A CASE OF MENORRHAGIA
Italics and bold have been used to highlights pertinent phrases.
In blue are my explanations.
Case has been edited for brevity.
A lady aged 47 yrs. consulted me for the uterine fibroid with profuse bleeding on 20.2.2003.
D: So tell me about you.
P: I have the problem of profuse bleeding since my first menses. I also have three fibroids since the last three years. On the second day the bleeding is too much. I am not feeling that strong though I want to do so many things.
D: How this is bothering you overall? What is the feeling about this?
P: The pain, weakness and the bleeding is so much…I have to urinate very often and each time I go to the bathroom I feel the clots going. Sometimes they are clots, sometimes they are like mucus and on the 2nd day invariably since last 4-5 years, I am feeling pure blood going, no mucus, no clots, just blood.
D: How does this problem bother you?
P: I can’t do anything. If I am going to bleed so much, I am afraid that I’ll stain my clothes and I am afraid every now and then I’ll have to visit the bathroom. I feel very tired. My backache, legs aching…I feel very weak, very weak. It doesn’t mobilize me. It makes me completely crippled and I hate that feeling because I always like to be alert. I always want to be in charge of…at least not the situation around, I should be in charge of myself at least. There is a lot of pain; lot of… I won’t say lethargy but it holds me back from doing anything. So I want my menopause to come.
[The chief complaint does not mobilize her and completely cripples her. And then she spontaneously talks about her need to be alert and always in charge of the situation (in general). Thus, here she moves from the local (chief complaint) phenomenon to the general.]
D: In charge of myself…tell about it.
P: I don’t want to be bedridden. I don’t want to be bogged down by anything. When I am doing something I have to be in charge. Even when he (husband) is driving the car, I feel that I have to be awake. I must know what’s going on and what’s happening. I get invited all over the world. We were going to South Africa we were in the plane- now even before the pilot could detect that there is some fault in the plane, I told my husband that the flaps of the wings are not opening and the plane is retarding. There is some problem and it was true. I don’t know even if I don’t want to be alert I am a bit too alert. That’s my problem.
[She wants to be in charge and alert all the time. She does not want to be bogged down by anything. “Bogged down” is the opposite of being in charge and alert all the time.]
D: What do you mean by this too alert?
P: Even when I am meeting people, traveling around, I know what’s happening around. I know exactly how this person is. When I am in a party or in a conference, I know where is this person coming from. Is he a good person or bad person. Sometimes I myself don’t like to be so alert. In the plane unnecessarily I was the one who detected it earlier than the pilot that the plane is retarding, the wings flaps are not opening…Why should I be so alert? But that’s the way I am.
D: What is the feeling of being too much in charge of yourself, being too much alert?
P: If I am in a party or traveling alone or with people of same profession, people drink, relax. I will never touch it. Only if I am with my husband I take some wine…little bit because I don’t want to be just you know… I have to be alert. I have to be in charge. I cannot let myself go. I have very strong values of do’s and don’ts. I will not touch anything if I am without my husband in a party. Even If I am traveling abroad even when it is terribly cold and I know that wine may help me, I will not touch it. I have to be alert. I have to be awake, alert, and fine. I never like to loosen-up…let myself go… It doesn’t agree with my system.
D: So what’s that feeling of being in charge?
P: There are lots of women who come with us. They will drink, laugh, sit till late but I won’t do that because I feel it’s wrong. I like to be friendly with people but I have to maintain that distance whoever it is. I have to reach my room on time. It’s not that I am time bound or disciplined but I don’t like it when people start controlling you. You are drunk, laughing, joking. That’s not the way I like. I don’t like anybody doing that.
[She does not like being controlled or bogged down by others.]
D: Tell me about this feeling of people controlling your life.
