Answer to Case # 4 of case solving contest: ‘I Use a Cabinet Scraper to Scratch My Psoriasis’

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Written intake followed by interview notes on a 49-year-old man, PF, suffering from lifelong psoriasis. Be sure to consider the miasm(s) involved. Maybe he reflects more than one! What miasm covers his chief complaint, his mental state?

Chief Complaint

What condition or issue would you like to address with homeopathy?

Psoriasis/depression/headaches

When did it begin? What do you think caused it?

At birth/unknown/also unknown, but at the time I was exposed to extremely high doses of X-ray radiation as treatment for the condition. The X-rays were directed at my face.

What symptoms accompany this condition?

Depression, listlessness, suicidal thoughts and feelings, low energy, withdrawal from life, hopelessness, resentment, an often strong desire that my life be over, being wholly persuaded that I will never escape this scourge, poor sleep, poor performance.

Mental/Emotional

Do you remember your dreams? Do you have recurring dreams? About what?

Occasionally/yes/I’m in a school, usually a high school trying to finish an assignment that I’m completely unprepared for (clueless) and there is an atmosphere in the dream of a looming deadline – once this deadline elapses I will be lost, left behind, left alone – the feeling of being left behind is very powerful, compelling (I can feel it in my viscera).

Do you weep easily? Under what circumstances?

Yes – music particularly – books – movies if it’s done well (not the mawkish, cheap-shit hollywood mainstream)

When I think about children all over the world who are beaten, abused, starved, abandoned, sexually abused, ignored, used as weapons of war etc. – I weep.

How do other people view you? What do others complain about in you?

I don’t know. Some seem to love me dearly and indulge my excesses and misfeasances, others instantly detest me.

– that I’m distant and withdraw

– chronically unhappy, dissatisfied with my lot

– indolence

– arrogance

What makes you angry? How do you express anger, if at all?

I seek God’s help in my life but it rarely if ever seems manifest or forthcoming. Perhaps I miss the forest for the trees. At any rate, I’m almost always angry at God these days.

By depression – or – by raving about things I can never change – like my age or the economic circumstances of my parents when I was a child.

Do you tend to have a lack of self-confidence and a poor sense of self-worth?

Yes, and yes.

Are you a tidy person or not so tidy? Do you tend to collect things?

I binge – I’ll make messes, get disgusted with the mess and embark on cleaning/culling rampage. yes, I collect shit like a pack rat.

On what occasions do you feel jealous?

When my wife and I visit a Westchester friend of ours and her 8 yr old son on their 2,000 acre rolling estate – her father is a multimillionaire as is her husband. I’m painfully aware of my shortcomings as a provider when I go there.

What were you like as a child?

hyper-active, troublesome, annoying, destructive, cruel to animals, academically inferior, bed-wetted, cruel to my younger siblings, bullied unmercifully by my father, utterly un-self-aware, zero self-control

What would you most like to change about yourself? Almost everything.

Family History:

Truckloads of alcoholism, boatloads of depression, self-destructive behavior by the car-load – not a lot of cancer, but some. colon, liver, breast. People on both sides of the family fence seemed to live into the 80s and die of the usual scourges of that age – pneumonia, heart failure, organic breakdown, stupidity, et al.

Time Line

Oy. Radiation treatments in infancy for eczema. Hi-dose X-ray radiation directed at face. I’m told it cleared the eczema, but what else did it do to me? I’ve come across stories about people who received these treatments back in the 50s and they reported a variety of side effects ranging from superficial to horrifying.

– skin problems of one stripe or another since infancy – eczema, psoriasis, poison ivy, poison oak, hives, dermatitis, reactions to herbicides/insecticides, diaper rash (bed wetted to age 12), funguses (ringworm, staph, et al.). My skin has plagued me since birth. Must be a karmic thing.

– Abused by grammar school principal repeatedly – slapped, strapped, humiliated publicly – also abused by teachers (altho in the interests of full disclosure I was a provocative little shit)

– Failed 1st grade – steadily downward scholastic spiral starting with 5th grade

– Couldn’t concentrate

– Couldn’t complete assignments

– Daydreamed frequently

– Found math, particularly algebra, inscrutable

– Dropped out sophomore year

– Went to work for a chain burger stand fulfilling my career expectations to the utmost – really reaching for the firmament – got fired – oh no! forced to return to high school – but thrown out yet again for a sick-note I forged before I quit high school – (hence my finely tuned appreciation for irony)

– Never graduated from H.S.

