A Case of School Phobia and Recurrent Stomach Flu

Seven-year-old George had a tough time starting kindergarten. On the first day of school, he begged his mother to let him stay home. After much gnashing of teething on the part of his distressed mom, George arrived to his classroom two minutes early, for which he received a scolding from his teacher. The reluctant child felt “squashed by the big kids”, and again dissolved into a puddle of tears after his mother left. As each day passed, George’s anxiety intensified. His sobs led to dry heaves. George’s teacher appeared incapable of helping the child deal with his feelings and instead sent him to the principals office instead, which, understandably, terrified him. George did not speak for an entire day after that epidsode.. Not only did his resistance to entering the school heighten, but George developed a block about entering other public buildings. Fortunately, George’s mother removed him from his classroom and found him a new kindergarten. After changing schools, he did well, as long as his mother accompanied him as he crossed the threshold of the school and opened the door. By Thanksgiving George felt comfortable enough to enter by himself and went on to enjoy an excellent school year.

Due to his kindergarten experience, George experienced a great deal of trepidation about entering the first grade. Highly nervous on the first morning of school, George complained of feeling “sick to my stomach”. For a week this queasiness was accompanied by constipation and painful bowel movements. Then his digestive upset seemed to settle down. George’s mother brought him to see us initially on Halloween. By that time, having attended first grade for two months, George continue to feel anxious each morning and irritable on returning home from school. Falling apart over little things, he had become very clingy and wept at even the thought of going to school in the morning.

When his mother asked George what upset him so about school, he explained that his first-grade class contained thirty children instead of only fifteen in his previous kindergarten class.  In addition, George shared that he was afraid he might forget the names of the other kids or that he might getting in trouble at school. “If I’m not perfect, they won’t love me anymore. I might get yelled at.” You can imagine how devastated George must have been when his teacher sent home a poor behavior report to be signed about bad behavior. Then the photography studio lost his school pictures, which confirmed his belief that he really had done something wrong. George became so distraught that he even kicked his teacher once. To make things worse, one of his classmate’s parents complained to George’s mother about his hitting and spitting on their child and threatened to sue the family if this behavior did not stop immediately. George’s parents had never received such a complaint previously and were quite alarmed.

Around this time George’s teacher noticed that he had developed the habit of biting his nails. “I’m nervous. I’m worrying a little bit,” George acknowledged. His mother tried to keep her cool, but if she became even a bit impatient with his nervousness, his reaction was way out of proportion. In the car on the way to school, George exclaimed, “I’m having a heart attack!” He started to fear that something terrible might happen during the day such as robbers breaking into the house or his mother dying.

George’s father tended to be very critical of him, yelling at the child for normal boy activities such as climbing on the furniture. His father also suffered from school phobia, though to a lesser degree. George’s father had little tolerance for his loudness and had a much easier time with his daughter, whom he considered the perfect one. “She’s the good one, I’m the bad one,” George shared with us. Apparently, as a toddler, George demanded attention only from his mother, often to the point of almost ignoring his father. A very pleasant baby and active nursed, he had loved being held. During toddlerhood, this progressed to clinginess and a constant need to hold his mother’s hand. George was afraid of being in strange places and of swimming in deep water.

The main physical health problem in this case is a recurrent stomach flu. As a toddler, George once vomited every fifteen minutes for three days straight. During his most recent episode, the child vomited twenty times. These acute gastrointestinal illnesses were painless. His only other problem was hypoglycemia, manifested by crabbiness and fatigue after not eating for four hours or so. Since we often find the parents’ emotions during the pregnancy to be very relevant to the child’s case, we inquired about this. George’s mom admitted to having felt extremely anxious, depressed and worried. She had vomited frequently during both of her pregnancies. In fact, she had the habit of clinging to her own mother during her morning sickness while pregnant with George.