P: My mother is a very subdued person. She has let people dictate her all the while and I was taught as a good Indian girl when I was married – ‘listen to your elders, don’t back answer them, don’t contradict them, do as they tell you’. While I am a very independent minded person and I never disrespect anybody but I don’t like anybody controlling my life or getting too overpowering with me because I will never do that to anybody else. So when I got married, it is a very conservative background. So ‘don’t do this, don’t do that. Why you did that?’ Till sometime I am fine with all these. I will endure it. I can take a lot of it but after a point there is no compromise. I just shut that person off. One fine day I will tell those people ‘do not interfere in my life because I have never done it with anybody’.
[Mother has allowed people to dictate her. Her sensitivity is reflected through her mother’s nature. She is independent and does not like anyone to control or overpower or interfere in her life. We need to understand the sensation behind all these feelings.]
D: So tell me what is the feeling of not being in charge, not being in control when people are overpowering you…What is that feeling?
P: Very frustrating. I feel completely bogged down. I feel somebody is just (H/G – hand straight catching the neck tightly, extending neck with eyes rolled up) strangulating me (deep sigh) but that is good upbringing…
[The sensation behind these feelings is that of somebody just strangulating her. This she even expresses with a strong hand gesture.]
D: Just tell about this ‘somebody is…’
P: I feel that I am locked in a room (H/G – hands coming close to each other) and I have to go out (H/G – widening arms), I have to gather fresh air. (Deep inspiration) I have to breath fresh air, take a deep breath and be on my own, be the way I am (catching her T-shirt). I don’t believe that one has to go to ceremonies and attend functions. Be honest. 100% honesty and 100% loyalty to the person you love. These things don’t matter.
D: Tell about feeling of strangulated.
P: It’s not more strangulation but I feel as if I am locked in a room. When people start saying that in this occasion you have to wear these clothes and put a big tikka (a religious mark in the middle of the forehead that signifies that woman is married.) and come do everything but don’t do anything that you don’t mean it. Don’t be hypocritical. Don’t cheat people even in social relationships and don’t dominate others. (H/G – 2 fists). I feel as if I am locked in a room and I must get out (H/G – 2 hands widening) and breathe fresh air. I may look modern with my haircut, but I have very strong values.
[She talks about a situation where she is asked to wear particular outfits. The feeling associated with it again is of being dominated. She gives the same image of being locked in a room where she must come out to take fresh air.]
D: We will go back to this feeling of strangulated and feeling of locked in a room and want to be free of that. Bit more about it.
P: Well everyone in his family, the society that I live in, they know that my FIL(Father-in-law) is an extremely difficult person. He is a little eccentric and too dominating. My MIL(Mother-in-law) is not eccentric; she is a very calculative, cunning woman and very dominating. 7 years we lived together I used to feel I am locked in a cage with…(Pause) because my FIL is very eccentric…with some mad person or some mad animal. You know wherever you go, in a cage you can’t run out. At the most you can hide here or there but he is going to be everywhere. So 7 years of staying together was hell.
[She is reflecting her perception about domination through the description that she gives about the FIL and MIL. Again giving the same image of being locked in a cage.]
D: So your FIL is like what you said a mad animal or something…
P: Yes, because he is completely eccentric. You know like a mad man or a mad animal… I am sorry to say but I am very frank. I have no relationship with him since last 4 years but he is the man who drinks too much. He talks the most abusive language. Language you cannot hear, language I won’t like my child to hear and when we were staying together my son was 2 years old. So all the time I had to protect my son from him. So that he (son) doesn’t get any bad influence of my FIL. My MIL has been very calculative, very scheming, money minded.
[She wanted to protect her child from her FIL.]
D: Just little bit more about this mad animal.
P: He is huge. He talks rubbish nonsense, abusive language, and drinks. So it’s not a trait of a human being. It’s not refineness. It’s not how a matured 70-year-old man should be. So I mean it’s not human. It’s very animalistic. It is disgusting.
D: So we will go back to that little bit more about that feeling of being locked in a room and like locked in a cage. Tell more about it.
P: Yes, this is the feeling, which I always get with people who talk too much, who are negative, who try to impose their views on me. I just want to break away from that relationship, from that atmosphere. Go out and breathe fresh air. I cannot bear such people.
