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Recovery Story: Case of Conduct Disorder: Violence
and Audacity in a Fearful Boy
by Tim Shannon, ND
Reprinted by permission.
Initial Appointment: 8/24/03
10 Year old boy: Patient is quiet and reticent
to talk. Much of his responses are one-liners and prompting yields only generic
information. Without prompting, he just looks around the room sheepishly saying
nothing.
CC: Conduct Disorder
-
Michael: Do you know why you are here? No, not
really. I think it is because I have trouble getting to sleep at night.
-
Say more about that?
I lay down and
stuff, then it’s hard just getting to sleep—it’s weird.
-
How long?
I don’t know, you could ask my mom.
-
Worst
sickness? I don’t know; think mom
would know that.
-
Anything about school? Pretty good, but
last year I had a little trouble with attention and stuff - it is okay, not into
school or anything.
-
Something you do like about school?
I like science
stuff and making things with clay; the art.
-
Can you tell me more about
paying attention in school? When he was talking it seemed like I got what
he said, and sometimes I’m talking to my friends too much.
-
Do you get in
trouble at school? When I’m talking when the teacher is talking.
-
Do you
have any fears, anxieties, or phobias? I’m sort of afraid of the dark. I
think that is it.
-
The Dark?
When
I’m upstairs and it is all dark and I’m by myself, alone in the dark. It spooks
me out.
-
Any fears when younger?
No, don’t think so.
-
Do you leave a light on? No, but I like the
door open, and mom’s door is close by.
-
What do you
worry about?
Something in a movie, or something on TV, makes me spooked out when I think
about it.
-
Example? There is a
giant boar in this movie; it was spooky.
-
Do you like animals? I like
animals, especially cats and dogs.
-
Do you
have other favorites?
Alligators and crocodiles, they interest me.
-
Which is your favorite?
Probably cats, domestic cats and jaguars. I like jaguars.
-
Are there any
animals you dislike? No, but once I had this dream of a blue whale
attacking me; it usually happens when I’m sick. I have it when I get sick.
-
More about the dream?
I’m awake
sometimes, but I’m in my mom’s room, doesn’t make sense a lot of it. In the
dream I’m half awake and half asleep.
-
Say
more about the whale? It is
chasing me. I don’t remember a lot of it.
-
What does it do?
It chases me through the water; I think I’m in the
sea, because it is deep and stuff.
-
What foods
do you like? I don’t like really spicy stuff.
-
Do you have any
problems with your head, stomach, or breathing? No; well, sometimes I have a
slight headache.
-
Headache?
My head hurts; I don’t really know.
-
Does it happen often?
Not very much, It happens maybe once
every 4 months.
-
Where is it painful?
In the middle.
[I excuse the boy out to
the waiting room and invite the parents in. This boys presentation is fairly
typical for his age group, where he doesn’t really want to say anything
incriminating or personal, but is too timid to be rude or too off-putting. I
often have to rely on the parents to get the bulk of the case in these
situations.]
-
Mom & Dad: He is somewhat troubled. He has anger
issues, dominance issues with friends. He is hard taken by criticism. He is
easily hurt; his self esteem is very fragile. He frequently feels out of place,
doesn’t feel welcomed by the world. School is difficult, especially the social
scene. He has a few good friends, but he tends to alienate them by being
aggressive. He has some deep-seated anger.
He also has a very sensitive side. If he
doesn’t get his sleep, he can be a real pill. He has sleep issues—it takes him
a while to settle down. It takes us a good hour and a half to read and settle
down. He’ll sleep in til 9. Our concern is his self esteem as he does not have
confidence. Fears are an issue with him. He fears the dark. He tries not to
be afraid of things, but he is. Abandonment stuff is pretty large. He fears
being alone, and the dark thing.
-
Examples?
He asks about going to the
bathroom - still does that. He went through a period, where he was
intentionally avoiding going #2
-
More?
