretative without any

reprimands. strong evidences. On the other

hand observer who is of an

extroverted type has been able to

perceive core with interpretations

base on evidences.

Level Of Similarity: Different

 245

Follow ups-

Sr. No Date Follow up Action

1) 1/11/11 Anxiety++, head pain++, Placebo for 1 week

Generals – normal,

weakness Case defined

2) 8/11/11 Anxiety >50%, headache Calc. Silicata 200 1 dose

>50% and Placebo for 1 week.

Weakness SQ
 246

CASE 28

Preliminary Data: O.P.D. Reg no.-527

Name- Mrs. SHS Age-35yrs/female Education-illiterate

Religion- Hindu Fa and Mo- Farming Occupation- Textile industry

1 son, 3 Daughters Married, 17yrs. Address- AXC

Chief Complaint:

Location Sensation Modalities Concomitants

1)Chest Itching pain >Balm Appetite-

Retrosternal Radiating pain application3+ reduced2+

region Tingling >Rubbing2+

Since 4-5yrs numbness <winter2+

O-gradual <lifting heavy

D-since 6 months weight2+

F-on and off >cold drinks2+

2)Abdomen Burning, no >after eating2+

Epigastrium nausea, no <empty

Since 1month vomiting, no stomach2+

flatulence, no

eructations.

3)Mouth,teeth Halitosis2+

O-gradual Pain2+ <eating hard

D-since1yr Offensive things2+

P-once/month discharge from >hard pressure2+

gums. >applying neem

oil2+
 247

Patient as a Person:

Appearance- Average built, fair complexion. Hunger<2+

Cr-sour3+ Av-curd2+,milk2+ Stool/urine- Normal

Menstrual function- regular, fishy odour2+, scanty, backache 1 day before

menses.

Sexual Function- reduced Thermals- Chilly

O/H- G6P4A2L4 2 spontaneous abortions.

Sleep- Startles during sleep 2+

Life space: A 35 years old female having average built and average height

with wheatish completion, wearing black sari and having bindi on forhead &

vermilion above it came with c/o retrosternal burning & chest pain. she was in

hurry to go to home due to her 'train timing & basically she had come for the

follow up of her daughter in paediatric department. So, she was much

concerned about the daughters health & neglected herself as she came for

case defination after one and half month & also there is financial problem.She

is working at Boisar in textile industry in packing department & her husband is

working at another company in dying department. Her husband does not go to

duty properly. She says that her husband is really lazy and sleeps for 24

hours, is drunkard and hits children when drunk. Because of his irregularity of

duty, she has to earn money and take care of family . if she speaks anything

to him, then he goes out for drinking alcohol, and comes late night at home,

he beats her, then patient weeps and thinks of doing suicide but she never

attempted because then she feels if she woulkd die then who would take care

of her children.
 248

She has a daughter and one son, when she was at her in-laws family, after

marriage. for initial days, even things was ok, but when her sisterinlaw‟s

husband died, then she came there & asked patient to leave home. Then

patient's in-laws told them to leave home, so patient went to maiden family

along with her husband & started living there & mother was also taking care of

them previously. Her husband used to do farming, after few months patient

along with husband, decided to leave for mumbai. for earning as they thought

it is not good to stay at her mother‟s place for too long. Then they came at

mumbai but husband does not got to duty properly, does not look after family.

Even patient told that when she was in village for initial days, in-laws were

good but due to the lazy behaviour of husband, they started behaving rudely

with patient and they were not giving food properly. Her mother in law would

say that there are many people to eat , but since her husband would not earn

she would taunt her and finally threw them from house. Whenever husband

beats her, she weeps & doesnot give back answer, because she said

ultimately, husband is considered to be God, and now it is my destiny to live

with him. She also fears her husband.

ANALYSIS:

1) PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. PP like to be with mix with people. He is nervous and

Score: anxious in nature and is touchy, often find difficult to express what he feels

E-11/24 into words, gets lost in thoughts.

N-20/24
 249

L-2/9

Observer: Observer is female and Introvert by nature according to EPI analysis. She is

Introvert very moody, touchy, doesn‟t like to mix with people. She is very focused

Score: and knows what she wants to do, can integrate things quickly.

E-14/24

N-17/24

L-2/9

2) CSEF:

Points Analysis

History From the data available from the screening it was understood that patient

evaluation has many family issues. Hence PP had decided to start the interview with

this issue.

Interview According to the observer patient appeared to be mild, sensitive, innocent.

Observer had anticipated possible difficulty of language problem. But as

PP had not anticipated any such difficulties. PP felt that interview was

inadequate especially PP had missed important data such as past history,

family history, dispositional data, childhood etc. Person understanding after

the interview according to PP was responsible, angry and vexed, fearful

and anxious. According to observer patient is mild, sensitive, helpless.

Doctor- According to the PP the relationship was that of a doctor-patient

patient relationship and was very much professional, the rapport formed was

relationship good. Observer also felt that it was a professional relationship.

Sensitivity PP had got highly sensitive on the issue of fights of husband, and her

& sufferings due to her husband. According to observer also PP had got
 250

Sensibility. very sensitive about the fact that patient was suffering and would even had

suicidal thoughts. PP‟s technical block was the language problem and

stammering. Apart from that PP had become anxious as patient wanted to

go early and he had to finish the interview in short time. Moreover he got

sensitized by the husband‟s issue and hence due to both the anxiety and

the sensitivity patient was not able to explore and elicit the data

completely.

Technical Receiving, was the technique mostly used. Apart from that questioning

skills & was also done. According to the observer PP was good in using technical

Blocks skills especially, where he would pause and give patient to recover when

she would start weeping.

3) LIFESPACE ANALYSIS:

Points Analysis

IPR with Patient‟s most sensitive issue was about the husband. Hence she herself

husband communicated that with him. PP was also sensitized by that issue to such

extent that he very well explored it but was not able to move away from that

issue neither was able to block patient in this and explore the other aspects.

He was also anxious about the time management and hence forgot to elicit

hard data such as family history, past history.

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Approach-Kent‟s approach Here kent‟s approach was

Anxiety, children about Av-milk2+ taken by PP. But presence of

 251

Anxiety, future about Cr-sour2+ characteristic modalities and

Suicidal disposition Hunger <2+ Physicals means

Starts sleep during vomiting, milk after Boenninghausen approach

Fear, death of could have been more suited.

Abortion, 3rd month recurrent. PP relied on Mentals which he

Remedies coming up in repertorisation- has not really understood in

Phos, sulph, Calc. Carb, Sepia, Kali carb, depth, and missed out on

Silicea. important physicals in case.

Final remedy(PP)- Sepia. Observer had considered the

Final remedy(observer)- Sepia same totality and in addition to

this she explored the sexual

data which was missed out and

where it was found that sexual

desire right from start has been

less to nil. With that occupation

amelioration was considered

and hence remedy was Sepia.

CONCLUSION:

Both PP and observer are of predominantly introverted types. But there is

difference in them as regard to the confidence level, spontaneity and ability to

be focused and integrate the things. PP being basically anxious and nervous

got easily sensitized with the sufferings of the patient and later was not able to

block. He forgot to even elicit proper LSMC, sexual data etc. PP and observer
 252

both arrived at the similar totality and patient understanding but PP in his

processing was interpretative whereas observer was more evidence based.

Supervisor is basically extroverted type, and he preferred to prescribe on

physical data as there were lack of qualified mentals.

Sr. No. Core perceived Reasons

Physician Observer

1) Anxiety with Anxiety with suppressed PP and observer both

suppressed emotions emotion and integration are of similar

with the one who has with the physical data personality type and

been working a lot hence both arrived at

but has not got any the similar

returns. understanding. Both of

them have been very

much interpretative in

their understanding.

Level of similarity- similar

Final remedy: Sepia

Follow ups- awaited.

 253

CASE 29

Preliminary Data: O.P.D. Reg no- 342

Name- Dr. Mrs. TGH Age/Sex-33yrs/F Occupation- Works in hospital

Education- B.S.C. PT. Religion- Hindu Mali Status- married

Add- DFG Husband and 4 yrs old Son

Chief Complaint:

No. Location Sensation Modalities Concomitants

1) R.S. < rainy season 3

Nose Difficulty in < cold drafts 2

O – sudden breathing2+ < bending down 2

D – since 6 – coryza2+ < loss of sleep 3

7 yrs Sneezing3+ < change of

P– climate

progressive Diagnosed as > sleep

(gradual) Nasal Polyps from > allop.Rx

F – off & on CT Scan > hot drinks

Patient as a Person:

Appearance- Tall fair, medium built

Stool/Urine- Normal Perspiration- Moderate face, axilla

Hunger aggravation2+ Cr- Sour2+ Av- Sweets2+

Wet getting <2+ Cold Air<2+

Thermals- Chilly

Menstrual History- H/O irregular menses, now regular, monthly moderate

flow.but abdominal pain3+

 254

Pa/H- PCOD, O/H- G2P1L1A1 G1-3rd month SPAB

G2- FT caesarean delivery due to prolonged labour

Fa/H- Father-IHD

Life Space: Patient is 31 yrs old female. Physiotherapist by occupation

residing at Mdf, belonging to high socio economic class came to OPD with

chief complaint diagnosed to be of nasal polyps. Patient brought up in , in

family of her father, mother & 2 younger sisters, she being eldest of all.

