The 3 Step Journey of the Case Witnessing Process

Creating a new theory is not like destroying an old barn and erecting a skyscraper in its place It is rather like climbing a mountain, gaining new and wider views, discovering unexpected connections between our starting points and its rich environment. But the point from which we started out still exists and can be seen, although it appears smaller and forms a tiny part of our broad view gained by the mastery of the obstacles on our adventurous way up.

– Albert Einstein

The question that bothers me is, are there any differences between old classical homoeopathy and modern classical homoeopathy?

Any new discovery in a true science doesn’t completely abolish an old known theory but rather improvises the old, enhancing it in the light of the new polished one. I believe that new is the further extension of the old one. Take for example the laws of physics. When new laws are derived in physics the old ones are not discarded. They still hold equally true. The fact is that the new laws nurture in the light of the old physics laws. This is true for all the universal sciences and so also is true for our homoeopathic science.

The new theories and new methods, discovered in homoeopathy do not throw away the age old theories and methods introduced by our masters. New understanding which rests upon the basic laws of homoeopathy does not negate the old theories but rather enhances it further.

The question that comes to my mind is, what should be the basis of any new discovery in homoeopathy?

We know the three pivotal laws on which homoeopathy rests:

Individualization
Holism
Law of Similars

Any new scientific discovery in homoeopathy must be based on these 3 laws. These three laws are the pillars on which the entire system of Homoeopathy is based, whether it is understanding the human core, whether it is searching the similimum, whether it is case witnessing, whether it is posology, studying materia medica, repertory or proving, follow up criteria, healing awareness.

Dr. Hahnemann bases the essence of individualization on obtaining the PQRS symptoms; we understand that these PQRS symptoms can be at the local level, general level, and holistic level. The PQRS symptoms at the physical particulars, physical generals, mental general level, as well as the subconscious level i.e. holistic level, all together make up the individualistic holistic expression.

Individualization and holism is the key to everything in homoeopathy. And applying this to the law of Similars, we see that the Similimum is the one where the individualistic holistic expression of the patient matches with the individualistic holistic expression of the remedy.

Therefore the individualistic holistic expression must be the most important to understand:

In constructing the core of a human being, the Aim of Case Witnessing Process (CWP) should be to bring out Individualistic expression at the holistic level.
Searching the remedy should be based on individualistic expression at the holistic level.
Study Materia Medica / Repertory / Proving and understanding the substance should be based on individualistic expression at the holistic level.
Follow-up Criteria should be based on individualistic expression at the holistic level.
Healing Awareness should be based on individualistic expression at the holistic level.

Individualization (PQRS) at holistic level is the perennial truth on which Homoeopathy is grounded and this is the level where both OLD CLASSICAL AS WELL AS MODERN CLASSICAL HOMOEOPATHS ARE CONNECTED.

Now the next question is, how should the case witnessing technique be done?

I knew that case witnessing technique should be designed in such a way that it is based on the three basic principles of Homoeopathy. It should be a confluence of individualization, holism, and the law of Similars. Ultimately the entire aim of the case witnessing process should be such that it brings out the individualistic expression at the holistic level.

Be it a follower of any system or any school of Homoeopathy, he or she should be able to apply the case witnessing technique in his clinical practice. Hence it should be ageless, timeless, beyond personality. It should be integrative; hence it would go beyond the confines of any system approach or personality approach. Case witnessing should be systematic, scientific, something that is reproducible by all homoeopaths belonging to different schools of homoeopathic knowledge.

The aim of the CWP should also be that it is simple and easily reproducible, which means that, one should be able to standardize the entire process and apply it with every patient. The entire case witnessing process must be simple yet scientific, every step that goes further in the journey into the human core can be taken scientifically, the questions asked should not be according to the whims and fancies of the physician but rather put forth logically and systematically.

The entire journey of the case witnessing should be human-centric, which means it should be “according to the patient”. The whole process will be scientific and standardized, but in order that the whole journey is smooth and spontaneous, it will be designed according to each individual patient, so that the basic framework remains the same, but yet the process will be individualistic differing from patient to patient.

