A sense of fear waving over me: a case of Pearl

The patient is a woman aged 27. She has a new job to raise £1.5 million for a school building development. She previously taught drama.
Presenting complaint:
Emotional: Feeling very stressed and sleeping badly.
Physical: Back pain. Spinal scoliosis since childhood; has lived with back pain all her life.
Cystitis up to age 12; recurring since her early 20’s.
Family history of prostate and ovarian cancer on her mother’s side of the family.

She had cystitis on holiday in Barbados, six months ago. It was treated with antibiotics but the cystitis symptoms recurred several times, with blood in the urine and left-sided lower-back pain. An ultrasound scan revealed a 1.4cm kidney cyst (doctor said it was unlikely to cause the pain). She was referred back to the scoliosis clinic.
She appeared stressed, pressured, animated, and talked non-stop with little prompting about her situation and symptoms.
“Since summer I’ve felt very anxious about work, the house, everything. I’m prone to mild depression. My sleep has been fractured. I’m worried about another cystitis attack. I feel very lethargic, low and exhausted; it’s hard to feel motivated to walk or exercise. I’ve put on weight. I feel like I’m on a treadmill. I’m very tense all the time; I haven’t once felt relaxed. If I’m not doing something, I feel guilty. I feel a lot lower down the ladder than I should be. I pride myself in being a bubbly person – that’s the mask I put on.”

Work: “It’s a very stressful environment. Some days it’s so hard to get motivated – I can’t see beyond a bubble of things to do. The support (at work) is good – moral support, as opposed to professional or practical support. It feels like a lonely job. I feel like I’m muddling through everything – I’m so tired. Stress spirals in my head, I’m fumbling through panic. My partner is supportive but he runs his own business. If I’m really stressed, it’s hard to convey the panic and sheer terror of failing. I don’t feel I can talk to anyone about it. It’s such a huge challenge, it drains me. I get overwhelmed very easily; I have a sense of it being immense and overwhelming.
“I hold on to things emotionally; if someone’s annoyed me it’s hard to let go of it. It’s draining.
“I was a nervous child. I suffered from panic attacks and was very shy and had low self-esteem. My self-esteem has recently gone right down.
“I used to have a fear of not being good enough for anyone; now I’ve found someone who thinks I’m good enough; it was love at first sight. He’s wonderful. He reminds me of my father; he’s very gentle, caring; we just fit.”

Fears: “My parents dying. My mum lost her parents when she was young; she didn’t get over her mum’s death – she had ovarian cancer and died quite rapidly at 62. My mum is 60 this October – I find that scary.”

Panic attacks: “I got very anxious after my grandmother died (when she was 6). I got panic attacks. I was so worried about my mum; I knew everything had changed for her. I knew she was depressed. I missed my grandmother so much.
“The panic attacks got really bad when I was 9; little things drove me to tears, like going to school. I felt incapable of controlling it. I’d cry about random things. It was as if I was going to die, or I’d never see my parents again. I became very clingy towards my parents. I was painfully shy. Leaving home and going to university was like climbing Mount Everest for me.” After university, she taught English in a small town in Japan for 4 years. She lived alone. “It was so frightening. I just had to get through it.
“Now (since her 20’s), I’ve been getting panic attacks again. When I was watching a film on my own in Japan: I felt a sweeping sensation of fear that something would happen to me. It’s been worse in the last year – a sense of fear waving over me. I feel a wave in my stomach; like going over a bridge too fast.
“I’m the kind of person to shy away from challenge, but if I’m presented with a challenge, I’ve always done it. Inside I’m feeling “I can’t do it”, but on the outside I’m saying “I can do it!”  

What do you most enjoy?
“Chocolate and sweet things – it’s a comforter. I love being around friends I find genuine, that are genuinely happy for me and supportive; also my family.
The youth theatre; being around theatrical people (she runs a local youth theatre project). Going to the cinema; romantic comedy makes me feel happy.
Being in my house; alone time; my kitten; holding hands with my boyfriend. The prospect of getting married; the thought of having a family.”

Perfect holiday?
“I’d like to take my partner to Japan, and go to the Pacific Ocean and Australia. You couldn’t be distracted from anything there – life is so simple. I’d lie on a beach and do nothing, read, chill on the beach. I like being by the sea; it’s so relaxing. The sound; its infinity; it goes on forever. If you lived by the sea you’d have no choice but to have a carefree attitude, and walk along the beach.”