Patient since childhood was very much focused in her studies, always

maintained an opinion about herself that she has a very good intellectual

capacity do as to attain a particular level. Her father & mother aren„t highly

qualified but they had always encouraged them to pursue studies. Since

childhood, patient has concept of space in her life. By this she means when

she is with herself she doesn„t like anybody„s intrusion. She has been very

particular about her study place, her study timings, environment without has to

strictly calm when she is studying or the she gets much irritated. She feels

that since childhood. Although didn„t had as such any stressors but still

constantly felt that she lacked emotional support & understanding. When

asked as to what & why she felt so, she says that, she always wanted to be

listened to alter without being labeled upon. But her parents never gave her a

patient ear & have an opinion about her, if she being stubborn, & wasn„t he

person who could ever become part of typical Indian family setup. The ward

typical for her means, family where in – laws, husband as dominating, and

predominance of gender, female expected to do everything perfectly. Patient

is ambitious by nature & wanted to reach a certain „level„ of education as well

as good financial status. Throughout her school she was a good student
 255

scoring up to 79% in 10thstd after that she took up science & then further did

graduation in B.Sc. Patient as she didn„t wanted to go far MBBS, reason

being that she wanted such a job with which she would be comfortable in

managing her home and work as well. Patient got married at the age of

around 22yrs, in higher class with her consensus. When asked about

relatively early age of marriage, patient says that at that time she didn„t feel it

as an obstacle for her ambition as the in laws family didn„t had problems with

she pursuing her education. But post marriage she found the picture to be

different. Her husband was Mama„s boy„, & although initial days were fine, still

her MIL would want her to work in house do cooking etc, which patient was

never willing for. She had her own ambitions. By then she was working in high

profile hospitals had good clinic, & hence thought of pursuing her education

abroad. Since the level of education there is always better & more over felt

that pay scales given to physics were not good enough. She had very strong

drive for that but due to some immigration problems things didn„t materialize.

Apart from that her husband who is B.A. economics didn„t had much scope in

abroad & wasn„t very supportive to her. There is a communication block

between her & husband. This is happening because she is a person who

speaks only to the point & her husband according to her is quiet elaborative

which she can„t bear. More over her husband as she feels is not very active,

lazy as compared to her & at times behaves as a typical Indian husband by

putting same amount of restrictions on her e.g. Regarding going to mother„s

place etc. creating tussles between them. In such situations she is very

straight forward & speaks out openly whatever it is especially when she

knows that she is right. She had similar tussles with her in laws, where she
 256

felt that her FIL was too proud of his family & was egoistic. Her MIL too would

intrude in her „space‟ on small issues of her son„s meals etc. when she felt

that all there relations & tussles are affecting her IPR with husband. She

decided to separate out from family which she actually never wanted as she is

a family oriented person. Her pregnancy was a sudden event, and in a way

first did feel as an obstacle to her career but then again felt that far medical

reason it was right time to have a baby. Post delivery she left full time job from

Hospital & joined part time job in a hospital but still she is keep to continue

further studies, if possible. According to patient since childhood patient has

been facing many obstacles as regards to her academics but most of the

times she has overcome the difficulties & has been able to move ahead. But

still patient has a feeling that she has not been able to achieve what she was

capable of. Overall patient feels that whatever has been her past she has

been able to handle the things but still there is an attitude of whatever

conflicts she has now will always remain and hence has stopped thinking

about it.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is Female by gender EPI Analysis shows that observer is predominantly

Introvert introverted in nature. EPI analysis shows that she is basically moody, and

Score: like PP doesn‟t like to mix with people, worries for a long time , gets

E-5/24 anxious, is very much sensitive and touchy.

N-12/24
 257

L-2/9

Observer: Observer is male and EPI Analysis shows that observer is predominantly

Extrovert Extroverted in nature. EPI analysis shows that he is basically happy go

Score: lucky, likes cracking jokes, is lively and an easy going person. But at the

E-18/24 same time he is organized.

N-12/24

L-1/9

2. CSEF:

Points Analysis

History A long history form was given by the patient and PP got nervous right at

evaluation the start after seeing so much of issues in the history form itself. From the

history the first impression formed by both PP and observer was that

patient is sincere, hardworking, but disappointed.

Interview PP was anxious throughout the interview. Her focus was to just explore

feeling states of the patient in the events that patient has mentioned.

Overall the interview went on smoothly according to both PP and observer.

Most of the areas were adequately explored.

Doctor- PP created a very good rapport with the patient and she was almost like a

patient sister to her in the interview. Observer also felt that a good rapport was

relationship created between both of them.

Sensitivity PP had become slightly sensitive and had identified with the patient so she

& accepted whatever patient said and hardly did confront or questioned. PP

Sensibility. by nature had become anxious but did not let her anxiety affect the

interview. Also many time PP felt that she had identified with the patient

Technical Recieving was mainly utilized by the. No significant blocks were identified
 258

skills & by PP and observer.

Blocks

3) LIFESPACE ANALYSIS:

Points Analysis

Areas not Most of the areas were explored.

explored

4) TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Boenninghausen‟s approach PP was anxious throughout the

Contradiction agg<3+ Cr sour2+ interview although tried not to

Hunger aggravation2+ Aversion- sweets3+ hamper the interview. Most of

Cold air <2+ Thermals- chilly the data in life space shows

Getting wet<2+ Mentals- more about the dispositional

Rainy season <2+ Irritable3+ qualities. There are good

Reserved number of characteristic

Group of remedies- Silicea, Sepia, Arsenic, modalities.and hence This

Phos etc approach was selected.

PDF- H/O spontaneous abortion, Prolonged

2nd stage of labour, H/O irregular menses

PCOD, Independence, concept of space,

Ambitious

Final remedy (PP)- Sepia

Totality Observer (Observer)- same as PP

Final remedy (observer) - Sepia.

 259

CONCLUSION:

PP is basically introverted in nature and in this case at the start PP was

nervous as regards to the interview. But PP did not let her anxiety get

reflected anywhere in the interview. She was focused as to what and how she

was going to about with the interview and what points she was going to

explore. Hence Most of the areas were explored. PP while formulating totality

preferred to consider the hard data and went by Boenninghausen approach.

But for final remedy differentiation she was interpretative as regards to some

points such as ambition, independence etc. Observer also perceived the

same totality and arrived at the same remedial understanding.

Sr. No. Core perceived Reasons

Physician Observer

1) PP perceived the Observer also perceived the PP and observer both

core to be of an same understanding of the have different type of

independent patient. personalities but PP

ambitious female in this case have

who has also hatred been evidence based

about gender and observer by

differences nature is so they

arrived at similar

totality.

Level Of Similarity: Similar

Final remedy: Sepia

 260

Follow ups:

Sr. Date Follow ups Action

No.

1) 1/4/2010 Coryza2+, Sneezing3+, Sepia 200 1dose

Noseblock2+

Generals normal Sepia 0/1 3P weekly

Coryza reduced, sneezing SQ, and placebo for 2

2) 8/4/2010 Noseblock SQ, dysmenorrhoea ++ week

Coryza reduced 3+, Sneezing Ct all for 2 week.

reduced, no nose block Generals

normal
 261

CASE 30

Preliminary Data: O.P.D. Reg. no.- 836

Name- Mrs.SKA Age/Sex- 43yrs/female Status- Married since 22yrs

Religion- Muslim Education- D.Ed Occupation-House wife

Fa- expired 4yrs back , mo- 65years 1 sister, 1 brother , 2 sons

Add- MJH

Chief complaints:

Location Sensation Modalities Concomitants

1)M.S.S. Pulling pain2+ A/F lifting weight

Lower and dorsal No radiculopathy < exertion2+

back Feels disc will <long standing2+

Since 16yrs prolapsed if does <Flexion2+

O-sudden not use belt >warm

D-continuous Stiffness2+ fomentation2+

P-Progressive >lying right

lateral2+

< prolonged

sitting2+

2)M.S.S Electric current <exertion2+

Bilateral knee like pains2+ <movements2+

joints Swelling+ >rest2+

Rt>lt Stiffness2+ >warm

No redness fomentation2+

3)Endocrines

Pancreas Diagnosed as DM
 262

O-gradual type 2

P-Progressive No complaints at

D- since 1 year present

4) Metabolism Obesity A/F- first

Since 22yrs. Weight now is 87 pregnancy

kg

5)F.R.S Profuse bleeding <2nd, 3rd, 4th day

Menses with clots >hard pressure2+

Since last 2 >tight bandage2+

cycles.

