No matter how extended and sophisticated our software programs and how up-to-date our analyzing method, the crucial point stays: how to elicit the information we need from the patient. It is done in the past with questionaires, with particular questions to clarify the CC , gather modalities, generalities and possibly a KN, it is done by exploring the story, later the delusion, and nowadays the sensation. With exception of the small percentage of cases where the patient reveals the substance, as a result we are left with information that should allow us to make a sensible prescription….which is not always the case.
Case taking though is something one learns by practice. In the process so many things come together and overwhelm the beginner. Each piece of information the patient gives must be scanned like the groceries at the counter in the supermarket. Does it tell us something about the level of experience?, is at a personality trait?, a common expression or a Strange, Rare and Peculiar symptom?, is it a vital or a local symptom?, is it miasmatic information or denial of feelings? On top of that we are supposed to at the same time observe the patient carefully, make meticulous notes, and be aware of the interaction between the patient and us and the evolution of the interview.
And in doing all this, the aim is not to gather as much as possible information (leading to a bulk of quantity) but to select the precise and helpful information to spot the pattern (quality). Without a pattern we have loose bits of information leading to nowhere and everywhere. It is like with baking: we have flour, sugar eggs and butter but… no cake yet. Or like having musical notes spread all over the paper but no melody.
In previous articles and seminars I explained in length how we can spot the vital disturbance/sensation on all levels. It isn’t necessary to ‘bring’ the patient to sensation level because his disturbance is on ‘all levels all of the time’. In fact the patient can not do anything else than express his vital sensation because it characterizes him in every respect. Our job is to look and see.
So the crucial question is how to differentiate between common symptoms on a particular level and vital symptoms. A few examples will make this obvious: a patient with migraines, describing his one-sided pain, photophobia, nausea and need to lie down in a dark room gives level 1 information. When he adds that the migraine makes him extremely angry leading to violent thoughts and deeds, we understand that this doesn’t belong to the physical pathology (level 1) hence it belongs to the patient. That is vital. It is part of the pattern that will eventually give a coherent picture. When somebody who is reprimanded is indignant or feels treated unjust, it might belong to the story (level 3) but if he as a result wants to hide at home and not see anybody, it might as well belong to the patient. Grief after somebody passed away is normal and thus not a symptom – we don’t treat normal and appropriate behavior- but if he feels abandoned and not cared for as a result, it must have been in the patient before. (level 3) A liking to travel is common, but be totally euphoric when paragliding or flying an airplane is SRP. Worrying when your job is at danger is not so rare but building your whole life around security calls our attention. (level 4).
So it takes a keen sense of discernment because we, as empathic healers tend to understand the patient so well that we sympathize all his symptoms away.
In former blog posts I went into the reasons why we miss the elephant in the room, the importance of the context in the case and how prejudices can blur our perception.
But I must say that taking a case is something one can hardly learn by theory alone; again like art it must be learned in practice. No one learns to paint by reading a ‘How to….’-book. With colleagues I spend days dissecting the whole case taking process in small slices and discussing every piece and parcel of the interaction, the questions and answers and the thoughts of the homeopath that did the actual case taking. It became clear that the homeopath doesn’t stay out of the game, he is not merely applying a method or technique, at the contrary: he as a person might indeed be the decisive factor.
In the book “Homeopathy: Strange, Rare and Peculiar” I described the conditions for a healing setting to be successful. The conditions for the homeopath were: the intention to heal and to have the knowledge to take a case and make a meaningful analysis. I came to the conclusion some more conditions need to be fulfilled.
Condition 1: Love the patients in front of you, no matter how he behaves or make you feel. Whether they are demanding, intimidating, childish, sceptic, impolite, long winding or whining, love them just the same. It is not about you. You just notice in what specific way they suffer, try to help, make them feel good about themselves, their situation and hence to the world.
Condition 2: Give full attention. Obvious as it seems, it is hard to sustain. Attention is different from concentration in that you are not trying anything, not finding something, scanning your knowledge, worrying about your professionality, doubting your abilities and so on but simply hold the space – all of the space- for the patient. He is invited and welcomes to tell whatever he wants and the homeopath is receiving all of it with openness and genuine interest. In general it means we hardly put any question to the patient, other than ‘can you tell a bit more about this?’ (‘this’ being what he was talking about already). We can do this in any way suitable, adapting to the patient psychology, without intruding, invading or pushing him beyond his boundaries. The only objective is to understand him better, even if the issues bothering him seems totally trivial to us. We shouldn’t think we must drill to something deeper to find the source, ignoring the fact he is already trying his best to tell you.
Condition 3. Act normal. You want to know the patient in front of you, get the overall idea first, later fill in the details. The question that keeps astounding the students and homeopaths in the first analysis of a case ‘what kind of patient is this, what kind of case’, refers to this. The answer could be something like ‘secretary-like single woman in her forties with weight issues’. Or ‘bearded awkward shy young man with telephone phobia’ or ‘sensitive, eloquent woman of 50 with insomnia since traumatic event’.
After the first and overall impression a normal conversation follows in which the homeopath is eager to know all about ‘it’, without having remedies or boxes in his head to squeeze the patient in. Since it is not a mutual dialogue but a healing setting we implicitly agreed on an unequal conversation, where the one displays his world and the other observes and receives. It is unnecessary to ask clever questions, even a simple one like ‘ tell me more about stuck’ will give the patient the impression that he said something interesting that attracted the attention of his homeopath. As a result he will exhaust himself to give every possible thought, idea and image to please him while in his experience it might not be something particular at all. Many patients love to be taken on these semi –spiritual, shamanic-journey-like tours in their psyche, hoping something special will emerge. As a matter of fact, it often does, mostly a weird animal or a remedy with great placebo potential.
Of you nudge the patient a little bit to explore in detail the subject they shared with you in the opening sentences (as an answer to ‘what can I do for you, what is the problem?’) he usually leaves the room well-listened to and thoroughly understood, while otherwise after bizarre sensation questioning he might go home in total bewilderment.
But as I just stated: all this is hard to learn from the books. It also reaquires some self-knowledge and maturity. And a good similimum to feel OK with oneself…
At its best case taking becomes a platform for beauty, truth, care and connection and a blessing for the homeopath and the patient both. It then just all comes naturally and in a relaxed way.
I told you: homeopathy can be sophisticated yet simple at the same time!