(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., Merc., 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.
From Vermellen’s Concordant:
INSTABILITY on all levels.
Internal HURRIEDNESS with SLOWNESS in acting [as if everything is seriously considered].
“EXTREMELY CLOSED. Feels like you’re not really making contact with patient; suspicious; cautious; vulnerable” [Morrison].
Stammering; “want to communicate but can’t, so they hold back. Speech comes out as a stammer” [Morrison].
Fear being ATTACKED FROM BEHIND. Delusion EVERYONE IS AN ENEMY.
Lack of SELF-CONFIDENCE [trembling inside]; easily embarrassed.
Very sensitive to criticism and contradiction; may be become violent [desire to kill the person that contradicts her , hatred of persons who had offended him ].
Inner conflict between desire for law and order and violent impulses. Restraining themselves requires a lot of energy, = forgetfulness.
Slow in answering questions. Memory weakened, and loss of willpower. Weary of life. Mistrustful. Thinks he is losing his reason; and will die, has numerous illusions. Hurried; in speech. Suspicious in daytime. Chaotic. Confusion; loses his way in well-known streets.Fear; at night; of robbers; of suicide. Heedless. RESTLESSNESS AT NIGHT.
What was interesting about this case was the indication of Merc IR, rather than Merc Sol, which is what was indicated with repertorization. It was later observed that the patient had marked left sided symptoms besides the throat, which elevated this tendency to a strong general. Hence the choice of Merc IR was more appropriate. It has begun the process of cure where no other remedy was able to do anything for this man, in more than 10 years.
His sleep improved first, along with his intellect and OCD symptoms. Also the headache and offensiveness of body discharges responded. These changes were in a space of a few months and 3-4 doses of Merc IR 200C.
On the link provided above, there are details of all the remedies, treatment and responses to past remedies including a recent followup.
The Mercury Mind:
Roger Morrison: Has one of the best descriptions of the core of the Mercury state.
Introversion. On the emotional level, the Mercury patient tends to be withdrawn and introverted. The emotions are often strong internally but are rarely given expression. The patient feels different than other people and has a sort of instinctive reserve about expressing himself or even a suspiciousness of others. He puts on a facade of normality and conservatism. The patient will often confirm a noteworthy symptom: It is necessary for him to feel that the person he speaks to is listening carefully, with undivided attention or he will be unable to speak. This need for deep congruency may explain why many Mercury patients feel more comfortable in homosexual relationships.
Impulses. Often in Mercury cases these intense emotions which are withheld take the form of impulses. The patient has a strong impulse to strike or even kill an offending person. But these intense feelings are almost never revealed to others. In fact the Mercury patient often will cultivate a deeply conservative and proper appearance toward the world.
Anxiety. Deeper breakdown states occur in some Mercury patients. The inefficiency of mind often is a cause for concern, and to compensate the patient begins to hurry to try to accomplish all of his responsibilities. Eventually he finds that he is constantly rushing about. The Mercury patient may develop deep phobias and anxieties, especially about his mental health. He comes to the interview looking emotionally weak and broken. This is a remedy we must keep in mind for advanced states of depression, paranoia and even organic brain disease and imbecility.
Children. The Mercury child is often very precocious and seems to have almost adult-like emotions. He can seem flirtatious, intense and sensitive. The child has strong emotions and can be very irritable. More often the child is shy or withdrawn. In almost all cases the child suffers with poor resistance to infections – chronic otitis media, pharyngitis and stomatitis. The child usually exhibits the typical confirmatory keynotes.
Some Central Rubrics of the Mental State from Knerr’s repertory:
ANGUISH: Stool, before. 0>1>0
ANXIETY: Night, at: Escape, with desire to. 0>1>0
COMPLAINING: relations and surroundings, of. 0>1>0
DISGUST: Himself, with, had not couage to live. 0>1>0
ENEMY, Considers everybody. 0>1>0
FEAR: Escape, with desire to, as if she had committed some crime
IDEAS: Crowd: one constantly chasing the other. 0>1>0
KILL: Contradicting her, dsire to, the person. 0>1>0
NOSE, Inclination to when walking, to take people by. 0>1>0
SUICIDE: Desire for: headache, with chronic, Caused by suppression of footsweat. 0>1>0
SUSPICIOUS: Enemy, Considering everybody his: Melancholia in
TRAVEL, desire to, far away, almost uncontrolable. 0>1>0
In my experience with Merc-I-F, these people have violent, destructive and impulsive qualities but the destructive quality is not as much as in Merc-sol. I found that these patients are extremely energetic (like Iod: very active), have a very strong desire to travel (Merc, Iod) and need to be occupied. Hence they take up jobs where they can travel. Their energy seems inexhaustible. They are very cheerful and talkative; may even sing and whistle – a sort of elated, manic state. At the same time, they can get intensely angry, especially when they feel betrayed/attacked. The symptoms are right sided as opposed to Merc-I-R which has an affinity for the left side. The pathology is destructive and glands are often involved. They may crave salt and sour things.