6) Ear Severe pain3+ >looking

2-3 months Heaviness2+ upward2+

No nausea, no <5pm onwards till

vomiting night2+

Patient as a person:

Appearance- fair, chubby, round face, smiling and laughing,

Cracks- heels3+, no bleed Perspiration- Scanty

Cr-sweets3+, prawns3+ Stool/urine-normal

Menses- 25-26 days cycle, no odours, no stains, no clots, before marriage

had severe colicky abdominal pain.

Sexual function- normal Thermals- hot

O/H- G4P2A2L2 2- induced abortions, 1 L.S.C.S , 1F.T.N.D

Fa/H- Fa- D.M. Pa/H- history of renal calculi, typhoid

Life Space: Patient appeared very vivacious and she was sitting on chair with

confidence and while she was talking, there appeared to be some ego in her.
 263

She was born in Calcutta and at 5 years of age whole nuclear family shifted

to malad ( in jungles). Here, she had many pets like hens, chidis, goats, and

she loved them a lot. She had brother, elder to her and a younger sister with

whom shared good IPR. Her father had small business and he was calm and

loving. He always supported patient and so she was more attached to him.

Financially they were not very well off but were able to sustain well. Mother

was little orthodox and always made distinctions between boy and girl. She

supported patient's brother always, gave him best food, more time for studies

etc. whereas patient has to manage had to do household work even at

exams. She used to feel very bad and angry, but never raised voice. In order

to get appreciation and love from mother, she would work more, help more to

mother and even started cooking at 5th standard. She wanted to be in

mother‟s good books. She was average in studies (weak in maths and

marathi). She was teachers favourite. In fancy- dress competition worked

always became angle. She was always appreciated by teachers. She never

had any anxiety during stage, dramas. From 9th standard she started taking

Tuitions, as financially they were not good. She would feel very happy when

with this money she would by clothes for herself. She completed her

education till 11th after that she got married; but she completed D-Ed. after

marriage and also worked as a teacher for one year in Jogeshwari till she

conceived. Patient says that her inlaws were very good people. She got lot of

love, in fact more than at maiden family. She discussed few incidents about

her first delivery. She got delivered at mother's house. Husband would come

to meet her daily as he was alone and loved wife a lot. Patients mother would

work very less so when patient was at home right since is first day of delivery
 264

had to work,cook, wash cloths, etc. She did not get proper rest. She herself

sent away massager as house was small and it was not possible to get

massage in front of all male members. Patient would feel bad and frustrated

but never replied back. If she replied back to mother, she would feel bad and

if to husband, then entire house would be agitated. And if she did that, people

will think bad about her she would often be sad and would cry alone in

bathroom but next day, would again do same work in order to be liked by all.

She says that she used to feel very bad and angry, but never raised voice.

She says that all her family members are like that except for her father, who

died four years back. she hates her brother, sister, & mother very much.

Patient‟s sister is her Devrani. She feels lucky as compared to her as she

does not get love and attention like patient. Also her sister‟s husband has

extramarital affair and one son out of wedlock. Patients sister is not aware of

it. Patient feels bad, but has not told this to her as at present her relationship

is O. K. Her sister is happy and gets whenever she wants. According to her if

her brother in law is managing both the ends without problems then it is

better rather break house and create problems. Patient says that she love

being appreciated. She likes wearing good clothes, so that she appears good

and liked by all. She cooks good food. When people says that she has really

done good job she feels in air. She likes keeping her house neat and clean.

Whole day when everyone is away from home, she keep cleaning house

again I again till perfection even if maid has cleaned. She likes keeping things

at proper place & neatness. If things (like nail cutter, glass ) are at improper

place. By doing things this way, people appreciate her and this make her feel

proud. She feels very ugly because she has gained weight due to which she
 265

cannot wear good clothes saris, or can go at functions. Feels people will not

like her & husband will also not like her. She feels whole world is her house

but does not like to have very close friends(only-hi' & 'bye‟) but she mixes with

all very easily and likes to keep IPR & likes to talk in very good way so that

people feel good and they praise her. If she does not get appreciated, then

she will do things more so that atleast will get love and appreciation or else

will feel bad. At times she gets angry, very frustration from family (not being

appreciated) or no attention is given in spite of so much work. In anger would

do more work. When angry she will blame herself and shout that she is not

caring. Also she will suppress her anger or else she feels that people will

know her real self. Her anger is short lasting and would forget matter easily.

She is very peculiar about things and she buys all things (table, cloths,

curtains) must be different than others and that she must be appreciated for

all good and different things that she does. If somebody copies her then she

feels jealous and angry. Does not like if she is not appreciated. She hates it ,if

her SIL takes attention by feeling that She has learnt cooking from her parents

(though in default patient has taught her). This reason has created hatred

towards maiden family. All these are her internal feelings where she says that

that she is not good or best but tries her best to be good. She hates it if not

appreciated. Patient feels lonely staying alone whole day and misses a

daughter in life. Mother wants her to look at the new factory they will be

building soon. Patient is yet to decide. Patient told other incident about her

sister-who often would come to sit but does not work. Patient does not like

ordering or telling her to do something as by doing this she will feel bad and
 266

would not be liked by others. She does not like to share her feelings to

anyone or else will create bad impression and won't be appreciated.

ANALYSIS :

1. PERONALITY ANALYSIS OF THE PHYSICIAN AND OBSERVER:

Type Analysis

Physician PP is Male by gender. EPI analysis shows that this PP is predominantly of

Introvert Introverted type. She is nervous and anxious in nature and is touchy,

Score: worries for a long time and gets easily conscious. Doesn‟t like hustle-bustle

E-8/24 around, gets fed up easily, but at the same time is not moody and likes

N-12/24 mixing with people.

L-1/9

Observer: Observer is Female by gender EPI Analysis shows that observer is

Extrovert predominantly Extroverted in nature. EPI analysis shows that she is

Score: basically happy go lucky, likes cracking jokes, is lively and an easy going

E-18/24 person. She is a person who may not really plan out the things.

N-12/24

L-2/9

2. CSEF:

Points Analysis

History Not much data available. But appearance of patient gave an idea to the

evaluation physician that patient appears to be very expressive and possibly would

communicate well.

Interview PP and observer did not anticipate any difficulties. According to the

observer interview went on smoothly because the patient really turned out

to be very communicative and but observer felt that somewhere patient

 267

had dominated the PP rather PP had got impressed with the patient.

Observer felt that interview was in general adequate but PP was not really

satisfied as he was not able to go into details as to why the patient requires

appreciation etc. According to PP this patient was charismatic, attention

seeking, talkative. According to observer too the patient was very talkative,

friendly, and very much communicative.

Doctor- According to observer PP had formed a friendly relationship with the

patient patient. But according to the observer PP had not been able to identify

relationship exactly what kind of relationship it was except for the fact he was highly

impressed by the patient. Rather he was completely under influence of the

patient.

Sensitivity Rather than sensitivity, PP was absolutely impressed by the patient and

& his observer was wondering why PP was not even cross questioning the

Sensibility. patient as for the observer patient was appearing as if trying to present that

she is doing so much but no one is bothered of it etc, trying to present only

her good side, still PP was completely passive and did not confront the

patient at all. PPwas not able to handle his sensitivity.

Technical Receiving was predominantly used by the PP and at times it was exploring

skills & and questioning. The major block was PP highly impressed by patient, her

Blocks talks, behavior.

 268

3. LIFESPACE ANALYSIS:
Points Analysis

Childhood Most of the areas receive a mention in the life space but all of them

Marriage revolve only around one theme i.e. of Patient, and her need for

and appreciation. But nowhere the exploration as to why such need developed

children. and is persistent done. Along with that her IPRS with husband are not

IPRs with explored. Patient mentions about severe dislike for her maiden family but

siblings. exact cause is not well understood.

4. TOTALITY ANALYSIS:

Totality –Approach and remedy Analysis

Kent‟s Approach. Mentals given prime

Totality: importance

A/F- suppressed anger Other approach such as

Flattery desires Boennighausen could have

Longing for good opinion of others been better suited as the case

Hatred was rich even in modalities.

Haughty Moreover mentals considered

Fastidious are one sided and are

Egotism inadequate to rely upon.

Dream-falling, dead people, anxious

Cr-fish,sweets Grounds of differentiation:

Differential remedies: primary usage of mentals.

Lyco, Sulphur, Natrum mur., Phos, Platina, Sector being considered

Sepia, Palladium. superficially.

