A secondary case of encopresis: Nautilus pompilius

Young Theo, 10 years old, comes to the consultation for secondary encopresis, with a background of respiratory allergies. His constipation is described as 'chronic' and has not been treated medically, except of course for the 'accidents' that lead to the consultation.
Theo is two years older than his brother, who is fine and who shines at conversations and games in comparison to him. Their mother has recently separated from their father (barely a year ago), and remodeled the new apartment with one bedroom for each boy.
Theo arrives with his mother, wondering what will happen during the interview. He talks about the fear of soiling himself at bedtime, which prevents him from accepting invitations to sleep at his buddies’ place. This is the classic situation, with shame being the major obstacle to realising social situations.

After listening to the present complaints, I oriented the interview towards the birth.

How was the birth?

"It lasted 5 hours; Theo did not come out and was stuck at the level of the rib cage. I was so scared of losing him,  afraid that he could not survive and breathe. Theo was finally born with mild cyanosis, but ultimately without major setbacks; however, I remember this episode of respiratory distress while transiting the cervix.”

Childhood diseases and mandatory vaccinations seem to have not played a major role in his problems.

Theo is attentive and very awake, with unconcealed curiosity about what is happening.

When did the first involuntary stools begin?

"Just after the departure of their father, and always in the same conditions. When Theo leaves his room to come into the living room, there is a certain eagerness. He is playing with his brother or alone; it's at this point that the disaster happens."

I speak directly to Theo, while asking him to clarify his feelings at that time, and especially to see if there are other times when this kind of ‘poo accident’ occurs.

Do you agree with what your mom described? Has that happened to you in other circumstances?

" Well, not at the beginning, but now when I have a bad grade at school or when I'm bothered by my friends, this happens more easily and more often, but I always feel it  when I go out of my room.”

Does it prevent you to sleep at your buddies’s place then? Has it ever happened on these occasions?

"Now, I'm afraid that it will happens at their home too, and I'd be too ashamed. I would not know how to wash and hide it all."

Has it already happened?

"No..."

This behavior seems to be confined to the small territory of his room, so I ask him to describe his room.

The description does not elicit any useful information for finding a remedy, nor do the gestures or words. I therefore propose Theo to draw me a map of his room.

The picture is a little small, since he is slightly myopic, like his mother. One detail nevertheless attracted my attention: the positioning of the door on the sketch.

I then create a little role play with Theo. I bring him to the door of my office and ask him to go in and out, crossing the threshold, either pushing the door or pulling it towards him. I asked him to select the version which is identical with his own bedroom door. When he identified the situation of the door that was like his bedroom, I asked him to make another drawing to represent the sensation he feels when crossing the threshold.

On the initial doodle, there are no arrows, however, the door is clearly positioned.

After asking him to place himself somewhere (the circle with the cross), he spontaneously describes ways to leave this space, using arrows.

Meanwhile, he accompanies his drawings with sighs, and the feeling of confinement and panic at seeking an exit are clear (as in respiratory allergies, allergy to dust or acari that occupy the space of security, making it "stifling").

My consultation then continues with a conversation with the mother and the child about the values that are usually brought by the father. After this explanation, which allows the mother and the child to be aware of the elements that could be missing in the lives of children between 0 and 7 years, I offer a synthetic summary schema, drawn from my Lego Anatomy courses.

This schema, which serves as visual prop, is an allegory that I created a few years ago. It probably stems from my past as a biologist.

I then asked Theo to make a list of the values listed in the diagram, and mention those he considers to have received from his father. Spontaneously, he produces the next drawing  (figure 3). He understands the concepts that have been given to him and now belong to him, but also those with which he has difficulty. The boxes with a tick, such as “name”, are ones that he feels are a valid part of his life, whereas the boxes with a cross represent ones he feels he is missing. One can analyze the strength of the line according to the checkboxes.

The right part of the drawing came spontaneously, a free interpretation of the image with the test tube (everybody has recognized a test tube!).

It is the latter, and especially his interpretation of it, that will make the link between the first doodles, and allow me to choose the remedy.

Can you talk to me a little bit about this little guy on the right side of your drawing?

“It is me, of course! I'm in your tube, I can't get out. Then I use a tool to drill glass and be able to get out in the open air, like burglars do.”

Analysis

After the first doodles, and in particular that of figure 1, I start searching in the mineral world (structured design, symmetry elements, precision in details). On reviewing figure 2, and especially the design of synthesis of figure 3, I'm leaning towards the mineral component of an animal, or an animal whose Anatomy is made of mineral features.

