A case of seronegative arthritis

A 39 year old man came, in August 2004, for asymmetric pains in his joints and swelling in his fingers; he has been diagnosed with seronegative arthritis. He has pains in his right hand, his elbow, and his right hip. The pain increases at night and is worst about 12 – 1 am; he uses an Ayurvedic spray (Reli) to relieve the pain. The pain comes about once a week and he has premonitions about when it is going to come, using the spray in advance. It hurts him to put weight on the right side, so he has to support himself to get up from a sitting position. Eating sour food, especially unripe mangoes, increases the pain. He also has a mild tendency to stutter, especially when meeting people for the first time.

Dr: Tell me more about the pain.

Pt: “It started when I was sixteen, in the tips of my fingers. The slightest touch used to aggravate it, and my fingers would turn red. These days, the pain is very severe; it is like a boil inside, I can’t bend my limb from the pain. It feels as though I have been hit by a blunt object, as if blood is clotted inside. It is worse when my hand is hanging down, worse on touching it, and better from jerking my hand. When it started, I used to weep from the pain and wonder what will happen in the future. Today, I can tolerate this pain but I don’t know about tomorrow. I feel that if I tell my wife she’ll get worried. I know it’s going to worsen, so these days I just keep quiet; I have the capacity to keep quiet even if someone would cut me with a blade, I would not even say “oooh” (weeps). I feel it’s going to stay, it is out of my control to alleviate it, and so I just tolerate it.

The first time the pain came, I was sleeping and I had a dream. In that dream, I was in a boat in a flood and I saw many people drowning and being pulled in by the force of the water. I saw myself trying to save people. I got on the right side of my boat and saved someone, then I went to the left side of the boat and saved someone else. I saw myself doing that and with every motion the pain in my hand got worse. The pain was as if something had been broken, as if it was frozen from the inside. I could hardly move my arm but I was forcing myself to do it even though my limb was not giving me support. I was slowly moving my arm from right to left with lots of pain. When I was sitting still there was no pain but there were so many people, they wanted me to help them, to save them. Someone was calling me from one side, then the other side; it was intolerable. The worst part of the dream was the pain, my entire concentration was on it; it was limitless, intolerable, beyond my limits to bear, and I cried out with the pain. At that time, I was explaining to myself that “this pain is here and it’s going to be here forever, so forget about the pain and concentrate on saving people’s lives.”   

It is essential to understand the psyche of the patient for, even though his physical disease is arthritis, his way of dealing with his problem is equally diseased; the feeling is that he is hopeless, the pain will stay, and his only way of coping is to endure the pain. The pain is intolerable and so is the situation that he finds himself in during his dream; a very demanding situation, where one needs a superhuman effort, which he seems to tackle successfully. We can see his sensitivity to pain and the fact that he tried to control his pain in order to save people’s lives. This type of coping suggests the cancer miasm: a situation beyond control, beyond one’s limits to handle, very demanding, requiring a superhuman effort to deal with it, which is exactly what we see in his dream.

The second thing that we need to understand is how he uses his dreams to describe how he is coping with the pain; how intense and demanding the situation is in his perception. This is the level of imagination and delusion.

Now, we need to trace other uncompensated areas of his life and explore them in order to understand his experience. If we have explored the correct track, we will come across similar experiences to those we have already encountered. If exploring another area brings forth something completely new, it either means that we have left the earlier experience half-explored or that we have taken a wrong path. In such case, we need to understand the newly-explored scene until the entire vital core is clearly understood, and then we can go back to the earlier experience and find the missing link.

Commenting about the pain, he repeats: “It is out of my control, out of my pain limit. If it increases, I won’t be able to walk, I’d be bed-ridden and that would make me depressed.”

Dr: Tell me more about yourself in general.

Pt: "My goal is to stay fit. Since childhood I do skipping, 400 at a stretch."

Dr: Is there any incident in your life, which has had a deep impact on you?

Pt: "Yes, and even today if I remember that incident, I get tears in my eyes. Once my eldest daughter, who was under a lot of pressure for exams, was found laying down unconscious on her bed; her eyes were wide open and her limbs were straight out but she was not moving (tears in his eyes). It happened right in front of my eyes. I thought “what if something happened to her?” I was shocked. She was suffering and I couldn’t do anything about it, I was helpless. It was beyond my imagination, I couldn’t bear it.”

Dr: Tell me more about “shocking”.

Pt: "It was so unexpected, coming suddenly like that and again so painful. Seeing that the one whom I love so dearly was suffering, and that anything could happen to her, that was shocking for me. Another incident: I was walking with my mother, holding her hand, she missed a step and fell down. I was shocked and thought: “I am with her and still she falls down, oh my God!”  I blamed myself for being helpless; in that situation, I could not do anything. In general, I become sentimental over various things and I weep easily, especially concerning my family."