– Never took S.A.T.’s

– Never took a girl to the prom

– Never won an award for scholastic or athletic excellence

– Never made the honor roll

– Never got a 100 (or A+) in a class (any class)

– Never made my parents proud of any academic achievement(s)

– Never came within a long weekend of a college or university

– At 49, with a few notable exceptions in the course of my working life, I’ve held or been terminated from a veritable catalogue of shitty, low-paying, depressing, soul-crushing jobs.

– I once had a fantasy of pursuing a career in pop music as a singer but that died with all the other dreams

– Began a serious career in alcohol/drug abuse at age 17 and spent most of the ensuing 12 years committing suicide on the installment plan

– Overdosed on methadone & alcohol in Aug. 1977 (same day Elvis died) survived but only just

(Psoriasis reappeared after 10 years at age 21)

– Drank like a pig

– lived in squalor

– cheated, lied, stole

– Got married @ 25 – why ruin just my life when I can ruin 2 for the same price?

– Oh, did I mention? One of the shittier jobs I held in my early 20s was in a film processing factory – lots of swell toxic chemicals everywhere, acids and alkalis at extreme ends of the P.H. scale – anyway, I mixed chemistry for the film processing in 4,000 litre vats w/huge industrial mixers mounted across the tops – my hair was long at the time and whilst reaching into the top of the tank for a sample for the lab, my hair brushed against the shaft, caught, and was torn from my scalp. It should have broken my neck but here I am.

Is this a sad litany or what?

Anyway that’s enough for now –

I got sober at 29 – the 1st ray of lite to peek into my dark little shit-hole of a universe in years

– Got divorced (no kids thank God)

– More crappy jobs

– Blah Blah

– The cumulative effect of 28 yrs. of psoriasis has been dreadful

I’m so beaten down by it words fail me.

– I don’t have any zest for life or living

– I don’t care about anything – except my 2 children

– I love my wife but most of the time I lack the energy to express it

– I look forward to death but not much else

– I have constant headaches & sleep wretchedly – I almost never feel rested or refreshed after a full night’s sleep

– I have 0 libido

– I detest my current job

– I’m broke and in debt

– I hardly eat yet I gain weight

– I feel like shit most days

– I seriously doubt that 1 remedy is going to address all of this – but I’ve been wrong b-4.

What sort of weather do you DISLIKE most? (damp, cool, hot, windy, etc.)

I loathe a cold wet climate so naturally I’m living in a bog swamp like Jersey City which offers the very finest in a wretched winter weather.

Are you a chilly or a hot person?

I’m a chilly person – frozen would be more accurate.

I like 80º to 95º temps, but I’ll take the heat over the humidity every time.

How do you feel when you wake up? lousy – exhausted, drained of energy, mentally fogged, physically exhausted.

Do you typically wake up in the middle of the night at a particular time?

I wake up to pee anywhere from 3-15 x’s /night (Krist, no wonder I’m so tired)

Food: cravings for spicy anything – especially Thai food, Mexican food, Chinese, chili peppers, Fra Diavlo sauce etc.

aversions to (dislike taste of): turnips, curry, cauliflower, beets, anything bitter (like broccoli rabe)

Describe your diet in a few words: bland, dull (like my life)

Are you thirsty? Nah  For hot drinks? Nah   Cold drinks? Nah  Ice cubes? Nah

Interview: he’s a burly guy in a sweatshirt and baseball cap, a straight-talking guy who swears a blue streak but has an underlying sincerity, gentleness and spirituality.

CC: large areas of red lesions on arms, legs and back a 6 or 7 on a 10 scale. Start as round spots, then spread and become confluent, irregular patches.

So bad at times that to arise and dress is a monumental task. It burns so much, like a bad sunburn, it hurts to get up, skin cracks and bleeds.

Psych. landscape = he’s going into a dark place a week or 2 before. He knows an outbreak is coming before it starts and knows he’s about to go into the dark place.

The skin raises, exfoliation, cracking and bleeding. Lots of scaling. Sometimes flakes off in large patches. Uses a generic version of Aquaphor to moisturize; without it he would have no life at all. Uses very hot baths to help – 1-2 hours.

He gets non-communicative. He has no desire to describe what is going on.

Lasts 1-3 weeks. Respite period lasts a few weeks to a few months.