Physical symptoms?
“I had cystitis from as early as I can remember until I hit puberty; it’s debilitating; it takes a hit on all aspects of my life.”
Scoliosis was confirmed by her GP when she was 13, she was referred to the orthopaedic hospital; physiotherapy made no difference to the back pain.
Since her holiday in Barbados, she has been getting left-sided lumbar pain: a short, sharp pain; < certain movements, including lifting & bending; > resting left side on a chair; > painkillers (only uses occasionally). Some nights she is woken by a dull ache in the left lumbar area.
Frequent tension headaches from the shoulders and neck up. Her right shoulder feels “as if someone put an arrow in it”; the pain is > massage.
“I’m very uptight and tense – I’m rock solid half the time. I lie in bed and imagine myself falling into sand to try and relax. I feel like corrugated cardboard.”

What would you like from homeopathic treatment?
"I'd like to feel myself again; to be more lively and more bubbly vs. lethargic.
"I'd like to come back to me. If one thing goes with me it's my self-esteem - it crumbles.
"I need more focus; to be on a straighter path. I want to take control of me again."

ANALYSIS
Several themes emerge strongly:

1)  Cracking, Crumbling, Fractured, Parts, Hard, Solid, Stress, Pressure
She feels under pressure, like she might crack up. This language sounds like a mineral – something hard and solid, under a lot of stress and pressure, cracks, crumbles and fragments into parts. The word ‘stress’ is repeated.
“My sleep has been fractured”, “my self-esteem crumbles”; “parts of me were cracking under the pressure”; “I’m rock solid half the time.”

2) Attacked, Hit, Hitting
Some animal language: “attacked” and “hit”. Panic attacks. “The cystitis takes a hit on all aspects of my life”; “I’m very worried about another cystitis attack”; “as if someone put an arrow in it”; “I feel lower down the ladder than I should be.”

3)  In Control vs. Overwhelmed by something Huge & Immense & Very Frightening
I had the sense of her being small and vulnerable and being overwhelmed by something much bigger than her coming down on her from above:
“It’s a HUGE challenge – I get overwhelmed very easily; I have the sense of it being immense and overwhelming”; “I feel I’m muddling through everything ... I’m fumbling through panic”; “stress spirals in my head ... panic and sheer terror of failing”; “I feel out of control” “a sweeping sensation of fear”; “a sense of fear waving over me.”

4)  Support  & Isolation
She feels on her own and unsupported: “It feels like a lonely job”; she lived alone in Japan, isolated; “my partner is very supportive but he runs his own business”; “I love being around friends that I find genuine, and that are genuinely happy for me and supportive.”

5) The Sea
Water and the sea come through strongly: “I like being by the sea." “bubble, bubbly” “fear waving over me”, “a wave in my stomach.” She feels carefree by the sea – the opposite of the stressed state she is in at the moment!
Physically she has a problem with recurrent cystitis – a water problem.

6)  Problems at times of transition  
Change and transition are difficult times for her: her grandmother’s death; leaving university; living in a different country/culture; holiday; new job.

7)  Corrugated Cardboard
“I feel like corrugated cardboard.” I’d never heard anyone describe themselves this way before. The significance is its connection with ‘doctrine of signatures’.
These themes suggested to me that the remedy should come from a sea animal that has a hard mineral part that crumbles under pressure and that perhaps resembles corrugated cardboard.

Prescription: Pearl immersion 1M

I first encountered Pearl at a seminar by Peter Tumminello in the UK in 2005. He was launching his book ‘Twelve Jewels’. I was geared up for a day of gem remedies. I was surprised that a case he presented felt distinctly like a sea remedy. The remedy was Pearl; this was my first lesson in the multifaceted sea/animal/mineral/gem nature of Pearl.
I have since prescribed Pearl many times. Successful cases have mainly been of sensitive young women (20-40 yrs old) working in a solitary situation (vs. part of a team) and struggling with issues of anxiety, self-worth, and identity.

