By Douglas Falkner, MD, MHom
After years of Homeopathic practice, it has gradually become apparent that the skills needed to become a good diagnostician and prescriber in homeopathy derive less from a knowledge of pure materia medica and repertory (although both are essential) and more from the qualities of a good detective or criminal prosecutor. Of course a sound knowledge of medicine and broad clinical experience are essential to success in any kind of medical practice. However, being a careful, precise, unbiased observer is the backbone of good case-taking and effective prescribing.
In the practice of homeopathy, what separates the the lengendary from the run-of-the-mill is the ability to wrest the essential and important clues in a case from the plethora of data presented by the patient. To find the correct prescription consistently and reliably requires clear-headed, “unprejudiced” observation that few acquire without long painstaking practice and disciplined personal development. One’s intent has to be greater than merely attempting to expand one’s knowledge of Materia Medica and Repertory. One must learn to perfect oneself as an instrument of “seeing”.
Early in the Organon, Hahnemann introduces the concept of the “unprejudiced observer”. Nothing could be more central to successful prescribing than the actual state of the case-taker, Hahnemann’s “unprejudiced observer”. For the observer is indeed the central pillar in the process of case-taking. The strength and reliability of this pillar depend largely on the degree to which prejudiced observation has been removed from the field of inquiry.
Without an unprejudiced eye, a case lacks precision and clarity . It becomes subject to all kinds of distortions and speculations. In challenging cases, knowledge of Materia Medica and Repertory alone cannot compensate adequately for imperfect observation. Only the “unprejudiced” observer consistently discerns the true symptoms of the disease, which alone serve as a reliable guide to selecting the best remedy.
How then does one arrive at taking an “unprejudiced” case? Since the case-taker is the instrument of observation, it follows naturally that the evolution and mastery of casetaking is inextricably tied to the evolution and mastery of the self. Good personal homeopathic treatment helps immeasurably in this process. With the help of well prescribed remedies and disciplined study in both spiritual and and homeopathic practices, one grows as a person, becomes more vital.
The result of such personal growth leads inevitably to ever greater insight into oneself, as well as greater clarity in perceiving others. With this strong inner foundation, unprejudiced observation becomes more possible.
For the highest level of prescribing, one must learn to distinguish which symptoms in a case belong indisputably to the actual disease. It simply is not enough to compile interesting symptoms and modalities or the speculative so-called psycho-dynamics operating in the case. One needs to acquire the capacity to observe deviations from the healthy state.
That is, one must be able to find “objectively” what comprises the true disease, and not focus on symptoms that seem important because they are somehow “relative” to the personal experience of the prescriber. It requires that one actually observe and record faithfully what Hahnemann refers to in his writings as the “totality of symptoms of the true disease”.
To accomplish this also requires a degree of intent that does not permit interference from the force of personal bias or those forces generated by the patient’s own disease state. Otherwise, one’s observation becomes clouded by the many smokescreens raised by the patient’s illness in order to mislead the prescriber and thus avoid its own annihilation. Hahnemann describes the causes of disease as “forces inimical to life.” If such forces can overcome the vital force of the patient, then surely they can exert an influence on the field of the observer. In order to stay clear-headed while taking a case, one’s vitality must be strong, strong enough to resist the disease influence coming from the patient.
Hahnemann states in Paragraph 6 of the Organon: “The unprejudiced observer… notices only the deviations from the former healthy state of the now diseased individual, which are felt by the patient himself, remarked by those around him and observed by the physician.” In these deviations from health lie the heart of the case. If one is “prejudiced”, what one perceives as a deviation from health may reflect more about the prescriber than it does about the patient.
Let us look at an example. I attended a seminar in which a live case was taken. It concerned a young woman in her twenties. She sought homeopathic treatment because she heard “it could help people to grow.” She described herself as spiritually minded. She spoke of her fears of having to work hard to make ends meet at something she didn’t really like to do—restaurant work instead of painting. She spoke of her discomfort around people, of preferring to be alone. She mentioned how the father of her only child died recently of AIDS, which still caused her sadness and some persistent fear of acquiring the infection.
Later and well into the case, we learned she had a five year old son. She barely spoke about him. Only direct questioning elicited any further information about him: “It is still a discovery thing getting to know him. I have worked evenings for the past four years, so I haven’t spent so much time with him.” Then she adds flatly, “ I probably should try to spend more time with him.”
One could argue that the focus of the disease in this case centers around this woman’s struggles with finding fulfilling work, coping with her isolation, the loss of her lover. These psychodynamics describe the content of her current struggles in life. One could repertorize the case as follows:
MIND; AILMENTS from; grief, sorrow, care
MIND; FEAR; disease, of; incurable, of being
MIND; RELIGIOUS affections
MIND; COMPANY; aversion to, agg.; solitude, fond of
Remedies such as Aurum, Ignatia, Natrum muriaticum and Sepia figure highly in this analysis. However, none of these express anything truly characteristic about this patient’s illness. They feel too generic.
But much more striking and perhaps the true “deviation” from health in this woman was her lack of connection to her child, her very own flesh and blood. Details about her son and her relationship to him were conspicuously missing from her case. So I looked at the repertory: MIND; CHILDREN; aversion to. The remedy was instantly clear to me—Chocolate. And her follow up six months later confirmed the prescription. “My son and I are really starting to connect, really for the first time.”
How does such a case relate to the theme I am developing? If one’s personal issues overlap with one’s patients, they tend to remain transparent to the prescriber. To better understand human nature and the nature of one’s patients, one’s understanding of life as a whole must continually evolve. No expanding knowledge of materia medica and repertory alone will suffice. For example, if in my own life I also am disconnected from my own children, if I also have suffered the loss of a loved one and still suffer dearly, then in taking a case such as the one above I will likely focus heavily on this woman’s sufferings in relation to her loss and think nothing of her mentioning very little about her son in the interview. Yet, after all, is it not natural for a mother to have a strong connection with her own children?
In order to perceive clearly or as Hahnemann exhorts, without prejudice, one must find a way to identify and then rise above such personal prejudices. Working through prejudices engages the prescriber in the very process of personal growth and evolution. It involves learning to shed the skin of one’s delusions. As one becomes healthier and begins to grow in this way , he or she is better able to help others. The more truth one can bear the more one will grow, the more one grows the more truth one will see. (The eyes cannot see what the mind does not perceive/conceive)
In the disease state, we are “stuck” in a certain way. The challenges that emerge from disease serve to propel us to grow. We could say that our inner condition is essentially mirrored by our outer life. This is why the pessimist always sees the glass half empty rather than half full. Our experience of life is merely a reflection of our true inner state. Therefore, the prerequisites for taking a good case have everything to do with clarity of mind, and with impartial, unprejudiced observation. We must learn to rise above our own pathology in order to see the true pathology of our patients. Unless we begin to see our own blind spots, we will be unable to truly see what actually needs to be cured in many of our patients. Our practice of homeopathy evolves along with us. How could it be any other way?