Hence, the case witnessing process is aimed only at understanding the unique individualistic pattern of the patient. It has to be a scientifically designed, individualistic, human-centric approach.

When the case witnessing process is designed in such a way, the patient experiences a mirror image of his inner being right in front of himself, and this itself acts like a similimum for the patient. So our aim is to develop a CWP which is diagnostic as well as therapeutic to the patient. Also during this journey the physician’s subconscious vibrates along with the patient’s core, and has a healing effect on the healer too!!

Now, why do I use the term “case witnessing” rather than “case receiving” or “case taking” or “case examination”? The answer lies in the meaning of the verb “to witness”. A witness is a close observer, one who gives firsthand account of something seen. In relation to the legal system, a witness is the one who does not add to or subtract any details from what he has seen. A witness just observes and provides information, as it is. Every case that comes to us requires one hundred percent witnessing in order to understand the patient as he is. If we can witness our cases, only then will we refrain from superimposing the colours of our fixed knowledge and ideas on the real holistic understanding of our patients. That is the reason I feel it is important to use the case witnessing process with our patients and not just the case taking process! With the above aims in mind, the next question was how should I design the case witnessing process to fulfil the above aims?

As I was continuing my search subconsciously and consciously towards designing the case witnessing process, I knew that this process had to be a universal phenomenon, so I started observing other universal phenomenon in nature and I came to the conclusion that, be it meditation, be it love making, be it hunting by the bushman tribe in Kalahari desert, or be it the Ashtang yoga (divided into Bahirang yoga, Pratyahara, and Antarang Yoga) all universal phenomenon happen in 3 steps.

The centre is only three step inwards.

Go inwards to the centre

Like an arrow

The three step model of case witnessing process is divided into:

The Passive Case Witnessing process
The Active Case Witnessing process
The Active-Active Case Witnessing process

This notion of the foundation of Three Steps in everything we do, became a strong belief of mine as I saw it reflected in almost everything. It pertained not only to learning how to drive a car but to learning anything, for instance in children learning how to speak a language. Initially, they just babble, this is followed by making efforts towards speaking a few words, then one fine day effortlessly the whole language flows. This is how the whole journey of the case witnessing process goes, it starts from scientific effort and then becomes intuitively effortless.

In the Passive Case Witnessing process we put in scientific effort, and the journey becomes intuitively effortless in the Active-Active case witnessing process. The entire process of case witnessing travels from a divergent approach to a convergent approach.

We understand the meaning of a divergent approach: “It is when you need to explore and find new things, you use divergent approaches. This is a process of looking for options, new ideas and so on. Some people prefer diverging, as it means the potential of a wrong decision is never reached. Also in this approach we are being open: An important first step of divergent thinking is to be open. As a cognitive state, it involves temporarily suspending judgment and deliberately opening yourself up to new thoughts and ideas.” “Convergence is the opposite of divergence. When you are thinking convergently, you are seeking a conclusion, an answer, and closure on the topic in question.”

See also

Violent Man with Chronic Pancreatitis

Similarly, during the passive case witnessing process, we keep a broad divergent approach, exploring every area of the patients life, from current ongoing situations, childhood, interests and hobbies, fears, dreams, etc… to find a common thread running through these areas. Here we give ample space (and we ourselves are open and unbiased) to the patient and let him travel to any aspect of his life spontaneously until we find a focus. In the active case witnessing process, we start zooming in on the focus, but here we also remain open, to see if anything peculiar is coming up, so we confirm our focus in the active part. In the next step, which is the active-active part we totally become convergent, focusing only on one point, till we completely understand the entire phenomenon from centre to periphery. In active-active we do not let the patient wander off from the centre; our view is concentrated around that one central point around which the entire story of the patient revolves.

Passive Case Witnessing Process:

It forms the basis of the entire case witnessing process, it is the initial phase of case witnessing, during which we collect all the information about the patient. Without altering the flow of the patient we passively listen to all the individualistic expressions of the patient. During the passive phase the physician is non-judgemental, acting like a spectator, flowing alongside the patient, observing the steps he is taking. Here we make note of all the isolated, fragmented data, all the PQRS symptoms at the local, general and holistic level.

