A 31 year-old male patient, thin, fair complexion came with the chief complaint of anxiety disorder, tics on right side (of face), and eczema. He had eczema on and off since he was 13 years old, with tics in various parts of his body that began at the same time.
Initial Visit September 21th, 2011:
Doctor observation: Very objective, descriptive and organized in describing his health related problems in the case record. He had a lot of questions prior to making the appointment.
Designations : D: Doctor P: Patient Hg: Hand gesture
D: What is bothering you the most?
P: Anxiety. Obsessive about particular things like stains on my body and clothes. (or just clothes?) If I see people I feel self conscious. Fear of, as if I am dirty or unclean when in front of people. Obsessed with lawn maintenance. The weeds take over my lawn. I must check the weeds right away, instead of waiting for two weeks, as the weeds grow. I need to control things. It feels as if I have two parts in my head. The lower part is calm, relaxed and the upper part is all tangled, dense.
I’m extremely sensitive to other people. Over stimulated easily from too much light or noise. My mind takes lot of information; I do consciously and constantly, whereas the normal thing is for people to do all this at subconscious level and not become aware of it much.
D: Describe what you experience a little more?
P: It’s hard to be with more than 2 or 3 people. My mind speeds up. I think faster and faster, obsessed.
D: Talk more about that obsession.
P: When I am anxious I look for perfection e.g. the lawn, desire to be perfect, clean, smooth, not looking old, and all this happens when I am stressed. Need to have everything perfect. At other times, when I am relaxed I like imperfection. I feel two different voices – one is intelligent and the other is obsessed, which is so strong, and powerful telling me that my lawn is going to be wrecked, and my clothes are wrecked.
D: Wrecked means?
P: Rough weeds, the grass won’t go and is powerless, nothing can be fixed. When I am stressed I feel my body is weak and withered, sickly, cheeks gone. I look, I feel I have cancer, and my skin color is pale. When I am relaxed and look in the mirror, my body is strong and my body fills my T-shirt. When I don’t feel relaxed, it looks like I am bony and thin and my clothes are lying on a scare crow stick.
D: Tell me more.
P: Buying new clothes or shoes is difficult and confusing. If it is new shoes…I take them home and my first reaction is, it is wrong. One may be the wrong size or rubs the toe and that bothers me a lot constantly for a couple of days and I occasionally return it, but I gradually convince myself that they are good choices. I do meditation to convince myself. I have doubts even after meditation….all this lasts up to one month and then I will be accustomed to it and fine. I am confusing my own perspective. Few things in my life calm me down: meditation, having time to myself.
D: What makes you happy?
P: Being in nature. Either alone, with a few people, or outside in a thunderstorm in the middle of the woods. Then while I am at home.
D: What happens when you are at home?
P: In my home I feel all the corners feel like poking me physically …as if physically leaning at sharp edges.
D: How do you feel when you are in the city?
P: My stomach is tense when I drive in city. Going to small towns – a little tense. In the suburbs – feels the same sensation as perfect lines, sharp corners. Diaphragm is clenched (hand gesture) on right side. Worse getting in to the city. Better by decreasing the stimuli and to be in nature alone where I will be in peace.
D: Tell about your tics?
P: Have had a tic in various parts of my body since around age 13. They have been in my right eye/face for the past ten years; before that, it was sometimes in my neck, shoulder, stomach, hip, as well as a vocal tic in the 5th grade. Seems to be worse in public. When I am alone, I don’t feel like I am judged or watched. All my tics are on my right side (90%). My tics stop when I play music. Listening to music; I get excited if it is loud, passionate, I feel emotional…but I am worse. I love playing and it gives me relaxation. (what is he playing?)
D: How is your sleep?
P: Not terrible, but not great. I need to wear earplugs and sleep in a separate room to fall asleep (my wife and daughter sleep together in the bed, and while the bed is physically big enough for the three of us, I simply don’t relax or fall asleep). Without earplugs, my mind simply won’t “turn off.” When I am not extremely exhausted, I frequently wake up around one and a half hours before I need to, and simply can’t fall back asleep. It is also often difficult for me to get up in the morning (this has always been the case). When I am asleep, however, I tend to sleep deeply.
