Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
This article describes a patient with Oppositional Defiant Disorder. The case
An Impossible Pixie taking, case analysis, differential materia medica and follow-up care are
addressed. The concept of analysis using Paul Herscuʼs Cycles and Segments
She described the ongoing and escalating is also introduced.
battles with Claire that began the very mo-
ment she opened her pretty blue eyes each K E Y WO R D S Oppositional Defiant Disorder, Behavioural disorders, Pla-
morning. From getting dressed to brushing tinum metallicum, Cycles and segments
teeth to sitting for breakfast, from getting
184 Amy Rothenberg, Oppositional Defiant Disorder – Homœopathic Links Winter 2009, Vol. 22: 184 – 189 © Sonntag Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG
teenagers can bicker, fight verbally or l frequent temper tantrums that a remedy along with ongoing consis-
physically; they can overtly or quietly dis- l excessive arguing with adults tency of strong parenting would likely see
M AT E R I A M E D I C A A N D C A S E S
obey, and defy authority figures such as l active defiance and refusal to comply her behaviour improve and help her to be-
parents, school faculty and staff, and other with adult requests and rules come a healthier part of her seven member
grown-ups in their lives. They can break l deliberate attempts to annoy or upset family as well as her community of friends.
small and large rules in premeditated ways people
or seemingly without the ability to see the l blaming others for his or her mistakes I did encourage the parents to have their
consequences such behaviour might garner. or misbehaviour daughter allergy tested, for in some cases I
They can do things with the expressed idea l often being touchy or easily annoyed by have seen that severe food or environmen-
of hurting others; they can be less inten- others tal allergies can either cause or worsen all
tional in their behaviours but nonetheless, l frequent anger and resentment manner of illness, physical or psychological.
destructive. Unfortunately, as these chil- l mean and hateful talking when upset In Claireʼs case no allergies were disclosed.
dren get older, the stakes get higher, and l revenge-seeking behaviours
they can do more actual damage to them- What can we expect a remedy to do in this
selves or others, both physical and/or psy- Actual causes of ODD are not known but setting for this kind of child? For those with
chological. many parents and care providers will say emotional and behavioural issues we can
that this particular child was more difficult look for remedies, alongside consistent,
There are times in childhood when opposi- right from the start, perhaps there had been loving and firm parenting and appropriate
tional behaviour is quite normal such as in a difficult labour, issues with colic, inability school settings, to go a long way in stem-
toddlerhood and early adolescence. But to “go with the flow”. There can be co-mor- ming even the most challenging behav-
when oppositional and defiant behaviours bid diagnoses such as ADD, ADHD, learning iours. That said, I try to never work in a vac-
Amy Rothenberg, Oppositional Defiant Disorder – Homœopathic Links Winter 2009, Vol. 22: 184 – 189 © Sonntag Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG 185
5
High spirited/
M AT E R I A M E D I C A A N D C A S E S
vivacious
2 9
Inappropriate Obstinate/
behavior defiant
Jealousy/ Striking/
wanting outbursts
2 5
Remorse/
forsaken
3
Case Analysis although both parents tried mightily to love knowledge of materia medica and upon my
each of their children and to make time for clinical experience.
186 Amy Rothenberg, Oppositional Defiant Disorder – Homœopathic Links Winter 2009, Vol. 22: 184 – 189 © Sonntag Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG
I also made a number of other behavioural
suggestions to the family:
M AT E R I A M E D I C A A N D C A S E S
1. Continue with clear and logical conse-
quences for inappropriate behaviour.
2. Give Claire one job to do per week that
is only her job.
3. Create together a morning TO DO list on
a large piece of paper; have Claire come
up with the list. Use art on it if that ap-
peals to her. Hang it in an easy to see
spot. Have her refer to it in the morning
4. Consider purchasing an alarm clock for
Claire; put her in charge of waking her-
self.
5. Reinforce the NO hitting rule and spell
out consequences. Time out is fine; for
an 8 year old it should be a good 10 –
Fig. 3 Remedies in fundamental Segments 1. 15 minutes. No discussion, no talking
after the timeout: she knows why she
was put there.
6. Put things she WANTS to do after
with these three remedies, things are not kind of objective yardstick to help better in-
often this constant or this extreme; it is a form my follow-up decision making. I do Follow-up
matter of intensity. Veratrum album has not want this to be a difficult situation to
that intensity; it well covers the part of assess on follow up. I asked them to return six weeks later. Claire
Claireʼs Cycle that describes her haughtiness was chipper as ever, eager to sit right down,
and violent tendencies but does not well Hereʼs the list I wrote for Claireʼs parents of asked me right away if she could have more
address the more captivating and often things I expected the remedy to address: of those balls, they tasted like candy! We
charming and pleasant parts of Claire. Her (Sometimes students will ask me whether chatted a bit; Claire told me what she was
feeling of being forsaken which drives her that puts ideas in their heads about what a up to. Mom shared that things seemed a lit-
to a kind of haughtiness and from there remedy might do. I say – so what? If it does, tle better, that mornings was where most
leads her to destructive tendencies fits well letʼs use that element of positive thinking improvement was seen with cooperation
with the Cycle of Platina, to which I am in- placebo to everyoneʼs benefit!) and lack of conflict. Claire could still be dif-
creasingly led. In this remedy we also find 1. Easier morning time routines. ficult but there were days where things
the seemingly inborn ability to charm side 2. More days without major incident. went smoothly enough for this family with
by side with an utter inability to accept cer- 3. Some show of movement toward ma- five children. There were still incidences at
tain emotional realities that might beset a turity (such as taking on and complet- school and at home, but generally less of
family such as Claireʼs. So it was with Plati- ing a new chore, doing something with- them and they had less intensity. Claire
na 200 C I went, prescribing one dose. out being asked, a particular kindness seemed to recover more quickly when she
to a younger sibling, etc.). did lose her temper. She was helping
With patients who have all manner of be- 4. Improvement of the constipation, less around the house more predictably. When
havioural issues, I, much like teachers and reliance on or need for bulking agents. Claire had left the room, her mother said
therapists, insist that parents and I together 5. Less overall stress in the household, she had not noticed Claire masturbating
create a short list of what we expect to im- perhaps a family event or outing that since she had been in, at least she had not
prove with the remedy. I want to have some goes well. seen it in any shared household place.