AIMS of the PASSIVE case witnessing process:

The first aim is to pay attention to all the fragmented, isolated, verbal and nonverbal expressions (as it is), that are:

out of place
out of order
out of flow
out of content
out of proportion
out of physician’s and patient’s knowledge

All this data will be initially non-co-ordinated and non-connected; but here we will see that in this there are spurts of “common peculiars” that we observe. These will be the most characteristic expressions of the case and form the important threads of the case which will connect all the beads together into a whole necklace.

The second aim is to find the focus of the patient:

The focus is the entry point to the whole centre of the patient. It is that peculiar expression which consciously or unconsciously comes into the centre in every area that the patient talks about. The expressions can be verbal or nonverbal and will be repeated in more than two different, unrelated areas of the patient.

The third aim is to find out the patient’s Level of Experience (LOE), which is his experience of the inside and outside world at that given moment of time:

– Is the patient just naming his / her problems or describing plain facts about him / her? NAME AND FACT level of experience

– Is the patient just talking about common emotions or common situations? EMOTION level of experience

– Is the patient in touch with the imaginary world or his / her delusions? IMAGINATION / DELUSION level of experience

– Is he actually experiencing the sensation physically and talking about it? SENSATION level of experience

The level of experience at the end of the passive phase will decide how we would frame our questions for the evolving journey. Also knowing the LOE of the patient will help us decide the time that will be taken by the patient to reach the centre. It will decide the potency and probability of the repetition of doses that will be required by the patient.

Active Case Witnessing Process:

Active represents the in between transition period between the passive peculiarities that will form the complete pattern or picture of the source in the active-active. Here the flow is directed inwards, towards the altered pattern to get the whole phenomenon. The isolated individualistic expressions get connected slowly. The surety of the focus is established in this step. In cases when focus is not obtained in the passive process, the focus is first found and then confirmed in the active process.

AIMS of the ACTIVE case witnessing process:

The first aim is to find the focus, if not obtained in the passive process:

Many times the patient is unable to give the focus of the case by himself. Here the physician takes the patient into different areas, yet remaining open ended, he makes note of the common peculiarities observed in these areas to find the focus of the case.

The second aim is to confirm the focus obtained: The focus is confirmed by asking about it actively. When the focus is correct the patient starts connecting the focus with other out of place expressions of the case and also with other general and vital areas of his life.

With the Active process we have a specific aim in mind and do not wander in any direction as we do in the passive phase. It gives us surety about the focus of the patient and determines whether or not the journey is on the right track. During the active step we also observe defences thrown up by the patient, because it is the first time that the centre of the patient has been touched. When we observe such defences, the surety of the focus is doubly confirmed. In a broader perspective, it clears the path for the Active-Active Case witnessing process.

Active-Active Case Witnessing Process:

In this process we zoom in directly, converging to a single focal point, and keep the patient at this point until the entire non-human pattern from the sensation, kingdom, sub-kingdom, miasm, reaction, and source is crystal clear in front of us. All the scattered uncoordinated individualistic expressions of the patient get connected into one single pattern. It takes us completely in the realm of non-sense bringing a deep healing in both the patient and the physician.

AIMS of the ACTIVE-ACTIVE case witnessing process:

The first aim is to take the focus towards the complete altered pattern of the patient: We ask the patient to talk about the focus in as much detail as possible, allowing him to just be in touch with the experience. The more he slips into the process, the clearer the picture will be of the surfacing pattern. Gradually, all the isolated, scattered, verbal, and nonverbal expressions that spilled out during the passive and active case witnessing processes get connected in a single phenomenon. Our case will be complete here when all the PQRS symptoms are connected from centre to periphery.

The second aim of AA CWP is to understand the kingdom and subkingdom:

The Active-Active phase of case witnessing is the right place to think about the kingdom and subkingdom, since the entire nonhuman specific phenomenon will be understood in its entirety here. If we prematurely start analyzing the kingdom and subkingdom in the passive or active process, the journey is sure to take a wrong turn. Here we are also clear with the miasm, and the reaction of the case.