Once he got really constipated, 2 or 3 years ago. He has to be reminded
daily to do things. Like going to the bathroom for example. He loves
baseball but he doesn’t like to come up to the plate - he doesn’t like people
watching him. His feelings are easily crushed.
Then too even with the neighbor boys; when their energy was too much for
him, he’d push them away physically. He doesn’t stop to use words; he
bulldozes.
-
Example?
He regularly
gets aggressive with friends; it easily escalates.
Once it starts, he gets real aggressive.
He takes care of things on his own - he doesn’t tell anyone about his troubles.
There was this kid badgering him at school. This one kid really began to badger
Michael. Generally Michael can scare people off. When he meets with someone
and he can’t take charge, he is easily cowed. It is hard for him to back off
and go with the flow. His play can escalate, and he can be yelling about what
to do and you can’t do this and can’t do that – very intense.
-
Does he ever
hurt himself? Yeah, he has had suicidal talks, but it’s not a regular
thing. He is pretty cautious physically.
-
What is his pain threshold?
He
is pretty fragile, maybe a 4/10. One little hang nail, and he doesn’t want to
play hockey. He uses that as an excuse. “Oh no, my legs hurt, I can’t do
anything.” He likes to be back in the womb, loves being home - loves the
security. He doesn’t like the unexpected.
-
Example? I’ve been telling
him about this meeting; he said he wasn’t going to come – at the last minute. He
doesn’t want to do something new. He is used to getting his way pretty much.
We cave in to his demands on a regular basis.
He doesn’t like people to know he is in pain;
he is embarrassed when he is in pain. When he
is hurt, he will lash out, you can’t look at him. He doesn’t like being
embarrassed. If he gets hurt, he tells you to go away, he doesn’t want your
attention, but he wants you there. He’ll yell
“Get away from me!” as he is crying. While he is crying, he yells at you
to leave him alone. Then he starts to blame you for letting him fall.
It is someone else that did it; he is not
responsible for his trip ups. Does he
like attention? He never wants to be on stage. Once he had to do a speech,
it was small. He was one of the best. But it didn’t make any difference to
him; he was so scared up there.
-
Are there things he is good at? Yes,
but he is not willing to fail. We worked on baseball, but he avoids it because
sometimes he misses. He was getting competent, but still wilted away.
He gets obsessive with the computer games.
Whatever he is into, he is obsessive. But then he can’t go outside of that,
can’t relate to others outside of those things. He has led a sheltered life; he
is an only child. He was raised mostly with his mom, mostly a momma’s boy.
-
What are his biggest problems?
Aggression,
but if he has to defend himself, he gets physically aggressive. He has
an energy he doesn’t know how to control, or to back off. Even his best friend
was going to cut him off, because he was violent. He gets in people’s faces; he
is physical. He has come at me. He has a real physical aggression and an
emotional one. This kid at school, a street kid; they were kind of buddies;
then Michael would turn on him. Then the kid was stalking the house, hanging
out in front of the house. The second day, Michael started freaking out,
yelling. We’ve had some criminal activities around the neighborhood. He is
afraid, but if you bring it up, he gets attracted to malevolent acts. He has a
dark side that gets into it. There is definitely fear—“Would anyone come to our
house? People wouldn’t come over here, would they?”
-
Does he rage
physically? He can hit, and kick, yelling; that has always been a problem.
He’ll walk up the stairs yelling as loud as he can, he likes to use his voice.
It’s the same thing with play; we can hear him a block away. He likes
one-on-one play versus group play.
-
What are his fears, anxieties, and
phobias? Definitely fear of the dark, fear of being alone. We live in a
two-level house; he won’t go upstairs much, wants me to go upstairs with him.
He usually would take on the world like he is so tough. He is embarrassed to
talk about it. He has a fear of being on stage. He doesn’t like to try new
things, he’s not spontaneous. He’d wake up yelling for his mom, he did that for
years. If he knows I’m home, he’ll go back to sleep. He gets real dependent on
one person. He is like that in his friendships, one person. When his best
friend moved he didn’t think he’d get another friend. He is oppositional, very
picky. If you say something and don’t use the exact right term, he is all over
it. I think he will be more into individual
sports.