We prescribed Bismuth subnitricum 200 C for George. This medicine is used for children who cling to their mothers when anxious or fearful as well as children and adults with digestive problems, particularly vomiting.
At his next visit, six weeks later, George’s mother reported that he was doing great. George felt fine now about going to school, his moods were substantially more even, and he experienced no further episodes of hypoglycemia.. He had received one detention at school for running with scissors in his hand, but suffered no incidents of aggression or anxiety. To the contrary, he was having a great time at school now. George had been diagnosed with pinworms and treated with Vermox. Homeopathy can treat pinworms quite effectively however his mother was new to homeopathic medicine and unaware of this. We repeated the Bismuth 200C in case the antiparasitic medication might have interfered with its action.

Three months later, George’s mother reported that his school anxiety was returning with a lesser intensity. He had begun to worry again about his assignments and insisted that his mother stay with him while he completed his homework to make sure he did it right. We again repeated the Bismuth 200C. George’s mom reported that this dose worked “wondrously” immediately. He experienced no further problems for three months until the beginning of the school year, at which time he developed a stomach flu with fever, exhaustion, and vomiting. His mother prescribed Gelsemium 30C from her home kit, which helped immediately. It might be argued that another does of Bismuth 200C was in order and it would have also likely worked very effectively. Interestingly, Gelsemium, like Bismuth, is also used for anticipatory anxiety and digestive symptoms, but is not known for clinginess.

At George’s next appointment, his mother described him as “the best in every way,” a perfect child, relaxed, and cheerful. Thrilled to go off to day camp, George was manifesting a much higher level of self-sufficiency. On the first day of school, he reported feeling excited, not worried or anxious, for “maybe just 30 seconds.” Then he just jumped out of the car and ran right into the school and his classroom. George enjoyed his new teacher, joined the swim team, and made an excellent adjustment.

We gave George another dose of the same medicine a few months later when he experienced a partial relapse of his symptoms after eating a cappuccino lollipop. Following this dose, George became euphoric and literally danced around singing, “I love school!”He continued to feel quite well. Since that time George has needed an occasional dose of Bismuth , but none for the last 18 months.

Why Bismuth subnitricum? It was knowledge of a particular rubric that helped us choose the medicine: Clinging; of children, will always take the hand of the mother.

Rubrics:
Clinging; in children, will always take the hand of the mother
Fear of being alone
Fear of solitude

Clinging to the mother, fear of being alone and fear of solitude are the most important symptoms evident in George’s case. This seems to be the core of the Bismuth emotional state. It is quite interesting that during his mother’s pregnancy with George, she used to cling to her mother when anxious. In George’s case, the emphasis on stomach symptoms, especially vomiting, was a further confirmatory. Bismuth is a major component of the well known patent medicine, PeptoBismol. The physical focus of the medicine is definitely on the stomach and gastrointestinal tract.
According to Phatak’s Materia Medica, the main stomach symptoms are: “Craves cold drinks, which is vomited at once, or in great quantities when stomach becomes full; at internal of days. Vomits fluids only. Burning, cramping, feeling of a load in stomach. Slow digestion, with foetid eructations. Bilious vomiting, after eating. Food presses like a load in one spot. Stomach pains better bending backwards. Cancer of stomach, vomiting of brownish water. Gastralgia, not associated with any catarrh or any symptoms of indigestion. Cold water better. Atrophy of stomach. Stomach hangs down; hard lumps are felt below navel.”

It is easy to see the focus on vomiting, both in the symptoms of the medicine and in George’s case. He had recurrent bouts of stomach flu with extreme vomiting, and he was very clingy to his mother. The combination of school phobia, which often revolves around not wanting to leave the mother, and a significant tendency to vomiting, pointed strongly to Bismuth in this case. Although Bismuth, in our understanding so far, may only be indicated for this kind of clinging child situation, other uses may be found in gastrically oriented children’s cases where more common medicines such as Pulsatilla have not worked, and some element of forsakenness or clinging is evident. Stramonium should also be considered as a differential under clinging. The Stramoniurn child often clings as a result of night terrors, or fear of the dark and monsters under the bed.

A case like George’s can help us remember that physical concomitants of the mental state are often useful in determining the needed homeopathic medicine, especially for those medicines that are relatively narrowly focused on particular problem areas, such as Bismuth.