A case of heloderma suspectum

A case of heloderma suspectum (M.Mangialavori)
 Heloderma suspectum

 Heloderma suspectum

 Tommaso is a thirteen year old boy, brought in to see me by his parents because of "serious problems at school." Before the consultation, I had called his mother to ask if I could speak to her alone before I saw him. She gave me the impression of not being very pleased with my request, but on the day of his consultation Tommaso stays in the waiting room with his father while I first talk alone with his mother. She seems to be a very aggressive woman with an abrupt manner and a rather hostile attitude towards me. When I ask her who had recommended me, she tells me that it was her sister-in-law, a patient of mine. She adds that she had consulted various specialists, and that "now we want to try homeopathy." I am left feeling that she has little faith in me, and from her tone of voice when she was talking about her sister-in-law, it seems that there is no love lost between the two women.
 She begins:
 "We don't know what to do with Tommaso. We've tried the lot-everything from speech therapy to psychotherapy-both family and individual therapy. We even took him to see a priest. But nothing will make him talk properly."
 I ask her what she means by "talk properly."
 "He never talked well from the very beginning, and he only says words that he's interested in. He often misses out verbs, they're the hardest thing to get him to say. But at first he used to miss out whole chunks of sentences and expected us to understand him, or he'd get angry. It's odd, because his teachers have always said that he was bright and he has done well in all his tests so far, but he just doesn't want to know about talking properly."
 I ask her to give me an example.
 "It's hard but you'll hear him in a minute. I just wanted to tell you that we thought it was a psychological problem because it began when Tommaso was three years old and his little sister was born. At first he was terribly jealous. He'd only talk to his elder sister and he wouldn't say a word to us. The only one who has always understood him is his elder sister. She's two years older than him. She understands everything he says-and Tommaso never gets angry with her. Actually he was never keen on talking, and only his sister could understand him, but when the baby was born ..."
 I ask her to explain what she means when she says he gets "angry."
 "He insists on repeating what he was saying and he does it over and over again, thirty times even, in exactly the same way. He says it louder and louder till by the end he's shouting out loud-but the words are still the same as before."
 I ask about his behavior when his little sister was born.
 "I don't really know if I can tell you anything. He says that he only has one sister, and that the little one isn't his sister, that he never wanted her and that she's a nuisance. He also became very aggressive with us."
 I ask Tommaso's mother to tell me something about her and her husband's work.
 "We own a bar and we work together. I know it's not good but there's no other way. We get up early in the morning and when Tommaso wakes up his grandmother is there. He only sees us in the evening when we come home tired. But don't get me wrong, we are very much family people and that's why we had three children.
 "We've been told a thousand times that we ought to spend more time with Tommaso, but we have to be fair on the others too-he's not the only one, though he does everything he can to get our attention. All the doctors have said that he isn't ill and that things should sort themselves out as he grows up. But they also say that we should pay more attention to him." She trails off irritably and can no longer be bothered to hide her irritation.
 I ask how Tommaso gets on with his grandparents.
 "Huh, this came out too in the psychotherapy-his grandparents had only had boys and could hardly wait to have a little girl. Perhaps that's why Tommaso lost his role as the little one in the family after the birth of his sister. My in-laws rather prefer our eldest one. But that's just speculation, because the problem's still the same."
 I ask her how she thinks Tommaso reacts to his speech problem.
 "God only knows. Sometimes it's as though he's trying to wind us up. If he has to write something he can do it, but when he talks he can't say everything. I really don't understand it. We were told that he has a strange kind of speech disorder because children usually miss out nouns, not verbs. At first he used to miss out some of everything, but now he just gets stuck on the verbs."
 Then I ask her to bring Tommaso and his father into my office. Tommaso is a chubby little boy with a frown on his face, slow in his movements, and seemingly very suspicious. When he comes in, he peers round with lowered eyes, looking into every corner of the room. He keeps his head down while he looks at me.
 I ask him his date of birth and he replies correctly. I ask him what his favorite activities are, and he replies, "Paints, drawing, paper...white sheets of paper, not too big..."
 I ask Tommaso if he wants to draw something for me. "Paints, drawing...ok." He draws in a very concise way, with a few well-defined strokes, almost as if he were a cartoonist. He quickly draws some kind of animal in the middle of the sheet of paper.
 His mother interrupts: "It's a dragon. He's mad about them. Even when he was little he always wanted to look in a box we had with Chinese things in it-there was a procession with a dragon."
 Tommaso frowns at his mother and says, "Dragon hidden... big egg." After this he says no more and for a long time we remain in a silence that seems very embarrassing for his parents.
 I ask Tommaso what his favorite food is. His mother immediately intervenes, without letting him talk: "He's crazy about eggs-he'd eat several a day if we let him."
 I gesture to her to let the boy talk. "Good eggs...not too big...pasta too, rice, tagliatelle...eggs best of all."