-
Does he like animals?
He loves them. It brings out the
best in him.
-
Are there any he dislikes? No; he loved dinosaurs, went
through a huge phase of that.
-
More?
He studied them, went through a strong emphasis on them. He is very
scientific.
-
Tell me about the pains in his legs (trying to see if the Rx
confirms). It was something in his legs; we thought it was
growing pains.
-
What does he think about death (again confirmatory
questioning)? A few years ago, he said he’d want to die before me, because
it would be too hard to live without me. We went through a phase asking about
when you are going to know you are going to die. Once reading Harry Potter,
he asked about what would happen if we died. He becomes very unsettled if things
don’t go as planned.
-
Is he jealous (confirmatory)? Yes, like our
housemates, he has run them out of the house. If I show any interest in the
housemate’s kids, if I was chatting with the girls, he’d start getting loud in
his room. He needs to be reassured that he is number one.
[ I like to establish a baseline of symptoms before
treatment begins. So I typically ask the patient, or parents in this case, for a
list of symptoms. I ask “Let’s say you were coming to this appointment in 6
weeks or so, and you were thinking to yourself, Wow, I think this has really
helped, how would you know?” “What would have to change that would tell you that
Michael is really doing better?” I put that query to the patient in an attempt
to get them to articulate what are the most obvious and definable problems. Then
I coach them with each symptom or problem so it is definitive rather than
ambiguous. The list below was articulated by the parents with my prompting for
clarification.]
Baseline Tracking:
-
Outbursts/Rude/disrespectful approximately 3 times per day
-
Fear of dark
-
Fear of being alone in house
-
Verbally abusive approximately a dozen times a week
-
Falling asleep approximately 5 nights a week it is difficult for 40
minutes to an hour
-
Crawling into my bed (Mother’s) – Every night
-
Develop interests other than books and video games
Assessment: The remedy appears to be T-rex. The
highlights are: The dinosaur obsession, obstinacy, fear of the dark, the love of
big animals, big cats, and also alligators, fears transitions/change, and
complaining of leg pains.
P:
-
T-rex 200c (Helios) Q12 hrs X 2 dry
Comments about T-rex: I was at a seminar with
Massimo Mangialavori about reptiles prior to this patient. He told the story of
a very aggressive and jealous boy who lived in a big family. Massimo had been
treating the rest of the family successfully, but this one boy he could not
help. The boy would partially respond to Lachesis – especially with acutes – but
it didn’t help much with the behavioral troubles. The boy was very aggressive,
incredibly possessive, very afraid of the dark, and was afraid of death. During
Massimo’s continued attempts with the boy, he came upon a case of Karl-Josef
Müller’s (Refworks) of T-rex that he thought fit this boy. So he gave it and it
worked wonderfully. He now has four long term cases of this Rx, but all are
boys.
So, when I saw this boy and heard
the symptoms from the parents, I thought of this Rx and went about trying to
confirm it. Below is my repertorization (using Massimo’s repertory combined with
the Millennium)
First Follow-up: 9/29/03
-
Michael: Do you
feel anything different from the medicine? I’ve been remembering things
more in school, more than last year. I guess that is it; that is changing about
me.
-
How is being in the dark?
Actually it seems easier for me to be in
the dark now. When it is dark in my room, I’m not scared.
-
I wonder what it
was that you were scared of? Not anything in particular. I knew it wasn’t
there, whatever it was that scared me. I know it wasn’t there; the thought made
it creepy.
-
How is being alone?
I think I’m fine.
-
How
is your sleep? It has changed a little, my mom said I got more sleep one
night. Seems like I get to sleep a little earlier.
-
Do you like water (Massimo mentions hydrophobia in some of his
cases)? I love water though I usually don’t like it too deep.
