A case of Mr. S.V.aged 28 consulted me in June 1990 for complaints of severe headaches.These complaints of headaches started since an injury followed by malaria 6 months back. There would be a sudden onset of severe headache when eyes would become small and face swollen.

This pain would compel him to take large doses of pain-killers. There were times when he took 4 to 6 paracetamols to get relief. Very often these pains would not respond even to stronger pain-killers.

His concomitant mental state was very peculiar and intense. He was so sensitive that he would be offended by least criticism. Over a period of time he became so sensitive that he would feel and imagine that people were being harsh on him. For e.g. he reacted with a lot of anger and excitement at the lunch table when his wife asked him "Tell me fast what menu you want for dinner?" He misunderstood this as being forced to eat fast. He flared up with red eyes and was about to get up from the table in utter frustration.

He narrated many examples where his day to day life was greatly affected because of this excitability. There were 2 incidence worth mentioning which will clearly help us in understanding the finer dimensions of this sensitivity.

Once he was accompanying his father on a business trip for the purpose of marketing their product. The client made a casual remark, "Your product is not known to us. We have not heard of your brand". Such a situation is very common when you visit a new client. However his reaction was very intense. It was interesting to perceive his reaction, "I felt like telling him on his face that we are not going to supply you any material in future. I was damn angry; when you don't know anything about technology how can you talk to me like this! My hands were shivering and I broke into a cold sweat with a feeling as if life was leaving my body. The entire incident took hardly ten minutes. I felt like leaving his office immediately with a feeling that someday even he will come to my office and I will talk to him rudely and in the same way as he spoke to me. I will show him how to talk to people. He was really rude. Even now I have the feeling that at least once, I will behave with him in the same way as he behaved with me. I was telling my father, We should not have such type of customers. You should have got up with me.
That fellow also realized that I got angry and he became a bit softer. He cooled down and then he listened to our talk and looked at our reports and also asked for samples. I left his office and immediately got a severe headache. Even today that feeling is there".

This state was existing even prior to this injury and malaria, However the malaria and injury seemed to have aggravated his state. I could perceive that he was in such a state for a long time, since he narrated an incident which occurred long before malaria, during his day in college. The situation was about obtaining a recommendation letter or certificate of merit from a concerned professor in the college. It seemed as if the professor agreed to give such a letter, although reluctantly. The professor did not have a good impression or image about our patient. Hence he gave him the certificate where in he rated him as an average intelligent student. Knowing the nature of the professor he opened and read the recommendation letter. He was extremely angry and just tore it off. He felt hurt and bitterly let down. In this words.

"Even today if I see him in the library, I get angry. My eyes become red with anger. I feel like telling him, "you have not done justice to me. I will see you whenever we come face to face.I will pull you down.I see myself rise so high that I can feel him to be very small.... nobody is
giving importance to him. One day, in a seminar, when we meet face to face, somewhere in a company. I will prove myself so much better that nobody looks at him. I will see that he doesn't get any importance. I will pull him down in arguments and everyone will look down upon him. I will make him feel that there is something wrong with him. At least once. I will take revenge for the way he treated me."

Since then, he has almost become a book worm with a constant desire to gain as much knowledge as he can. He spends most of the time in the library, reading and studying with a great ambition to be a knowledgeable, learned person.

He theorises and imagines how his life is going to be, what sort of a person he aspires to become. In his words, "I get flighty thoughts, like being in the driver's seat in business. I am supposed to be a big businessman with many foreign collaborators. I will head them all. I will be known to industry people as a technical, knowledgeable man. People will come to me for guidance. I compare myself to big companies , that kind of fling.I will be highly competitive, making better products than these companies. It is not the money buy making a big name that's what I imagine myself to be. I will have an office with grand furniture."

He had fantasised a complete picture of his image and achievements, right up to the minute details of his office furniture. He is very hardworking and industrious and feels happy only when he has worked hard.

The other side of him was his weak, faint-hearted, coward side. The sight of a fatal accident effected him so profoundly that he was beside himself for days together. Even after months, he was afraid of passing by the site of the accident. He feels weak of passing by the site of the accident. He feels weak and faint in his legs as if they will give way.

He would be extremely anxious as if anticipating a bad news. Any setbacks in his business, a sickness in the family would make him feel very faint and nervous. During these phases of excitement with flow of thoughts and headaches, he feels better only by drinking coffee. He was highly sensitive to coffee, drinking coffee ameliorated his excitement and drinking coffee in a calm state got him into an excitement, thoughtful and sleepless state. Hence he needed coffee only when he was in a state of excitement.

Click Here to read the Explanation and Follow Up of Dr. Jayesh Shah's Case 2 - Angustura.