We again witness his sensitivity towards intolerable pain and the suffering of his daughter and mother, and his helplessness to control the situation.

Dr: Any other incidence which had a deep impact on you?

Pt: "Once, I got badly hurt on my scalp; it was very painful. Another time, my skin was torn open and the flesh came out but I did not cry. The pain was intolerable but I controlled it and I did not feel helpless."

Dr: Tell me about your stuttering?

Pt: "It has been there since childhood. I used to feel very bad about it, wondering what was wrong with me in comparison to others, so I used to avoid facing people, talking on the phone or leaving the house. After my marriage, I became more confident and I’ve started talking in public, participating with friends, in groups of people, and in business circles. Even if I do stutter, I do not feel so bad, and I don’t have inner fears now."

Dr: What are your interests and hobbies?

Pt: "I like outdoor games like cricket, taking active part in games, sports – you should play with all your heart, 100%. You feel tremendously happy when you win, proud of yourself, and full of excitement. You just dance with that.

I love music, listening to melodious songs, old sad songs, not the fun kind. Often, I just switch off the lights and I go to bed with the music on, and I’m peaceful. It feels completely fresh, like heaven; I forget everything and I’m calm, even if I am in pain."

Dr: What is the opposite feeling of “peace, calm”?

Pt: "I never confront anybody, I just let them be as they are. I feel bad inside when somebody hurts me or fools me, but I just leave the matter rest.”

Dr: How particular are you about keeping things in order?

Pt: "Very much, I want things in their place. I shout at my daughter if she does not keep things in order."

Analysis:

On the one side, we see sensitivity towards intense, intolerable, severe pain and suffering. On the other side, we see peace, calm, complete silence, and no pain. The issue here is a sensitivity towards one sensation: intolerable pain. We do not find the issues of structure, maintenance, lack, and so on that typify the mineral kingdom, nor is there the issue of victim/aggressor, which dominates the animal kingdom. This is purely an issue of the plant kingdom. Being such a sensitive person, who is easily tearful, confirms the plant kingdom. His sensitivity towards intolerable pain indicates the Papaveraceae family. When we study remedies of the Papaveraceae family, we get the following symptoms:

Painlessness of complaints usually painful (Complete)

Ailments from shock (Knerr)

Ailments from fright, fear, accident, from sight of an (1) (Complete)

Delusion; hurt him, people want to execute him (1) (Knerr)

We can see that the fright - and the pain - is intense, resulting in convulsions, numbness, sleepiness, and anaesthesia, and that the person cannot allow his pain and emotion to touch him, hence painlessness is one of the main symptoms of Opium and other members of the Papaveraceae family. On one side, we get intense pain at physical as well as at mental levels (shock, fear, fright from accidents, injury, murder, violence, stabbing), along with sleepiness, coma, catalepsy, anaesthesia, and numbness as a passive reaction to pain. This is the vital sensitivity of Papaveraceae: intense, hell-like pains, turmoil-like state. On the other side of intense pain is a state of no-pain, calmness, and tranquillity; a state that one experiences in meditation, resembling the state that our patient described when listening to music in the dark, where he forgets his pains.

Miasm: Cancer (trying to control)

Remedy: Opium, whose central issue is “to control the pain and suffering, or to fail to do so.” As we know, painlessness is one of the main themes of Opium, where the patient does not allow the pain to touch him, as he is so sensitive towards the pain sensation. That is the reason for meditation and tranquillity being a big theme in Opium. Chelidonium, Codeinum, Fumaria and Morphinum are other drugs from the same family sharing this state.

Characteristic Rubrics of the case covered by opium:

Mind; DREAMS; journey; water, by; anxious (1)

Opium is the only drug mentioned for this symptom. In combination with the symptom mentioned below, it more or less expresses the patient’s experience in his dream of water.

Mind; DELUSIONS, imaginations; casualties, sees (7)

Again there are only 7 remedies, of which Opium is one.

