A Case of Adolescent Self Harm

Tim Shannon, ND

Patient: A 16-year-old girl, conventionally beautiful, thin, petite, with black and red hair, wearing a black mini skirt and fishnet stockings. She was referred by a female colleague (partially because the patient preferred a male homeopathic physician) and was seeking help for depression, anxiety and self harm.

Initial Appointment, May 2004

My mom wanted me to come in for help for my depression and anxiety.

More? It began in seventh grade. I was very isolated and stressed. In ninth grade, I realized I was clinically depressed, and in tenth, started self-injury. I have social anxiety and blush often, feel constant stress, and use cutting and bruising as an outlet.

More? I’m trying to stop self-injury, but still want to do it when anxious. I’m nervous often, panic-attacky, and get extremely stressed in front of people. I’m fine with a select group, but uncomfortable in groups, especially if I’m the focus. I can’t control it, I get obviously nervous, blush and shake. It’s a huge problem – I can’t do anything. I go to great lengths to avoid giving a speech or to get out of going to a party, and if people pressure me, I’ll end up cutting.

Example? I got pressured to do a speech, I didn’t want to, but they kept badgering me, so I skipped school and cut myself in the bathroom.

Worst-case scenario? Suicidal.

When you actually do a speech? I’ll get up there, sometimes it goes okay, other times I blush, my lips shake, my heart races and I talk too fast, and am horribly depressed afterwards, and can’t forget it; things from long ago still bug me a lot.

Seventh grade? I felt isolated, had lots of embarrassing moments and was really, really shy. People teased me about it. I felt awkward and uncomfortable. I got homeschooled in eighth grade because I wouldn’t go back. Ninth grade was no better. I lost a big support in my life, for a while I thought that was making me depressed.

Support? My best friend moved and didn’t keep in touch; he didn’t seem interested, it was a big blow. I had no other friends. In seventh and eighth grades, I could still have fun. After he left, I became unmotivated, quiet and depressed. In ninth grade, I kept being sad, but realized it wasn’t about that anymore.

Grade now? Eleventh.

Most difficult now? The anxiety. I can’t hide it. If I knew I’d never blush, I wouldn’t be as crippled. It keeps me from doing stuff, restricts my life. The depression is related – I can’t go out when feeling vulnerable and depressed, I don’t want everyone to see. I can’t appear weak in any way – being nervous is weak.

Appearing weak? In eighth grade, I liked not being girly, I shrank away from girly things … slumber parties, wearing pink. I also didn’t want to look girly. It’s always bugged me that I’m physically small. I don’t want to appear weak, vulnerable, girly, helpless, naïve.

More? If someone implies I’m weak, comments about me being short, blushing or unable to lift something, I’ll go dead silent, get depressed and occasionally think suicidal stuff. I can’t control it, really bothers me.

Fears/Anxieties/Phobias? I’ve always been scared of deep water, of not being able to get away, of something swimming underneath me. I’m afraid of the dark, of public speaking.

Deep water? I hate the feeling of floating, of not seeing what’s under water, being unable to get away fast, feeling helpless. I have lots of dreams of things swimming underneath me and I can’t get away, or dreams of trying to run, but not fast enough, or trying to punch or kick but not fast enough, and people laughing at me because I can’t hit hard enough.

Animals? My favorite animal is a hawk; I’ve always liked bats, too. I also like big cats. Fireflies and jellyfish are interesting. Hawks and bats are the big ones.

About hawks? Hawks are fierce-looking, fascinating. I like that they’re predatory and dangerous.

Animals averse to? I’m fascinated by dangerous ones, typical ones are boring.

Nervous habits? I chew the skin around my fingernails, a lot. I rip at them and they bleed.

Appetite? Recently, the past year it hasn’t been there. I don’t have an appetite. Nothing sounds good, I’ve no will to eat. If stuff sounds good, I have no problem eating. I don’t gain weight.