[I excused Michael out to
the waiting room and invited in his parents. Again, Michael had little to say
that could help me in my assessment]
-
Mom and Dad:
He is doing fantastic, totally
changed, like he has grown up a year. I’m totally amazed. His attitude is way
better. He approaches things differently. He approaches us totally
differently. He recently said something to the effect that “I’m going to do
this myself, but I’m getting braver.” He is more willing to admit that he is
afraid. I felt him look back at himself, almost from inside himself, like some
separation. He is falling asleep quicker. He is making changes about that he
never did before. He decided to take a violin lesson. He is really getting a
good perspective on himself. He used to get all mad at me for my input about
him. Now he lets me know that I don’t have to badger him.
Baseline Tracking:
-
Outbursts/rude/disrespectful approximately 3 times per week
Hardly ever, only when he is
tired -- it has been a dramatic reduction
-
Fear of dark
He still has that, doesn’t
want to be left alone. He can tuck himself in; he is aware of it and more
willing to let it go.
-
Fear of being alone in house
Seems better; now he enjoys
being alone. He used to want to know someone was around; now he’s okay by
himself.
-
Verbally abusive – a dozen times a week
That has changed; I haven’t
seen that in weeks. He has to be messed up to lash out. He is getting better
about presenting himself.
-
Falling asleep – 5 nights a week difficult for 40 minutes to an hour
That has changed. Now a half
hour after I leave, he’s asleep – he doesn’t call out to me like he used to. He
was checking in to keep from being alone. If he does it now, it is to have
fun.
-
Crawling into my bed (Mother’s) – every night
He is not doing this; he
sleeps alone. We decided when we moved in, that was the arrangement. But it
also came from a place of confidence with the arrangement. He is adaptable,
able to change.
-
Develop interests other than books and video games
He has been really interested
in science, space travels. He has been asking questions, great ones.
In the mornings, he is waking up easier then he used to.
He used to wake up cranky, that is better, huge changes. He is mentioning that
his mind seems to be working. He is more flexible, and not so stubborn.
Sometimes he says one ear gets hot. He gets bloody noses, always on the left
side.
Assessment: Sounds good, needs more time to be
definitive.
Plan:
-
Wait & Watch
Second Follow-up: December 18, 2003
-
Mom and Dad (Michael refused to come): I think it is
wearing off, or something. Some of the other behaviors are coming back. Since
Thanksgiving on, we have seen that refusing, or very emotional or freaked out
about things he was starting to let go of. Like today, he didn’t totally flip
out but he did refuse to come. I think he still is doing good, still solid. He
says, “I don’t need any drugs.” I guess he is relating the behavior and the
medicine as drugs.
-
So what happened around Thanksgiving?
We have moved,
but it is kind of sinking in that he doesn’t have anyone there. He is somewhat
idealizing where we lived before, missing it somewhat. His dad lives a block
away; he still walks home from school. I don’t think anything else has changed
that much. Dad is like the police, makes you do
things. He had a fear thing about... Michael just freaked out about me
going to a bar. He has to have everything in place. If anything switches, that
is different, he just really freaks out. It came down to “People that drink are
stupid, and you’ll be around stupid people.” He was overly fearful for me. It
really threw him off. It was just huge; I ended up staying home. He did talk
about suicide recently. He’d brought it up before. He said something about
life being hard, why fight it, it would be a lot easier to be somewhere else.
Having to feel so defensive wears him out.
Baseline Tracking:
-
Outbursts/Rude/disrespectful – 3 times per day
He’s gotten much better about
being respectful. But sometime around Thanksgiving, he started slipping up,
trying out some of that stuff again with me. Like “Oh shut up, you’re stupid.”
He is getting much better about verbalizing and not getting too worked up about
things. He started getting physical, started coming at me, doing that physical
aggression thing again. But it is only once or twice since we last saw you.
-
Fear of dark
He definitely seems better
about that. He is sleeping through the night on his own. He tries to come in
my room, I shoo him back out. I think he is realizing the dark isn’t as
fearful. He is not as fearful; he is getting much better about going up to
people asking for help too.