Physical Characteristics of Mercury salts
Below are excerpts from a very enlightening lecture by Phillip Krichbaum, MD differentiating all the Merc salts at a glance. Studying these differentiations should help us make more precise prescriptions of the Merc salts associated with the type of mental state expressed above.
Proceedings of the International Hahnemannian Association, Session 40-41, page 264. “Mercury And Its Salts,” by Philip Krichbaum, M.D., Montclair, N.J.
The key note symptoms of Mercurius are classical; the modalities run through all the preparations; to wit, the aggravation from heat and cold, the aggravation at night, the profuse sweats with nearly all complaints, which sweating does not relieve and in some instances may even aggravate the complaint. The next particular found in this interesting series, is the mercurial odor. The Mercury patient is offensive, body and excretions, while the breath is often excessively fetid, with mawkish sweet taste in the mouth. Body tremor is another distinguishing characteristic. The mind under Merc. is as weak and tremulous as the body. Everything is hastily performed. Conversation is hurried and rapid. On the other hand, with the back swing of the pendulum, your patient may be very slow in answering questions. The Mercury subject has loss of will power and memory, suffers from embarrassment, is absent minded, and may lapse into imbecility. Time passes too slowly. The sores and ulcers of Mercury have many characteristic points. The grey lardaceous ashy or cheesy base, the burning stinging pain, the dirty look of the deep seated sore, the tendency to form pus, yellow or green, burrowing in cavities and excoriating the tissues; all this is Mercury, in one form or another.
Merc. corr. then we discover is Mercury plus. All authorities agree as to the intensity of the action of this remedy. The patient evinces a disposition to lie on the back, with knees drawn up. The well known tenesmus of Mercury is here markedly exaggerated; the stools have more blood, ulcers spread more rapidly and Merc. corr. leads all preparations of Mercury in the frequency with which it is called for in the albuminuria of pregnancy. In the male sexual organs, Merc. corr. is highly useful, when from slight irritation, we have phimosis or when the foreskin of an infant has been forcibly retracted and left so, inducing para-phimosis.
Under Merc. dulcis the key-note is pallor. Pale scrofulous children who have swelling of the cervical glands, or the cadaverous looking infant, whose breath smells like fresh cow’s milk, call for Merc. dul. When our old school friend sees these children, he says “Worms” and promptly prescribes Santonine and Calomel. In many instances his prescription is justified to the extent that he gets the worms and when any lasting benefit ensues, the Calomel was of course homeopathically indicated. Merc. dul. has many of the catarrhal symptoms of the family group, with a few accentuations, for instance you may run across a case where there is a literal gluing up of the Eustachian tube and a catarrhal inflammation of the middle ear. In the intestinal tract, the point of demarcation may lie solely in the fact, that the diarrhea associated with the typical Merc. grass green excoriating stools, is not attended with tenesmus.
Merc. precipitatus ruber has in its symptomatology one curious sensation, a patient suffering with gonorrhea will complain that the urethra is felt as a hard string. Phagadenic ulcers and buboes come under this remedy, when the edges are red, indurated, hard and spreading. Also syphilitic iritis when the pains have ceased. Pemphigus neonatorum and intertrigo syphiliticus, eczema acute or chronic with sero-purulent exudate, tinea tonsurans, circinata, and sycosis; all are conditions where this for of Mercury may prove valuable.
Merc. iod. (Merc IF) has a distinct individuality based on the general Merc. characteristics. The right to left direction of its symptoms in throat or chest is like Lyc. but the throat symptoms are aggravated by warm drinks and Lyc. is relieved by them. The tongue also is typical, it has a thick yellow coating at base while the anterior portion is clean and red. Head pains immediately following heart pain; pain in right forearm and left hip simultaneously; pain in heart with pain in chest. Jaws tired from clenching teeth during sleep. Nausea at sight of food. Cough worse from laughing. Susceptible to drafts while perspiring, very sensitive to damp and cold weather. Mostly a right sided remedy.
Merc. sulph. – Lippe considered this preparation as important as Ars. in dropsies of the chest. The indications for its employment are, pain in right chest extending to scapulae, patient can scarcely breathe and is greatly aggravated from 4 to five PM. When acting, this remedy often produces a watery diarrhea with great relief to the patient. It has a marked affinity for hydrothorax, depending upon liver or heart affections. Here again, the Merc. tongue comes up but under Merc. sulph. there is apt to be great soreness of the tip.