Hypersensitive to sound, light, odors or touch? If music I don’t like is playing I will want to explode. Occasionally, if something rubs against my skin, I can’t get to sleep.

Speaking up for yourself? I’m not very good about that. People used to think I was mute.

Physical health problems? A lot of headaches, I don’t drink enough.

Headaches? Usually one-sided; or it’s on both sides of my head, like a vise squeezing, and I can’t concentrate on anything.

Sleep? Don’t get enough; I stay up too late.

Waking? I hate getting up, not a morning person.

Dairy? No problems with milk, I’ve always liked it – drink some every day.

Feeling isolated? I don’t connect easily. I felt isolated from fourth grade till last year. I don’t connect well with girls. They have traits I really dislike, they value different things. I don’t understand how most girls think, don’t enjoy the same things, have a different sense of humor. I feel competition with them.

Competition? Her outfit looks better than mine, her hair … but I don’t show it. I can’t have girlfriends, I feel inferior. I’m more aggressive than most girls. I value my tomboyish side, but I’m getting physically aggressive, hurting people, but not meaning to. I’m friends with this freshman; if he bugs me, I push him, choke or kick him. Sort of playfully, but I enjoy that I can hurt him. Once or twice I choked him, and made his mouth bleed. I’m physical – if someone reaches out to me, I’ll grab their hand. I can’t help it. I enjoy it, but don’t mean to hurt anyone. I hit people playfully, but too hard.

Dreams under water? In one, I could see miles down. The water was clear, it was nighttime, there were giant sea snakes, manta rays, whales and sharks. Mostly I can’t see the things, which is worse.

Throat? The first sign I’m getting sick. At one point I was soprano in choir, the highest rank. In the second year, I had left vocal cord paralysis and couldn’t reach the high notes, nothing came out. They said it would go away, but it didn’t. It cut off most of my range, I still can’t sing very loud.

Jealous? I’m very jealous, insecure about everything about me, jealous of everyone that looks the way I want to look.

Envious? Of people who socialize easily, of people who can interact. I’m smart, but get competitive with people who do better than me.

Jealousy from boyfriend? It makes me uncomfortable. I’m insecure, I don’t need much to convince me of the worst.

Hobbies? Writing is my passion. I write almost every day. I’ve filled eleven journals over four years. I’m extremely self-critical. I just finished a short story – I’m proud of it.

Decision making? I’m indecisive; big decisions tend to stress me out.

Hot or cold? Cold fingers, sometimes toes. I have Raynaud’s syndrome. Sometimes, in winter, holding a cold glass makes my fingers cold, numb, yellowish. Sometimes my pinky goes numb and yellow when looking for something in the fridge.

Fears? I’ve always been fascinated by the things I’m scared of.

Hemorrhage? I tend to bruise and scar easily, and have bruises with no idea where I got them.

Bruises? Usually barely visible, pinkish or yellowish.

Allergic? My skin, to most sunscreen and lotions, some soaps. I get a rash – itchy, bumpy, red – that doesn’t last. I sunburn easily.

Menses? They are regular, started in ninth grade, normal.

Problems? Had horrible PMS for a while last year; my period would start and I’d be fine.

Depressed? I’m hopeless, sensitive, angry and easily upset about everything. Then, I felt completely hopeless, but as soon as my period came, I felt better. It was dramatic.

Dreams? I used to have lucid dreams. It was amazing, I could do whatever I wanted. If trying to run away from monsters, I’d disappear and then wake up. I want to be able to control things more.

When home by yourself at night? I used to think about someone lying in wait in the house.

Food? I like meat in general. I’m not a picky eater, I will try anything. No favorite.

Flavors you like? Spicy – lightly spicy things. Sweet stuff doesn’t appeal to me at all.

Feel appreciated? I feel pretty appreciated by those I’m close to, those who matter.

Abandonment issues? Yeah. With that guy I felt extremely abandoned, because he left and didn’t seem to care. It took two years to get over.