[She further generalizes this image by saying that this is the feeling that I always get when people try to impose their views on me.]
D: As if you are in a…?
P: Cage or in a blocked room where I cannot breathe. There are no windows, nothing. I am the person who wants a fresh air, lot of freedom, lot of honesty. Lot of fresh air. I am not a person will be tied down (H/G – 2 fists coming close to each other) by hypocrisies traditions, lies, manipulating other persons, cheating persons in relationship. I cannot manipulate and talk. I have to talk straight and frank. If a person is troubling me and the relationship is not working, put it to an end. I have the talent. I have the potential to work extremely hard. I don’t want to be (H/G – fist) crushed or bogged down by people who are negative and who try to control you. There are times when I just want to run away…running on a beach, running where there is open space, laugh, enjoy but yet be in control of myself. Moderation… I don’t like to go in extremes.
D: You were describing your FIL, a few more words about him.
P: The things he would talk about, the language, behavior, drinking… I mean it’s disgusting. My MIL’s meanness, calculativeness, lies… I cannot bear if anybody lies to me. Tell me the worst thing, I may be very hurt about it but tell me to my face. I don’t like people who lie. I’ve trained my son also. He’ll tell me the things that I may not like, I hate. But he will not lie. When I am in a relationship I am 100% honest. The moment I sense that this person is dishonest or cheating me or trying to overpower me, now since last 5 years this is the trend, I just stop.
[Again she expresses her sensitivity towards lies, cheating and she being overpowered. The feelings of being over powered and wanting to be in-control are coming up at general areas. Now let us see if the same is there at the vital area or not.]
D: What dreams do you get?
P: Sometimes very funny dreams and I laugh in my dreams. I mean I laugh aloud. Or I get dreams like I have my periods or oh I have to do so many things. I have to go here I have to complete this, finish this, go and meet there, this one. I have to finish off lot of work.
D: Any dream of childhood, which you remember till today?
P: Sometimes I see my maternal grandma in my dream. I was only 5 months old and because of a very bad financial state, I had to live with my grandma’s house because they were very well off…could afford to bring me up. So I always felt that she is my mother. So at times I feel very happy to see her in my dreams. I wait for her to come in my dream. That’s rare, she expired when I was 16.
D: Any incidence of your life from childhood till today which had a deep impact on you?
P: It was the time when I separated from my grandparents to join my parents because she felt she was getting old and she may not be there forever. So I had to start bonding with my parents and that I cannot forget.
D: What was the feeling like?
P: Feeling of separation and the day she died, I had this intuition. Somehow I don’t know why but I called at my grandmother’s house. My uncle said that she’s not well. She had a heart attack. I knew something is wrong. I rushed there and she had already passed away so that I cannot forget.
[She talks a lot about loyalty to family, bonding with family. Also the incident, which had a deep impact on her, was of separation from her grand mother and the bonding with the parents.]
[The reaction to the feeling of being locked up in a cage is always to run away.]
D: Many times you want to run away… tell about it- what thoughts come out, what imagination comes out… pure which has nothing to do with your life.
P: Maybe running on the beach, just keep running without any time limit. Just be yourself. Just running on a beach…there’s lot of fresh air, lot of breeze or maybe running in the fields, open air.
D: Tell more about running in the field, open air.
P: Even as a child I used to travel a lot with my grandparents. I was given a lot of space. Again this space is very important in my life. I want my space. In marriages and everywhere to a certain point its fine but people sticking together…even in traveling, in functions or in marriages…You should have space for yourself. You should give others their space.
D: What’s the feeling when there is no space?
P: Again like you know being cooked up in a room. (H/G – Both the hands coming close to each other.)
[The feeling behind the reaction to run away is her need for having a space for herself.]
D: What’s that feeling of being in a very closed space… it reminds you of?
P: It reminds me of jail that has so many prisoners together. It’s horrible and you don’t have any privacy. You have to use the same toilet, same things. I don’t like relatives visiting me too often. I can’t bear get together. I want my space.
