HOMOEOPATHY : The Art of Healing

"the unprejudiced observer -...- be his powers of penetration ever so great, takes note of nothing in every individual disease, except the changes in the health of the body and of the mind (...) which can be perceived externally by means of the senses ;" (Hahnemann's Organon § 6) (1)
"This individualizing examination of a case of disease, ...,demands of the physician nothing but freedom from prejudice and sounds senses, attention in observing and fidelity in tracing the picture of the disease." (§ 83) 

I would like to take up the challenge thrown by George Vithoulkas in the first issue of his European Journal of Classical Homeopathy (2) about the meaning of "art" in connection with Homoeopathy.

Firstly, I will explain my theoretical position in regard to the differences between intuition and art, because in the Vithoulkas paper I felt there was confusion between the terms, being used almost as synonimous.

Our main task as physicians is to "perceive the reality of human suffering" (Vithoulkas paper), but I arrived at the conclusion, from my learning based on A.Llorden's training (3), that there are 3 levels of human perception : 1.- a sensitive level ; 2.- a technical level ; and 3.- a creative level.

The first one, the sensitive level, depends on the development of the degree of sensitivity (of the 5 physical senses : sight, taste, touch, hearing and smell) and on the correct integration of the consequent five different perceptions in a whole (unified perception). Frequently, when you use the term intuition you are referring to an unilateral overperception (by one of the five senses) or some kind of extrasensorial perception, that often is innate, and permits some people to perceive sensations beyond the more immediate reality; but very often this gift in not well controlled and brings people a lot of suffering, as we can see in some patients. Rarely the term intuition is used with the meaning of an integration of the sensorial perceptions, in the most appropriate way. Anyway, intuition has nothing to do with art; intuition can be an ingredient of art if other conditions are present and well integrated in the same individual.

Now the test to verify that integration of sensorial perceptions ("canalization of senses") has been done, is named "measuring", that means the comparison and correct situation of oneself in front of the observation (e.g. the patient), but not only from one's point of view. [This should be checked in a training framework, because you need always a third person for an unpartial judgement]. This means, for instance, that you cannot treat in the same way a child, young people, another physician, an homeopathic colleague, a friend or a king! You must individualize the relationship with your patient.

Afterwards, the arising of a feeling (or sensation) from your emotional plane and the verbal expression of this feeling, places you in the best position to go on to the following level, the second one. If you continue the process of perception without expressing your feeling to the patient, you are taking a short cut that would hinders you in reaching a final global perception. The second level of perception is the technical one. Usually it's the most currently known and the one that leads to least discussion. As in other branches of human activity, it depends on a learned knowledge (e.g. Materia Medica, Repertory,...), including the skills in applying the theoretical knowledge in a practical way (e.g. special questions to the patient for a differential diagnosis). If you perceive the patient only from a technical approach you will not reach to an understanding of a human suffering but a kind of "object imbalance", you will probably lose the link between emotional and physical symptoms,...that is, the meaning, the sense and the coherence of the whole symptomatology.

When you put yourself into the field of observation, confronting your patient, you are using the sensitive perception. This is the usual field of action being used by poorly-trained practitioners. We must go on, incorporating to that first level of perception the second one, the technical, based on a good training. Now, without losing either you can go to the third level, the creative level. What are the measures used to check that the creative level has been reached? [ e.g. What is your concern (implication) with human suffering? What is your concern with Homoeopathy itself? What are you disposed to do for the development and the progress of Homoeopathy? What are you disposed to do for your patient? ]
The creative level implies the former two, is an evolution of the former by means of an integration of both. You feel your patient and you know the tools to alleviate his/her suffering, and you put them in his/her hands. Homoeopathy is not for us, it's only a tool for healing our patients; homoeopathy is for the patients, but we, as homoeopathic doctors, are obliged to develop our instruments of perception (including our sensibility and our knowledge) in order to reach our maximum capabilities.

Then, and only then, can we talk about the "art of healing", as Hahnemann himself entitled his opus magnum ("Organon der Heilkunst"), a title almost nobody has taken the risk of translating accurately.

"Art" is a way of acting after feeling and thinking. "Technics" is also a way of acting, but without feeling being necessary, mostly disturbing. And "intuition" can be also another way of acting but without knowledge. Intuition belongs to the hygienic level; technics to the psychological level; and art to the creative level (3).
I think there are three main instances in which "art" is necessary during homoeopathic daily work. The art of healing (homoeopathically) includes the art of interrogation (anamnesis), the art of interpretation (diagnosis) and the art of prescribing (treatment).

Maybe now you can understand the dramatic influences of these questions upon homoeopathic training, and therefore the responsibility upon the homoeopathic schools.

Do we want to produce well-trained technical homoeopaths? Do we want to spend energy on students who will mislead homoeopathy in his practice? How can we prevent this? My brief answer is: applying the consequences of the awareness of the three levels of perception, that I have already explained, and following step by step the process of learning homoeopathy.

From this point of view the central task of the homoeopath is the anamnesis, that involves firstly the "art of interrogation", the way of retrieving symptoms from the patient's memory, including a complete observation of all the patient's messages, verbal and non-verbal, and a good homoeopathic interviewing-technique. During the anamnesis, from the hermeneutics perspective (4), a double dialogue develops: beyond the conventional relationship doctor-patient, the true dialogue develops between doctor and symptoms through the remedies.

