CASE STUDY: DEPRESSION WITH FATIGUE

Connie Mullens was an attractive woman in her early thirties. She appeared to have many of the things which would help to make a person happy: a loving spouse, a beautiful home, a good educational background, and a rewarding job. Yet before she came to the Ecology Unit, she was contemplating suicide. Mrs. Mullens had many illnesses and problems practically all her life, but was completely unhelped by conventional treatment. In fact, her health was endangered by being prescribed amphetamines. Clinical ecology helped her, in part by breaking her dependence on these drugs.

During her childhood, she had had many illnesses, some of them bizarre. She had had asthma so badly that her parents doubted at times that she would live. This problem went away after the family moved to a new house. In high school, she had frequent stomach problems, diagnosed as the result of a “virus.” One such “virus” lasted for over a year.

In college, she demonstrated superior academic ability, got straight A’s most of the time, and was elected to Phi Beta Kappa. Nevertheless, during this same period a curious sort of malaise started to creep over her, imperceptibly at first.

At times, especially in chemistry lab, she would feel a kind of euphoria. She was known as the chemistry class prankster and would devise complicated practical jokes to play on her instructors. Of course, this sort of behavior among college students is “normal” when looked at in isolation. It is only when seen in the context of her overall development, and the onset of her more serious symptoms, that it begins to take on medical significance. In retrospect, some of this behavior may have been a lesser stimulatory reaction (plus-one) to the presence of chemicals and natural gas (in the bunsen burners) in the classroom.

At the same time, Mrs. Mullens had an increasing number of bad days. On these occasions, she had headaches of ever-increasing frequency and intensity. On some days, she could not get out of bed, could not concentrate, and could barely stay awake. To combat these doldrums, she relied on junk food. She would drink cola beverages or eat chocolate and candy whenever she had to “cram” for a test. Every day she would go down to the drugstore and have a chocolate malt and a piece of pie, which seemed to temporarily relieve her tiredness and headaches.

Because she was, not surprisingly, overweight, she consulted an internist, who prescribed diet pills which contained amphetamines. “With these,” she later recalled, “I could leap tall buildings at a single bound.” She stopped taking them when she realized that she was becoming addicted.

Connie was married in college, but the marriage did not work out, This was mainly because of her irritability, she says. She would throw temper tantrums in the house, fling shoes at her husband, or force him to watch his favorite television shows with the sound off (she was very sensitive to noise). She kept on eating, too; her husband called her the “cookie monster” because of her insatiable sweet tooth.

By the time she reached graduate school, her problems were worse. She now had headaches once or twice a week, but each lasted a couple of days. She began to consult doctors, and each had a different diagnosis and solution. One internist, she says, prescribed twenty different pills, mostly amphetamines. She was instructed to try each of them in turn and keep a record of their effects. None of them did anything for her head pain.

She also saw an endocrinologist (hormone specialist), an otolaryngologist (ear-nose-and-throat specialist), and, of course, a psychiatrist. The psychiatrist analyzed her psyche in depth and at length. He came to the conclusion that, as an only child, she had had too much pressure put on her to achieve. In fact, except for her illnesses, she had had a particularly happy childhood. Her parents were both successful and well-educated and probably expected their daughter to be the same, but did not force her to emulate them in this regard.

Connie could not drive an automobile. If she attempted to she became confused and could not interpret traffic signs or even make sense out of a simple stop light. Rather than look for something in the environment (for example, automobile fumes) that might cause such a condition, the psychiatrist interpreted this problem as a psychological need for perfection. He recommended that she relax more.

After finishing graduate school, Mrs. Mullens undertook a job which brought her into contact with industrial chemicals. All of her symptoms worsened. She got married again and gave up the full-time job.

As bad as all these symptoms were, her condition took a sharp turn for the worse (from minus-two or -three to minus-four) when her new home was sprayed with powerful pesticides, inside and out. Winter came, and the gas-fired heater was turned on. Soon afterward she started to feel so weak that she could not get out of bed. She was depressed to the point of dwelling on suicide. Her new husband would come home each day and find her crying uncontrollably.

Her psychiatrist prescribed amphetamines again, this time for ten days, to bring her out of what he called a “short-term depression.” At the end of this period, she was worse and had developed a numbness in her fingers and a tingling in her limbs. To all of her other problems, she now added a fear of multiple sclerosis—an unfounded fear, it now appears.

When she was admitted to the Ecology Unit, her symptoms were particularly bad. The water fast accentuated her symptoms; she developed a terrible headache and cried almost continually at first. After a few days on the fast, however, she underwent a remarkable recovery. “I got completely better,” she recalls. “I became absolutely convinced that my problem was related to the environment.”

Mrs. Mullens reacted to most of the foods she was given. Some brought on arthritislike aches in her fingers and other joints. The worst food for her was beef. After eating a portion of beef, she told the nurse on duty that she wanted to kill herself. She wandered the halls, crying aimlessly. The next day she said that she felt as if she “had been run over by a bulldozer.”

All of her many symptoms were reproduced in several weeks of food testing. What is more, tests with chemicals in various forms showed that this patient had the problem of chemical susceptibility. Mrs. Mullens has made excellent progress in controlling her food and chemical difficulties. “In the real world we face serious problems,” she has said. For example, it is difficult for her to avoid all exposure to natural gas. The gas heater and range have been removed from her house, but she still runs into them in other peoples’ homes, as well as in stores. In certain shops, she becomes so irritable that she feels like strangling those who get in her way. It is only in gas-heated stores that she has this problem. Despite periodic setbacks, her mental state recently has been cheerful.

An understanding of the food and chemical problem has brought with it many rewards. But it also has added responsibilities. Once, when she was in a hospital for some physiological testing, a conventional doctor “caught” her making lists of her reactions to artificially colored and flavored medicine. He actually took papers which she had discarded out of the wastebasket, read them, and remarked, “I see that you are involved with your symptoms. You apparently want to be sick!” When she tried to reason with the man, who was a gastroenterologist, he said brusquely, “I have forty other cases in the hospital. I don’t need you.” To his amazement, she promptly checked herself out of the hospital.

Mrs. Mullens’ case thus represents both the triumph and the tragedy of treatment by the methods of clinical ecology. On the one hand, like many other patients, she was brought back from the brink of suicide by coming to understand the multiple environmental factors responsible for her reactions. She credits it with saving her life. Yet, on the other hand, the world itself sometimes seems hostile to this new approach. Much yet needs to be done to make the environment completely livable for the Connie Mullenses of this world.

In summary, it may be said that the concepts and techniques of ecologic mental illness are opening up new horizons for patients with the symptoms of depression and related psychiatric disturbances. In contrast to the longstanding artificial distinctions between physical and so-called mental illnesses, both physical and cerebral and behavioral manifestations of allergy/ecology represent different levels of reaction. At long last, large sectors of the field of psychiatry are yielding to medical management based on the demonstrability of cause and effect.

*89/110/2*

Google Bookmarks Digg Reddit del.icio.us Ma.gnolia Technorati Slashdot Yahoo My Web
Share and Enjoy:
  • Digg
  • Sphinn
  • del.icio.us
  • Facebook
  • Google Bookmarks
  • LinkedIn
  • Reddit
  • StumbleUpon
  • Twitter
  • Yahoo! Bookmarks

Random Posts

Comments are closed.