I'm on the ferry with lots of my family, we lose each other: a case of Physalia physalis

The patient is a woman of 27 who came to see me with conjunctivitis of the left eye since a holiday in Greece 3 weeks ago. It started the same day as she got sunburned and a cold sore on her lip. The cold sores have been “quite vicious” appearing on the right corner of her lip for the last 6 months. Her eyeball is red and itching – “like ants crawling behind my eyes.” She is woken at night by heat, dryness and itching in her eye. Her eyes feel swollen. She feels better being outside, in cool, breezy weather. She has had antibiotics, antihistamine and ‘antiviral’ drops from her doctor, but the problem is getting worse. In the last few weeks, her sleep has been light and sporadic, her energy is low and she has lost her enjoyment of food.

She is a singer and singing teacher and started a new teaching job 6 months ago. She has been feeling low and tired and stressed by a difficult pupil and by money. She is finding it difficult to relax and switch off. She is quite active and likes to be productive. She is sociable, happy and excited easily by small things, but her mood drops off every 6 weeks or so, when she can feel quite negative about herself. She is sensitive to rudeness, unfairness and injustice – this makes her feel “angry and powerless.”  She gets “frustrated by things happening beyond my control.” She says she is “very tidy – too tidy. I’m always worried I’ll forget something – I never let myself off the leash.” “I try and plan my time and work so I do everything in a considered way so that everything is done properly.”

She likes being outdoors and walking by the sea. “I love water.” One of her hobbies is sail-making. She likes windy weather: “I’ve got something to lean against if it’s windy.” She enjoys travelling and travels a lot for work. “I’ve travelled too much this year and feel world weary.”  She likes eating shellfish, sushi and fish. She feels nauseous if she eats rice. She drinks a lot of water, 4 litres a day.

She is < before menses: her premenstrual symptoms include irritability. Her mother says she is “nasty and hurtful” before her period], skin eruptions (spots), nausea, aching knees and elbows. She craves prawns before her period but these make her vomit. Her periods are variable, better since taking the contraceptive pill for the last 3 years.

Her mother (who is also my patient) describes her as very considerate, conscientious, generous and selfless, but also as overanxious, very self-critical; she pushes herself a lot and expects too much of herself. She is dyslexic and has a very high IQ.

Prescription: Sepia 200 (x2)

Follow-up 1 month: she generally feels better. Her energy has improved and her sleep is more restful. Her eyes have stopped itching at night, but they still feel swollen and aching. Her left eye feels “too big for the socket”. Itching < daytime, smoke, air conditioning in car. Eyes ache < continued use of eyes, > cold water. Itching and achiness comes and goes in phases of a few days at a time. Her premenstrual symptoms are not better.

For the last 2 weeks, she has been having dreams about car ferries (she has had these dreams in the past) : “The sea starts calm and gets stormy, or starts stormy and then becomes calm. I’m on the ferry with lots of my family – we lose each other and are searching for each other. The ferry is at an angle (almost 90 degrees) and people are walking on the sides. We need to get off the boat because it’s stormy and the boat is sinking or we’re in peril.”

Overall she is feeling about 50% better. “I feel much more normal – I feel I’m getting back on track.”

Prescription: Pulsatilla 30 (bd x3)

Follow-up 6 months: her eyes got a bit better after the Pulsatilla but did not clear up. She has been using saline drops for her eyes; the doctor thinks she has ‘dry eye syndrome’. She is "on the go all the time".

Follow-up 8 months: she is still having trouble with her eyes: both eyes get red, bloodshot; < left; with intermittent itching on edges of eyelids. “I get a cramp at the back of my eye – something twists and tightens (HG – she twists and contracts hands) – then my eyes suddenly go red and achy.” Her eyes have become sensitive and reactive.

Tell me more about that hand movement?
“It’s like there are little tentacles on the back of my eyes – it’s like they cramp up and retract and stiffen.”

Her mother had reminded her to tell me about something that happened when she was 12 on holiday in Italy: “I was swimming with my dad and there had been an influx of jellyfish –Portuguese Man-of-War. I saw something that I thought was a plastic bag floating in the water and I swam towards it. I got stung all over my body; on my feet, legs, abdomen; it left ‘tyre-marks’ on my belly. I started to go into shock. I was taken to First Aid; I had lots of injections (antihistamine?). It was an emergency; I nearly died. I had to take antihistamines and steroids for 6 months afterwards.”

Her mother said she “wasn’t herself” for a long time after being stung. Since that time, she has reacted strongly to bites and stings, with blistering and swelling of the affected part.

Tell me about your relationship with the sea?
“I like the sea; I get very scared of its strength. When I was a toddler, I was very scared of the sea. I adore it if it’s calm and clear – I stay in the water for hours. I like snorkeling. I like being by the seaside; I like heat and sunbathing. As a child, I wanted to be a marine biologist and I was a member of dolphin and marine clubs. I’ve always had blue bedrooms and dolphin mobiles on my ceiling. I love (to eat) raw fish, smoked fish, oysters, shellfish. I love all crustaceans apart from mussels.”