In some cases during this phase we see that the patient reveals the source to us. The entire process becomes so evolving for him, we see the whole altered pattern coinciding with the source. Sometimes the patient identifies with the source itself. But here it is important to be cautious and confirm the source and not mistake just one peculiar image given by the patient as the source.

The third aim is to confirm the similimum; this is done by confirming whether the centre of the patient matches with the description of the remedy in materia medica, or provings, or repertorial rubrics. Are there any peculiar craving, aversion, aggravations, ameliorations which confirm the simillimum for us?

PRACTICAL ILLUSTRATION OF THE CASE WITNESSING PROCESS

(Note: D: Doctor, P: Patient, Italics: Consultants commentary, Bold: Pertinent portions in the case, HG: Hand Gestures)

Preliminary data:

A lean, emaciated 10-year-old girl of dark complexion coming from lower middle class family consulted us on 23^rd July 2012 for PUO (pyrexia of unknown origin and USG s/o of hepatosplenomegaly) since 4 months. Her main complaint was recurrent fever which used to recur every week, with loss of weight; she used to get fever with chills especially in the evening.

ACTIVE WITNESSING PROCESS TO FIND THE FOCUS:

I am scared of ghosts and aliens.
I am scared of insects also.
I got burnt in my childhood at abdomen area.
I was scared to cross the roads.
I can’t go out in night, scared to go alone at night.
I get dreams of ghosts, sometimes I get good dreams, once there came a ghost at our place we were scared and we went and hide and the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.
Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

FOCUS OF THE CASE AT THE END OF ACTIVE CASE WITNESSING PROCESS:

We see that if someone hits then she is hurt; memory of being burnt in childhood still has had an impact on her consciousness; the feeling of being hurt with knife by some bad people and getting hurt when the ghost was shaking his legs. Throughout we see that injury and being hurt is coming up very strongly in her subconscious areas, thus this becomes the focus of our case.

LEVEL OF EXPERIENCE: HER DREAMS AND IMAGINATION ARE VERY PROMINENT SO SHE IS AT LEVEL 4 i.e. DELUSIONS. So she needs 1M POTENCY.

ACTIVE-ACTIVE CASE WITNESSING PROCESS:

He was hitting everyone with his hands.
He was carrying us and throwing us.
Bad people hit us with knife
If I am crossing the railway track and then suddenly train will come then.
I am scared.
Car comes, and my father shouts and says that sees and cross the road so I am scared.
Will get injure and hurt.
Mummy was making the tea and I was sleeping and as I turned the tea felled on my stomach.
If they come near me also then I am scared.
They bite with their teeth.
If I will do mischief then teacher will hit.
If we talk then teacher hit us.
If we write wrong then teacher hits.
If we don’t study and don’t do our home work then teacher hit us.

ESSENCE OF THE CASE:

We see that main thing in this child is about injury, hurt, burns.

Fear that she will be hit with knife, scared of being injured while crossing the roads, fear of being bitten by insects, of being hit by school teacher and memories of being burnt in her childhood. The sensation that comes up clearly in the case is of being injured. And along with this she needs a remedy which also has prominently—dullness, sluggish, slow, with marked action on liver.

WHAT IS SENSATION?

This common point where the body (physical complaints) and the mind (fears, dreams and fantasies) both reflect the same phenomenon is the Vital Sensation. When we see that a specific pattern is running through both the physical symptoms and the mental aspects of a case, we are seeing the Vital Sensation. For example we know that in the remedy Bryonia, at the physical level there is aggravation from least motion, and at the level of mind it has an aversion to being disturbed. A little close attention to these two apparently different aspects allows us to see that aversion to being disturbed and aggravation from the least motion both convey sensitivity to disturbance. The commonality between mind and body shows us that this sensitivity to disturbance is the Vital Sensation of Bryonia. The level of Vital Sensation is beyond mind and body, beyond emotions and situations; it is the meeting point of mind and body.

We see in this case the physical symptoms were very less however the symptoms of subconscious were very clear and prominent.

The commonality of these subconscious areas (fears, dreams, and memories of the past, imaginations) lead to a common phenomenon that is injury, hurt, burnt. So the vital sensation in this case is of being injured, hurt.

