Installment 12 of a series on case analysis
© Will Taylor, MD 2001 (bio)
The Story Board
Another direction - Grouping of Symptoms
A grouping according to dimensions may be all that a case requires. In other instances, the case may provide a sense of its own structure.
Below is an edited caselet, followed by a sketch grouping its characterizing symptoms for analysis:
27 yr/o woman
CC: anxiety, depression
Very sensitive to any criticism or embarrassment. "Even little things. It just feels like scolding. My mother was like, always scolding me. Always."
"I just feel it like a knife is stabbing right through me"
"My mother, she was a real back-stabber"
"I've done lots of therapy. Mostly like focusing on how I was injured as a kid"
No relationship; only some very brief relationships in the past several years
"I just like can't get to where I can believe anyone could like me."
"I mean I'm always like going, I'm sure they think I'm like, totally stupid."
" So I like, lose myself at work. I keep myself busy, then I'm OK. I don't think about it."
"I like, hold everything together there. They'd run out of staples and pens if it weren't for me. I'm real good about attending to the small stuff that holds everything together. And I don't get any credit for it; I'm just a secretary in their eyes. I suggested they at least just like, change the name of my position, to office manager. I don't think they even heard what I had to say."
"I'm usually pretty quiet, but I can lose it sometimes, big-time."
"If somebody takes what I say the wrong way. Like with the office manager thing. He said, 'oh, so you're fishing for a raise, huh?', and that's like, totally not what I was talking about. Not even close."
"Don't even get near me when I fuck up. I turn into this bitch, "
By spending time organizing the characterizing symptoms of the case in this way, we assure that we are taking more than just a collection of symptoms into our reportorial analysis; but rather, are accurately recording - as Hahnemann implores us to do - the image of disease. It is this Totality - this Gestalt that is greater than a mere collection of its symptomatic expressions - which we will need to match with a Simillimum.