 269

Ground of further differentiation:

-Thermals- hot Final remedy (PP)-Pallidum

-strong desire for appreciation Final remedy (consultant):

Probable remedies: Palladium, Calc. Sulph. Pallidium

Final remedy(PP)- Palladium

Final Remedy(observer)- Observer not

able to conclude as she wanted to explore

the patient as found the interview too be

inadequate. But her probable remedies

were Lycopodium, Natrum mur etc.

CONCLUSION:

PP of this case is basically of introverted type, and observer being extroverted

type. PP throughout the interview becomes very receptive and passive due to

the highly expressive and extroverted kind of a patient. PP was highly

impressed after meeting a personality who is exactly opposite to his own

nature. Whereas observer herself being of an extroverted type was constantly

feeling that patient needed to be confronted which the PP was not doing and

was just accepting whatever the patient was saying. .This dynamics itself

becomes a block for this introverted PP. Because of this kind of relationship

PP was not able to even explore where needed. These fundamental opposite

perceptions have occurred because of their own different personality. One

being highly impressed due to this drastic personality difference and other

being very critical and censorious being of same personality type. In totality

formation PP gives importance to all mentals that he has derived and

 270

interpreted but revolving on a single theme and the one which has been

inadequately explored and hence arrives at a remedy based only on the

theme of appreciation although there are many other remedies cover hard

data better than Pallidium. Whereas observer being very critical does not at all

accept this totality and prefers not to conclude upon a remedy till things are

confirmed.

Remedy (consultant)- Palladium.

Sr. Core perceived Reasons

No.
Physician Observer
1) Basically egoistic Could see what the Observer is extroverted type and

and wanting to PP had but felt that probably wanted to go in the finer

be flattered much of the data details of each aspect, but then still

lacking and hence agrees to what PP had perceived.

did not arrive at a

complete perception

but agreed to what

PP believes

Level of Similarity: Similar.

Follow ups:

Sr. no Date Follow ups Action

1) 29/3/11 Back Pain3+, stiffness++ Bryonia1M 4 pills Q.D.S for

Bilateral knee joint pain2+ 2 weeks

Pains slightly better Palladium 200 1 dose

weekly, placebo for 2 weeks

 271

2) 11/4/11 Back pains and knee joint Ct. All for 2 weeks.

pains much better than

earlier, no new complaints.

Pains better. No stiffness Ct. All for 2 weeks

3) 25/4/11 No back pain. No knee joint Placebo given for 2 weeks

pains. No stiffness.

Generals- normal
 272

Observations and
analysis
 273

OBSERVATIONS AND ANALYSIS

1) PERSONALITY DISTRIBUTION:

Table 1: Distribution of Personality Types

Personality types No. of volunteers Percentage

Extroverts 25 74%

Introverts 9 26%

26%

Introvert
Extrovert

74%

Figure- 1

Observations & Analysis:

In the study total 34 physicians had volunteered.

On EPI analysis it was found that 9 of the total volunteers were

predominantly Introverts and 25 out of the 30 volunteers were

Predominantly Extroverts.

Percentage wise 74% of the total volunteers were Extroverts which is a

significant number.

It is possible that Extroverts are more open for such study.

 274

2) SEX DISTRIBUTION:

Table 2: Sex Distribution

Personality Type Male Female

Extroverts 15 3

Introverts 10 6

100%
90%
80% 3
10
70%
60%
50% Female
40% Male
30% 6
15
20%
10%
0%
Extroverts Introverts

Figure- 2

Observations & Analysis:

IN this study total number of male Physicians who volunteered are 18

and total number of females are 16.

Hence there is not much difference in overall sex ratio.

Percentage wise amongst Extroverts 60% are males and 40% are

females.

Among Introverts there are 33.33% are female and 66.66% are males.
 275

3) DOCTOR-PATIENT RELATIONSHIPS:

Table 3

Sr. Types of Doctor-Patient Total no. times relationship formed

No relationship

Extrovert % Introvert %

1) As a Close Relation e.g.

(Mother/Father, 8 53.33 7 46.67

Children, Sister/Brother)

2) Friendly 3 50 3 50

3) Professional 3 42.85 4 57.14

4) Undefined Relationship 1 100 0 0

5) Inimical Relationship 0 0 1 100

100% 0
90%
80%
7 3
70% 4

60%
50% 1 1
INTROVERTS
40%
EXTROVERTS
30%
8 3
20% 3

10%
0% 0
Close Friendly Professional No Inimical
Relations relationship

Figure- 3
 276

Observations & Analysis:

In the 30 cases, most commonly formed Doctor-Patient relationships

were close relations such as son/daughter, brother/sister etc,

A few were friendly, professional and in one case inimical relationship.

The above observations show that different types of relations were

formed by physicians of both the personality types. It is seen that out of

15 extroverted types and 15 introverted types the kind of relationships

formed are nearly same in number.

4) PREDOMINANT FEELING STATES OF THE PHYSICIANS:

Table- 4: Predominant feeling states

Sr. No Feeling States of physicians No. physicians feeling states

Extrovert Introvert

1) Rejection 1 1

2) Identification 1 4

3) Getting Impressed 1 4

4) Confusion 1 1

5) Irritation 3 0

6) Neutral 0 0

7) Sympathetic 8 3

8) Anxious 1 2
 277

NEUTRAL 0
0
ANXIOUS 2
1
SYMPATHETIC 3
8
IRRITATION 0
3
INTROVERTS
CONFUSION 1
1 EXTROVERTS
GETTING IMPRESSED 4
1
IDENTIFICATION 4
1
REJECTION 1
1

0 2 4 6 8 10

Figure 4

Observation and Analysis :

It is seen that in the case records, that both the personality types have gone

through many feeling states, here we considered predominant feeling states.

The feeling states such as rejection, anxiety, confusion, irritation etc.

have been experienced by both personality types without much of a

difference. But a neutral state which is an ideal state in the process of

interview has not been achieved by either of the personality type.

The states of sympathy shows apparent predominance in Extroverts

and those of Identification and getting impressed show apparent

predominance in the Introverts. Hence statistical significance was

checked through Chi-square test. The results were as follows: Feeling

state Sympathy: The chi-square value for Df-1 under probability of 0.05

is 3.84. The calculated value for chi square is 3.59 which is less and

hence under probability for 0.05 is not significant. But if probability

under 0.1 the given value is 2.71 and the calculated value is 3.59 which
 278

is higher and hence significant at this level. So if this study is

considered for a larger sample there are very much chances of

significant differences that might come up.

Feeling states of identification and getting impressed: The Chi-square

value for Df-1 under the probability of 0.05 is 3.84 and the calculated

value is 0.125 which is less than 3.84 and hence the difference is not

significant. But the sample size is too small to conclude upon these

feeling states and personality predominance. But considering the

difference in number of times such states have come more frequently

in Introverts there is chance that a larger sample may show significant

influence of personality and feeling states.

5) NO. OF TIMES THE PP IS ABLE TO OVERCOME FEELING

STATES:

Table 5: Ability to overcome feeling states

Ability to overcome Extroverts Introverts

Yes 3 3

No 12 12
 279

EXTROVERTS INTROVERTS

3, 20% 3, 20%

YES Yes
NO No

12, 80 12, 80%

%

Figure- 5

Observations and Analysis:

It is seen that after developing particular feeling states very few times

i.e. only 6 out of 30 times in the cases the physicians have been able to

overcome their feeling states and move ahead in the interview.

But it is difficult to comment as which personality type has this capacity

to overcome their feeling states as in this study, the number is equal for

both the personality types. Again a small sample makes it difficult to

arrive at a conclusion.

6) INTERVIEW SKILLS:

Table 6: Interview Skills Predominantly used.

Sr. Types Of Interview Skills Total no. Of physicians

No. Predominantly used.

Extrovert % Introvert %

1) Receiving/listening 2 18.18 9 81.81

2) Questioning 8 61.53 5 38.46

3) Exploring 4 100 0 0
 280

4) Blocking 0 0 1 100

5) Confrontation 1 100 0 0

100%
0
90% 2
80%
70% 1
8 4
60%
50%
9 1
40%
30% EXTROVERTS
20% INTROVERTS
4 2 1
10%
0%

Figure- 6

Observations And Analysis:

In the 30 interviews the interview techniques used were that of Receiving,

Questioning, Exploring, Blocking, Listening, Confrontation. Both the

personality types have used multiple skills in each interview, depending on the

circumstances, but a predominance of a particular skill was seen in each

interview which has been considered here.

Receiving as an interview skill was often used by Introverts as

compared to Extroverts, questioning as an interview skill was more

often used by the Extroverted Physicians. As the sample size is small

 281

and the data is qualitative to know about its statistical significance Chi

Square test was applied as follows:

Interview skill: Receiving. Chi-square value obtained was 7 which is

higher than the value of Chisquare for Df-1 under probability 0.05 is

3.841. hence we can say that the difference in the receiving skill used

by both the personality type is significant.