Fear of dark? It is ominous. When I’m really tense, the fear manifests as a guy in the room.

Negative experience? Sometimes when scared of the dark, I listen to music, and imagine the singer protecting me.

Critical? I don’t judge people very harshly. I’ll bristle in someone’s defense. I’m pretty much nice to everyone.

Someone compliments you? I respond positively. It’s rare, so I remember it, it means a lot to me.

Mother’s input: Loss of appetite, especially in the morning. Likes variety, quickly tires of foods. Doesn’t sleep well or enough. Not able to sleep until 2 or 3 a.m. Compulsively chews on fingers. Exceedingly low self-esteem and self-confidence. Hopeless outlook on life, doesn’t have motivation in school, because she doesn’t think she’ll be around for long. Urge for cutting, a fight all the time not to do it, whether cutting or punching herself. An ongoing struggle day in and day out. Broadly applied social anxiety, doesn’t want to do anything that involves others. Gets tense and adamant about not wanting to be around people. Fears/doubts her ability, doesn’t want to learn to drive due to a fear of looking stupid. Sensitive about people thinking she is young, or ignorant. Started falling apart in adolescence. Seventh grade, was a happy kid. Is bright, gorgeous, but doesn’t know it. Wakes up in a smoldering ruin. An amazing writer. A lot of her poetry is dark, with slashing and knives. Writes poetry all the time, very gifted artist. Her writing is puzzling. Just finished a disturbing story – two companions in a sculpture gallery smash it up, destroy a sanctuary. A staunch atheist, strict about it. Very sarcastic. Doesn’t like girls, doesn’t want to be around them. Hangs out with guys. Last guy friend, she enjoyed physically wrestling – it felt good to show her strength. Kicks them in the shins. Has red hair and wants to change the color of her eyes, with contacts. Is in major agony that she’s short, too little. Traumatized by her size. If someone says she’s sweet, she’s hurt and angry. A disconnect if anyone thinks of her positively – misreads situations. Never been afraid of bugs, usually fascinated if there’s a snake in the yard; she’ll want to catch it.

Assessment: Patient given various potencies of Palladium for three months, which appeared to help for a time. Her bashfulness and appetite improved, but not the self harm.

Aug. 2004

(Patient): The only change is really vivid dreams, really violent nightmares. I had a nightmare four nights in a row. They are creepy, scary, violent or despairing, and lots of gruesome, graphic images of people I care about. My boyfriend was in my backyard, with his hands almost cut off and his legs cut off – I knew it was a suicide. Another was a friend beheaded in my backyard – along with two other anonymous people. Another [dream] was I found my boyfriend in bed with a black eye and bloody mouth. The most recent one was of two guys torturing or shooting this woman. It was horrible. After those nights of violent dreams, my mom gave me Rescue Remedy, and they stopped. I didn’t even want to go to bed for a while. It’s weird, because for years I didn’t have any nightmares.

Previous dreams of cut off body parts? No.

Previous graphic violent dreams? Yes.

These dreams? They have to do with other people, never me. During the day, when depressed, it is always about me. I have this creepy habit when depressed; I have ideas of getting shot, stabbed or of stabbing myself, like a movie playing in the background. I don’t even have to be feeling awful, but think about stabbing or shooting myself in the temple, or stabbing myself in the stomach. It repeats over and over, especially if thinking about a bad, embarrassing memory, but it’s comforting.

Is this morbidity familiar? It’s always been there.

Worse recently? Yes, I never dreamed horrible things like this. Also, I’m overwhelmingly empathetic, it’s almost crippling. I feel all negative emotions of others, it’s been worse lately.

Wear black? Colors clash with my hair. I feel better mentally wearing black. It isn’t even my favorite color.

Favorite? Bright red orange, like fire.

Biggest concern? Blushing, it makes me scared of socializing.