 I notice that Tommaso is wearing a thick woolen sweater. I ask him if he likes being in the mountains. "Too cold. Sea better...not so cold. Hot better. Nice sweater, very warm and feel good."
 His mother interrupts again, saying this is typical of Tommaso. "He doesn't like the cold at all. Ever since he was little we've had to dress him up very warmly because he always felt cold. He's rather a lazy boy and he doesn't like to do sports or to move around. Perhaps that's why he doesn't like the cold. When I was a child we were always outside and we never felt cold."
 This time it is Tommaso who interrupts his mother very irritably: "Cold...cold. You don't know, I cold, and you don't know, you don't know, you don't know." Then he blushes red and looks very angry.
 I ask Tommaso what activities he likes most. "Computer, TV, draughts...Ken with his camper." (Thanks to my less-thanextensive knowledge of contemporary toys, I remember that Ken is Barbie's companion. Tommaso's sisters both have many of these dolls.)
 I ask what Ken does with his camper. "Lots of journeys together, by day..."
 I ask what Ken does at night. "Bed by himself, the girls sleep together."
 I ask Tommaso what his room looks like. "Big bed, not that big...Lots of big posters on the wall...TV, computer...bedside table with lamp."
 I ask him what the lamp is for. "Sleep in the dark, without light, I don't like...all dark scared."
 I ask him what he's scared of but he doesn't reply. He stops looking at me and turns his head away as if to avoid my eyes.
 Then I ask Tommaso if he wants to draw me a picture of being scared. He willingly draws for me, with an almost obsessive attention to detail, a vertical section of his house, taking a long time to finish drawing all the flowers on the settee in the living room and to add every last knick-knack in all the rooms. While waiting for Tommaso to finish his work I go out of my office for a few minutes. The parents seem very impatient.
 Tommaso finishes by drawing his parents going out of the house. His mother is clearly angry and interrupts again, trying to change the subject: "Tommaso always says that when he wakes up in the night his legs itch and he has to rub them to make it go away. He wants to get into bed with us."
 I ask her to explain. "It's been going on for months-he says there are little animals walking on his legs. Once he noticed a millipede on a wall and since then he's been saying that he can feel it walking on his legs."
 Tommaso interrupts his mother this time: "It's not true...it's not true...it's not true...Walks on the wall and comes into bed?...What comes into bed? You with Daddy...me on my own."
 I ask the mother to tell me something about his sleep.
 "He's very restless. He often rubs his legs with his hand, it's as though he's warming himself up-not that it itches-I've never seen him scratch himself."
 There is nothing of note in the child's health history, except for the fact that he has not had any of the typical childhood illnesses. Also, he has been vaccinated against everything it's possible to be vaccinated against, including several shots for colds and flu. These preventative treatments were evidently effective because Tommaso is in excellent health as far as I can see and from what his parents tell me. He has apparently not been vaccinated against Yellow Fever only because there have not yet been any outbreaks in that part of Italy.

Analysis
 The child's general symptoms make me think of a remedy close to what I call the "snakes family."
 I consider the head of this family of remedies to be the renowned Lachesis muta, that strange crotalid which entered the story of homeopathy thanks to Hering. The role of Lachesis in this group of remedies is, I believe, important only because of the number of symptoms it has in the repertory. There must surely be few homeopaths who would deny that the poison of this snake is over-prescribed as a remedy. I am convinced this is the main reason why it has a huge number of symptoms compared with other interesting and just as useful remedies derived from the poison of other reptiles.
 In fact, by studying the homeopathic literature and by observing clinical cases from my own practice and from those of my colleagues, I have found that many of the symptoms considered characteristic of Lachesis are actually shared by all the snakes in the materia medica. Moreover, other remedies like Zincum phosphoricum and Cimicifuga share many of the behavioral and clinical symptoms that are generally considered characteristic of the great rattlesnake without a rattle.
 In particular, there is the forsaken feeling, together with a distinct feeling of jealousy. They do their utmost to be the center of attention, often manifesting "special" symptoms outside the range of normal conditions for their group or their family, thereby highlighting their uniqueness. This pathology can be as difficult to cure as it is effective in its aims.
 On the clinical level, there is a feeling of great chilliness, often accompanied by throat problems, but without there being any corresponding complications of their lack of vital heat, even in very weak patients. Indeed it is usually striking that such glacially cold patients should otherwise feel quite well.
 Speech disorders have been noted in our literature only when they present themselves in an advanced stage of decompensation. They are often related to disturbances in function in the area of Broca (the part of the brain that deals with speech), and are in my experience very common in this group of remedies. A clinical audit will reveal that they are often present, in states of both hyperfunction and hypofunction, in children, who frequently make use of them to capture the attention of those around them.
 All these features recur in the remedies which I consider to belong to the "snakes family."
 What seems to be more specific to Heloderma suspectum, however, is the characteristic kind of stubbornness with which this remedy expresses itself. Those patients whom I have successfully treated with this remedy are often described by their family and friends as very obstinate people, especially when engaged in conflicts or in their most destructive strategies. They are described as apparently lazy people who even find it a chore even to talk. In actual fact I find them to be restrained and careful in their behavior, as well as verbally, giving the impression that the whole world should turn around them and adapt to their rhythms. They present themselves as being apparently passive, but stubbornly flaunt theirs as being the only possible way.
 This aspect does not seem to me to be so typical of the other remedies in this family. The other reptiles attain their objectives using a wide variety of strategies, first and foremost among which is their highly effective charm, easily able to penetrate their victims' defenses.
 On a different level, Heloderma's relationship with food is remarkable compared to the other remedies in this family. Using an obsolete homeopathic terminology, one could define Heloderma as carbonic, like the animal from which the remedy derives.
 In the case of Tommaso, it is interesting to note how many symptoms of such a little-known remedy as Heloderma are present. Also noteworthy is that various other symptoms, including for example "Indolence" and "Talk, slow learning to" are shared with Lachesis, whose venom has many physical similarities with that of Heloderma.
 My analysis of this case is based on a set of assumptions that are central to the way I study remedies, and therefore to the type of prescriptions I make.
 Firstly there is the supposition of the law of similars. While of course this is common to all homeopathic models, I consider that the concept is applicable at different levels of analogy. I don't believe there is only one possible simillimum, but that there is rather a group of remedies capable of stimulating optimum homeostasis in the patient. If the patient's reactive ability is not very compromised, a remedy that does not have a very deep analogy will still work. A typical example would be the action of a classic polychrest prescribed on general symptoms, like Belladonna in many cases of fever, or Arnica after any injury. But when the patient's adaptive mechanisms are fewer, or seriously compromised, it is not sufficient to use a remedy based on superficial similarities. In such cases there are various possible homeopathic approaches, each following different interpretative models belonging to different schools of thought.
 My own approach is based on a model which takes into account the following aspects of each substance:
 • the known homeopathic symptomatology, taken both from provings and from clinical experience;
 • toxicological symptoms and where possible, information obtained from the pharmacological study and medical use of the substance;
 • knowledge of the traditional uses of the substance;
 • the symbolic aspects and/or mythological qualities of the substance;
 • the peculiar characteristics of the substance in its natural state, which define its relationship to the environment in which it lives.
 Obviously it is not always possible to obtain all these different kinds of information about every substance we use in homeopathy, but they are nevertheless fundamental to my approach.
 Next, I consider it essential to study homeopathic symptoms by organizing them into concepts. These are the themes which describe a certain type of dynamic situation, and which have a significance above and beyond the literal descriptions furnished by lists of individual symptoms.
 Just as it is important to find a coherence between the different symptoms that belong to each substance, so it is necessary for there to be a coherence between all the different approaches which tell us about that substance. In other words, the relationship between the patient and the remedy in question is expressed in a wider context (what one might call a metagroup), without the presumption that any one approach is sufficient in itself. Neither scientific study nor the best homeopathic provings can claim to represent more than one possible point of view on the substance in question.
 In the case of Tommaso, we are dealing with a remedy which is little-known and little-used in homeopathy, but which is interesting in light of the model I have described above. In the repertory we find symptoms such as:
 Coldness: icy. {0> 6> 15} [PTK2]
 COLDNESS: OUTWARD, FROM WITHIN. {0> 1> 0} [C1]
 COLDNESS: RINGS AROUND BODY. {0> 1> 0} [mjs]
 Heat: vital, lack of. {0> 45> 178} [K1]
 Coldness in general. {2> 46> 192} [K1]
 Beginning: feet. {8> 20> 0} [CDA1]
 Chilliness. {39> 51> 104} [BG2]
 Icy coldness: body, of the. {6> 7> 19} [BG2]
 Forgetfulness: words, of, while speaking. {17> 55> 0} [schps]
 Idiocy. {11> 44> 0} [C1]
 Indifference. {74> 209> 0} [K1]
 Indolence, aversion to work: morning. {3> 50> 0} [murk]
 Indolence, aversion to work: work. {0> 2> 0} [C1]
 Memory: weakness of: words, for. {23> 41> 0} [C1]
 Mistakes, makes: spelling, in. {5> 26> 0} [K1]
 Mistakes, makes: speaking, talking, in. {17> 74> 0} [AH1]
 Mistakes, makes: speaking, talking, in: omitting words. {1> 10> 0} [schps]
 Mistakes, makes: writing, in. {16> 77> 0} [schps]
 Formication: lower limbs. {2> 5> 17} [K1]
 FORMICATION: LOWER LIMBS: NIGHT IN BED. {0> 1> 0} [K1]
 Coldness, sensation of: tongue. {2> 25> 0} [K1]
 Paralysis. {0> 41> 0} [mjs]
 Paralysis: tongue. {6> 25> 51} [mjs] (Complete Repertory)
 Heloderma, or Gila monster, is a strange animal. It stubbornly persists in living in its own way, a throwback to the Oligocene period.