Aspects of The Homeopathic Encounter
by Peter Morrell
Crete, 26-4-2000
Whether a doctor or lay healer will succeed in curing his patients,
or whether he will fail lamentably, depends very largely upon the first interview. [1]…what is applicable for each individual case, demands of the
physician nothing but freedom from prejudice and sound senses, attention in observing and
fidelity in tracing the picture of the disease. [2]————–oOo————-
In the contact between patient and homeopath, there are many complex
dynamics and so many important elements to the event, that need to be acknowledged and
brought out, that this is always a complex topic. Yet, it is highly instructive to try to
disentangle and lay bare what is the sole basis for the progress of every case we see.The scientific doctor looks impersonally at the patient, and
scarcely listens to his complaints, because they may be imaginary or largely imaginary.
[3]I wish to describe the essentially two phases that comprise this process.
The first is a quiet and predominantly listening, more passive phase of information
gathering, where direct and sustained contact between patient and homeopath occurs, and in
which the homeopath endeavours to be a patient listener and neutral observer. There has to
be an intimate meeting of minds in this phase.The homeopath must be sympathetic, calm, and receptive…
without…preconceptions or prejudice. Silence is golden, especially in the beginning of the
inquiry…every homeopath can listen empathetically and establish a good rapport with the
patient. [4]
But it must be emphasised that the homeopath holds back, reigns in his
analytical or judgmental skills in this early phase, where they do not contribute to
listening to the patient and encouraging the patient to tell their story, and in delivering
their narrative.
We should not hurry the patient in his narrative. [5]
Such judgmental or discerning skills may act as a definite obstacle in
this first phase and must not be indulged, as they prevent the patient telling their story.
They must be held back until the second phase, where they can be exercised more freely.
One of the most important things in securing the image of a sickness
is to preserve in simplicity what the patient tells us in his own way…in his own way
without interruption and in the record use of his own language… [6]
Leave the patient in freedom always. Do not put any words into his
mouth. Never allow yourself to hurry a patient…say as little as you can, but keep the
patient talking and keep him talking close to the line. [7]
The homeopath must hold back, watches the patient neutrally, says very
little, takes notes, makes the patient feel comfortable and at ease, and creates a god
ambience conducive to many things being brought to the surface. The patient must feel that
they can say anything at all. Any minute detail or troubling intimate facet of their life
can be safely brought to the attention of the homeopath. Thus, it is vitally important that
the patient be placed at ease and allowed to tell their story in an easy, flowing, natural
and as-is fashion. It is for these reasons that the good homeopath is often female. She
often has superior empathic and emotional skills, compared with males, to put the patient at
their ease and to give an impression that she is listening respectfully all the time. Nor
giving any type of judgmental air to what is being said.
I encourage my patients to talk about extraneous matters which worry
them, and after a very little while there is a pleasant relationship established between
patient and prescriber…even the dullest individual feels instinctively whether the
prescriber takes a personal interest in him or not. [8]
During the first phase, the homeopath may take copious notes of every
detail, or they may just sketch out in note form the main points, with any unusual symptoms
that are stated or unusual aspects of the pathology as it has been unfolded before them. We
might agree with Margaret Tyler that your notes become briefer with experience [9].
Essentially, the patient is assisted to unfold their pathology at their own ease, under
their own steam, at an easy pace, which is then inspected more carefully and gone over in
finer detail through questioning in the second phase.
The selection of the homeopathic remedy…is based very largely and
sometimes almost entirely upon the phenomena…of subjective, conscious experience,
perceived only by the patient and stated by him to the examiner. [10]
Homeopathic medicine aims to treat the patient as an individual and as
a whole. [11]
First off, we can say – and emphasise – that the homeopath is an
assistant, a servant, a non-assertive person who helps the patient, who never pushes the
patient around and always sits below the patient, like the wise old owl might politely
and patiently listen to the brayings of the donkey – a surreal but very helpful image.
The spirit of the clinical symptom picture is best obtained by
asking the patient to tell his own story…this account is then amplified and more
accurately defined by the questioner. [12]…record the patients complaints in their own words…an
accurate written record of all the patients symptoms, using the patients own words.