Questioning.: Chi square value for Df-1 under probability of 0.05 is

3.481. The calculated value for chi square is 1.22 which is less than

3.481. Hence as far as this study is concerned we cannot say that

difference in the questioning skill used by the physicians of different

personality types is significant. But for Df-1 , under probability of 0.5 the

value given is 0.46, and the obtained value is 1.22 which is greater and

hence is significant at that level. Hence probably a larger sample may

show significant difference.

The above observations also show that personality types have

influenced the other skills also.

Both of the Personality types have rarely used blocking which can

create difficulties for a physician. Introverted physicians have never

used exploring as a predominant skill in interview. Extroverts have

been very few times in a receiving mode and most of the times

questioning the patients. But for a proper and a complete interview a

physician irrespective of his personality type must be able to use all

these skills rationally so that balance is ensured. The skills such as role

playing, guiding, empathizing etc were not at all seen to be used by

any of the personality type. Hence it is important for a not only to be

 282

aware about his ownself and trains himself accordingly so that his

personality serves to be an asset and not a liability but also subject him

to a training which will develop other skills also.

7) TYPES OF APPROACHES USED FOR TOTALITY FORMATION:

Table 7: Approaches used for totality formation

Sr. No. Type of approach used Total no. of physicians

Extrovert Introvert

1) Kentian 9 12

2) Boenninghausen 2 1

3) Boger 0 0

4) Others 4 2

OTHERS 4 2

BOGER 0

EXTROVERTS
BOENNINGHAUSEN 2
1 INTROVERTS
KENT 7
12

0% 20%
40% 60%
80% 100%

Figure- 7

Observations And Analysis:

Out of the 30 cases 19 times Kent‟s Approach was used for totality formation

and Introverted Physicians have used this approach more as compared to

Extroverted Physicians. On applying Chi Square test the results obtained

were as follows:
 283

The calculated value of Chi square was 3.57. The value given under

probability of 0.05 is 3.84. Hence the difference does not stand

significant. But at the probability under 0.5 is 0.46 and the calculated

value is greater than 0.46 and hence the difference at that level is

significant. Hence there are high chances that in a greater sample

there could be more number of introverted physicians using Kent‟s

approach as compared to the Extroverts.

8) NUMBER OF TIMES PERSONALITY PREDOMINANCE SHIFTS:

Table 8

Extroverts Introverts

E- Dominance 7 3

N-Dominance 8 12

14
12
12

10
8
8 7
EXTROVERTS
6
INTROVERTS

4 3

0
E-Dominance N-dominance

Figure- 8
 284

Observations And Analysis:

Through EPI Analysis of the physician I had a knowledge of the predominant

personality type of a physician. But in the 30 case records I came across that

in certain cases perceiving of the core and totality of patient by the PP has

been at a very interpretative and an abstract level, without any strong

evidences. This has been seen in case of extroverted physicians too, vice

versa was seen in the introverted Physicans who inspite of being

predominantly introverted type have been analytical and critical in their case

processing. But to understand the statistical significance Chi-square test was

applied, and the result obtained was as follows:

The Chi-square value for Df-1 under probability 0.05 is 3.84. The

calculated value is 3.5 which is less but on considering the Probability

at 0.1 which is 2.71 then the calculated value 3.5 is higher. Thus there

are very much chances that this study conducted on a larger sample

would give significant differences. But one thing that is definitive that

preferences and predominances in a personality type have potential to

mobilize or can get subconsciously mobilized from one particular

location, and possibly more often in extroverts.

9) DIFFERENCES IN PERCEPTION:

Table 9-a: Pairs and perceptual differences

Perception

Pairs Number of cases Similarity Differences

E-E Pairs 12 8 4

N-N Pairs 5 4 1

E-N Pairs 13 4 9
 285

Figure- 9-a-i

E-E PAIRS

4, 33%
SIMILARITY

8, 67% DIFFERENCES

Figure- 9-a-ii

N-N PAIRS

1, 20%

SIMILARITIES
DIFFERENCES
4, 80%

Figure- 9-a-iii

E-N PAIRS

4, 31%
SIMILARITIES
DIFFERENCES
9, 69%
 286

COMPARATIVE ASPECT OF PERSONALITY SIMILARITY WITH

PERCEPTIVE SIMILARITY.

Table-10

Personality Type Total number Similarities Differences

of cases

Similar (E-E,N-N) 17 12 5

Opposite (E-N) 13 4 9

Figure- 10-a

Similar Personality Type

total cases-17

5, 29%

SIMILARITES
DIFFERENCES

12, 71%

Figure- 10-b

OPPOSITE PERSONALITY TYPE

TOTAL CASES-13

4, 31%

SIMILARITIES
DIFFERENCES
9, 69%
 287

Observations and Analysis:

 On further analysis it is found that although the percentage of

similarities and differences is exactly equal but personality types of

physicians have been playing the key role leading in these perceptual

similarities and differences.

 It was seen that there were total 17 cases out of 30 where both the PP

and Observer had similar personality type i.e. either Extrovert or

Introvert . From these 17 cases it in 12 cases i.e. nearly 71% cases the

outcome was that both PP and Observer have arrived at similar

perception of patient as a person and 29% i.e in 5 cases there were

differences in the perception inspite of having similar personality type.

The statistical significance of this observation was checked with the

help of Chi-Square test. The results were as follows:

- The Chi-square at Df-1 under the probability of 0.05 is 3.84. The

calculated value is 4.66 which is greater than 3.84 hence the

difference is significant. Thus we can definitely conclude that

definitely when 2 dissimilar personalities perceive patient they arrive

at different perception more often as compared to similar

personality types.
 288

Discussion
 289

DISCUSSION

1) Out of the M.D students in M.L.Dhawale Memorial Hospital it was seen

that 34 of them volunteered for this study. Out of them 25 physicians

were found to be predominantly extroverted type and 9 were found to

be predominantly introverted type on EPI analysis. This kind of studies

demand a will to get reflective as well as be open to a particular

assessment of self. As regards to the understanding of personality

types it has been observed that Extroverts are usually more

adventurous experimentative as copmpared to Introverts who are

known to be basically of close nature and usually prefer to be aloof.

The figures seen in this study as possibly indicate the same thing that

Extroverted people are more open to this kind of studies as compared

to Introverts.

2) As far as the sex distribution is concerned it was found that number of

males participated in the study was higher than females. And as far as

the personality type in both the genders is concerned not much

difference was found except for the fact that in general number of

extroverts in both the genders was more than the number of introverts

from both genders. Also we can say that probably females do not show

much interest in such kind of analytical studies.

3) The kind of doctor patient relationship formed by the different

physicians was analysed and it was seen that both the personality

types have been able to form a wide range of relationship irrespective

of their predominant personality type. The relationships more often

formed were close relationships like father, mother, sister, son,

 290

daughter etc. (in 8 cases extroverts and 7 cases by introverts). While

the other relations formed were friendly, professional etc. but the

difference as regards to personality type was not significant.

4) PP in the case taking have used different types of interview skills. It

was seen that out of 15 cases defined by Extroverts in 8 cases the

extroverts have used the skills of Questioning whereas in introverts it

was seen only in 5 case. Exploration was done in 4 cases by

Extroverts but not a single case by Introverts. But Introverts had used

the skill of receiving in 9 cases as compared to extroverts who utilized

them predominantly in only 2 cases out of 15.

5) It was found that all the physicians irrespective of their personality type

underwent a strong mental state. The different feeling states that were

seen in the physicians were those of Sympathy, rejection, Irritation,

getting impressed, Identification etc. But certain feeling states were

seen to be occurring more frequently in a particular personality type. In

8 cases out of 15 Extroverts were seen to get sympathized with the

patients and Getting impressed and Identification with the patient was

seen more in Extroverted physicians. Where as Introverted types had

got impressed or identified more often as compared to the Extroverted

Physicians. But for establishing the statistical significance a large

sample is required.

6) As seen earlier all the physicians underwent a strong feeling state

during the interview. But what is more important is ability to overcome

such states. This was seen in less number. i.e out of total 30 cases

only 6 times the physicians were able to overcome the states to some
 291

extent whereas 24 were not. But it was seen that there was no

difference as regards to number of times each of the personality was

able to overcome their feeling states and vice versa.

7) As far as the approach was concerned it was seen that Kentian

approach was used for 21 cases with introverted using it in 12 cases

and extroverts in 9 cases. Other approaches such as structuralisation

was also used more often by Extroverts. But Boger‟s approach was not

seen in any of the case. The reason for this was that most of the

physicians lacked knowledge about this concept. Kentian concept was

considered more often as most of the physicians had been

interpretative in approach and hence mental symptoms were given

more importance. This was seen more often in Introverts who utilized

this approach in 12 cases out of 15.