D: When you say ‘you are locked in a cage or in a jail’ what does it remind you of?
P: It’s very oppressive, frustrating. (H/G – bringing both hands towards the chest)
[She experiences oppression, being locked up in a cage or jail with the same hand gesture that she did earlier while describing the sensation behind being alert and in charge of herself.]
D: What is oppression?
P: Being with so many people and what I hate is you have to do like this. ‘Now there is this ceremony, so you go and tie a knot because you are the SIL(sister-in-law). Then you stand behind her and do it.’ It’s rubbish. Why should you do all these? Is it for the attention? Center of somebody’s focus ….And maybe I have learnt this from my son. I like dogs, their eyes. They are so innocent and they are so loyal… because loyalty is what turns me on. I feel very happy when I see loyalty in any form like a dog would be very loyal to his master. In the same way in any relationship you have to be loyal.
[Again she talks about being loyal.]
D: Any other animal which you like to watch or you like?
P: When I was in Africa we saw lot of wild animals.
D: Which one any particular?
P: Maybe lions. Yes. More so the lioness, because she goes out and hunts, you know and lion is just around. I like…
D: Tell me about it.
P: She is very protective for her cubs. Like I am very protective (H/G – 2 hands coming close to each other) and very attached with my son. I mean… I am so attached to him that I make sure even if I am going abroad, I will make him comfortable, cook for him. I make all the arrangements possible before I leave. I have to call him up at least once or twice a day to see that he is fine at least. I am trying to detach now. So much attention is not good…
D: What else?
P: My mother being a very subdued person, since the childhood I was a little different from my relatives so whenever a relative would try to find faults with me, she didn’t have guts to protect me – ‘you shut up. This is how my daughter is’. You know which I have. If my son is wrong, yes I will reprimand him but if somebody says something about my son, which is not true, I will take it up very seriously.
D: What else about lioness you like?
P: Boldness, fearlessness, she has certain loyalty, a bond (H/G – one fist in other hand’s palm) with the family, with her cubs, with the lion more that anything its boldness. When she goes hunting in the wild, she is protective, loyal…
D: And not very alert but…
P: She is very alert… yes she is extremely alert. That’s the point, which I missed. Lot of time I can make out from people’s lips what they are saying and 90% of times I am really at it… I mean I am too close to it. Yes she is alert.
D: In what way?
P: Meaning if you may be talking about me or not, from lip movements or body language, I can make it out what you are talking. If I am on the phone, I may be taking down notes most of the times when I interview on the phone, I have to be very alert because I cannot miss if I am quoting somebody. I can be sued for that if I misinterpret or misspoken. So I am very alert when taking down the notes but at the same time I know what’s happening behind me. I know what’s happening in the other room.
[While describing about lioness, she describes the very same qualities that she has been talking about herself till now…like being too alert, bold, loyal, protective about its cubs etc. Also while describing about lioness, she talks about herself in between and spontaneously relates herself to the qualities of lioness. She constantly interchanges herself with the description of lioness. Thus identifying herself with lioness.]
D: In what way the lioness is alert?
P: When she goes hunting, she can sense that there is an animal around and once she is chasing the animal, she has to be alert and she has to concentrate. She cannot let go. When I chase up my work… I wanted to write for Bombay times… come what may, people stop me, people put hurdles, people talked about me but I said no… if I am good, I have to write. Let me see who stops me and why… I have to make it happen. Even if a person has misunderstood me, I have to call that person up and tell him why he has done this. If there is some communication gap, I don’t have any fear for talking to people and talking straight. I am not scared that that person will insult me. If that is the misunderstanding, it will get cleared. It doesn’t hurt me.
[The characteristic here is she is using same words for herself that she uses to describe a lioness. ‘I chase my work…’ thus relating herself with the chase of a lioness.]
D: To peruse you have to be very alert and … so how you compare this with the lioness?