[13]
The homeopath is a facilitator, a catalyst, but should never assume the
role of director or controller of the encounter. It is so important to recognise the
essentially passive and listening role of the homeopath. It is a role that sets it apart
from that of the ordinary clinician, as someone who is by comparison much more assertive and
dictatorial.
I always try to be humble to encourage the patient to speak more
freely. [14]
It sets homeopathy apart from conventional medical practice right from
the first encounter, placing it much closer to psychotherapy, in which the story of the
patient is the central activity and which is respected and celebrated as the main medical
event.
It follows, therefore…that we should at once endeavour to put
ourselves upon such a footing and in such personal relation to the patient as will best
favour a full, frank revelation…of all the circumstances and conditions that have led up
to his illness; and an equally full, simple and frank statement of his sufferings as they
are seen by him. [15]
The obvious benefit to the patient unburdening themselves of their story,
is that this has a healing effect in its own right, and it also enables the patient to get a
clearer perspective on their innate pathology. It relieves them of a burden they may well
have carried for years. They become more at ease with and less uptight about themselves.
There is a certain cathartic release of tension from telling their story. This can be
noticed, for example, by the patients face becoming hot and red with the release of
emotional tension, associated with talking about personal or sensitive matters that may have
remained buried and undiscussed for many years. This often occurs during a consultation.
A well-taken case is a valuable experience for the patient as well,
because it becomes an opportunity to consciously examine the most crucial and intimate
regions of his or her life. [16]
There is no doubt that the well-taken case gives the patient much inner
food for thought, which they can then reflect on and digest over the coming weeks.
Pierre Schmidt used to say, try to make your patient laugh once and
cry once during the initial consultation… [17]
Consultation clearly brings to the surface many topics that a person has
often not considered for many years. The deeper therapeutic impact of this material
trickling to the surface, must be incalculable and in some cases is probably at least as
important as the action of the potentised drug.
The physician must be possessed of an uncommon share of circumspection
and tact, a knowledge of the human heart, prudence and patience…to form to himself a true
and complete image of the disease in all its details. He must live the life of the neighbor,
and be known as a man of honor…to know the human heart well is largely to examine into
oneself and ascertain what ones own impulses are… [18]
Above all else, the good homeopath must be a good listener and a patient
observer of the flow of narrative coming from the patient. Indeed, the first function of the
homeopath is to facilitate this flow of narrative of the patient and to keep it flowing at
all costs. It is the major source of clinical information – apart from what one can directly
observe about the behaviour, dress, posture, mannerisms and habits of the patient.
…you will become expert in questioning patients so as to bring out
the truth. Store up materia medica so as to use it and it will flow out as your language
flows. You must put yourself on a level with the form of speech your patients use. Be sure
you have not put any words into your patients mouth or biased his expression. [19]
The patients narrative is the main source of the information for the
homeopathic prescription, and it must therefore be treated with enormous respect. It must
not be interrupted or interfered with, in any way, and it should be allowed to flow
effortlessly from the patient with a minimum of interruption or disconnectedness.
Unnecessary interruptions break the continuity of the patients
thoughts and she will forget symptoms…remain silent and observe the patients facial
expression, body language… [20]
Questions and interruptions in flow should be kept to a minimum and the
patient only directed gently and occasionally back to key points, merely for clarification,
and amplification, but not seeking to place excess emphasis upon a point that was only
mentioned briefly in passing. The homeopath must avoid unduly disturbing or interrupting the
natural flow of the patients own version of their pathology.
The most important facts relating to the patient are discovered, not
by what is called a scientific examination, but by a careful interrogation, which is usually
omitted by medical and surgical practitioners. [21]
This is favored in a general way by a calm, dignified, but at the same
time quiet and sympathetic manner…confident, but not pompous; simple and direct, but not
aggressive; cheerful but not flippant; serious but not grave or funereal. We should try to
put the patient at his ease by adapting ourselves to his personality and mood. [22]
The phrase adapting ourselves to his personality is very
enlightening and shows how it is the homeopath who must do the adapting, not the patient.
This again emphasises how malleable and fluid the successful practitioner must be. Any
tendency towards a rigid or pompous style has to be resisted as it demolishes any chance
that the patient can display their real self. Inability to display their real self is ipso
facto a major reason why homeopathy will fail them. Thus, it follows, that the personality
of the practitioner can become a major obstacle to successful practice. This single point
cannot be emphasised enough and shows why egotistical people, amongst others, should be
persuaded not to become homeopaths – they bring the entire field into disrepute, as they
cannot engage with patients well enough to gain successful clinical results. Kent even says
as much in one of his aphorisms.