It has driven him to seriously consider suicide. He has sat on the ledge of a building and thought about it. Not violent guy. He is angry about his condition, about what his body is doing to him, and he wants to get back at it by destroying it.

Has been in therapy. He has his own theory of why he got psoriasis. As a baby, he was exposed to radiation therapy for eczema. He believes he had some food intolerance to his baby formula, was not breastfed. Had eczema on face. He went to a pediatrician who prescribed x-ray treatment, the treatment then for various skin conditions.

Has had emotional problems and headaches for most of his life.

It is common for people treated with x-rays to be depressed and maladjusted and to have skin conditions like psoriasis.

Has had it since age of 20, when it re-emerged after being gone from age 11 (in childhood was a large patch on back of L leg). Exposed to photo chemistry in a lab in Calif. at 20. Got dermatitis, that was treated and went away [suppressed], psoriasis came back. He has never stopped trying to treat it. He has always looked for ways of treating his psoriasis with both allopathic and alternative modalities. Has done homeopathy since age 36. Has even tried drinking his own urine. Also allopathic modalities including methotrexate, light therapy.

Whenever he starts a therapy, it usually works well initially because he is doing something. Then it stops working, he goes off it, then there’s a snap back period. Feels it is now intransigent. It’s locked into the cells, in his cellular memory. Has managed to persuade himself that he is going to be “put into the box” with lesions on his skin. Believes it is his fate.

What is concomitant with the psoriasis is the mental landscape. It has beaten me down. My life is goddamn dreary. No energy, my Vital Force keeps getting weaker. The inflammations take tremendous energy, that is why I withdraw.

Regrets – I was a singer. I could have done something. I knew how to do it, to get on stage and work a room. I drank myself out of my career. I was usually drinking or drunk when I got on stage. It colored my performance. I drank myself out of a career in pop music.

Had a spiritual awakening 20 yrs ago in AA.  In Dec. 1996,  I was going to an early morning AA meeting in Manhattan, in therapy, reading Scott Peck’s The Road Less Traveled. He felt a soft touch on his shoulder. A voice said, “Everything is all right. I am with you.” He felt a tremendous feeling of awakening and light. Realized that we act mostly out of fear. All of that fear fell away from me. I felt fearless for the first time in my life. It lasted for 12 days. I had visions. All the static that occupies one’s thoughts went away. This eclipsed any love experience by a couple of hundred suns.

I was doing yoga at the time. I was open to it the awakening. I thought about joining a monastery after the awakening, leaving my wife and kids. But I never did anything with the experience. I slept for 2 hours a night, prayed and meditated and enjoyed the experience. I didn’t have any weight.  I floated like a dancer. I didn’t do anything with the experience. Just one more thing I didn’t act on.

O: tone of regret, self-reproach.

I stood at a fork and went the other way. The psoriasis cleared up during those days. Was it God’s way of saying “Follow Me”?

I have never been able to square my experience with God with the psoriasis.

I could not abandon my wife or my kids. It didn’t seem Godly.

But I was convinced that to follow that ascetic path was a way to heal or to shoulder my responsibility.

After the awakening, the more I enmeshed myself in this world, the worse I got.

When he’s really mad at God, he tells him he doesn’t like a bully. It reminds him of his Dad, he got the strap as a kid. God has all the power and I don’t have any of the power.

I do not like cold even a little bit except my pillow, I keep turning my pillow. Head of bed makes it worse. Skin is > hot weather. I like heat in any form, saunas, hot tubs, hot weather. I can take 90% humidity. I like hot weather but the consequence of having this condition is that I would be rejected from a public pool. It has an inhibiting effect on one’s life. It’s a disfigurement. IT feels malignant and horrible.

We go to Asbury Park because there are no people there. People gawk at me. It makes me live my life in particular ways. It gets tiresome. The leprosy experience. I was one of those kids that didn’t know to shut up. I didn’t care if I got caught. I was stupid. A little self destructive.

Skin -worse early morning on waking 6 am. Uses a cabinet scraper to scratch it!

Also late afternoon at work, his legs itch.

Mentals worse at 1-2 am, can wake up feeling, “My life is a nightmare.”