-
Fear of being alone in house
Better, now he is trying to
get rid of me. In the apartment he feels pretty cozy; the other house was
bigger and scary. He is fine at his dad’s. He is shifting away from me more
(Mother), but he doesn’t know how to do that gracefully. He is alone some at
his dad’s and okay with that. He definitely seems to be doing better with this,
starting to trust people more too.
-
Verbally abusive – a dozen times a week
Now it is only when he is
tired. He has gotten much better at saying, “Oh, I’m sorry.” He is catching
himself, able to see himself a little better. He has been able to do more
owning up. Before he felt he had every right in the world.
-
Falling asleep – 5 nights a week diff for 40 minutes to an hour
He has gotten much better
about staying in his bed. Went through a phase recently, messing with me trying
to come to my room. There is improvement.
-
Crawling into my bed – every night
That is no longer an issue.
-
Develop interests other than books and video games
He has taken up violin at
school, which was his choice. So he is proud of that. He is playing
basketball. He also took a cartooning class. Really attribute that to the
homeopathic, he is actively taking interests. He is doing projects at school.
He was getting more locked in before.
One day he got physical; I had to pin him down. That is so
much less frequent. Overall, definitely there is groundedness happening in
him. That fear he didn’t want to come here, didn’t want to think something is
wrong with him. He was able to be objective - that he has attention issues.
And he said he was getting better at his grammar. He is starting to see himself
as capable. He is doing great on his school projects. He has been evaluating
himself in a better light. We also used your Rx, when he was sick, and it
seemed to really help. Any history of hemorrhaging or easy bruising (trying
to see if the Rx has similar themes to other reptiles)? When he was younger,
he did bruise easily. Any bleeding? Yeah, always been a nose bleeder -
his left side, just like his father.
Assessment: Doing well, mild relapse
Plan:
-
T-rex 200c (Helios) Q12hrs X 3 for now – also hold onto bottle for
future acutes.
Case Comment: Another follow-up was set with the
parents, but it was cancelled a week or so prior. They felt he was doing great
and also Michael was reticent to come back in. So I didn’t hear from them again
until Late November of 2004 – almost a year later.
Third Follow-up: December 06, 2004
[Patient
still seems reticent to open up, not looking to pleased to be here. I speak to
Michael for a few minutes, but he has little to offer except he still has some
fear of the dark. So I invite his parents in.]
Mom and Dad:
We saw a lot of progress, amazing results in the first 6
months. Incredibly so, like he grew up a year in a week. It was mind blowing.
He was much more respectful. There was a big shift in him. We are back, not
because it has reversed. He is not fighting life as much, which had to do with
fears. The fear of the dark is still there though he is much more adventurous.
He is crawling down dark tunnels now. We live in the city, and there are some
people there on the street, he doesn’t like to pass them by. He’s had
encounters with them; he doesn’t like that at all. The TV is downstairs, in the
basement; he is more willing to go down there. If in dark, likes TV or a game.
He still has that fear of the dark. Because he is so brave about some things,
but he has admitted it to me. He doesn’t always accept help or ideas; he likes
to do things on his own. We had a conference with his teacher. She said he is
not focused. Oftentimes he comes into the activity in his mind, like “where are
we?” He spaces out. All of his teachers have mentioned that. They wanted him
tested for ADD. She also said he is an instigator. He wants to please her.
When her back is turned, he is pushing buttons with other kids, looking for
attention. He doesn’t feel he has any friends at school. Participating with
others has always been tricky for him, in a group. He has recently had a huge
falling out with his best friend. Recently with his friend, being rude, he had
to be mister know-it-all. What it always comes down to is his friend Brian,
putting him down. There are times when Michael doesn’t feel quite up to Brian.