8) In the 30 case records another finding was different physicians

behaved in different manner during the case taking at times contrary to

their personality type which was available to us through EPI analysis.

There were 8 cases in which the extroverts have been displaying

introverted features such as getting anxious, irritated, getting

influenced easily etc. (case no. 2,4,5,7,8,15,etc.). In these PPs it was

found that there N score was also on a higher side as compared to the

other Extroverted physicians. Then there were 3 cases out of 15 where

Introverted PPs displayed extroverted features such as going into

details, being analytical etc. (Case no. 22.25.29). These PPs were

consciously aware of their possible states which might create

difficulties and hence had tried to remain focused.

 292

Lastly a comparison was done as regards to what are the chances of

perceptual differences when 2 physicians of same or opposite

personality type perceive the same patient. Then it was found that the

differences that arise when two opposite personality type perceive the

patient are much more as compared to the situation where similar

personality type perceive the patient.

Analysis of these differences:

These were the case no 2,8,9,15,22.

- Case 22 has both PP and observer being of predominantly

Introverted type. In this case both the PP and observer have got

sensitized by two emotions i.e. of anxiety and Grief respectively. It

is seen that both of them have equal N score and PP having higher

E score as compared to the observer.

- Cases 2,8,9,15 have both PP and observers both are Extroverted

Personality type. In these cases it is seen that the perception of PP

has differed from that of the observer because these PP‟s have

become emotionally unstable and underwent feeling states like

anxiety, irritability which they have not been successfully overcome

till the end of the interview. As compared to the observers it is seen

that EPI analysis of these PPs have shown presence of higher N

score or Lower E score as compared to that of the observers.

 Then the remaining 13 cases out of 30 were taken by the physicians

and observers who had opposite personality type. i.e Extroverted and

Introverted.Out of these 13 cases inspite of having opposite personality

 293

type there were 4 cases in which physician and observer had arrived to

a similar patient understanding. These were Case no. 4, 12, 2, 29.

- In case no. 4 the PP is predominantly Extroverted and Observer is

Predominantly Introverted in nature. But still the perception of

patient is Similar as in this case it was seen that PP again had got

stuck up in irritation and had formed an image of patient from this

feeling state from which the PP was not able to come out.

- In case no. 12 PP is again of Extroverted type and observer being

of Introverted type. But in this case PP has been mostly able to

derive most of the data and observer inspite of being Introverted

type they both could understand the patient in similar manner.

- In case no. 25 it the PP is of an introverted type and observer is

extroverted type. In this case also it was seen that PP was able to

obtain a lot of data as she has been mostly into receptive mode

throughout the case taking. Hence as there was substantial data

both of them were able to arrive at a similar patient understanding.

- In case no. 29 PP is of an Introverted type and Observer is of an

Extroverted type. In this case too lot of data was already available

and in addition to that PP in this case was conscious about the fact

that she might get anxious lost an avoided it consciously and tried

to be as evidence based as she can. Hence the perception of

patient was similar inspite of fundamental personality differences.

 294

Summary and

conclusion
 295

SUMMARY AND CONCLUSION

It was my long time quest since I entered in homoeopathy to know why we get

so prejudiced about certain things in life and look only from those spectacles?

The curiosity went on increasing especially when I started taking cases and

found that same patient is perceived so differently by different people. Apart

from the upbringing, past experience was our own innate personality

responsible for the way we relate to the outer world? This was the first

question that came into my mind. After entering into post graduation in

M.L.Dhawale memorial Homoeopathic institute, the training methodology of

Homoeopathic physician practiced here inspired me to take up this study so

as to find answers for my quest.

I read various books for understanding what is personality and then what are

different personality types. Through my review of literature I found Carl Jung‟s

personality theory to be more complete in itself. But then all the review stated

only possibilities based on certain observations of how personality types

behave and relate to things differently but there was hardly any study

conducted to understand exactly how a personality of an individual or in

homoeopathic language we can say how a disposition of a person would

influence his behavior, perception etc. The knowledge of own personality I

believe is utmost essential for an homoeopath as also stressed by Dr.

Hahnemann because Homoeopathy ultimately means perceiving patient in

totality as an unprejudiced observer. Hence I started thinking that how can I

understand how different personalities of different physicians would influence

perception of patients. Then I went through certain tests by which would help

in understanding the personality and its influence. I came across through

 296

Eysenck multiple personality inventory. With that I also went through the

training methodology followed in M.L.D.MHI. In the training pattern there is a

form known as CSEF form which also gives us an idea that how and why a

particular physician conducts an interview what are the difficulties that are

faced by him, his/her sensitivities etc.

Then study was conducted where P.G students in Dhawale Memorial institute

were oriented about this study and the volunteers amongst them were given

first, the EPI. After analyzing the EPI I classifed the physicians into

predominantly extroverted and predominantly Introverted Personality types

based on their EPI scores. Interestingly it was found that there were very few

Introverts amongst the volunteers(total 20). Once more orientation was done

and inspite of that there was increase in the volunteers(14 more got added)

amongst whom again there were 10 extroverts and only 4 were Introverts.

After that, the cases taken by these volunteers were considered. 15 cases

taken by extroverted types and 15 cases taken by Introverted types were

considered. Care was taken that the observers with them who go are from the

volunteers in the study so that the observer‟s Personality type is also known.

When the case taken up by such pairs were analyzed. In this study the

objective is to understand how the personality influences perception of

patient, perception in terms of its process and the final outcome. Hence the

basis of analysis was:

1) EPI- which was helping us to diagnose the personality in general

2) CSEF- It was of help in knowing what was the process that particular

physician carried out to perceive his patient, the location taken by the
 297

physician and the difficulties encountered. The CSEF filled up by

Physician and his observer both were analyzed to maintain objectivity.

3) Life space exploration and Approach used- for patient understanding

and totality formation.

Certain Observations were made and analysis was done as mentioned is

mentioned prior. Based on these observations I have arrived at the following

Conclusions:

1) As per the first objective of the study the personalities of the physicians

were analysed with the help of EPI and it was found that The number

of extroverts(74%) who volunteered for this study was more than the

Introverts(26%). Hence probably as compared to Extroverts the

Introverts are usually not open to any process which will demand being

introspective and which will subject them to any kind of self

assessment. This is could be dangerous for the physicians who are

Introverted as most important part of Homoeopathic case taking is

knowing oneself and own prejudices. Hence these are the physicians

who must be trained to introspect themselves.

2) Close or friendly relationships with the patients was formed by most of

the physicians (21 out of total 30 cases) irrespective of their personality

type. Considering the review of literature one doesn‟t expect Introverts

to form very close relationships. But in this study it was found that the

personality type doesn‟t have influenced much in the type of

relationship formed.(53.33% extroverts and 46.67% Introverts formed

close relationships). Such relationships land up the physicians into

strong emotional states such as Irritation, rejection, getting

 298

sympathized etc. and only in 6 cases the physicians have been able to

handle their emotions (both personality types showing equal number of

cases Extrovert PP-case no. 9,11,12, Introvert PP case no-17, 18, 25).

Hence irrespective of their personality type the physicians have most of

the times (24 cases) been unable to overcome their emotions.

3) The life areas explored by both the personality types was also

considered in individual cases but, it was found that no significant

observations were found as regards to personality type of the PP. This

was because the areas that were explored were according to the

demands of the cases and circumstances.

4) The kind of interview skills used by the PPs was also studied. It was

found that Extroverts mostly would question(61.53%) and explore their

patients but do minimum of receiving while Introverts were mostly on a

receptive mode(81.81%). Other skills that were used by the PPs were

exploring,This has highly influenced their perception of patient. Hence

his needs attention that all physicians need to subject themselves to a

process of sensitivity training. Also there are certain skliis otherwise

such as role playing, guiding, couselling, empathizing etc were not at

all seen in these cases. These skills can be acquired only through

training of the physicians.

5) Usually we know that two people cannot perceive same patient in a

similar manner due to prejudices arising out of our upbringing, past

experiences, values etc. In the 30 cases, it was seen that 17 cases

were defined by similar personality types out of which in 12 cases the

perception came out to be similar of both the physicians irrespective of

 299

their background, upbringing and past experiences. Whereas 13 cases

were defined by physicians of opposite personality types where only in

4 cases the perception of both PP and observer were same while in 9

cases the perception was different. Also there were 3 cases in which

the Introverts were able to overcome their anxieties and emotions as

they before going for the case definitions had become consciously

aware and had anticipated it. Thus a training to the physicians of

formulating a prior problem definition and a process which would make

aware about self would help the physicians to overcome the liabilities

of their own personality type.

6) It was difficult to achieve the objective of understanding the manner in

which PPs have derived the mental state, attribute, disposition due

inadequacy of the data.