Figure 2 already makes me think of an ammonite, or a marine animal fossil, a shellfish for example.

In zoology, the ‘test’ is a covering made of mineral substance of limestone and silica, chitinous or composite, whose function is to serve as a protection for certain animals, such as diatoms, sea urchins and mollusks. In sea urchins, this envelop has the name 'test',  and is usually called "a sea urchin test". In diatoms, it has the name of frustule. In molluscs, it is called the shell.

The term ‘test’ comes from the Latin "testa" which means 'hard shell '. This term has also formed the word 'head' in the meaning of skull. Have you noticed the perfect correspondence between the head of the child and the opening?

In figure 3, the outdoor activities remind me that the door is a major element in the occurrence of the main symptom.

The opening to provide more space, more air, can immediately imply a relationship with allergies or breathing difficulties (sighs).

Rubrics:

- Closes the door to his friends, feeling of confinement, concern for his house (Nat-phos).

- Wants an open door towards the other, interpersonal communication that never fails, refuses the conventions of human language (Aeth.).

- Hits at the doors, wants access to something. Opens them up without knowing what he is seeking (Crot-ca.).

- Wants the doors closed, is sure that the known world is full, does not see what it lacks (Vip.).

Analysis (continued):

From the drawing of figure 4, things come alive a little more and after thinking about Silicea or Diamond (cut glass), I look for a gas (Oxygen), or an animal that expels gases through an opening, if possible of a rounded shape.

Repertorisation of the clinical signs of constipation:

Rectum / constipation (see inactivity) / mechanically, the stool should be expelled: Aloe, Bry, Calc, Con, Lyc, Med, Nat-m, Flat, Sanic, salt, Sep, Sil, Sulph.

It appears that Sepia and the idea of molluscs should be the lead to follow. The expulsion of liquid or gas to move (to cross a door), or go to an outdoor area, leads me to the cephalopods.

Nautilus pompilius

Without any materia medica available, I refer to the only study I know of this remedy by Rajan Sankaran in « Survival - the Molluscs ».

The characteristics of the animal kingdom are well confirmed:

The feeling of being dominated (here by the younger brother), fighting for territory,

The invasion of the disorder around him that prompted him to flee (DD Sepia with its impulse to put everything in order). Being attacked from behind, creating a headlong rush forward.

With regard to shellfish:

 - Isolation

 - Exist by itself (the stools are not the mark of our presence in a part of territory)

 - Stops talking abruptly, for fear of revealing a secret, or from shyness, holding on (constipation)

- Introversion (letting his younger brother shine)

 - Cut off, isolated, no longer having access to something, someone, somewhere (the gate)

- Keep, refrain 

More specifically in Nautilus:

- Collapse

- From the bottom of the abyss (at the bottom of the tube)

- Staying afloat, the keel of the ship (no escape from the top)

 - Bumping against (e.g. a wall) 

Prescription: Nautilus pompilius 1M 

After having made my decision, out of curiosity, I asked Theo what  his second drawing reminds him of. "A fossil, you know, with small boxes, this animal which enlarges his house when it gets bigger!"

Follow-up

Two months later: the constipation is resolved and there are no more accidents of soiling himself. Theo occasionally sleeps in his friend’s home. Relationship with his younger brother is more peaceful, and Theo expresses himself more easily, taking his place as the elder sibling. He asked to change his room planning and now feels safe with the position of the door. Allergic episodes appear to be much less frequent.

One year: he speaks more easily and feels much better away from home. The initial symptoms have completely disappeared. The relationship with his father has become easier, and the trust between father and son is restored. The mother then came for herself, telling of some episodes of confinement when she was a child. She had good results from a single dose of Sepia, including her situation with her children.

References

Diversité bactérienne associée aux organes excréteurs des Nautiloides :

caractérisation du système symbiotique, implications évolutives et physiologiques - Thèse de doctorat présentée par Mathieu PERNICE - Biologie Intégrée des Invertébrés - Université Paris 6

NOTES ON THE ANATOMY OF NAUTILUS POMPILIUS.

LAWRENCE E. GRIFFIN, B.A., B.Ph. DEPARTMENT OF ANIMAL BI0L0GY OF THE UNIVERSITY OF MINNESOTA.

Évolution des biominéralisations nacrées chez les mollusques Thèse de doctorat présentée par Benjamin MARIE - Biologie Évolutive - Université de Bourgogne