…each interview is a unique process demanding of the interviewer
different kinds of sensitivity and different approaches to each patient… [23]
We do well to consider the basis for the great respect, which is accorded
to this flow of narrative. It derives firstly from its obvious psychologically therapeutic
[cathartic] value to the patient and second from its immense preciousness as a resource for
the clinician. It is a precious resource and must not be mucked about with too much.
It should be viewed as-is and treated as-is. Without doubt, one of the greatest dangers in
the encounter is for the homeopath to dissect, over-analyse, and intellectualise it and thus
completely ruin and distort it. Or to allow the patient to do that. That is one of the
greatest dangers and constitutes one of the cardinal crimes of the bad homeopath as
opposed to the good homeopath whose approach is more valuable. Such actions will spoil
the case and lose the remedy just as surely as giving repeated doses of a strong drug.
Keeping silent himself he allows them to say all they have to say, and
refrains from interrupting them unless they wander off to other matters. [24]
The patient must be encouraged to tell his story freely and relieve
his mind…the first part of the examination should be conducted in an easy,
semi-conversational manner. The best results…are obtained by making him forget that he is
being examined. [25]
It is clear from the patients story, that the type of emphasis or
slant they give to each nuance of their story is likely to be roughly the same emphasis that
exists in the life of their condition and problems. They will tend to emphasise the main
points and not overemphasise the small matters. Having said that, however, it is also true
that the patient is not always the best arbiter of what is wrong with them or what
particular symptoms are more important than others are. Such judgments are best made by the
homeopath in the second phase of the encounter. It is also true to say, that patients can
obtain in the longer term a very distorted or mangled appraisal of their problems,
especially if there is a large psychological component in their pathology.
Kent case taking quotes
330. If you can get your patient to talking you can find out how he is
sick. It requires a good deal of experience to keep a patient talking to the line.
331. It is not an easy matter to keep your mouth shut and let the patient
tell his own story. It has to be acquired.
294. Don’t change the slightest symptom, observe everything. Receive the
message undisturbed and get it on paper, there is no other way for a physician to perform
his function and do his duty.
221. The quiet, silent manner of perception is to be cultivated.
218. Man must keep on plodding as long as he lives. He must be patient
and toil on; candid, kind, and gentle as a lamb, ready and willing.
329. The physician must penetrate the inner recesses of symptomatology.
The very life of the patient must be opened. Learn the fears, instincts, desires, and the
aversions of the patient. The remedy often crops out through the affections.
411. The physician must be possessed of a knowledge of the human desires,
must be a reader of human nature, not only as it relates to the sick room but in health.
382. Confusion comes from losing one’s head, prescribing on few
indications and giving medicine when no medicine should be given.
408. Never prescribe for a chronic case when you are in a hurry; take
time. Never give a dose of medicine until you have duly considered the whole case.
410. Just so sure as you prescribe a one-sided remedy for an Hysterical
case, just so sure will she leave you after a while because you do not cure.
219. Perception comes with use.
366. Now you should never think of Measles or Scarlet Fever as a fixed
form of disease which you have sometimes treated thus and so, and expect to treat again in
the same way. You must keep your mind from getting into ruts.
17. Technicalities are condemned in Homeopathy. Only frame in your mind
that you have seen a species of Scarlet Fever, a species of Measles, or a species of
Tuberculosis, or Diabetes, and speak of them as such; that the speech may be a true outward
representation of the internal thought.
15. So long as man is capable of believing that Diabetes is disease, and
that Bright’s Disease is a disease, so long will man be insane in Medicine. His mind is only
directed toward the results of disease.
286. The physician is not called upon to cure the results of disease, but
the disease itself. All pathological changes must be regarded as the results of disease
since all disease is dynamic.
324. In the infant we see the father’s history; in old age the history of
youth. This enables us to look into the future to see whether a patient will recover, or
die, or be palliated.
277. Any physician with pathological notions in his head, if he find no
organic disease, is apt to think his patient is sick only in the imagination.
278. The prejudiced mind is not content to write down simple facts and
symptoms but says “I will examine the organs and parts, and see if congested or
inflamed, and then I shall know what to do.”
