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 Ignatia Case

One of my patients brought her sister to me for the treatment of pain in epigastrium accompanied by a very strange behaviour. Before bringing her sister, my patient told me about her sister, that she is not ready to take any medicine. 

She told, "if anybody asks her to take medicine she just answers, "I want to die, kill me, give me some poison" in a very harsh tone. 

She asked me, "Can you treat such case?" 

I told her, "I will try my best."

She took appointment and the very next day she brought her sister to me.

The lady started narrating her history, "Do you have medicine or injection which can kill me, I don't want to live. I feel there is no need for me to live."

I changed the topic and asked her, "what is the real problem"?. 

She said, "I have very severe acute pain in epigastrium. It was diagnosed as a case of cholelithisis, for which I have been operated recently, but despite that the pain is still continuing. During the pain, I become very angry and irritable. I am unable to eat any food and physically feel very weak and am reduced to the bones."

Her sister intervened, "Doctor, she has number of mental stresses. She is not in good terms with her in laws. They always complain about her rude and angry behaviour even with the elders."

I asked her to explain the cause of her extreme anger.

Suddenly she shouted, "I want to kill my mother-in-law or myself" and started weeping and sobbing. 

She continued, "I was married 8years back. Since then my mother-in-law has been torturing me. I never tried to do anything bad, but my mother-in-law always criticises me that I don't know how to do the things, how to prepare food. If anybody comes from my house she always tell them that I don't work properly. I don't know anything. She always tries to put poison into my husband's mind against me. Doctor, I always keep on working. I never answer back my mother-in-law unless it exceeds my threshold. I know that I should behave nicely with every body. But they should also do the same. If they cannot regard others then why should I do? I am their daughter in law,that does not mean I don't have any self respect or regard." 

"My husband is also changed now and he always keep on showing red eyes to me as reprimand etc." She further added, "Doctor, even my parents do not believe me. They also started saying that it is me who is wrong and not my in laws."

Her sister again intervened, "she had been neglected since childhood". The fact is that she is the eldest child. Being the first child In the family, in the beginning she was loved very much. But as soon as the younger child got birth, she was totally neglected and the new born got all the attention. Since then the problem of her mood swing started. Then things progressed day by day. She became very irritable, angry etc. She started withdrawing from social life. Her father was a dominating person, always commanding others. She could never express herself.

I asked her, "you want to either kill yourself or your mother-in-law. But you never attempted to do either of them?

She explained, "If I would do either of them, it would give a bad name to the reputation of my family. People would laugh and mock at my papa that her daughter has done like this. But, what should I do? Neither the condition improves nor I could do this immoral act. I want to kill myself, give me some poison. I do not want to survive. I do not want to listen comments from my in laws as well as from my parents. It exceeded all the limits. The kind of insult they do I cannot bear."

She cried and added, "Now I do not have energy to continue all this. My health is not keeping well. The pains are so much that I cannot tolerate now, whom should I tell."

This was a simple case. Let's analyse it thoroughly to understand the mental state of the patient.

Let's take the very first line of the patient's statement and analyse : "give me some poison or injection to kill me. I want to die".

In fact, she doesn't want to do so. It is because of the utter frustration and a reaction to the situation she is living in. She wants the doctor to help him to die.

SHRIEKING - help; for

Many times patients come and ask straight, "Doctor, give me an injection or poison, I don't want to live anymore," with very irritable tone. This is nothing but "SHRIEKING - help; for".

Why she is shrieking? Because the things are not happening as per her wish. She cannot bear further more. Had she wanted to commit suicide, there are many other ways of doing so. Then why did she want the doctor's help for doing so? She didn't have the courage to do so.

COWARDICE

She told she wanted to murder her mother in law but never attempted to do so. On the contrary she kept on bearing the atrocities. When asked why she never tried to do so? She replied it is because of the social status they have and her act would castigate her parents as well as her in laws in the society. Above all, her mother in law is elder to her and should be respected. Because of the social constraints she thought it is better to bear the atrocities then to do any immoral act.

This is nothing but:

SENSITIVE - moral impressions, to 
DESPAIR - social position, of
MILDNESS - complaining; bears suffering, even outrage without

But the situation makes her very sad and she stays quiet. She didn't want to talk to any body and always withdraws herself into deep sadness.

SADNESS - quiet
TACITURN
GRIEF

Most of time patients use to tell "What is the need for me to live"?

It does not make any difference to others, if I live or die. This is nothing but shrieking. The shriek part reflects the need of urgent attention to the subject.

Actually the kind of torture mother-in-law inflicts through out the day shakes her from within. It hurts her dignity, which is all important to this person. When her mother in law complains everybody about her she feels very down as it lowers social status.

Ailments from horror
Ailments from mortification
Ailments from shame
Social position concern about

Here, horror to this patient means any sort of criticism which hurts her feeling and she becomes irritated. Till the time her moral and conscience are strong she keeps on bearing everything. She suppresses her anger and didn't react. She feel, "I always work for them and they give me such inhuman treatment." She feels insulted. 

Offended easily
Ailments from anger suppressed 
Ailments from disappointments.

All these above analysis points to the very fact that, for this patient honor and position in the society is very important. She feels that these two things are to be earned at any cost. She is moral and conscientious to the core. But when her morality is suspected and exposed wrongly in the public, it becomes unbearable. All her endurance ends and she erupts like a volcano. She becomes mad which is reflected in her anger, rage, violence. She revolts against authority and deny their control over her. She fights back for justice denied to her without thinking about the consequences.