P: Like when she pursues you know like… when she goes hunting, she is at it. She will not be distracted, no matter what. But more than that quality I admire her boldness. One has to be bold. I like people who are bold, who are frank and who are forthright. I can’t bear people who cheat, manipulate and lie. It happens in everyday life. People do it all the while. Women do it all the time. Hence I don’t like women. I don’t like to be friendly with women. That small and mean talk I don’t like.
D: What else about this wild animal you are talking about – what else about it you admire the most?
P: Well…. The freedom she has, the open space. That is what I admire.
D: Tell about it. Little bit more.
P: Well she, the lioness is not curbed and bogged down by the rituals and traditions and social norms, all that stupid lies that we have created for ourselves. They are true to themselves. This is their nature. They are wild. They are meant to be that way. They don’t put on an act – ‘no no, no I am not like this actually… I am like this, you know’. They are transparent. They are what they are. You see any wild animal for that matter. Like Human beings they don’t create a false notion about themselves, ‘oh! I am so good you know and I am pure and I fast 10 times in a month you know…’ They are pure. They are what they are. Hats of to their beauty…
D: What else about it you like the most?
P: I admire for the open space they have. Another very not traumatic but very strange experience I had in childhood that 5 months when I was baby, I was left with my grand mother in a huge bungalow with a big garden, open spaces and then when I have to go and live with my parents. It was such complete change in one room kitchen, in a chawl (a street). I learnt to socialize there but from that big bungalow and garden and open space it was a sudden…
[While describing about a lioness, she starts describing about an incident that had a deep impact on her. Again showing her need to have space.]
D: What you compare this with?
P: Well like you have stories from rags to riches, I was happy with my parents. I don’t complaint because I had to bond with them it was very important that I go and stay with them in that chawl (a street) but the space you see….
D: It’s like a wild animal is put into a…?
P: Cage again yes, but still I had some wonderful experiences there. I learnt to bond with my parents.
[In this incident also she has the same feeling of being locked in a cage. Again she mentions about the bond in the relations.]
D: Now you remember any dream of your childhood which had come up or which used to come recurrent or once but it is still there in your mind…
P: Yes, I always used to dream of going somewhere out of India and there was this beautiful pink building and beautiful pink bungalow and a beautiful road … winding road and something that’s all but this dream has recurred several times.
D: What were you feelings associated with this dream?
P: A very special feeling… very happy… normally my dreams are very happy dreams and this is beautiful bungalow lovely pathway lot of trees that what I have dreamt couple of times.
P: Again I have this feeling of being in a cage or a prison when I have my periods because of this heavy bleeding I get the same feeling.
[At the level of the chief complaint also she gets the same feeling of being locked in a cage.]
D: Describe this cage feeling more.
P: All the time I feel, the moment this is over, I will just go out in fresh air …may be we will go to beach or some place get out. And the only person who I don’t feel should give me space is my husband. Because he gives me my space. He doesn’t enforce himself on me…
D: A bit more about it? Anything else which you are sensitive to?
P: No sensitivity. Yeah even this jewelry… I feel it is a kind of bandhan (restriction). Wear this, wear that and then get scared that somebody will loot me… I hate it. I don’t like wearing chains and bangles. If I am in a mood and nobody has told me to wear, I will definitely wear but I should feel like. It doesn’t speak of my status or my intelligence at all. I hate it. I feel it’s like hard wear. If I am to wear jewelry or traditional things to please somebody and prove that I am worth, is cheating. It doesn’t impress me at all. It makes me very unhappy and out of place if I wear lot of things… because again it’s not freedom. I feel a locked up feeling. Just get rid of all these things… be yourself maybe. That is what I like about animals also. Wild animals…they don’t need help of jewelry to prove their worth. They don’t have to prove anybody. They know what they are. Simplicity maybe scores over others. I have seen very silly women wearing the best of jewelry, they open their mouth and they make complete hash of everything or they are very wicked from the inside. When I see such women I feel as if it’s a wicked cat wearing all these and sitting there. You have in cartoon films very wicked looking cats wearing diamonds and all. Scheming little cats. Unless you can bear these things and be very honest it will beautify you even more.