EXPRESSING A SYSTEM OF PRINCIPLES
ENCOMPASSING NUMEROUS TECHNIQUES
The case taking method taught at The Montreal Institute of Classical Homeopathy (MICH) follows as closely as possible the instructions of Hahnemann, as is shown below. MICH attempts to encompass a therapeutic and diagnostic method, which is unprejudiced, scientific, systematic, reproducible, individualized and faithful to Hahnemann’s instructions.
As we follow Hahnemann’s instructions, we also admit that every case is unique, and requires a unique approach. Fulfilling the requirement of individualized therapeutics brings out the need for more than one system of interpretation, and a broad spectrum of techniques. Individualization requires from us as homeopaths to be inclusive rather than exclusive. As homeopaths, we need to have an open mind and an expansive view of our practices, respecting the clinical findings, clinical results, and techniques of our colleagues. Our understanding of our patients, of ourselves, of disease and of homeopathy should be constantly expanding and evolving. This Method is a work in progress, a starting point for future discussions.
THE MICH METHOD = THE HOMEOPATHIC METHOD = HAHNEMANNIAN METHOD1
The MICH Method is a procedure of inquiry and exploration between a homeopath and a patient, with clearly defined stages whereby the disease picture/ the image/ the totality of symptoms of what is to be cured in a patient is discovered. The goal of the method is to completely individualize the anamnesis, diagnostic, treatment and prognostic. In all stages of the method, there is a process of the unconscious becoming conscious.
THE MICH SYSTEM2
Encompasses all the principles of homeopathy as described by its founder, Hahnemann in the 6th edition of the Organon.
Include every manner of successful techniques developed over the past centuries in homeopathy, as they are understood, organized, and applied, within the framework of the system, which underlies its method. Numerous techniques can be applied according to the situation: acute, children, animals, using Chinese medicine, rubrics, 50 questions, following the chief complaint, unicist, pluralist, drainage, etc.
CHARACTERISTICS OF THE MICH METHOD
The MICH Method IS:
1 Scientific and Systematic
The Method operates within
- Proven and precise guidelines of procedure and goals.
- Clearly defined stages.
- Clearly identifiable levels.
- A step-by-step process: each step going deeper.
- Clearly defined process. Example: It is clear why a certain question is being asked at a particular time.
- Every homeopath comes to the same understanding of the individual.
- Other homeopaths taking same case come to the same understanding of center of case.
- They would ask the same question or fully understand why a question was asked.
- They would agree on the best fitting Similimum.
- If treatment is to be individualized, the whole method, including the case taking, has to be individualized.
- The approach and techniques, language, attitude, pace and depth are adapted to the patient. The method is “patient centric”. The patient determines the approach.
- When case taking is dictated by the patient, the similimum is provided by the process.
- The process itself becomes a similimum of the patient; the case taking itself is healing.
- Techniques used within the method can change over time for one person, the level of experience of that patient can change, and therefore the approach needs to change as well.
4 Integrative, Global, and Holistic
- The Method involves taking the case as a whole not in parts.
- The patient is understood as a whole, including his/her disease as a movement within that whole.
- The process is neither analytical nor synthetic, it is integrative and whole.
- The case taking and treatment are global not local.
- The patient is regarded as a single expression of the whole of humanity, a reflection of humanity.
- Treating the patient IS treating humanity.
- The homeopath is an integral part of the process.
- The primary goal of the process is to discover what needs to be cured in the patient: the state at the core of the disturbance.
- Once the primary goal has been achieved, the next goal is to match this core with what is clearly perceived as the core, and thus curative in each particular medicine (understanding the core of each remedy).
- The process itself is a similimum of the patient; the case taking process itself is healing.
- The method is therapeutic for both the patient and the homeopath.
- Diagnostic involves both the patient and the homeopath.
- It is not externally observable.
- It is unique for every patient.
- When case taking is dictated by the patient, the similimum is provided by the process.
- Prognosis is predictable: based on the patient’s experience.
- Every case is regarded as unique, every process is unique, every individual is unique, and therefore is completely unknown and uncharted.
- There are no pre-conceived notions of how the process needs to unfold or of its outcome.
- While working towards the primary goal of determining what needs to be cured in a patient, no theories, maps, systems, categories or classifications can come in the way of that process.
- There is no judgment of anything the patient thinks, does, or says (from both homeopath and patient.)
- The Method requires that no thought process is occurring on the part of the homeopath during the first stage of the primary goal.
- The homeopath must be completely free of prejudice (cannot be in a thought-dominated state) in order to induce a similar unprejudiced state in the patient.
- The process is like a spontaneous alchemical reaction, both the patient and the homeopath rise to another level of consciousness.
- If the process is shaped by the patient, there is a smooth flow, case taking goes to a healing level.
9 Faithful to Hahnemann’s instructions
- Aphorism 3: Clearly realize what is to be cured in each single case of disease.