Amy Rothenberg, Oppositional Defiant Disorder – Homœopathic Links Winter 2009, Vol. 22: 184 – 189 © Sonntag Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG 187
We waited. There was no other remedy I was another key ingredient to helping For instance, if I have a patient with abdom-
would have given with a report like that, Claire find a more effective and satisfying inal bloating, I ask what is this bloating an
M AT E R I A M E D I C A A N D C A S E S
and it seemed that the Platina 200 C was way to be in this world. Things are not al- example of. Perhaps it is an example of full-
still acting. In other words, things were not ways how we want them to be in family set- ness and swelling. Perhaps they also have
perfect, but they were moving in the right tings, work environments or in our com- swelling around the eyes or swollen ankles.
direction. The mother still appeared to be munities, but to have the support and help I would put all these symptoms in one Seg-
somewhat shell-shocked by her entire needed to find ways of being that are more ment, as they represent the same idea, and
household, but she agreed that things did productive and less destructive is some- then I would look for the best rubrics to
seem somewhat better. thing we homeopaths can do and do well. represent these specific ideas. I would call
Oppositional defiant disorder is not some- the Segment “swelling” or “bloating”. Some-
Two months later they returned and this thing that generally goes away on its own; times we see Segments that include physi-
time Claireʼs mother was quite certain in fact, many who have it go on to conduct cal body as well as mental, emotional or
things were going in a good way. Claire disorder or have co-morbid diagnoses cognitive concerns. In a section called
was, as always, a high-spirited child, but made in later years. Whatever we can do “swelling”. if it applied, I might also use a
she could take some feedback and not lose to aid these children and their families rubric like Mind: Haughty. On the other
it, she could wait her turn and not shriek helps at the moment but perhaps more im- hand, if there was abdominal swelling that
out dissatisfactions. She had not been abus- portantly, also potentially helps them tran- was quite firm and hard, I might see that as
ing her siblings and they in turn were more sition from angry, destructive, antisocial an example of “hardness”, and would won-
willing to play with her. The report from people into more productive, creative and der if there were other examples of “hard-
school was improving, with only the occa- capable members of their families and ness” in the patientʼs story, such as hard
sional outburst. communities. nodules in the glands or tendency for form-
188 Amy Rothenberg, Oppositional Defiant Disorder – Homœopathic Links Winter 2009, Vol. 22: 184 – 189 © Sonntag Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG
laptop as I take the case. After an initial pe- patient go, is that you understand the pa- C & S perspective for over 220 remedies.
riod where I work to connect with the pa- tient, understand all their symptoms, the Many of these are found in the Herscu Let-
M AT E R I A M E D I C A A N D C A S E S
tient, which includes explaining my ap- modalities and the physical generals. Most ter, available through www.nesh.com. Us-
proach a bit if they are interested, I can be importantly, be sure by the end of your ing C & S, homeopaths learn that many
found clicking away as we speak. I am not time together you understand what makes remedies share Segments, but have unique
saying it is easy to do this; i.e. taking the that patient tick, what drives their behav- Cycles which differentiate the remedies. In-
case, staying connected to the patient and iour, what most limits them. Grasping their stead of having long, seemingly random
remaining grounded myself, grouping nature, personality, their interests, likes lists of symptoms that describe a remedy,
symptoms according to Segments as they and dislikes will all be helpful, too. If you the materia medica is organized by Seg-
are flying at me, moving Segments around understand all that, as opposed to just an ments, where both physical, cognitive and
to put them in a logical order that reflects elongated laundry list of problems and mo- emotional qualities and symptoms can be
the patientʼs life, thinking about rubrics, dalities, you will be well on your way to found across Segments as well as organized
taking adequate written notes AND using finding a remedy that can help. into more logical order. Those newer to
the homeopathic software. But as a long- studying homeopathy have found this ap-
time and competent “multi-tasker”, I love One advantage of repertorising while you proach accessible. Those who have studied
it! The program also allows for easy move- go is that you can see what remedies are materia medica from other perspectives
ment of rubrics, moving whole Segments coming through the repertorisation, and enjoy being able to filter what they already
and seeing what remedies are coming you can ask questions that help to rule in know through such a lens.
through as I go. and out those remedies. If this occurs dur-
ing the flow of the interview, it might take
Like many others who have come along on you in new directions with your question- References
Amy Rothenberg, Oppositional Defiant Disorder – Homœopathic Links Winter 2009, Vol. 22: 184 – 189 © Sonntag Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG 189