7) The Approach taken by the physicians for patient understanding and

totality formation were more often Kentian approach (21 Cases). Thus

it is seen that physicians have preferred on an approach which is more

interpretative and not very much based on hard data. In this Introverts

have seemed to be taking this approach even more commonly (12

cases out of 15 taken by introverted Physicians). Thus it is evident that

more often the physicians have went on interpretations rather than

being evidence based which has higher chance of error.

8) Also it was seen that irrespective of Personality Predominance,

Physicians would shift into opposite predominance during the case

taking. This shift can be both asset and liability depending on the case

and circumstances. Hence the need as well as problems that may

 300

come up due to such shifts must be known and physician needs to be

aware of it.

Hence it is seen that the personality of the physician influences his process of

perception and final patient understanding at multiple levels.

 301

recommendations
 302

RECOMMENDATIONS

It is seen from the study that Physicians personality is very much responsible

for the manner in which he is going to perceive his patients.

The conclusions drawn in this study gives us an understanding of following

important facts:

1) It is seen from the study that Physicians personality is very much

responsible for the manner in which he is going to perceive his patients

but it is not very clear in all perspectives due to smaller sample size.

2) Irrespective of the personality type it has been seen that certain

Physicians have been able to stabilize themselves emotionally, have

been analytical, and were fairly objective. As mentioned in the The

Introverts and the Extroverts both have functions such as Thinking,

Intution ,feeling, judging etc. The dominance of any of these will again

influence perception of the patient.

3) Most importantly is any homoeopathic physician need to be aware of

his personality type, his sensitivities, its advantages and disadvantages

so that he can be objective as far as possible.

Hence following things need to be done:

1) Similar type of study needs to be undertaken with a larger sample and

must include the study of above mentioned functions and other aspects

of personality of these two fundamental types.

2) A training programme if possible must be included from the

undergraduate level. The training programme followed at M.L.Dhawale

homoeopathic institute could be helpful. In 51/2 yrs of undergraduate

training programme this methodology if implemented would result into

 303

better development of art of case taking and hence would be an

important milestone in the journey of unprejudiced observer. The

training Programme must consider to train the physicians in following

aspects:

- To formulate a prior problem definition and his/her own approach

towards that case.

- Improvising the art of case taking through Sensitivity training by

sending the observers with the physicians in each case and then

post interview discussion with the supervisor about the whole

experience of the interview. This would help the physician as well

as observer to know his own disposition and assets and liabilities of

the same.
 304

Bibliography
 305

REFERENCES

1. Close Stuart (2005) The Genius of Homoeopathy Lectures and Essays

on Homoepathic Philosophy, chapter 1- The Psychological Point Of

View. B. Jain Publishers Pvt. Ltd, New Delhi.

2. Dhawale M.L (1994) Hahnemannian Totality Symposium VOL 1 AREA

B2, Publication: Institute of clinical research Bombay.

3. Dudgeon R. E., (2004) The Lesser Writings Of Samuel Hahnemann

The Medical Observer (1825) Reprint Edition, Publications: B.Jain

Publishers Pvt Ltd, New Delhi

4. Hahnemann Samuel, (2001) Organon of medicine 5th & 6th edition,

Publishers- IBPP.

5. Jung, C.G., ([1921] 1971). Psychological Types, Collected Works,

Volume 6, Princeton, N.J.: Princeton University Press

6. Kaplan & Saddock, (1985) A comprehensive textbook of psychiatry,

Chapter 9 Personality and psychopathology: Cultural and Interpersonal

Psychoanalytic schools Seventh edition, William and Wilkins U.S.A

7. Kent J. T., (2002) Lectures on homoeopathic philosophy, lecture-5

Publication: B. Jain Publishers Pvt Ltd, New Delhi.

8. Rummel R. J., (1975) Understanding conflict and war: vol. 1: the

dynamic psychological field, Chapter 7, Perception and Reality. Sage

Publications, California

9. Wansbrough C. J., The Homoeopath, No.61 1996. Publisher

C.J.Wansbrough
 306

10. Whitmont Edward, (1969) The Symbolic Quest, Chapter 3 The

Objective Psyche Publication: G.P Putnam‟s Sons, New York.

11. Whitmont Edward, (1986) Psyche & Substance, Indian Books and

Periodicals Syndicate, New Delhi.

 307

ABBREVIATIONS
 308

ABBREVIATIONS

K/C/O- Known case of

DM: Diabetes mellitus

Fa/H- Family history

Pa/h- Past history

O/H- Obstetric History

Cr- Cravings

Av- Aversion

HTN- Hypertension

DM- Diabetes mellitus

CA- Cancer

T.I.A- Transient Ischaemic Attack

PP- Primary Physician

H/F- History Form

CSEF- Clinical Session Evaluation Form

EPI- Eysenck‟s personality inventory

E-Score- Extrovert score on EPI Analysis

N-Score- Introvert score on EPI Analysis

E- Extrovert

N- Introvert

FTND- Full term Normal Delivery

SPAB- Spontaneous Abortion

</Agg- Aggravation,

> amel- Amelioration

 309

Acknowledgements
 310

ACKNOWLEDGEMENTS

A Journey - From Darkness to Light…… from Inactivity to Activity.

This sentence represents my experience while conducting this small

study. I am fortunate to be a student of Dr M. L. Dhawale Memorial

Homoeopathic Institute.

I feel a deep sense of gratitude to my guide, Dr. N.L.Tiwari, M. D.

(Hom), HOD, Organon of Medicine and Homoeopathic Philosophy

,M.L.Dhawale Memorial Homoeopathic Medical college, Palghar, for his

expert guidance, valuable suggestions and kind support during this period of

study. I feel extremely fortunate to have him as my guide.

It gives me great pleasure to express my heart-felt thanks to Dr.

Kumar M. Dhawale M. F. (Hom), Principal, Dr. M. L. Dhawale Memorial

Homoeopathic Institute, Palghar for being a source of inspiration and

constant encouragement. Without him, I cannot imagine how this study would

have ever seen the light of day. I am also equally thankful to Dr. Sunita

Nikumbh, Reader, Department of Psychiatry for her time to time guidance

without which my journey would have been really difficult.

I take this opportunity to express my gratitude and sincere thanks to,

Dr. A. R. Kapse, Vice Principal, for providing me with all the necessary time

and Guidance to conduct my study.

I am grateful to Dr. Prashant Tamboli, and Dr. Sunil D. Bhalinge for lending

there guidance and full cooperation in my study.

It would have been nearly impossible to complete my dissertation on time if it

would not have been for Dr. Ashwini Desale, Dr. Devendra Chavan, Dr.
 311

Pushkar and Dr.Pankaj who relieved me from my duties for my dissertation

work.

I wish to express my sincere thanks to Convener, the members of the

Ad-hoc Board of Studies in Homoeopathy, to the members of the Research

and Review Committee and University of Mumbai, for permission to work on

my dissertation. I am grateful to Central Council of Homoeopathy for their

efforts to give Homoeopathy its due place in the science of medicine.

I am highly thankful to Visionary Dr. M. L. Dhawale for having made

the journey of Homoeopathy, path of MY MISSION much easier, through the

symposium volumes, and publications.

I am obliged to all my patients who were the best teachers to keep me

always on my toes for refining the skills of practice.

A very special thanks to all my colleagues, senior as well as junior,

especially Dr. Faisal, Dr. Radha, Dr. Shruti, Dr. Sunil, Dr. Sainath, Dr. Urvi,

Dr. Deoyani, Dr. Nishit, Dr. Bhagirath Dr. Sunitha, Dr. Swaraja, Dr. Kedar M.

Dr. Kedar R., Dr. Munni, Dr. Latika, Dr. Keyur, and all of them who

volunteered in my study and displayed a lot of enthusiasm, without their co-

operation and support, this study would just not have been possible. A

special thanks to Dr. Dinesh B. for his moral support.

I am grateful to my father Mr. Madhusudan S. Deodhar, and my mother

Mrs. Manasi M. Deodhar who have been my strength throughout and

bestowed all the love and affection on me.

Finally I would like to thank God to give me this beautiful life and love

to do something worthwhile for mankind.

 312

ANNEXURES
 313

ANNEXURES

ANNEXURE 1-EPI

EYSENCK PERSONALITY INVENTORY

Form B
Name:
Age: Sex:
Date:

Instructions:
Here are some questions regarding how you feel, behave and act.
After each question you of options of „yes‟ and „no‟ given to you.
Work them quickly and don‟t spend too much time, we need your first
reaction and not a long drawn out thought process.
The whole questionnaire should not take more than a few minutes.
Be sure as to not to omit any question.
Now turn the page and go ahead.
There are no right or wrong answers, and this is not the test of
intelligence or ability, but simply measure of the way you behave.

In case you don’t understand some question you attempt others and

approach us for clarifying the meaning.