Prescription: Physalia physalis 30 (x2) (Portuguese Man-of-War)

Follow-up 10 months:
A week after taking the remedy, she was itching in the places she was stung by the jellyfish. She had headaches above her right eye; “like a dull, sharp, deep pain – as if I wanted to grab it.”  Her eyes cleared up a lot: “They seemed to clear for several weeks, better than they’ve been for ages; they looked bright again, but have been worse again in the last 2 weeks."

She has been very busy, work has been “all consuming”; “It’s been a bit of a yo-yo, trying to be all things for all people.”

Have you noticed any other changes since you had the remedy?
“I have felt a bit more fluid. I feel a bit less in control – I’m flowing from one thing to another. I’m used to being the director or orchestrator of what I do. I have a tendency to hold on to things, to make things happen, to be responsible, vs. allowing someone else to be responsible.
”I’ve been thinking a lot about my connection with the sea. I’ve been consumed with that time in my life – from 10-14 years old. I remember jumping off a cliff into a deep sea – I keep thinking ‘How did I do that?’ – that feels like a distant person.”

Her fiancé has been away a lot with work – “He’s been really distant – physically and emotionally.” She suspects he is having an affair. “I feel vulnerable, abandoned and angry. I’m the one at home dealing with everything, it’s a bit unfair. I’m realising I can’t fix everything. I’ve been crying a lot – something’s releasing."

"I liked the remedy: when I took it, when it was in my mouth, in my blood – I liked it.”

Prescription: Physalia physalis 200 (x2)

Follow-up 12 months: (4 months since first prescription of Physalia)
The remedy worked really well and her eyes have been sparkling clear ever since. Her mother says: “It’s as if the remedy has taken the scales from her eyes and she’s beginning to see the real source of her problems. She is becoming a lot stronger, mentally as well as physically. A lot of other issues have risen to the surface, including the troubles with her partner, who’s been having an affair.”

Follow-up 16 months: (8 months since first prescription of Physalia)
“I have grown a bit in some ways; my spine feels longer. A number of people have said I look taller, as if I’d been carrying a weight on top of my back before.
“My eyes have cleared up and they’ve been fine. They’re getting bluer – my eyes are back to how they used to be. I was crying a lot for 2 months after taking the remedy, and I found it difficult to speak or sing; it was the most silent I’ve ever been in my life.
“We were engaged but my fears that he was having an affair proved to be right. We were together for 5 years.
 “I moved him out 3 months ago and put all his stuff and boxes in a van; at the time I was scared – I didn’t know what I was doing.”

How do you feel now?
“Amazing – everything’s amazing now! Everything feels lighter, younger and sillier.
“My work is really easy but fulfilling; for the first time I can say I’m finding work easy. It’s fun work and I don’t have to prove anything to anyone.”

Do you feel your relationship with work has changed?
“Yes, before I felt I had to prove a lot, either to myself or to my ex-partner. I was trying to make myself more mature, more valid. Also, I was tired, like a ‘tired turtle’ – as if I had a shell on my back, and my posture was rounded.
“I’m relying less on my brain and trusting my instincts more; I don’t feel I need books and papers around me now. I feel I’m carrying less mentally as well as physically.
“For the last few months, I’ve been talking to myself in silly voices and making myself laugh. I used to do that before, but not for the last 5 years.
“My voice has been dropping – it’s deeper – it feels different.”

What do you feel the role of the remedy has been in all of this?
“Even before I put it in my mouth, it felt like a strong remedy – as if it was trying to jump out of the packet. It is strengthening – bringing strands together.
“A Portuguese Man-of-War will only sting something with tendrils – as if your energy is fractious; if you’re more contained, whole, then they won’t.”

She had earlier described how she hadn’t been getting on with her parents very well around the time she got stung, and she felt people weren’t understanding her.

“When my eyes were bad, it was like fraction, things being split, like a cracked window. After the remedy, it looked like my eyes had come together again vs. being fractured.
“There’s something less tumultuous. I don’t feel like I’m in the sea anymore – I feel I’m standing on the ground. I’m no longer scared of the sea. After I took the remedy, I went swimming a lot in the sea – I’ve remembered my love of the sea – the fear came after being stung.”

What was your experience of swimming in the sea?
“I felt it was something I was doing for me and not for anyone else – it was something I needed to do. Even when I was upset and grieving, the one thing I would do is sit, or walk by, or go swimming in the sea – it’s been like coming back to myself.
“I used to have lots of dreams of ferries, tumultuous seas, seas of mud, red seas – I haven’t had any dreams like that for the last few months.”

She had actually been having these dreams for several years – since she’d been together with her ex-partner.