When alone? I do self injury. First it was scratching, but I couldn’t break the skin. I felt weak, so I got a better knife and made really deep [cuts]. It’s just a stress or anger release. I punch myself, but always feel like I’m not doing a good enough job. I gave myself a horrible black eye.

Cut yourself? I cut my right thigh mostly, or left wrist, but only when I want people to see. When angry, I punch myself. I go into the bathroom and hit my head really hard. I think bruises and cuts are really pretty. I admire the cuts or bruises I make, I really like how it looks. I think scars are beautiful, memories, like a scrapbook.

Assessment: It became clear that Palladium was off. So I began to consider a snake. In particular, Elaps (bashful, persecution, icy cold hands, biting self, etc.) looked likely. I gave Elaps (coral snake) LM2 daily.

Sept. 2004-April 2005

Improved bashfulness, wavering improvements with self-destructive urges, little change in sleep or appetite.

Assessment: There were some good improvements, so I continued Elaps for approximately eight months. However, in April 2005 she came to an appointment with a black eye she’d given herself and she had been cutting on her left wrist. I questioned Elaps at this point, as the deepest issue – the self harm – was not improving significantly. So I prescribed a single dose of Agkistrodon piscivorus (Agki-p) 1M. Agki-p is the venom of the cottonmouth snake. The proving for Agki-p notes incredible violence and morbidity, so I thought it might be a better match.

May 2005

Patient happy, able to stop urge to cut or punch herself which, she says, is a “miracle.“ She is going to bed earlier, has more energy, has stopped wearing only black clothing.

Assessment: Agki-p 30c once per week (a few pellets in 1oz dropper bottle, four drops per dose).

July 2005

Patient reports minor morbid impulses, no longer feels shy, estimates being 300% more confident.

Assessment: Continue Agki-p 30c once per week.

Sept. 2005

Patient adjusted to college quickly, with surprising ease. She was confronted by another student and put down in a harsh way. After this, she punched herself. Describes moods as stable and happy, feels more “resilient.” Appetite is stronger than ever remembers. Waking is “really easy.” Recognizes self-harm behavior as addiction.

Assessment: Patient still doing very well. One episode of self harm, from extenuating circumstances.

Summary

The patient has done well to date (February 2008). She has used the Agki-p for colds, sore throats and stressful situations, and it always works. In a May 2006 meeting, she couldn’t remember the last time she hit herself. She came back into treatment recently for irregular menses and PMS. A single dose of 10M resolved both. Her mother is also very pleased with her progress.

Important Themes for Agki-p

We can tentatively hypothesize a few themes to help differentiate this medicine from other snakes:

• Morbidity Self destructiveness, violent gory dreams.
• Dark side All snakes have a dark side, and this snake appears to indulge in it
• Fears of water In common with Hydro-c
• Weakness Oversensitive to comments, dreams of weakness
• Colors Better in black, likes flame red color
• Low self confidence Similar to Elaps and Naja
• Staying up late An aside: The cottonmouth is most active at night
• Isolation Patient isolates herself, and is sensitive to being abandoned
• Empathy Lacks a filter for others’ feelings
• Low appetite
• Articulate, intelligent, talented writer, artist

The general themes of reptiles, according to Massimo Mangialavori:

• Seductiveness
• Forsaken e.g., jealousy or paranoia about betrayal
• Duality a fight or struggle with the self or two parts
• Constriction not so explicit in this case
• Congestion/Hemorrhage
• Thermal Regulation often evident with cold extremities
• Persecution fear of snakes, delusion of someone behind or someone breaking in, etc.

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Tim Shannon, ND is in private practice in Portland. He specializes in the treatment of mental, emotional and behavioral disorders. He uses classical homeopathy to treat a wide range of mental health complaints: ADHD, OCD, PMS, autistic spectrum disorder, depression, anxiety, eating disorders, PTSD, bipolar disorder and schizophrenia, as well as others. Dr. Shannon lectures at NCNM as well as to the local community on a variety of mental health complaints.