Other rubrics:

Mind; AFFECTIONATE

Mind; ANXIETY; future, about

Mind; ANXIETY; pains, from

Mind; AILMENTS from; excitement; emotional, mental symptoms from

Mind; AILMENTS from; fright or fear; accident, from sight of an

Mind; AILMENTS from; grief, sorrow, care

Mind; AILMENTS from; injuries, accidents

Mind; DELUSIONS, imaginations; enlarged; he is

Mind; DREAMS; unsuccessful efforts to; do various things

Mind; SENSITIVE, oversensitive; general; pain, to

Mind; TIMIDITY

Mind; TRANQUILLITY, serenity, calmness; general

Mind; WEEPING, tearful mood; general; pains; with

Mind; WEEPING, tearful mood; general; easily

Generalities; SIDE; right

Generalities; MIDNIGHT; agg.; about

Generalities; INJURIES, blows, falls and bruises; general

Generalities; PAIN; general; joints

Generalities; PAIN; sore, bruised

Generalities; PAIN; tearing; internal

Generalities; SHOCKS; general; injury, from

Extremity Pain; RHEUMATIC

Extremities; STIFFNESS; general;

Extremities; BOENNINGHAUSEN; lower limbs; agg.; touch

Extremities; SEPARATED sensation; body, from, lower limbs; severed from his body, legs

The patient mentioned that he wants to cut his painful leg from his body and put it aside.

Prescription: Opium 1M, one dose.

Follow-ups:

20/09/04: “I had two episodes of pain but they were much less severe. I feel that my complaints will go away, they will be cured. I feel fresh and I do not get tired even with a lot of physical work. I am not depressed or hopeless. Previously, I used to be sad without any reason but now it’s not there.”

01/11/04: “No more pain all this time and my energy levels are very good. I had some minimal pains in my fingers these last few days but no swelling.”

22/11/04: “My mood has changed; I became angry at small stuff, which was unlike me, as usually I do not confront anybody. Since the last two days, I am better and in general I am fine, no more pains in my joints.”

His anger is a very good sign; in the past he used to control his emotions, now they are coming out.

“I had a dream: I was going out with a few friends, I think we were going swimming and I thought it was impossible to swim, but I heard a voice telling me “go ahead, you can do it.” So, I started swimming and I reached the shore. I feel there is a lot of change in my attitude. I don’t care about what people think of me, which I always did. I have always compromised, myself, my wishes, but now I decide what I want and what I don’t want. I will be in control of my life. I like this change. My confidence has increased.”

Over the following months, his improvement continued. Opium 1M was repeated after a continuous dry cough and painful throat, worse on swallowing and worse on laughing, and loose stool. Another repeat of Opium was given after a two day fast, with neither food nor water, while on a pilgrimage. He developed a stomach upset and pains in his epigastrium, worse on touch. He also dreamt that he was trying very hard to finish the pilgrimage but not getting there, making him restless.

His energy level remains good; there is no tiredness in the evenings anymore. Pain in the joints has reduced to nothing after resurfacing from time to time. His mood continues to improve: “I used to have many tensions concerning my life, my finances, my health, and my family, but now I think positively. If something is going to be there, why bother about it by bringing it up again and again. In the past, if anyone passed a comment, I used to feel excited and angry, thinking 'I’ll do this or that to him' and it would go on and on. Now, I think 'let them talk as much as they want'.”

His irritability towards his daughter has lessened and he has more fun with her instead of becoming upset if she leaves things untidy. He has fewer doubts about whether or not he will be able to accomplish things, feeling that they are no longer out of his reach. “I used to feel tense about the future, how I would handle things, but now I feel much more confident.” His stutter has decreased and he has stopped paying so much attention to it when it occurs.

3/12/05: "I am feeling good, fresh, and enthusiastic. I have hardly any pains in my joints now and no more stomach acidity. I used to be occupied by worrying thoughts, so I couldn’t give my attention to my business and my family, but now I have come out of this and I feel as happy as if I had won a lottery! My confidence is so much better, I feel at peace. I know that if something happens, I can face it. I am care-free, I dance in the streets when there is music playing and I don’t care what others think; I just enjoy myself. I used to just live for my work and my home, and I never took part in religious or social work, but now I feel that I should do something for someone. If I only live for myself it’s of no use; I want to live for my family but also for others."

Evolution:

He continues to feel better. While he occasionally has pains in his finger joints, they are much less intense and stop in a day or two without requiring any medical intervention. His stammering is still present but reduced. The shift in his attitude has completely opened a new aspect of his personality, which he never realised he possessed, and this awareness has surged through his life with a feeling of true joy and satisfaction. He is still a very sensitive person but now his sensitivity does not curb his potential or colour his perception in negative ways, as it did in the past.

A recent encounter with the patient revealed that he has no more signs of the paralysing pain he used to have, and he is off all medications.

Photo from Wikimedia
Deichbruch an der Elbe 1825; Friedrich Thöming (1802-1873)
Papaver somniferum; Mohnblumenfeld in Frankreich Aufgenommen im Sommer 2003 von Wolfgang Horlacher