—————————-

ANSWER

This was a Psorinum case. The client did extremely well on Psorinum with a great reduction in his suffering. Several participants suggested X-ray. He had been given X-ray by a previous homeopath; he could not remember the immediate results at the time, but apparently it did not work longterm or he would not have ended up consulting with me. I had to give him X-ray several years later when the Psorinum stopped working. Interestingly, at about the same time he told me about a possible cause for his being born with psoriasis: the nuclear cloud from an atomic bomb testing drifted over his city just before he was born!

Characteristic Symptoms, Organized into Themes

psoriasis:

confluent lesions, red, raised, tend to be symmetrical

voluptuous itching: itches with cabinet scraper

scaling, flaking

cracked, bleeding

head, back, extremities

> heat, hot bath, hot weather, sunlight, salt water

burning like sunburn

drains energy

< 6 am, < evening

from suppression of eczema, dermatitis

intermittent possibly < weather changes, change of season

< dietary indiscretions (nightshades, fried foods, meats, processed foods)

depression

suicidal from discouragement

goes into dark place

despair of recovery, believes he will die with psoriasis

wakes 1-2 am with despair

lack of energy

poor sleep

withdrawal from life, no zest for life

chronically unhappy, discontented

lack of libido

anger

thoughts of suicide: angry at body

lots of anger/suppresses his anger at work

fears confrontation with others

self-destructive/syphilitic

family: alcoholism, drug abuse, depression

personal hx: alcoholism, drug abuse, self-destructive behavior (invited punishment as a child)

reacts to stress by withdrawing, isolating

self-loathing

feels he is a failure, has wasted his life

dream: lost, left behind, clueless

timeline focuses on all his failures

religious

religious experiences, God speaks to him

angry at God

sympathy for others

concern for children who are suffering

wants to help young musicians get a start

bullying

sees God as a bully

bullied by father, principal as a child

bullied others: cruel to younger children, animals

psora

family members on both sides lived in 80s, died of old age

he keeps struggling, trying different things

concerned with survival: jobs, making enough money to support family

lots of skin problems: eczema, poison oak & ivy, hives, dermatitis, rashes

Find rubrics:

psoriasis:

Skin, eruptions, psoriasis

(many subrubrics for the location are too small to be helpful;; rubrics for Skin, eruptions, itching, patches/circumscribed/dry red/violent itching are too small to be helpful)

Note: psoriasis in children Staph is a 3 and the only remedy; after suppressed emotions, Staph is a 3 and the only remedy

Skin, eruptions, scaly

suppressed

itching, voluptuous

Skin, itching, scratch until it bleeds, must

Skin, eruptions, burning

depression

Mind, loathing, life

Mind, suicidal disposition

(juicy subrubrics like “from eruptions” “from itching of skin” and “about his miserable existence” are too small)

Mind, despair, of recovery

Mind, despair, itching of the skin, from

anger

Mind, ailments from suppressed anger

self-destructive/syphilitic

Gen, family history of alcoholism

(rubrics for aversion to company and alcoholism are too big, for fam hx syphilis is too small)

self-loathing

Mind, loathing, self

delusion, fail, everything will

remorse

religious

Mind, religious affections, religious melancholia

delusions, sinned away his day of grace

delusions, doomed

(Mind, delusions, God . . . subrubrics are too small)

bullying

Mind, ailments from domination

psora

Generals, psora

Results of repertorization:

Sulph, Staph, Psor, Puls, Ars, Aurum, Lyc

Miasmatic analysis

Family is both psoric (long-lived) and syphilitic (alcoholism, drug abuse, depression, self-destructive behavior)

Pt is both psoric (keeps struggling; CC itchy skin condition) and syphilitic (depression, despair, self-destructive/suicidal impulses, hx alcoholism and drug abuse)

CC is mixed miasmatic condition

Choose three, pick one

Although Sulphur shows up slightly higher in the combined repertorization, I cannot consider it seriously because the modality of > heat and > bathing is so strongly marked. The patient is chilly and likes hot weather, whereas Sulphur would be hot. Sulphur and Psor are similar in many ways (especially in terms of skin conditions) but these modalities point towards Psor and away from Sulph.

A better differential would be with Arsenicum, especially considering his 1-2 am wakeup time and the combined psoric-syphilitic quality of Arsenicum. However, he shows none of the typical Arsenicum fretfulness, anxiety about and overfocus on his health. His attempts to deal with his condition are proportional to how much it interferes with his life. He also shows more of the messiness of Sulphur than the fastidiousness of Arsenicum. Arsenicum would also reach out to others in despair over his condition, in a self-centered demanding way, whereas this pt withdraws and isolates.