1. Do you like plenty of excitement & bustle around you?

A) Yes B) No

2. Have you got a restless feeling that you want something but
don‟t know exactly what?
A) Yes B) No

3. Do you nearly always have a a „ready answer‟when people talk to

you? A) Yes B) No

4. Do you sometimes feel happy, sometimes sad without any real

reason? A) Yes B) No
 314

5. Do you usually stay behind at the parties and „get-together‟?

A) Yes B) No

6. As a child did you always do as you were told immediately

without grumbling?
A) Yes B) No

7. Do you sometimes sulk?

A) Yes B) No

8. When you are drawn into quarrel do you prefer to „have it out‟
to being silent hoping things will blow over?
A) Yes B) No

9. Are you Moody?

A) Yes B) No

10. Do you like mixing with people?

A) Yes B) No

11. Have you often lost sleep thinking over your worries?
A) Yes B) No

12. Do you sometimes get cross?

A) Yes B) No

13. Would you call yourself happy-go-lucky?

A) Yes B) No

14. Do you often make up your mind too late?

A) Yes B) No

15. Do you like working alone?

A) Yes B) No

16. Have you felt listless and tired for no good reason?
A) Yes B) No

17. Are you rather lively?

A) Yes B) No

18. Do you sometimes laugh at a dirty joke?

A) Yes B) No

19. Do you often feel fed up?

A) Yes B) No

20. Do you feel uncomfortable in anything but everyday clothes?

A) Yes B) No
 315

21. Does your mind often wander when you are trying to attend
closely to something?
A) Yes B) No

22. Can you put your thoughts into words quickly?

A) Yes B) No

23. Are you often „lost in thought‟?

A) Yes B) No

24. Are you completely free from any prejudices?

A) Yes B) No

25. Do you like practical jokes?

A) Yes B) No

26. Do you often think of your past?

A) Yes B) No

27. Do you very much like good food?

A) Yes B) No

28. When you get annoyed do you need someone friendly to talk
about it?
A) Yes B) No

29. Do you mind selling things or asking people for money for
some good cause?
A) Yes B) No

30. Do you sometimes boast a little?

A) Yes B) No

31. Are you touchy about something?

A) Yes B) No

32. Would you rather be at home on your own than go to a party?

A) Yes B) No

33. Do you sometimes get so restless that you can‟t sit long in chair?
A) Yes B) No

34. Do you like planning things carefully well ahead of time?

A) Yes B) No

35. Do you have dizzy spells?

A) Yes B) No
 316

36. Do you always answer a personal letter as soon as you can after
you have read it?
A) Yes B) No

37. Can you usually do things better by figuring them out alone than
A) Yes B) No by talking to others about it?

38. Do you ever get abort of breath without having done heavy work?
A) Yes B) No

39. Are you an easy going person, not generally bothered about
having everything „just-go‟?
A) Yes B) No

40. Do you suffer from nerves?

A) Yes B) No

41. Would you rather plan things than do things?

A) Yes B) No

42. Do you sometimes put off until tomorrow what you ought to
do today?
A) Yes B) No

43. Do you get nervous in places like elevators, tunnels or train?

A) Yes B) No

44. When you make friends ,is it usually you who makes the first
move, or does the inviting?
A) Yes B) No

45. Do you get very bad headaches?

A) Yes B) No

46. Do you generally feel that things get sort by themselves and
come right in the end somehow?
A) Yes B) No

47. Do you find hard to fall asleep at bedtime?

A) Yes B) No

48. Have you sometimes told lies in your life?

A) Yes B) No

49. Do you sometimes say first thing that comes into your head?
A) Yes B) No

50. Do you worry too long after an embarrassing experience?

A) Yes B) No
 317

51. Do you usually keep „yourself to yourself‟ except with very

close friends? A) Yes B) No

52. Do you often get into a jam because you do things without
thinking? A) Yes B) No

53. Do you like cracking jokes and telling funny stories to your
friends? A) Yes B) No

54. Would you rather win , than lose? A) Yes B) No

55. Do you often feel self conscious when you are with superiors?
A) Yes B) No

56. When the odds are against you, do you still usually think it
worth taking a chance? A) Yes B) No

57. Do you often get „butterflies in your stomach‟ before an

important occasion? A) Yes B) No

---------------------------------------------------
 318

ANNEXURE 2

CSEF (CLINICAL SESSION EVALUATION FORM):

PHYSICIAN OBSERVER

I)HISTORY EVALUATION
A) PROBLEM DEFINITION
1) COMPLAINTS
2)PERSON
B)PROBLEM RESOLUTION
1)PROGNOSIS
2)DIFFICULTIES
3)REMEDIAL MEASURES
C)INTERVIEW PLAN
1)OPENING
2)DIFFICULTIES
3)ALTERNATIVES
II) INTERVIEW
A)IMPLEMENTATION SKILLS
B) ADEQUACY
III) PROBLEM FORMULATION
A)SCR RECORDING
B) COMPLAINT DIAGNOSIS
C) PERSON DIAGNOSIS
IV) PROBLEM RESOLUTION
V) DOCTOR -PATIENT
RELATIONSHIP
VI) PHYSICIAN
KNOWLEDGE:
GENERAL
SPECIFIC
SENSITIVTY
SENSIBILITY
TECHNICAL SKILLS
JUDGEMENT
BLOCKS
VII) SPECIAL
RECOMMENDATIONS
 319

Annexure 3

Case Proforma

Preliminary Data:

Name: Age/Sex: Education: Status:

Religion: Occupation: Address:
Family Members:

Chief Complaint:

Patient as a Person:
Appearance:
Appetite:
Thirst:
Stool/Urine
Sleep
Dreams
Thermals:
Reactions to the environment:
Menstrual functions:

Pa/H
Fa/H
O/H

Life Space:
 320

Master table
 321

MASTER TABLE (CASE RECORDS 1-15)

2 3 4 5 6 7 8 9 10 11 12 13 14 15
1
PP E E E E E E E E E E E E E E
E
Observer E E N N E E E E E E N E E E
E
Relations:

Close √ √ √ √ √ √ √ √ √

Friendly
√
Professional √ √ √ √

Inimical

Not definable √

Feeling states:

Rejection √

Identification √

Impressed √
 322

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Confusion √

Irritation √ √ √

Neutral

Sympathetic √ √ √ √ √ √ √ √

Anxious

Interview Skills:

Receiving √ √ √

Questioning √ √ √ √ √ √ √

Exploring √ √ √ √

Blocking

Listening

Confronting √

Repertorial approach:
 323

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Kent √ √ √ √ √ √ √ √
Boenningh-
√ √
ausen
Boger

Others √ √ √ √

Perception by PP/ Observer:

Similar √ √ √ √ √ √ √ √ √ √ √ √

Different √ √ √
Remedy: Calc Calc. Calc. Kali. Nat Calc
Sil Lyc Sil Sep Lyc - - Sil Sep
PP Phos Fluo. carb Phos Mur Carb
Remedy: Arg. Calc. Nat. Calc. Calc Kali Nat. Nat.
Sil Sil Lyc Sep Arn Sil Sep
Observer Nit carb Mur Fluo Carb. carb Mur Mur
Arg. Aur. Nat. Nat. Calc Kali Nat.
Final Remedy: Sil Lyc Sep - Sil Sil Sep -
Nit Met Mur Mur Fluo. Phos mur
 324

MASTER TABLE (CASE RECORDS 16-30)

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
PP N N N N N N N N N N N N N N
N
Observer E E E E N N N N E E E N E E
E
Relations:

Close √ √ √ √ √ √ √
√
Friendly √ √ √

Professional √ √ √

Inimical √

Not definable

Feeling states:

Rejection √

Identification √ √ √ √

Impressed √ √ √ √
 325

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Confusion √

Irritation

Neutral

Sympathetic √ √ √

Anxious √ √

Interview Skills:
Receiving/
√ √ √ √ √ √ √ √ √
Listening
Questioning √ √ √ √

Exploring

Blocking

Confronting √ √

Repertorial approach:

Kent √ √ √ √ √ √ √ √ √ √ √ √ √
 326

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Boenningh-
√
ausen
Boger

Others √

Perception by PP/ Observer:

Similar √ √ √ √ √ √ √ √

Different √ √ √ √ √ √ √
Remedy: Nux Nat. Merc Kali Arg.
Sep Phos Sep Sep Caus Lyco Sil Sep Sep Pall
PP Vom Mur sol Carb Nit
Remedy: Nat. Nat. Mer Nat Nat. Calc
Sil Pall. - Sep Lyco Caus Sep Sep Pall
Observer Mur Phos Sol Mur Mur Carb
Nat. Nat. Nat. Merc Kali Nat. Calc.
Final Remedy: Sil - Sep - Caus - Sep Pall
Mur Phos. Phos Sol Carb Mur Sil