| (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
Other complaints:
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.
Analysis:
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 [2], hatred of persons
who had offended him [1]].
Inner conflict between desire for law and order and violent impulses.
Restraining themselves requires a lot of energy, = forgetfulness.
INSTABILITY
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.
Discussion:
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
Rajan Sankaran:
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.
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