“I hear lots of different rhythms; I realise my feet are tapping, or my hands are tapping; as if I’ve got music in my head.
 “I’ve been writing lots of songs and been enjoying singing. I’ve been listening to a lot of music – more than for years. I’ve been dancing around the room whenever there’s music on.”

What about being fluid?
“I’m more allowing people to have responsibility for themselves vs. overly planning; I’m letting the day flow for itself. Before, I was determined to control things vs. let things flow.
“I’ve started running by the seaside.”

Follow-up 1 year after the last appointment: “A lot has happened. I’ve moved, got some great new work, and have lots of friends around me. The old house was sold which was a great relief. My health and energy have been great ... I can only thank you for your all your help over a very tricky time.”

Analysis
I think the choice of Physalia physalis as a remedy is fairly self-explanatory, given the richness in sea imagery and the dramatic and vivid aetiology of the case. However I would like to highlight some ‘doctrine of signatures’ and materia medica connections that may be less obvious:

The Sea
So much mention is made of the sea that it would be hard not to think of a sea remedy for this patient! Also, the “never been well since” incident was in the sea. So, the sea inflicted the wound, and after the remedy, the sea assumes a very healing role – so the circle is complete.

Animal language
There is plenty of animal language in the case, suggesting the patient needs an animal remedy: Vicious; nasty and hurtful; all consuming; I never let myself off the leash; like ants crawling; there are little tentacles on the back of my eyes”. Various marine animals are mentioned – “like a tired turtle”, dolphins, oysters, prawns, shellfish, mussels, crustaceans.

Dreams of ferries
“I’m on the ferry with lots of my family – we lose each other and are searching for each other. The ferry is at an angle (almost 90 degrees) and people are walking on the sides.”

Despite its appearance, the Man-of-War is not a true jellyfish but a siphonophore, which is not actually a single creature, but a colony made up of many minute individual organisms called zooids. Each of these zooids is highly specialised, and they are attached to each other and physiologically integrated to the extent that they are incapable of independent survival. So, Physalia is actually a floating family of individual but co-dependent organisms.

The ferry being at an angle is also interesting: The Man-of-War is found in warm water seas floating on the surface of the open ocean, its air bladder keeping it afloat and acting as a sail while the rest of the organism hangs below the surface. It has no means of self-propulsion and is dependent on winds, currents, and tides (unlike Medusa, Aurelia aurita, which can swim gracefully). Man-of-War have different ‘angles of sail’ to ensure widespread propagation. The patient mentions sail-making as a hobby and likes the wind as it gives her “something to lean against.” She travels a lot, globally (like Physalia), and feels “world weary”. Her mother says: “She’s on the go all the time.”

The separation from her family in the dream reflects a separation in real life: “As an early teenager, I didn’t get on with my mum well; I didn’t get on with my parents; I felt people didn’t understand me.” There is a general curative move in the case from split, separation, disconnection, fraction; to “bringing strands together” on different levels.

Correspondences with the proving 

Physalia physalis (a.k.a. Physalia pelagica) has been proved by Alastair Gray, and details of the proving appear in Jo Evan’s book ‘Sea Remedies: Evolution of the Senses’. Correspondences with the case from the proving are as follows:
Anger, rage, abusive, insulting, cursing & swearing. Anger before menses. Irritability, impatience; with his family; when questioned.
”Great effort is required to maintain a sense of self.” Delusion her body is elongated; her eyes are red.
Overwhelmed by stress; forgetful. Mind feels heavy. Thoughts disconnected. Feels alienated, disconnected, detached, separated from the world.
Aversion to speaking, or being spoken to, answering, being looked at, to family, mother, and all company.
Restlessness; pacing back and forth. Busy mind; worried. Hurried.
Reproaches himself; ailments from remorse. Feels he has done wrong; everything goes wrong; something is wrong.
Dreams: escaping from danger; fleeing; water; sea; swimming; people bathing; pools of water; flood; waves; family; turtles; glass; broken glass; cannot talk because of glass in mouth. The dreams of broken glass are especially interesting – cf. “When my eyes were bad, it was like fraction, things being split, like a cracked window. After the remedy it looked like my eyes had come together again vs. being fractured.”
Heaviness; tiredness; weariness; weakness. Vibration; trembling; pulsation; buzzing; twitching. Constriction; pressing (outward); stiffness; tension.
Sleeplessness; despite weariness. Restlessness; tossing and turning. Light, unrefreshing sleep. Hungry with aversion to food and drink.
> Cold Water, Cold air, Open air, Music, Occupation, Cursing
Burning; stinging; itching of skin.
Head pains dull, cutting, aching, pulsating, shooting, stitching; pains appear and disappear suddenly.
Eyes burning & stinging. Ecchymosis. Dry eyes.

Photos: Wikimedia Commons
Physalia physalis; Rhalah
Close-up siphonosome of Portuguese Man o' War (Physalia physalis); Taro Taylor