Aurum is also an interesting differential. Aurum certainly covers his religious aspect, his suicidal impulses (in particular the desire to throw himself from a height) and his sense of failure. However, Aurum does not typically manifest itself in this type of itchy skin condition. I would expect an Aurum to come in for sinusitis or a heart condition. In addition, he does not reflect the perfectionism or seriousness of an Aurum. Finally, Aurum does not well cover his psoric miasm.

In reading his intake, it was clear to me that Psorinum would be a helpful remedy (although as the patient himself pointed out, he will probably need more than one remedy to clear such a mess of symptoms). I remained open to the possibility of another remedy coming up in the interview, but I felt it confirmed Psorinum. Psorinum is an excellent remedy for psoriasis and itchy skin conditions in general, as well as for suppressed skin eruptions. It is chilly and > heat (< > Sulphur). It is both a psoric and syphilitic remedy (and I have to credit Asa Hershoff for pointing out to me the syphilitic aspect of Psorinum. I wonder if the patient who donated the original scabies fluid had a syphilitic background?) Psorinum is well known for doom and gloom, for despair of recovery. Of course, being the quintessential psoric remedy, it has the psoric anxieties about money and survival.

Here are some more Psorinum keynotes (from RADAR) which apply to the patient:

•     anxiety and despair about the future; pessimism

•     thinks himself a loser, hopeless

•     forsaken feeling (this pt feels forsaken by God)

•     sadness and despair from itching

•     suicidal thoughts

•     anguish < at night

•     < draft of air, < fasting

•     itching < heat of bed, scratching until it bleeds

Here are some specific Psorinum rubrics from the Mind section which apply:

•     anxiety on waking at night / with anguish / about business / of conscience / about future

•     company, aversion to

•     concentration difficult

•     confidence, want of self

•     confusion of mind when calculating (he says he couldn’t do arithmetic as a kid)

•     death, desires

•     delusions, doomed, being

•     delusions, fail, everything will

•     delusions, hearing, of (delusion in the sense that it is his inner reality; I don’t doubt that he experienced the voice of God)

•     delusions, laughed at and mocked at (again, his inner experience at the beach)

•     delusins, sinned away his day of grace

•     delusions, seeing spectres/ghosts/spirits

•     despair of salvation

•     discontented with everything (he says people complain of this in him)

•     discouraged

•     doubtful of recovery

•     eruptions, mental symptoms after suppressed (he feels that his mental state is due to the suppression of his eczema)

•     fear of being damned / of failure / something will happen to his family (he worries about his kids “being preyed upon”) / of misfortune / of poverty

•     forebodings (when he knows his psoriasis will erupt soon)

•     forsaken feeling (forsaken by God)

•     indifference, apathy (one of his depression sx)

•     mathematics, inability for, calculating

•     mental exertion impossible

•     morose

•     pessimist

•     prostration of mind

•     religious melancholia

•     sensitive to moral impressions (his concern about children being mistreated)

•     suicidal disposition

•     untidy

•     weary of life

Prognostic Evaluation:

Strength of Vital Force: moderate (I would rate it as strong for a 49-year-old man but he says he has been weakened by repeated bouts of psoriasis, he has the past hx alcohol and drug abuse)

Center of gravity: physical (of course he has lots of emotional sx but they mostly come from the physical sx; in other words, if we can fix the physical, I believe the emotional will resolve)

Sensitivity: not sensitive, by his own assessment

Family/miasmatic hx: psoric and syphilitic

Medications: Flo-max for enlarged prostate

Confidence of prescription: high

Sx expected to respond: psoriasis and m/e sx; may have to deal with headaches separately

General prognosis: fairly good. I am concerned about his history of initially doing well on a new regimen, then having it stall, becoming discouraged and giving up. Using homeopathy for an itchy skin condition will not be smooth sailing. I need to make the potency/dosage low enough not to aggravate but high enough to give quick, lasting results so that he does not get discouraged.

About the author

Begabati Lennihan

Begabati Lennihan is director of Teleosis School of Homeopathy in Cambridge, MA. A Harvard alumna, she practices homeopathy at the Lydian Center for Innovative Medicine and teaches meditation at Harvard Health Services"™ center for mind-body medicine. She is an Adjunct Instructor in homeopathy at Massachusetts College of Pharmacy and has edited several textbooks of homeopathy.

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