The immediate and simultaneous second important task for the homoeopath is the "interpretation" of the symptoms to reach an unified understanding of the patient's suffering. Interpretation according to hermeneutics requires globality (the majority of symptoms), hierarchic deepness (hierarchy of symptoms), temporality (biopathography) and individuality. "Speculation" comes when interpretation is forced by imposing a theoretical background prior to the four characteristics stated.

The aim of the two former tasks is to find the correct remedy, the simillimum, the remedy that fits best the hermeneutical interpretation of the individual case ("homoeopathic diagnosis"), and could transform disease to health. Prescribing is subject to some general rules but a lot of questions are still technically unsolved. Nowadays the "art of prescribing" is still lacking of scientific knowledge.

Leading homoeopaths knew intuitively about the importance of the sensitive level of human perception: when they talk about "circumspection, tact, knowledge of human nature, caution and patience" (Hahnemann)(5), the physician being known as a man of honor, who may be believed and respected, a candid man (Kent)(6), provoking emotional outbreaks in the patient (as P.Schmidt said that Austin taught him)(7), "a state of conscience that the physician must cultivate: the sympathy or capacity of enthroning in the intimate of the patient"(Paschero)(8), feeling the patient's feelings (a theatrical training technique well known by Vithoulkas)(9). But when someone has talked or written about "art" between homoeopaths I have not found real knowledge, only personal opinions, speculations or confusion; maybe I have failed to find the right source. Only lately I have enjoyed some articles from a rigorous philosophical point of view (10).

It's for this reason that I have turned to other disciplines to find knowledge about that item and finding it in a person that deals with creativity in a philosophical and in a practical way (A.Llorden)(3). From this training I have learned the attitude that is required for learning, the rules you needed to achieve integrated and applied learning, the process that a human being must undergo to achieve creativity. I thing this is an important knowledge for homoeopathic community. This special training is achieved by learning from the body, suspending for a while the usual "prejudiced minded thinking", finally getting to a coherent body-minded learning.

When you learn or teach (homoeopathy) or observe (the patient) only with your mind (with your habits of thinking) you are subject to all your prejudices (educational, familiar, social, political, religious,...). How do you suspend your prejudices with the same "organ" that produces and stores them (i.e. your mind)? This is a knowledge that comes from the origin of humanity, all traditional cultures have their own way of incorporating the body in the learning process. A.Llorden's teaching appears as an actual synthesis of that ancient knowledge for today.

The evolution of Homoeopathy lies in the evolution of homoeopaths as human beings. As Paschero has said, "In a medicine of the person ... you cannot and is not permissible to set apart the person of the physician from the integral problem of clinics; is a new dimension of medicine that must confront the knowledge of man"(8). For that purpose you must develop specific tools, the training and the human quality of homoeopaths. How that is done is the challenge for the homoeopaths of the 21st. century. Allopathy doesn't need this kind of development bacause the technical perception is enough for its aims, but for Homoeopathy we need to enquire as Hippocrates did: "Know thyself".

As you are aware the main tasks of homoeopathic practice (interrogation, interpretation, prescribing) are very subjective. To avoid projections of homoeopath's ego on his/her job, s/he must be trained in some discipline of self-knowledge. The knowledge of oneself is the only way to prevent "biased interpretation" and speculation, by avoiding "to project our own little theories or fancies" (see Vithoulkas paper), and our personal conflicts and contradictions, our own belief system, upon the patient's suffering.

The art of healing is the art of obtaining and interpreting the maximum useful information from the patient in the least possible time in order to reach a sufficient basis for a successful prescription. As in any other art, healing needs from the healer: sensibility, intuition, the knowledge of a specific technique, self-knowledge, a special human relationship between patient and doctor, and a clear will of conducting your actions to the welfare of others, passing through your own interests; without either of those, art is not possible, therefore healing is not possible, or only by sheer chance.

As a conclusion, I think that the downfall of Homoeopathy will come not from the desertion of practitioners but from the incompetence and the inability of "non-deserter" practitioners, to face responsibility in developing their human, medical and homoeopathic skills. I hope this situation can be prevented by the efforts of our more aware colleagues.

(1)- Hahnemann S. Organon of Medicine. B.Jain Publ.
(2)-  VithoulkasG.-Homeopathy : Art or Science? Classical Homeopathy,Vol.1, nº1, 1995: 3-5.
(3)- A.Llorden's teaching consists briefly on the process's assessment of going toward the creative level of the reality, starting on the hygienic level (locus of the sensibility), and passing through the psychological level (locus of the concern).
(4)- LarribaJ.-Samuel Hahnemann's Clinical Hermeneutics. Natura Medicatrix, 28-29, 1992: 22-24.
(5)- HahnemannS.-Organon of Medicine, § 98.
(6)- KentJT.-Lectures on Homoeopathic Philosophy. Lecture XXV. North Atlantic Books.
(7)- SchmidtP.-La consultation homoéopathique: L'art d'interroger. Impr.Rapp. Génève, 1975.
(8)- PascheroTP.-Homeopatía. Ed.El Ateneo. Buenos Aires, 1983. (own translation)
(9)- VithoulkasG.-The Science of Homeopathy. Grove Press,Inc.New York, 1980.
(10)- PhilippeM-D.-Is a realistic philosophy necessary to the art of healing? Homoeopathica, Spring, 1994:10-17. Is Medicine a Science or an Art? Homoeopathica, Summer, 1994: 32-36. Realistic Philosophy and Biological Sciences : Servants of the Art of Healing. Homoeopathica, Autumn, 1994: 46-50. Quality and Quantity: Art and Science. Homoeopathica, Winter, 1995: 45-49.

Publicado parcialmente en European Journal of Homeopathy.

No hay comentarios: