Fastidiousness and the Need for Control

A third fundamental aspect of the Carcinosin picture is the fastidiousness. The Synthetic Repertory gives Carcinosin as a black type remedy, and this is my experience. It is much more basic to the being than, for example, the fastidiousness of the Natrum-muriaticum patient, which it resembles; it is usually for order, rather than for dirt. Though the latter is seen, the Natrum-muriaticum relationship to punctuality is only rarely present. Even though outwardly the Carcinosin patient is not necessarily more persnickety than the Natrum-muriaticum, it is the part in his life that this tendency plays that we must examine. It seems to me that it is the result of a rigidity, a need to control that stems from the patient's knowledge that he or she is sitting upon a wildfire which is potentially all-consuming if not strictly contained. It is the same sensation that generates a fearful reaction when sickness arises, or that is the root of the fear of cancer. Patient K.A., whose case is quoted here, always felt that she would die young. Deep down, the patient knows that there is a pathological time-bomb ticking inside. The fastidiousness is an attempt to control it. Put another way, the fastidiousness is a valiant effort to keep mortality at bay. Somehow the Carcinosin subject feels that if she can keep her environment perfect, or her figure perfect, then she just might live forever.

Case K.A. illustrates something fundamental about the remedy in this regard. She always has exercised religiously, owns a health food store, and has been addicted to all the products that she sold. She looks several years younger than her age, but has always planned to have a face lift at age forty-five. She is terrified of aging. She takes meticulous care of her body, at least its appearance, and her environment. When she was raped a couple of years ago, she did not tell her son (she is a single mother) because she did not want him to be concerned. Another patient presented with herpes as her chief complaint. She had other symptoms, like constipation and sleeplessness, but the herpes, which in her case appeared in rather mild form, threw her for a loop. "I feel diseased. Why is this happening to me. I wasn't born to do a trip like this." She felt unclean, and became extremely agitated when even the tiniest lesion would appear. She was the kind of person who "loves things to be nailed down."

Mortality is the real issue here, and the anxiety upon the appearance of the herpetic lesions is just a proxy for the dread upon the appearance of the specter of death. It is fundamentally true that all fear is, when fully inspected, only fear of death. Yet all remedies do not have fear of death, and some remedies fear certain things while others have other terrors. Arsenicum is one of the remedies whose very fabric is woven upon a fear of death. Carcinosin is likewise. I would not add it to the repertory for this symptom, and indeed, I have never seen it frankly manifested in a Carcinosin patient. Yet the same mortal news that, in an Arsenicum patient leads to stark fear and insecurity, is manifested in Carcinosin as WORRY and ANTICIPATION. Essentially, the Carcinosin patient fervently hopes that, with planning, and organization, and by staying on top of things that, just maybe, she will not die.

The difference between Arsenicum's fastidiousness and Carcinosin's neurosis is best illustrated as follows: Two girls are leaving on a cross-country trip; anxious mothers stand on either side of the car, bidding tearful farewells to their "little girls." The Arsenicum is the one saying, "Honey, drive carefully! I've heard awful things about how they drive in Ohio. Make sure you fasten your seatbelt, and don't sit on any toilet seats, and make sure you don't talk to strangers. Oh! your hair needs some work, the part is crooked. Make sure to call me every night. Yes, it's fine to call at 1:00 a.m., I can never sleep then anyway." The Carcinosin mother whispers softy to her daughter, "Sweetie, take care of yourself, and make sure you always wear clean underpants. What if you had an accident, and they brought you to the hospital with dirty underwear on?"

A little bit of a caricature, but not much! I have seen it suggested in print that perhaps the Carcinosin fastidiousness is not primary, that it stems from a desire to please. This is most definitely not so in my experience, and this point would distinguish Carcinosin from Staphisagria, which is not fastidious. Nevertheless, the desire to please is there, and because this remedy is so sensitive to reprimand and sympathetic, the Carcinosin patient is often quite adept at conforming his or her life to the expectations of those around. Case K.A. expresses this perfectly. In the second follow-up, quoted below, she says, "My masks are gone, I don't have to perform any more. I always figured things out and performed, so that I would not have to deal with the fear."

This issue of fastidiousness leads into the matter of control, a core issue in the pathogenesis of Carcinosin. Foubister gives a history of fright and prolonged unhappiness as features in the history that suggest Carcinosin. These are in fact often present: the Carcinosin pathology arises when the boundless centripetal life energy and great sensitivity to and concern for others are constricted, confined, and traumatized by the cold and brutal facts of life. Thus one often hears a life story of extensive sexual abuse and horrors that tests one's credulity. This is the essential process occurring in the pathogenesis of Carcinosin, and if one grasps it, one will find the remedy where it is hidden to others. Yet it is true that Carcinosin is as hard to pin down as the color of a chameleon. This is because, depending on which of its component characteristics is present to the greatest degree, the remedy may mimic Natrum-muriaticum, or Medorrhinum, or Staphisagria, or Phosphorus, or Sepia, or Tuberculinum, or Calcarea-carbonica, or yet some other (Pulsatilla too). Thus a woman with high sexual energy, very social, sympathetic, and clairvoyant may resemble a Phosphorus and share its food desires. One may be at the point of giving it until she mentions how much she likes to drink tea, and no, she never drinks cold water. Or a fastidious, pathologically responsible woman who loves chocolate and salt, but does not care for sex, and is not very receptive to consolation, may be about to receive Natrum-muriaticum until it is realized that she loves to sit in her car in the sun with the window rolled up, and likes soft, gooey fat on meat.