As an aside, symptoms are not really ‘important’ in any profound sense,
except insofar as they lead one to the right remedy. What possible value they have beyond
that is open to question. Likewise, one might even claim that the homeopath is not really
interested in the nuances of the patient’s symptoms except that they can lead to the right
remedy. In this sense, the sincerity of their compassion towards the patient might be
regarded as an illusion.
It is a good rule to keep the patient talking, but say little yourself
during an examination…we should not ask leading questions nor put words in his
mouth, but let him express his feelings and observations in his own way. Afterward, we
analyse, complete, correct and interpret his symptoms in accordance with the principles of
homeopathic symptomatology… [26]
In the second phase, the homeopath becomes much more detached, discerning
and analytical, sifting the information they have received into an orderly pattern and
assessing its various elements. It is a weird combination of qualities that a homeopath must
possess. They must have both the warmth and empathy, the passive listening skills as well as
the ability to go into analytical and pattern-forming mode. Both qualities are ever-present
and centrally important to the process of taking the case. In the second phase, the
homeopath must begin to make sense of the case and place symptoms into an order of priority
and this involves beginning to separate psychology from pathology and sorting the pathological
wheat from the irrelevant chaff of patient quirks. It is very hard to do this and it
improves only with practice.
…the homeopath attaches equal importance to the patients
subjective sensations, his mental state, everything that characterizes the patient as a
whole, and as an individual. [27]
At your first consultation with a homeopath, there are a great many
questions to answer
about your medical history from your mothers pregnancy onwards,
your appetite, likes and dislikes, and the regularity of your bodily functions. [28]
The second phase of the encounter sees the homeopath switch from
information gatherer to information sorter and it is in this phase that much more rigorous,
sustained and detailed questioning [and some gentle badgering] of the patient begins. This
is vital in order to clarify certain symptoms most explicitly.
When the narrators have finished what they would say of their own
accord, the physician then reverts to each particular symptom and elicits more precise
information…reads over the symptoms…he inquires for further particulars… [29]
In the second phase, the homeopath must switch from passive witness to
analytical interpreter and pattern formulator. In this second phase, it is as if the
previously dormant and quiet homeopath is suddenly roused as if from a coma. They suddenly
leap into life, bombarding the patient with a million questions to clarify many details of
the given symptoms. This is the nature of phase two.
…the homeopathic physician looks for those strange, rare, and
peculiar symptoms that set one case apart from all others… [30]
The main elements of the case have been given by the patient to the
homeopath. It now becomes the latters task to flesh out this picture with much more
detail, to hunt out and retrieve from the patient new information and finer details about
every aspect of their problem – especially the rare and peculiar symptoms that so often lead
us to the simillimum.
The patients generally call attention to the commonest things, while
it is the strange and peculiar things that guide to the remedy. The symptoms most covered up
from the observation of the physician are often the things guiding to the remedy…these
symptoms that are withheld and seem to be so obscure, and so difficult to obtain, are the
very ones that the patient thinks do not amount to anything. [31]
In this search for the homeopathic specific remedy…the more
striking, singular, uncommon and peculiar…signs and symptoms of the case of disease are
chiefly and most solely to be kept in view…the more general and undefined
symptoms…demand but little attention…[and] are observed in almost every disease and from
almost every drug. [32]
It is in this second phase, that the narrative of the patient, as an
entity, begins to get translated into homeopathic language and the symptom details get
sifted and weighed against each other. In effect, the symptoms compete with each other in
importance, within the homeopaths mind, for prominence of position in the final picture –
a picture that will be used as the basis for the prescription. The whole encounter is headed
towards that final end-process. The homeopath must very carefully evaluate and weigh all
evidence in this process.
The patient’s raw symptom information becomes ‘homeopathic language’ and
then the homeopathic language is translated into rubrics and sorted into order. From what
needs must be a brief list of rubrics, the main remedy can usually be seen fairly easily.
That must be a single drug that covers all or most of the main rubrics and ideally a good
measure of other aspects of the psychology and pathology of the case also.
