(This case was presented for discussion by Dr. Manish Agarwal on a public board. Below are relevant details. The complete case, analysis and discussions are available here. )
Male 30 years, unmarried, is very intelligent with an eye for detail. He was a brilliant scholar till the psychiatric illness took hold and he could not finish his studies. He is spiritually inclined, interested in meditation, with strong spiritual beliefs. Father was an obsessive compulsive patient (now dead).
Sleep – insomnia at night, feels like working at night and sleep during daytime. Can work whole night. He sleeps on his right.
Mental State: Memory very weak for facts, road / streets / what he just said (though he won a prize for photographic memory when he was 8 years old). He cannot study because of this.
Obsessive compulsive symptoms (checking again and again, perfectionist, fear of germs and infection, cleanliness mania, making lists of works to do again and again, washing hands repeatedly). He has many, many ideas, and overwhelms homeopath with the information. He has a fear of antidoting his homeo remedy. He questions all aspects of his case. He is very sensitive to music, poetry, arts and beauty and is very appreciative of their finer aspects. He presents a ‘manufactured image’ to others. He hides his symptoms. He has a fear of examinations. Sexual desire is strong and he masturbates often. Spiritual yet he feels a strong need to express his sexual desire. Longs for love. He works fitfully for a few days and then collapses. He used to study whole night before his examinations
Introvert. Clairvoyant. Likes thunderstorms. Always hurried. Meticulous and a perfectionist. He has struggled a lot in his life. Always wants to do things with perfection. Even in this mentally sick condition he has written books and papers (on philosophy). But he has to put a lot of effort for this. Though his mind fails, he tries to read medical topics. He puts in extreme efforts to study and is in a constant struggle to improve his health. He is very sensitive to admonition and reprimand. He likes consolation and sympathy. He weeps easily.
What are his inter-relationships like? What is his life situation?
Why does he need to present a manufactured image to people?
He feels that he is a failure. Basically he is extremely talented and is a genius, with a very sharp intellect. He sees himself more a failure because of this. He feels that he could have done something really great had he not been afflicted with a psychiatric problem. Life has been a struggle because of his mental problems and physical weakness. Many remedies by many homeopaths have broken him further and he wonders if he will ever get well.
However he likes to hold forth and “preach” in order to project an image that he knows everything and is very intelligent. He does this in the presence of people whom he can boss over or who know less than him. Loquacity is tremendous. He was good at debates / speech contests in school, before the illness set in.
Why does he need to project this image? What would happen if he could not project this image?
What was going on (socially, emotionally, in the family) at the time the illness set in?
Please detail the Location, Sensation, Modality, Consomittants of the head pain, the sore throats and the neurofibromas.
He doesn’t want others to know about his mental state.
He needs to project an image to protect his low confidence and hide his failures / illness / abnormality. He tries to show that he is normal and vibrant. He feels guilty about his shortcomings and his sexual encounters. He feels worthless / let down / broken / insulted / humiliated when he cannot project this image or when someone realises the real situation.
I think illness was inherited from his father. Both have the same symptoms. The whole thing was triggered when he was 20 yrs. of age. His father had died 8 or 10 years earlier. Since he was a topper (top of the class) throughout, there was heavy parental pressure to study / get into a good profession. This caused a mental breakdown and he had to leave his studies.
Physicals and generals:
He is Chilly, very thirsty. Sensitive to noise and light.
Phymosis (was helped partially by Thuja 1M given 10 years back. Thuja 10M given 3 or 4 years back helped a bit more. thuja CM aggravated. Still cure is partial)
Sickening sweetish odour in stool, urine , perspiration, semen
Very thirsty – large quantities of water at a time.
Likes sweets(++) , salt or sour (+). likes spicy food (++)
Likes fruits(++), eg. oranges, mango. craving for orange juice and lemonade but they aggravate the cough/cold tendency.