D: What dreams do you get?
P: Dream that I have to pick a dentist and in my dream I felt I was disappointed, frustrated. I think he told me that I needed a procedure that I didn’t trust. The previous dentist mentioned that I have 8 cavities but my aunt who is a dentist said I have none.
D: What was the experience in the dream?
P: Powerless, lack of control.
D: What else?
P: I love music. I am not a great performer, I become self-conscious and make a lot of mistakes. The more familiar I am, the less the stress. I am worse by travelling, as everything is new and different to handle. I am also frequently checking… to turn off the stove, and lock the door.
Below are the physical generals and particulars of the patient that were considered as characteristic:
- Diarrhea, particularly when very worried about something and anticipating.
- Tip of nose is cold in winter.
- Hands and feet cold to touch.
- Better when head is wet cool
- Worse from sunrise to sunset.
- In hot weather: anxious and unprotected; in cool, cloudy and rainy weather: pleasant and protected
- Covering makes him feel safe and cozy
- Ameliorated at night – very happy and comfortable.
- Thirstless
- Grinding of teeth
- Talking and walking in sleep in childhood
- Hot sensation
- When angry wants to hit and kick things. Or, heat/burning sensation inside, and eczema flares with prolonged anger.
Case evaluation:
- Image self-conscious, worried about what people think about him. Insecure in groups of people
- Delusion being judged by people
- Anticipatory anxiety/public fear
- Confusion
- Delusion all of the corners feel like poking, sharp edges.
- Anxiety going in cities, perfect lines, sharp corners.
- Delusion Diaphragm is clenched (hg) on right side
- Delusion being watched
- Fastidious
- Delusion: Brain’s lower part is calm, relaxed and the upper part is all tangled, dense
- Delusion not attractive
- Delusion, dirty
- Sensitive to noise (dislikes)
- Difficulty in balance in life, struggle to get balance
- Lack of control and need to control the things
- Life’s seems to be too much weight
Repertorial Totality (From Kent’s Repertory):
- Mind, Delusion, corners of houses seem to project so that he fears he will run against them while walking in the street:
- Mind, Fear crowd in
- Mind, Fear in public places
- Mind, ANTICIPATION, complaints from
- Mind, Sensitive noise to
- Generalities, daytime aggravation
- Extremities, Coldness, hands
- Extremities, Coldness, feet
- Nose, Coldness, tip of nose
- Grinding, sleep during
Classic reportorial analysis showed
Argentum Nitricum scored 14 points,
Arsenicum Album 15 points and covered most of the symptoms but fear in public places; and complaints from anticipation is not prominent in this remedy.
Gelsemium 9 points and it didn’t cover the peculiar symptoms like delusion of houses projecting and poking sensation
The case was also solved using the Sensation Method:
Source considering Mineral Kingdom:
Image conscious
Organized
Straight perfect lines and edges and corners
Confusion
Insecurity-security
He lacks control over things
Miasm:
Need to control things “Cancer miasm”, avoid or cover up is “Sycotic miasm” and hurried & intense nature is “tubercular miasm”. This patient is pointing to all the above three miasms.
Mineral kingdom
Row 5
Creativity & performance
Need to explore the new, be creative, perform and be appreciated need to process the information & come to conclusion, to analyse, to improvise, to invent, to devise, to strategise, to plan, to solve.
Row 2
Separation: he is an entity. “Am I part of something or am I separate”
Carbon, oxygen, nitrogen: the separation develops further. “ I must break this attachment and be completely separate“
For this patient the theme had to do with performance, and with the nitrogen theme of separation. Hence, Argentum Nitricum was prescribed on the following symptoms:
Indication of Argentum Nitricum :
It is compound of silver, argentum whose main theme is performance and nitrate whose main theme is “feeling of sudden danger”. The two things come together in Argentum nitricum, so the main theme becomes “Performance in sudden danger or crisis.”
There is a feeling as if the person will be accepted only if he can perform at the time of crisis. There is a feeling of being neglected and despised if he does not perform at the time of crisis. They are trouble shooters of the highest degree and see their role as that, feeling very much neglected and isolated and feeling a failure if they can’t perform in a crisis.