The whole aim of the physician is to secure the language of nature. If
it has been masked by medicines, it cannot be secured. Any meddling will so affect the
aspect of the case that the physician cannot prescribe… [33]
There is a problem with those cases where the pathology is profound and
therefore they do not respond well to remedies. There is another problem with stuck cases
due to an extensive history of allopathic drugging. The problem with all drugging is just as
Luc De Schepper says:
“
the homeopaths task is made more difficult [not impossible]
through continued drug suppression. The homeopath has to battle constantly against heavy
odds to demonstrate the superiority of homeopathy.” [34]
“
homeopathy is superior to allopathy because the material doses
of allopathic drugs have a pathogenic action. They produce new symptoms, euphemistically
called side-effects
they compel a defensive or eliminative reaction which exhausts the
already weakened Vital Force. The material dose is a toxic dose.” [35]
What I think Schepper means is that a suppressed case is essentially an
over-drugged case and thus needs first to be freed from drugs of all kinds [including
homeopathic ones] for some time to straighten itself out. The vital force has been swamped
by excessive stimulation. Suppression can thus be viewed as a form of proving which engrafts
new symptoms upon the organism. Repeated doses of homeopathic drugs can also cause this type
of ‘iatrogenic proving’, through what is an over-stimulation of the vital force.
There are also those patients who will not – or cannot – open up and
disclose their symptoms. They are disinclined to do this for various reasons – this is an
element of their pathology. There are also those who over-intellectualise their pathology
and thus display what is a distorted picture to the homeopath. Conflicting and confusing
signals are given. All such cases present problems.
On a deeper level, we might regard the patients story as a story of
profound holism in time and space. It is the story of symptoms as they have changed and
evolved through time, and spatially through the different physiological arenas [what
Vithoulkas often calls layers] of the organism. It has been moulded through time by events,
by drugs and illnesses. This is a perspective denied to the allopath who reductionistically
views each organ and system in isolation from the rest, and each medical event in the
patients history as a separate occurrence, quite unconnected with any of its predecessors
or successors. This is not a view homeopaths adopt, who uniquely view all time and space of
the one vital organism as deeply and inextricably interconnected as a living whole – a true
holism of time and space.
I have to ascertain the medical inheritance of my patient, and the
strain which runs through his family…the diseases of his parents, and of their children,
of uncles, aunts and grandparents, if possible… [36]
For the above reasons it is vitally important at some stage during the
first consultation to make notes on the entire family background to the patient. This
includes all episodes of serious illness in self, in brothers and sisters and in parents or
grandparents, where this is known with any certainty. Some sketch can then be made of the
family background from a miasmic perspective, which is extremely useful for two reasons.
Firstly, it gives a quick measure of the likely complexity of the case overall; second, it
flags up any likely nosodes that might be needed should the first indicated remedy fail
or indeed, to open the case, should no single remedy shine out in the first consultation.
Getting a good clinical history is one of the most important parts of
case taking. By the same token it is also the one most generally neglected or badly
done…all acute diseases are in reality acute outbreaks or exacerbations of previously
latent, deep-seated, underlying, chronic diseases or inherited tendencies and
predispositions to disease, which exist in all persons… [37]
…it is important to ascertain the family history: that is a brief
history of the diseases, causes of death, predispositions and tendencies to disease and
individual peculiarities not only of the patients brothers and sisters, but of his
father, mother, uncles and aunts and his grandparents too, if possible. [38]
It is also instructive to consider the things that each party brings to
the homeopathic encounter both in terms of knowledge and expertise, and in terms of
expectations. The conceptual baggage each party brings can greatly influence and
distort the outcome. So many things impinge upon the encounter and warp or twist it in
various ways to greatly influence the final outcome. The homeopath must also be a critical
observer and able to sift and subtly discern between differences in psychology and
pathology, so as to build up what is not only a very neutral account of the patient’s
symptoms but also one that is accurate and meaningful too. No easy task, by any stretch.
…get the original form of the malady….trace through a mass of
difficulties and conditions to get back to the original form of the trouble, but you must
get there because you will see that in the beginning this malady…must have conformed to
some remedy that had been created for its cure. [39]The remedy must also cover every possible way the individual has
been affected by his illness subtle changes, including the way in which the illness has
altered the patients personality and his reactions to outside influences. [40]
It is also worth considering the various things each party brings to the
encounter. The patient brings their pathology and their story while the homeopath brings
his/her listening skills, their sympathy and empathic skills as well as their detailed
knowledge of materia medica. Above all, the homeopath must have an open mind and a passively
listening, observing manner. Knowledge of miasms and theory is useful, but can get in the
way of taking the case as it is.