- Aphorism 82: No genuine cure can take place without the strict individualized treatment of each case of disease.
- Aphorism 83: The individualizing examination of a disease case demands nothing from the medical art practitioner except freedom from bias, healthy senses, attention while observing, and fidelity in recording the image of the disease.
- Aphorism 84: …The physician sees, hears, and notices …what is altered, unusual …he writes everything down with the very same expressions used by the patient…The physician keeps silent, allowing them to say all they have to say without interruption.
- Aphorism 86: When the narrator has finished what he wanted to say of his own accord, the physician enters a closer determination… Aphorism 87 : without ever asking a question that would put words into the patient’s mouth or that would be answerable with a simple yes or no.
- Aphorism 88: If nothing has been mentioned in these voluntary statements about several parts, or of the patient’s emotional mood, the physician should then ask about…
- Aphorism 89: only after the patient has finished freely relating the pertinent information upon simply being invited to do so, and upon being prompted with general questions, thereby proving a fairly complete image of the disease, is it allowable and indeed necessary for the physician to ask more precise and specific questions if he feels he has not yet been fully informed.
- Most importantly, the MICH Method fully embraces and provides the procedure and techniques required to fulfill the criteria of the disease picture as required by Hahnemann. Aphorism 104: Once the totality of the symptoms that principally determine and distinguish the disease case – in other words, the image of any kind of disease- has been exactly recorded, the most difficult work is done. During the treatment (especially of a chronic disease) the medical art practitioner then has the total disease image always before him.
- The definition of the totality of symptoms is found in Aphorism 7: The totality of symptoms is the outwardly reflected image of the inner wesen of the disease, that is, of the suffering of the life force. The totality of symptoms must be the principal or the only thing whereby the disease can make discernible what remedy it requires, the only thing that can determine the choice of the most suitable helping means. Thus, in a word, the totality of symptoms must be the most important and indeed the only thing in every case of disease that the medical art practitioner has to discern and clear away, by means of his art so that the disease shall be cured and transformed into health.
- The totality of symptoms as the outwardly reflected image can be observed at different levels – wesen, essence, condition, state and appearance. The image is reflected in the 7 LEVELS of the patient’s experience.
STAGE 1 PURE WITNESSING
This is the most important stage, as it lays the foundation for the rest of the case taking. This first stage involves passive case witnessing. The homeopath listens without interrupting, questioning, directing, or altering the flow (Aphorisms 84, 86, 89). The homeopath is just allowing the natural unfolding to happen. This forms a base of essential elements of what is to be cured in the patient, created by the patient without interruption. These elements can be further explored in the later stages.
Allowing the patient to say whatever he wants to say without interference allows for a faithful image of his disease picture to emerge, and provides direction for the next stages.
In summary, the goals of Stage 1 is to discover what is:
- Important for the patient
- The center of the case, or at least what seems to be a focus
- The technique(s) to be used in further stages
- The questions that must be asked and in what way
The physical symptoms of disease are created on the limbic-neuro-endocrine level, which is out of reach of the conscious process of the neo-cortex. In this first stage, as in all stages of the MICH method, there is a process of the unconscious becoming conscious. Ideally, through self-inquiry the patient will slowly become conscious of the dynamic which underlies his or her physical symptoms. This process is encouraged throughout the 3 stages of the process, and is central to the method.
The underlying, unconscious disease dynamic is non-rational, instinctive, and, by definition, disturbing. The disease dynamic arises directly from the central disturbance of the vital force. Thus, by following disturbing, non-rational elements, the patient can follow the breadcrumb trail towards the central vital disturbance, and describe it. The role of the homeopath is to quietly identify and note what might be possible breadcrumbs as the patient speaks.
THINGS TO IDENTIFY WHILE LISTENING ATTENTIVELY WITHOUT INTERRUPTION
1. “WHAT STICKS OUT” During the patient’s description, it makes sense that the homeopath notes both the verbal and non-verbal elements that are not flowing with the rest: “what sticks out.” (Aphorism 153…the more striking, exceptional, unusual and odd (characteristic) signs and symptoms of the disease case are to be especially and almost solely kept in view.)
The most useful and well-tested case taking indications and tools to be found in modern day homeopathy come to us from the extensive clinical research done by Dr. Rajan Sankaran, and the group of well known of medical homeopaths in Mumbai who formed the Homoeopathic Research and Charities. Below are excerpts from the book “The Sensation Refined” (Mumbai: Homeopathic Medical Publishers, 2007) by Dr. Rajan Sankaran. Every homeopath should read this book. It outlines and defines how to elicit, and how to identify, the dynamic level as expressed by the patient. It is the patient’s expression of the dynamic level that must be matched to the closest simillimum in order for the homeopathic remedy to act most effectively as a dynamic medicine.