Vital Sensation can be classified, at the most basic level, into plant, mineral and animal kingdoms. Each kingdom has its own characteristic kind of sensation.

A Mineral Sensation has to do with structure. The patient feels something lacking in himself, or that he will lose something of himself. Thus a mineral person sees the problem as being within himself – either as a lack, or as a potential loss. For example ‘I may lose my money’ or ‘I may lose my voice’ are typical mineral expressions. Everywhere in a case needing a mineral remedy, the Vital Sensation, the common phenomenon, would be ‘I lack’, or ‘I will lose’.

An Animal Sensation has to do with survival. An animal patient has the issue of ‘me versus you’. The problem is seen as ‘someone is doing something to me’; the problem is personified as someone who is attacking, or who is in competition. For example: ‘the pain is killing me’; or, ‘my mother in law is stronger and I am weaker.’ The entire pattern of his life will be experienced in the form of ‘me versus you’, victim versus aggressor, strong versus weak.

A Plant Sensation has to do with sensitivity. Sensitivity means that things affect him/her. For example,’ my husband’s screaming affects me.’ We see here that the husband is not the problem; rather she is affected by quality or a behavior in her husband. She is sensitive to his screaming and shouting. In the plant kingdom there is a stimulus and a reaction, and this reactivity comes from an underlying sensitivity.

KINGDOM:

We see that this child is very sensitive. She is deeply affected by the ghosts, thieves, teacher or father who might scold her. This point towards plant kingdom

SUB – KINGDOM:

Fear of being hit
Fear of being bitten
Memories of being burnt

This is Compositae or the Arnica family.

MIASM:

The miasm was not very clear in the case. However, what was seen was a very slow dull patient who hardly speaks and has developed a liver pathology. The search was limited to remedies from Compositae family which has the dullness, slowness and the liver as its main sphere of action.

All the remedies in Compositae family were carefully studied.

Arnica, Calendula, Chamomilla, Cina, Taraxacum, Eupatorium perf, Senecio, Abrotanum, Inula, Lappa, Lactuca, Bellis per, Echinacea, Abisthinum , Ambrosia, Artemsia v, Anthemis nobillis, Brachyglottis repens , Carduus benedictus, Carduus marians, Erigeron, Grindelia, Gnaphalium , Millefolium, Tanacetum.[1]

The remedy Carduus marianus covered the essence of the case.

REMEDY PRESCRIBED: Carduus marianus 1M ONE DOSE

References:

Vermeulen

Listless, joyless and forgetful.

CHILLY. “Chilliness is prominent, on awaking; at night;

Intolerance of fats

Influenza when liver is affected

Phatak

Poor appetite. Nausea, retching and VOMITING of green acid fluid, or blood.

Pulford

Suffers greatly from the liver.

Extremely sensitive to cold

Follow ups:

She received just 2 doses of Carduus marianus 1M one dose for the first two months. Since then for the following 3 months she was on placebo.

Last seen on 23^rd November 2012:

There have been no fever episodes except once in September 2012. Since treatment she gained a few kilos of weight, her appetite came back to normal and she started playing and enjoying her life. As far as the mind state is concerned the fears of ghosts and crossing the roads were significantly better. In fact, she loves to cross the roads now. She was much more active and vibrant and full of energy. Physical examination revealed no more abnormal enlargement of liver. She maintains good health to this day.

Comments: In this case the miasm did not stand out very clearly. One should not feel handicapped if the miasm is not clearly evident in a case. One has to see what is characteristic in each case. In this case it was sensitivity to injury, the manner of answering which was very dull sluggish and the affection of liver. Here the sensation method took us to the plant kingdom and the Compositae family. The remedy could not be determined on just the sensation approach; we had to resort to the Materia medica. This is an example of how the sensation approach is a tool to be included, to be used with classical Homoeopathy, and not as an exclusive method for treating patients.

Watch Dr. Dinesh speak about the key to successful case-taking:

https://www.youtube.com/watch?v=PLReucYJHP4

Watch Dr. Dinesh speak about understanding a child’s psychology:

https://www.youtube.com/watch?v=4KgLat8Iw4Y

[1] Ref: VitalQuest software