Materia Medica
‘Negative’ keywords for Pearl include[1]: Boundaries, lack of; Centre, loss of; Confusion; Crumbling; Crushed; Darkness; Blackness; Desolate; Drowning; Erratic; Extremes of emotional reaction; Fear – overwhelming, panic, terror; Fragmented and disintegrated; Insanity; Insecurity, deep sense of; Irritation; Isolated and alone; Closed / vs Open, too open; Sense of self, loss of; Suffocated, closed in, pressed down, trapped; Shut down, killed and ended.
From the proving of Pearl[2]:
“From above me came a dark, black, crushing sensation. I could feel the black, black, black force moving down onto my head. Its power was overwhelming and I was overwhelmed by fear. I was being crushed, killed, suffocated, closed in, trapped, squashed down by a force I could not see or identify.” [2]

Look at a photograph of the oyster shell to see some resemblance to ‘corrugated cardboard’

Follow-ups
After 1 month: “I feel a lot lighter, brighter and perkier in myself. The moroseness and depression has been knocked on the head.”
“As busy and stressful as my job is, I’m getting on with it, vs. things getting on top of me. I seem to be getting on top of things more. I feel more focused.”
“I used to take my partner’s stress on – now I’m not putting up with it.”
“My sleep is a lot more solid” (cf. “fractured”)
“I feel confident and focused within my role. My self-esteem is better.”
“I can articulate things better vs. rambling and babbling.”
“My back is ok. There’s still slight pain, but it doesn’t get me down so much, everything is so much more positive in my life.”
“I’ve had no more headaches; they were nearly every day before.”
“I’m not as tense; I try and relax. We’ve had a lot more laughs. I feel more rested.”
“I’m doing a lot more things that I want to do. I feel more myself again – I feel a lot, lot better.”
After 4 months: “I’ve had a couple of work panics but they haven’t completely crippled me. I feel I have a more solid base at work. My successes have solidified my status. I feel more integrated at work – before I felt very fragmented and that I was ‘standing alone’.”
“I’ve been more assertive so that I don’t get overloaded.”
She still has back pain. An X-ray showed that her scoliosis has got worse over the last 10 years. She is due to have an MRI scan. She’s concerned the doctors may want to do a spinal fusion to straighten her spine.
“I’ve been very perky and positive, (since the remedy) everything takes on a different meaning. I’ve been fine in myself, happy and content.”
We talked about yoga and Alexander Technique and osteopathy to help with her scoliosis and back pain.
After 5 months: she was feeling apprehensive about the MRI scan results:
“I’m in pain; I think “will this pain be forever?” I feel worried and confused; there’s a possibility of having a spinal fusion – I need to think about the impact that would have. I don’t know what’s going to happen, I feel like I’m in limbo.”

Prescription: Pearl immersion 1M

After 7 months: she says her confidence has been good. She seems light, bubbly, animated.
“I feel a lot more chilled out about my back situation – what will happen will happen. I’m looking forward to (seeing the orthopaedic consultant) to see what he has to say. I can look at alternatives; I’ve booked to see an osteopath; there are ways to cope with it. I’m not too concerned.”
Her back pain has been bad: “The worst it’s ever been – but I’m not worried and confused – you can’t control what you don’t know.”
The pain is in the lower left-hand lumbar area, a dull continual ache: the muscles feel very tight; it feels very hard and tender. The pain is < a lot of walking, < sitting, and > lying. TMJ (jaw pain): “I have a clicky jaw and grind my teeth at night; I wake with my teeth clenched. It feels very tense at night.”  

Prescription: Berberis vulgaris 30C

After 9 months: she has been feeling “positive, in-control, at peace, confident”. “Investigating it vs. ‘not wanting to know about it’ has been more worthwhile than I imagined. It’s answered a lot of questions; it’s given me a peace; it gives a bit of closure.”
She was told she did not need surgery, which “took a weight off my shoulders.”
She’s got engaged to her partner.
After 12 months (by email): “I feel well and seem to be coping. I’m keeping on top of things and doing lots more activity outside of work and that makes me feel great. I’ve taken up running and enrolled on a part-time postgraduate course at university.”

References:
1) ‘Twelve Jewels’ by Peter Tuminello. [P.296] 
2) ‘Twelve Jewels’ [P.294]

Photos:
Oyster shell; cepolina.com
Wikimedia Commons; Oyster pearl; Manfred Heyde