Defiant 
Audacity
Injustice cannot support.

In this case she had been fighting since last seven eight years but there is no improvement in the relation with her in laws. To add to this, the disease further broke her to the finish. The continuous fight in the family and struggle to project in the society that nothing is wrong with them had drained all the energy in her and she is not in a position to fight back further.

Disconcerted

A stage comes when she feels that she has to bear all this, even god cannot help her, even to die. 

ANXIETY - salvation, about

Follow up of the case:

A dose of Ignatia 30 was prescribed with Placebo for a week. The pains went off immediately. The food which she was earlier unable to eat started eating now. Gradually the general health started improving. 

After a week when she visited me she realized that living along with others is better than staying alone. She told, "I work for my child and I have no idea of suicide or committing murder of my mother-in-law".

If we go to the Ignatia symptomatology things would be clearer. 

Let's consider some more rubrics to make its picture clear.

Sensitive to moral
Consumption
Earnest
Duty to sense of duty
Benevolence
Affectionate 

Ignatia is a very genuine person; he does things with all the seriousness and honesty. The word neglect is not found in his dictionary. He works with full faith, loyalty, and faithfulness and is always kind to others which leaves a very good impression on others mind. He does all this just out of moral and social obligation as explained by Late Dr. M. L. Sehgal: "Being so loyal and honest earns in turn a repute and position. Any work assigned to him or any duty is being done by him without any mistake."

I had a lady patient, who had just missed her duty for one day. On the entrance of the clinic itself she started crying, "I could not go to the office because of excessive bleeding during menstruation."

I told her, "there is nothing to cry that much; I would give you a medical certificate."

But she sharply replied, "I didn't come for medical certificate, you make me alright I would like to go to the office."

What I mean to say, the Ignatia patient sacrifices everything for his excessive concern for his duties.

I sometimes wonder though Ignatia has so many qualities for righteousness and duty especially doing things on his own, why this remedy is not found in Egotism?

Ignatia never boasts of her own qualities rather pulls down others to gain upper hand.

The following rubrics support the above statement:

Haughtiness
Censorious
Abusive 
Contemptuous 
Selfishness 

She never reconciles with other's good qualities. She would always criticize other's performance. She feels she is the best and other's are below her standard. She cannot withstand any objection to her way of working.

CONTRADICTION - intolerant of contradiction

There is a peculiar rubric in Ignatia: DELUSIONS, pregnant, is distension of flatus, if there is 

Let's understand the words of this rubric:

Pregnant - Producer of result fruitful
- Inventive, full of meaning, significant, 

Flatulence - Wind, empty in speech, pompous, self importance, pretension, high showing or extremely artificial behavior or style of writing.

That means, this person has a false feeling of self-importance because of the pretension and ostentation. She feels that she is pregnant which shows her capacity to produce results. But in reality it is nothing but distension from flatus. This show the claims she makes are not true but false. This she makes just to earn position and reputation in the society. 

Affectation

There are number of rubrics in this remedy which happens during menstruation, after menstruation or before menstruation. Though they happen during menstruation but the effect appears to influence the mind hence put in the mind section.


This means Ignatia always want to be in the state of pregnancy. This indicates Ignatia always wants to be in the state of fullness. The mind works prolifically during that period generating some innovative ideas. She aims to go higher and higher during these period.

As soon as the menstruation appears pregnancy comes to an end. 

That's why Ignatia is in the rubric Remorse menses after.

Menopause is further worsening situation for Ignatia. Because that is the end of sexual life. The fertile period is over. She feels after menopause no body will give importance to her as she is now unable to produce. This condition brings on embarrassment for Ignatia which makes her extremely irritable and angry.

Many times patients come and say, "lc vPNk vPNk jgsA", all the goods should come to me.

They are very jealous to their siblings. If she is ignored she cannot bear it. Rejection is intolerable for her.

Once I want to see patient suffering from Ca Ovary. There were few secondaries and the abdomen was full of ascites. She was unable to eat, to pass urine etc. She couldn't sleep for so many days. 

When I entered the ICU, she was angrily abusing all the staff and doctors and was crying, "Take me home. I do not want to stay here, all the doctors are fool here. They do not listen to me. They do not understand their duties. They even don't have knowledge how to handle my case."

I didn't ask anything and thought of this remedy on the basis of following rubric:

SHRIEKING - help; for
DELUSIONS - doomed, being, cries and rages
IRRITABILITY - pain, during 

After a dose of Ignatia 3X she slept for two hours which she did after more than one year. On waking she took food and then passed urine and in span of three days she was sent home and still she is enjoying the good life. I have repeated the dose as per the symptomatology.

Being dependent is great curse for Ignatia patient. They always tell that I should be at least able to manage myself.

FEAR - invalidity

But destiny has its own role. The disease or the circumstances sometimes makes you such that you understand that you are nothing in front of the all powerful disease or nature. You have to avail the services of others and then Ignatia realizes what wrong she has done. She feels that she might have committed some crime. Then she feels that everything is finished, she is ruined. When no body listen to him, she feels irritated and the she remembers those golden days of her past life.

SEARCHING - floor, on
FORGETFUL - everything - dreams; except of 

Even then the shrieking remains. The weeping and sobbing remains.


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