Cheese (++), chocolate(+++), pizza, coca cola
He has a sensation of obstruction / pressure (difficult to explain) at the root of the nose (more when he concentrates at that point) which is always present. He cannot sleep because of this. He says this is his main problem right now.
He developed this problem after a meditation course, where he had put an intense effort in meditating. There is a feeling of pressure / obstruction / constriction in the region of the root of nose, which is very difficult to explain. Sometimes it changes location to the centre of forehead, then sometimes above eyebrows and then sometimes the dorsum of nose. It is aggravated with meditation, concentration on the area, mental exertion and eye strain. It is ameliorated with sleep.
Chronic history of tonsillitis, more on the left side with pus pockets formation and referred pain to the ears. Tendency to recurrent cough colds. Left sided nasal turbinate hypertrophy with left sided nasal polyp.
Neurofibromas: Hard neurofibromas. First on right thigh, then second on left of the abdomen below the costal margin, a third on right arm, fourth and fifth on left upper arm. These are the main big ones. There are several small ones here and there. All were painful in beginning – painless hard later.
WHile reading through the case, the basic mental state was very clearly evident in the following symptoms.
– However he likes to hold forth and “preach” – likes to project an image that he knows everything and is very intelligent. He does this in the presence of people whom he can boss over or who know less than him. Loquacity.
– He presents a ‘manufactured image’ to others. He hides his symptoms. He has a fear of examinations. Sexual desire is strong and he masturbates often. Spiritual yet he feels a strong need to express his sexual desire.
– He needs to project an image to protect his low confidence and hide his failures / illness / abnormality. He tries to show that he is normal and vibrant. He feels guilty about his shortcomings and the sexual encounters. He feels worthless / let down / broken / insulted / humiliated when he cannot project this image or when someone realises the real situation.
I did not look for rubrics to include the above expressions as these themes are clearly represented in the Materia Medica of Mercury (especially Vermeullen and Roger Morrison). They show a combination of both Sycotic and Syphillitic miasm.
Neurofibromas are an affection of nervous tissues along with fibrous changes. This type of OCD expression (fear of germs and infection, cleanliness mania, making lists of works to do again and again, washing hands repeatedly) is Syphillitic. Hence I felt this case was miasmatically syco-syphillitic with a predominant Syphillitic expression of intellect ‘destruction’ at this stage.
The expressions of this destruction were:
– HE works himself to exhaustion/destruction before exams.
– HE had a breakdown from pressure to work and the OCD does not allow him to function normally, with a corresponding destruction of his intellectual capability. In sycosis, some level of normal function would have been there.
– HE has a high sexuality and seeks to always express it and feels guilt and worthlessness from it, inspite of a ‘high spirituality’.
The other characteristics including the “main” complaint could be easily repertorized as below:
1. HEAD; CONSTRICTION; Forehead; eyes, over the X HEAD PAIN;
2.PRESSING; Forehead; nose, above X NOSE; PAIN; pressing; root: chel., glon., iod., meny., merc., sil.
(or elimination) Constriction X pressure forehead X above the nose, eyes: acon., aeth., arn., bar-c., bell., bism., camph., cann-s., carb-v., chel., chin., glon., hep., ign., iod., kali-n., Mercurius, ruta, sil., verb., zinc.
3. GENERALITIES; SLEEP; amel.; after
4. THROAT; SUPPURATION; Tonsils
5. THROAT; INFLAMMATION, sore throat; left
6. THROAT; PAIN; General; extending to; ear
7. GENERALITIES; TUMORS, benign; neuroma
8. MIND; HURRY, haste; tendency; movements, in
9. PERSPIRATION; ODOR; sweetish
10. MALE; PHIMOSIS
11. MIND; COMPULSIVE disorders (Fastidious), (Washing; always; hands, her)
The remedy indicated in this analysis was clearly MERC SOL. It covered all these rubrics, except the left sided throat inflammation which is covered by MERC-I-R. (instead). There were furthur indications that fitted the case and included the expressions mentioned earlier, based on the Materia Medica.