They do these imaginative games. He says he’s not into that anymore, and the
gap got wider and wider. He has always felt a bit like an outsider. He is
starting to see that in himself. He doesn’t feel he has any friends. Sometimes
it is how he views himself; he gets wound up when he plays, and gets aggressive,
trying to be the hotdog. Recently I saw him out in play, and he is very
competitive. He wants to be top dog. He is never really playing, but more “You
win” or “You lose.” He is aggressive; it is hard for him to back down and turn
it off. When he is yelling, you can hear him from a block away. And his
relationship to water? Loves it, totally loves it. He has been fascinated
by deep sea creatures; he has always been into sharks. He gets obsessed about
those sharks. We went swimming in a deep lake, but he was a bit nervous around
deep water. He is very defensive, but he is also starting to see other people’s
perspectives.
Tracking:
-
Outburst/rude/disrespectful – 3 times per day
That is much different now.
He says you don’t get it. He is not as rude like he was. In school he is well
behaved. Seldom raises his voice.
-
Fear of dark
It has improved but not gone
-
Fear of being along in house
Better
-
Verbally abusive – a dozen times a week
Not really happening anymore
, occasionally, but not very often anymore.
-
Falling asleep – 5 nights a week difficult for 40 minutes to an hour
That is still true, but some
of that is because I stay with him til he falls asleep.
We talked about setting a new baseline of symptoms since
some of the originals are gone or are not the current focus anymore:
New Baseline Tracking (12/6/2004):
-
Take criticism – defensive, denies it consistently
-
Fear of dark
-
Distracted @ school, focusing problems
-
Competitive
-
Staying up to late
-
Quarreling – mister know-it-all, he is mister expert, does it with peers
too.
Assessment: Patient still appears to be in the T-rex
schema, being brash as a compensation for being fearful. Contrary, taking
criticism poorly, etc.
Plan:
-
T-Rex (Remedia) Q1 Qd – 20/80, in 4oz water, then ¼ tsp
-
RTC in 2 months
Case Comments:
The next follow-up was again cancelled. I saw
the patients mother around town recently and we spoke about Michael. Apparently
he responded well to the Q1 potency and is again doing well. She spoke about
possibly bringing him in for another visit in September. She gave permission to
have his case published.
Some comments about T-rex: My general understanding
of T-rex is that it is appropriate for boys who have the juxtaposition between
their wanting to be strong and powerful, and not wanting to show their
vulnerable side. So they use a loud voice, aggression, obstinacy, and become
interested in big animals (Like dinosaurs but also other large and powerful
animals) to compensate for a feeling of low confidence.
They can share some of the
symptoms of reptiles, in particular the more audacious reptiles like Lachesis
and Bothrops. The confusion is that they can also look like a nightshade because
of the fears.
The growing pains appear to be a
problem that they have with the idea of aging, growing old, or making
transitions. According to Müller & Massimo, these patients are vulnerable around
the idea of getting older, of eventually meeting their mortality. The bone pains
are showing that they are in fact growing up, getting older. The fear of the
dark may also be some kind of holding on to an earlier safer time, a younger
more dependent sense of self. So perhaps in some sense, these patients are in
fact in a kind of limbo, between not wanting to seem vulnerable, yet they also
don’t really want to grow up.
They can also have the fear of
persecution – in this boy it comes up around homeless people, in Massimo’s
cases, it was around policeman getting them. Massimo has seen some of his
patients be either afraid of death or suicidal. These patients can be quite
aggressive and audacious in clinical practice so they can be mixed up with Stram,
Lachesis, Bell, Lyssin, Bothrops, and possibly Alligator (See Todd Rowe’s
excellent proving).
I am publishing this case because
for many of us, the differential for these types of cases can be challenging. I
don’t want to pigeonhole this Rx for boys only or only children. This is the
only experience I’ve personally had with the Rx and I suspect that there are
other cases walking around in need of it. Of course, once we begin to have some
females and adults, the understanding of the Rx will mature.
To my
knowledge, the primary information came from Karl-Josef Müller. Karl has a lot of information in
Reference works that helps to clarify his understanding of the Rx. I do not know
of any proving of the Rx. Karl obtained the Rx from a curator, I believe it was
from a fragment of the fossilized femur bone that was then sent to Helios for
processing. Remedia in Austria also has the Rx in multiple potencies.
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