“Indicator words for what sticks out” MNO & PQRS
M = Movement (speed, direction, force, sound, gesture) in HG & all levels
N = Non human specific (common between man and nature, global, not local) esp. when they lead into a NHS realm.
O = Obdurate: persistent, holds throughout the questioning – does not change into something else or goes back to a previous description or word.
P = Picturised: creates an image, metaphor. Visualization indicates delusion, sensation. It usually bridges to a new level.
Q = Queer: A word that is used out of context, that doesn’t make sense within the context used.
R = Repeated: Same theme, same word, comes up in different contexts, levels, or situations.
S = Synonym or antonym of a previously mentioned word. A word used on its own often has no significance.
2. “THEMES” The vital force is at the root of the whole individual, therefore, a disturbance in the vital force will be reflected in all areas of an individual’s life. Thus, the homeopath pays attention to themes that come out in different areas of the patient’s life to find the point of confluence between them, or the focus. These can be areas which are not related to each other, or, different times of the patient’s life. Theme indicator words are defined by one of the 7 R’s:
“Indicators of themes” 7R’s
Root It feels basic and strongly related to the source or origin of disturbance.
Representative It is a symbolic metaphor of the core experience.
Repeated It occurs in the same way or form (e.g. in different parts)
Replicated It has very similar sensations/feelings in different contexts.
Retained It is a theme that is not dropped or altered during the process.
Refined The client will be trying to accurately describe it, make it precise and pure.
Related There will be many words to describe the sensation but they will belong to the same family, type or group of feelings/experiences, etc.
3. “ENERGY OBSERVATIONS” Because the central disturbance is a dynamic, energetic disturbance, it peeks through ordinary conversation in the form of hand gestures, movements of any part or the whole body, restlessness, change of position, body language, facial expression, eyes, direction of focus, intensity of focus, tears. If used judiciously and in a timely manner, these observations can open doors to the unconscious and provide confirmation of the focus of the underlying unconscious dynamic.
For example: “Hand Gestures”
Is the HG congruent to and illustrative of what the patient is saying? (The less congruent the hand gesture, the greater the distance between conscious and unconscious.)
- When the gesture is congruent, it is appropriate to ask about the HG.
- Is the HG showing exactly what the person is saying? Are the words and gestures congruent to each other?
4. “LEVEL OF EXPERIENCE” In order to guide the patient further in stages 2 and 3, the homeopath must resonate with the patient. The homeopath must follow the patient and be at the very same depth as the patient, so that they go to the next level together. Thus, the homeopath must be aware of the level of experience in any given moment, and be able to see if the same level is present in two or three different areas. This information will help the homeopath formulate his/her questions in a way that will encourage further and deeper exploration of the unconscious without confusing the patient. There are specific questions for each level, which will be illustrated in a separate document.
Some examples of questions tailored to the level of experience of the patient.
- Emotional: What is the feeling when …?
- Delusion: What is your perception of the event …?
- Sensation: What is the experience?
5. “NARRATING STYLE”: Again, by adopting the patient’s narrating style, the homeopath creates resonance with the patient which facilitates the process of uncovering the unconscious patterns. Examples of styles are: Projection, Denial, Avoidance, Intellectualization, or Rationalizing, and the “MIASM” as the patient’s coping mechanism and reaction to the core issue.
Questions must be tailored according to the narrating style of the patient. Techniques adapted and centered to the individual. For someone who uses denial language, you would ask the questions in the negative. Example “What faults don’t you have?” “What things would you never do?” “What kind of dreams don’t you have?”
Use the miasm for case taking purposes: if you can identify the coping mechanism, then you can make the process homeopathic and individual-specific.
6. “DIMENSION” As the goal is to move through unconscious levels to reach the vital dimension, the homeopath must observe the language of the patient, to discover the dimension that is most predominant, as well as the depth of dimension that the patient reaches on his/her own, so that the patient can be guided to the next dimension in Stage Two. Local descriptions constitute the first dimension, more general statements, the second, “I” statements which refer to the individual as a whole are third dimension or global, and the fourth, vital dimension brings sensation and energy into the description.
- Global, “other dimension” experience (I experience a feeling, sensation etc of…)
- General, global (I feel, I am …)
- Local (my pain, my leg, my stomach…)
TYPES OF QUESTIONS WHICH ARE PERMITTED IN STAGE ONE
What can be said to the patient to keep the flow going?
- Keep talking.
- A bit more about you.
- Whatever comes naturally to you right now – doesn’t need to be anything specific.
- My goal is to understand you.
- If anything comes to you – just say it.
- If your brain is making connections just go with them.
- Say anything that comes to mind.
- Tell me more, continue…please elaborate.
- Keep going deeper.
- Go deeply into yourself.
- Explore the core of what you just said.
At the end of Stage 1, themes have begun to form in different areas of the patient’s life.