Situational Materia Medica is when a patient has to struggle and nobody is going to help him; he is trying, but not succeeding. This situation arose from being trapped alone in some circumstances and trying desperately to find a way out, but these fears are due to a tremendous sense of fault within which he is trying to cover. It is important for him to keep control in this situation and find his own way out of the problem. Fear of losing control. Fear of high places, fear of narrow places. Anticipation, Fear of failure, Fear of falling. The patient tries to get out of the trap impulsively. He feels there is no way out. Another situation is during a performance on the stage. These patients are anxious to go on stage. But when persuaded, they feel isolated and trapped.
Argentum has a lot to do with suspense. They like challenging jobs in order to overcome the fear. When they feel trapped they almost do suicidal, impulsive things.
Rubrics :
Ailments from anticipation
Delusion, corners of house projecting so that he fears he will run against them while walking in the street.
Delusion, deserted, isolated
Fear of failure
Fear falling of
Fear narrow places.
High places aggravation
Time passes too slowly.
Dosage and Potency: Argentum Nitricum 1M was given in water in split potency. As per sensation method he was at delusional level so 1M was the potency selected. This remedy was occasionally repeated when the symptoms relapsed.
Follow up in person after 2 months
Doing good over all in all aspects. About 75% better with his anxiety and obsessive nature.
Small red bumps that came up
Able to read when music is on – this never happened in his lifetime
Tics occasionally (covered by Arg nit)
Wakes up in morning very tired.
He said he is using the remedy once a week to overcome his anxiety as he needs to take care of his daughter who is an infant, which triggers his anxiety.
Case Evaluation on follow up: The patient has made great improvement with the remedy and there is an external stress demanding him to repeat doses frequently. At this time I advised him to take LM 6 potency daily which is equivalent to 1M potency.
Follow up after 6 months
D: How are you?
P: Much improvement. As Spring season comes my anxiety issues pop out. Definitely much better. Sometimes my clothes, or yard things bother me, but not much. I feel I am continuing to improve. Prostatitis has come back. Started 3 weeks back…seen intermittently. Doctors prescribed antibiotic, but I didn’t take it. I have very slight burning while urinating. Normal color urine. Blood work was done. I’m waiting for test results.
D: Thirst?
P: My thirst is ok. Currently I’m doing a religious fast from sunrise to sunset and don’t eat or drink during the day for the past 2 weeks.
D: How is this prostatitis affecting you?
P: It doesn’t bother me a lot…2 or 3 in the scale 0-10 where 10 is more and 0 is less. Mild discomfort…don’t want to make it worse. I am afraid of it, so wanted to take precautions.
D: Dreams?
P: Now I remember my dreams; before treatment I never remembered them. This morning I had a dream of remaining calm with outside things not affecting me. Trying to get lid out. Experience is good. Able to turn inward, for calmness….in a half awake state. Family vacation – better than in the past….enjoyed it . Went to a new place. During vacation frustrated a little more with my anxiety- dirty clothes and then repeated the remedy and felt good after the remedy. 80% anxiety better on a daily basis….which is a good sign. Sleep is good without ear plugs. I am sleeping better now. Before treatment, I had to keep earplugs in to sleep. My right tic is improved. Reduced intake of remedy, am only taking as needed.
Case Evaluation at 6-month follow up: Patient is continuously improving with the remedy. He has seen all positive changes. Able to remember dreams clearly which shows that he is getting connected to his inner consciousness.
Advised Argentum Nitricum 10M single dose to act more deeply.
Follow up after 1 year
P: Doing great. More than 85% relief. Tics not seen much. Playing on piano was easy; earlier felt nervous. Going into new places. Camping easy – much less anxiety. Occasionally repeating Argentum Nitricum LM6.
This case was posted in Japosa Souvenir in 2012.
Follow up after 2 yrs
Client was still doing great and needed an occasional dose of Argentum Nitricum 10M or LM6. He also gave testimonial after 2 yrs.
Follow up after 3 yrs
Client was still doing great and needed an occasional dose of Argentum Nitricum 10M or LM6. Advised some healthy tips, tapping meditation, supplements and homeopathic color remedies.
Kavitha, Nice case. Thanks for sharing.
Thanks Vatsala for appreciating the case.