Problems can also arise with certain remedy types. For example, Natrum
mur, Fluor ac, Bufo and Staph types who are often reluctant to disclose important and
intimate details about their sexual or emotional life that is vital to their pathology.
Likewise, the over-intellectualisation of some Sulphur types, for example, can make
accessing their real pathology a difficult task.
Other individuals…refrain from mentioning a number of their
symptoms, describe them in vague terms, or allege some of them to be of no consequence.
[41]
The arrogance of Platina types, or the touchy defensiveness and secrecy
of Sepia, can also present great obstacles in the path of the homeopath, which, with
experience, they learn how to recognise all such people, through all the pitfalls of taking
their cases. Fortunately, most such cases also present symptoms of cold or heat,
perspiration, odours, eruptions, etc, which also lead one to apprehend their pathology just
as surely but via more concealed routes.
A third phase exists, which sees the homeopathic language and rubrics
successfully used to find the simillimum, and that completes the overall process of finding
the remedy and giving it in appropriate potency to the patient.
We have now completed a detailed appraisal of the main elements contained
in the homeopathic consultation and explored its defining characteristics. We have explored
the methods used to extract the correct information from the patient and how that
information can be used as the basis for a successful prescription. We have also emphasised
those superior qualities a homeopath should possess in order to become a successful
practitioner who brings great credit on homeopathy. As we indicated, the patient contains
all the information we need, it is merely the approach of the clinician which must be
adapted to the psychology and pathology of the individual patient in order to elicit all the
useful information from the patient. Then the skill of the clinician arranges and condenses
it into a small picture suitable to allow the right remedy to emerge from this encounter.
Sources
[1] J Ellis Barker, My Testament of Healing, ~1935,
London, p.21
[2] Samuel Hahnemann, Organon of Medicine, combined
5th/6th edition of Dudgeon and Boericke, Aph 83
[3] Barker, op cit., p.21
[4] Luc de Schepper, Hahnemann Revisited, 1999, p.113
[5] Stuart Close, 1924, The Genius of Homeopathy Lectures
and Essays on Homeopathic Philosophy, New York, op cit., p.172
[6] James T Kent, Lectures on Homeopathic Philosophy,
1900, N Atlantic Books, p.158
[7] Kent, op cit., pp.160-1
[8] Barker, op cit., p.24
[9] see de Schepper, p
[10] Close, op cit., p.168
[11] David Gemmell, Everyday Homeopathy A Safe Guide for
Self-Treatment, Beaconsfield, UK, 1987, p.4
[12] Cyrus M Boger, 1952, Studies in the Philosophy of
Healing, Jain Reprint, India, p.40
[13] Michael Weiner and Kathleen Goss, The Complete Book
of Homeopathy, 1982, Bantam Books, New York, pp.41-2
[14] de Schepper, op cit, p.120
[15] Close, op cit., pp.170-1
[16] George Vithoulkas, 1980, The Science of Homeopathy,
Grove Press, New York, p.170
[17] de Schepper, op cit., p.120
[18] Kent, op cit., p.173
[19] Kent, op cit., p.160
[20] de Schepper, op cit., p.117
[21] Barker, op cit., p.24
[22] Close, op cit., p.171
[23] Vithoulkas, 1980, op cit., p.169
[24] Organon, Aph 84
[25] Close, op cit., p.171
[26] Close, op cit., p.172
[27] Weiner and Goss, p.42
[28] Andrew Lockie, The Family Guide to Homeopathy, Hamish
Hamilton, London, 1998, second edition, p.13
[29] Organon, Aph 86
[30] Weiner and Goss, p.44
[31] Kent, op cit., p.169
[32] Organon, Aph 153
[33] Luc de Schepper, Hahnemann Revisited, 1999, p.271
[34] Schepper, op cit., p.309-10
[35] Kent, op cit., pp.164-5
[36] Barker, op cit., p.23
[37] Close, op cit., pp.178-9
[38] Close, op cit., p.180
[39] Kent, op cit., p.166
[40] Janet Pleshette, Cures That Work, Century Arrow,
London, 1986, p.114
[41] Organon, Aph 97