Merc. biniodatus (Merc IR)- this preparation acts more intensely on the lymphatic glands and cellular tissues than Merc. sol. Its great sphere of action is upon the throat especially the left side. Tonsillitis with Merc. symptoms. Aggravations are on empty swallowing, also upon swallowing food. Merc. bin. will often help you out in case of asthma, where general Merc. symptoms are present. Merc. bin. has special affinity for old cases of syphilis in persons of lax fibre, the scrofulous, and those who have taken much Mercury. In the female generative organs, we have ulcers and erosions of the cervix with profuse greenish corrosive leucorrhea.
Merc. nitricus is to be studied when we find conditions suggesting Merc. and at the same time exhibiting the sharp sticking pains of Nitric acid. Pustular conjunctivitis and keratitis with burning lachrymation, photophobia and the aforesaid sharp sticking pain calls for Merc. nit. Coldness also predominates under this remedy, with a flushed face. The pains are intolerable, driving the patient to thoughts of suicide.
Merc. aceticus should receive consideration when we find the key-note symptom congestion with stiffness, dryness and heat of parts affected. The eyes are inflamed, worse in the corner with burning and itching, worse morning and evening. Lack of moisture is the distinguishing feature here. The throat is so dry that talking is difficult. Merc. aceticus also has a barking cough which causes lancinating pain in the larynx or pharynx. Simple swallowing does not hurt but there must be enough motion in parts to move the cellular structure. “Pressure in lower sternum and dyspnea on standing erect,” is a peculiar symptom but is in keeping with the general aggravation from moving the affected parts; i.e., mucous membranes wherever attacked. In the urinary organs there is burning in the urethra so intense that it awakens him. This burning increases as the bladder fills and is associated with cutting pain upon emission of last drop. It is aggravated by cold bathing but relieved by tepid water. Profuse sweat moving about obtains here as under Merc. in general.
Merc. biniodatus cum Kali iodatum; Hale says of it: It causes profuse discharge of watery mucus from the nose with sneezing, coughing and watering of the eyes. Take a patient who cannot ride in an automobile winter or summer, without the above phenomena ensuing. It is a condition that conforms to this preparation of Iod., Merc. and Kali. The combination consists of one equivalent of red oxide of Merc. and 2 equivalents of Iod. of Potassium. Acute facial paralysis from cold (Merc. sol. and corr.) come under this remedy. Remember to look for the Merc. tongue with the Kali expectoration.
Last but not least we have Merc. cyanatus., the great cure and prophylactic in diphtheria. Extreme feebleness, trembling, and syncope, the characteristic trio, appear of course. In diphtheria when the membrane is greenish and inclined to spread through the nose involving a large surface, with great destruction of tissue and intensified fetor. Swallowing is well nigh impossible because of the severe cutting pain. There is icy coldness with nausea, thought of food causes retching. This is a dark picture but Merc. cy. has won many laurels in just such conditions. The chronic sore throat of public speakers with rawness in spots in the throat as if about to ulcerate, will often be benefitted by a dose of Merc. cy. if the general supporting and basic symptoms of Merc. are present.
From “Nash’s Testimony” by E.B Nash MD
“7 characteristic indications for Merc are:
1. Swollen, flabby tongue, taking imprint of teeth; gums also swollen, spongy or bleeding; breath very offensive.
2. Sweats day and night without relief.
3. Creeping chilliness in the beginning of a cold or threatened suppuration.
4. Sliminess of mucous membranes.
5. Moist tongue with intense thirst.
6. Glandular swelling, cold, inclined to suppurate. Ulcers with lardaceous base.
7. Modalities, worse at night; in warmth of the bed while sweating, lying on right side.
This set is common to almost all the combinations of the Mercuries, but the very yellow coated tongue is found under the Merc. iod. flavus. The bladder and urinary symptoms stand out most prominently under the Merc. cor.
So far as the Merc. viv. and Merc. sol are concerned they are so nearly similar that equally good prescribers use one or the other indiscriminately. Dr. Adolph Lippe preferred the Merc vivus, H. C. Allen the Merc. solubilis. I use the Merc. vivus offenest, though for skin affections and the second stage of catarrhal affections I prefer the Merc. solubilis.”
Clarke’s Dictionary: Has some more clinical points of possible interest.
“According to Teste, Merc. cor. is suited to males, and Merc. sol. to females.
Merc. cor will act in men on indications for Merc. sol. He lays this down as a positive law, and without going into the details of experience on which it is based, he mentions this as a “curious fact”: Both Merc. cor. and Merc. sol. antidote Sepia, which antidotes them in turn but imperfectly.”
But “this neutralization of Merc. cor. by Sepia, and vice versa, does not take place thoroughly except in the case of males, nor does the neutralization of Merc. sol. by Sepia, and vice versa, take place thoroughly except in females.”