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Achieving Freedom from Prejudice - The Unprejudiced Observer-- Dr. N.L. Tiwari, MD (Hom) |
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| The concept of unprejudiced behavior is a cornerstone of homeopathic practice as stated by Dr. Samuel Hahnemann in the Organon of Medicine (Aph:6). He rightly identifies the central problem of perceiving in homeopathic practice as that of prejudice. “this … demands of the physician nothing but freedom from prejudice … in tracing the picture of disease”. (Aph: 83) As a homeopath and a teacher of homeopathy functioning in various roles, I have always experienced an urgent need to understand clearly what prejudice is. The selection of this topic for my dissertation has given me a much needed opportunity to explore my learning in this area. What is prejudice? What is its link to perceiving? How is perceiving linked to perception? Are perceptual niceties and difficulties linked in any way with niceties and difficulties of perceiving? We will explore this at the outset.
Perception and Perceiving The link between perception and perceiving, we can say, is observation. Let us observe the two pictures below and see what is revealed. Picture 1
What do you see in Picture 1? If we carefully observe it, we can see horses camouflaged in the background. There are 5 such horses that can be seen distinctly. All one needs is careful observation so that the details may not be missed, as the images may be inseparable from their background. With partial observation, one may miss the 4th or the 5th horse. Picture 2 should now be easier to observe and comment upon. Picture 2
What do you see now in Picture 2? Many people beautifully describe the picture as a romantic couple standing on the seashore near a weird shaped tree, probably very old. The couple is watching the sunset and admiring the mountains on the horizon. My son asked me whether I could see an infant in it. I searched but could not find it. Even the small stone lying near the couple was not it. My wife standing next to me could see the infant in no time, but it took me 24 hours to see the infant in the picture. Can we not see, like the picture hidden in the picture, a meaning hidden behind the surface in the complaints of the patient? Or can we not see, like in the picture, the story of the Observer unfolding behind the evaluation of the patient? Prejudice and Its nature Now that I am in the sixth decade of life, I have taken this opportunity to revisit the areas in Life and Living (1981) to understand the deeper meanings of the unprejudiced observer in general and homeopathy in particular. More often than not, what we call our beliefs and our knowledge are our prejudices, and we are not even aware of this fact, let alone being able to overcome them. Prejudice is not at the conscious level but subconscious and still deeper into the unconscious and its recognition becomes the first step in overcoming it. The Practical Meaning of “Unprejudiced” Sometimes one can say with affirmation that one is aware of one’s prejudices. One knows of other people who are this aware, and they take care that it does not affect their functioning in any area of life – family, work or social life. When this state is achieved, then the person can be said to be free from prejudice, i.e. unprejudiced. This can be understood as the practical, working definition of the unprejudiced observer – different than given in books, and is the most stable position to achieve. The key to this achievement is our ability to observe. We learn to observe – others first and then ourselves. Finding our way through the errors of mal-observation and non-observation we gradually learn to be objective in our assessment so that we perceive the patient truly and well. This is taken up further through the cases. Prejudice and State of Health While living our life, we are constantly faced with questions like: Who am I? What am I doing? Why am I doing what I’m doing? Am I evolving or am I stagnant? Am I enjoying health, happiness, harmony and peace? Or am I dissatisfied, unhappy, having ill health? Having examined both the states in my life, I have understood the cost of health. I have understood how a prejudiced (faulty) lifestyle results in production of disease. This teaches us the deeper impact of prejudice on ourselves. Therefore I felt the need to explore this subject in detail and present a way by which it can be dealt with and hence reduce its ill effects. Dr. ML Dhawale The late Dr. ML Dhawale from 1968 onwards was actively involved in translating the concepts of homeopathic philosophy into practice. After a thorough study of the Organon, he concluded that Hahnemann had given all the directives regarding education and training in the first six aphorisms of the Organon, as follows: Aim of education and training – Aphorism 1,2 Curriculum of education and training – Aphorism 3,4 Methods and Techniques – Aphorism 5,6 Passing through this process helps him to understand the meaning of prejudice, recognition of prejudice and freedom from prejudice. The learner evolves the professional competence to meet the demand of homeopathic practice. Group discussion makes the learner aware of his prejudices and he deals with them through the different roles, like an observer in the clinical session and then through the sharing of experience in the role of guide, supervisor and evaluator in the group session. Learn, analyze and evaluate self and others, and in the process know thy self and heal thyself. Life and Living (Dhawale, 1981): He made clear the demands of homeopathic practice. “Life and Living” was his favorite book, a creative one, which has brought the sensitive artist which got reflected in poems expressing pain, conflicts, suffering and pathos. Perceiving 1 (Dhawale, 2000): Portrait of Disease: How to perceive totality – what, where, how to perceive. Pg. 16. Enter and evaluate the people in the homeopathic Materia Medica. We need to heal ourselves first, make ourselves whole through efficient resolution of our problems, before we can ever hope to help others. Hahnemann directs : Follow my methods and report your failures. It is imperative that the healer is healed first, is rendered whole, before he embarks on the task of healing. Physician! Know thyself for what you are. Claim not what you are not. Worship the patient for the courage he displays in placing his most precious possession, his life, in your hands. Work is worship: it confers health All education and training begins with perceiving. We come face to face with ourselves: we get frightened of the monster we have seen and tend to run away! We find the monster traveling with us! We recognize him, finally. It takes us long to settle our scores with him. Till then, we are locked in a long-drawn-out battle. All education and training ends when we have learned well the art of perceiving without prejudice: we become the master observer. Conclusion: All the master homeopaths are agreed on the importance of the physician being an unprejudiced observer of the patient in his circumstance, so that he can give the appropriate treatment. However it was left to Dr. Dhawale to work out a program for the training of the observer. Below are two of the methods he developed for evolving ‘unprejudiced’ homeopathic physicians. Each is highlighted by a background case A) Training of the Observer B) Group discussion A) Training of the Observer: Diagnoses of prejudice and acquiring freedom from it I was fortunate enough to work with the late Dr. ML Dhawale as a clinical assistant or as an observer, as he called it. I would attend the interviews that he or one of the other assistants conducted and later we would have a discussion on the same. Case: The following case is an example of my experiences as an observer taken by one of my colleagues. An excerpt of the interview is presented. The patient was an MBBS doctor age 25 years. Fair looking, red lips, brown hair, a smartly dressed and successful practitioner well known in that area. He suffered from bronchial asthma for the last 2 years. Before we asked him any questions he told us, “Doctor, ask me anything else, but do not ask me anything about love affairs. I have been to so many different homeopaths who have asked me, “Did you have disappointment in love?” Below is an excerpt of the conversation that followed
The physician remained fixed to his point. As an observer, I remained silent, just listening and recording the transaction. Conclusion: The physician was my good friend and I knew that he had a love affair that resulted in disappointment and it took a long time for him to be able to overcome that experience. This case taught me how personal unresolved experiences result in prejudiced thinking that could affect our perception and observation. It taught me how one could become a slave to one’s experience. The totality formed by the physician was: A/F disappointment in love Intolerant of Contradiction Obstinate Asthma The remedy chosen was Natrum Sulph. There was no relief after six months and the patient changed his physician. But my friend remained fixed to his idea and concept of psychosomatic illness. The patient was asked to fill out the history form and submit it again. His case was re-defined and the constitutional was instead found to be Calcarea Flour and the acute, Kali Bichromicum. B) Case 2: Learning through Group Discussion Method Analysis and evaluation of the performance of the observer, guide and supervisor involved in case taking, has the by-product of knowing one’s prejudices. This repeated exercise helps to evolve faculties of analysis, synthesis, integration and creativity. The group discussion method is a large topic to discuss, but here I will discuss the basic information and explain it through action during a clinical case. Learning and change: Learning is directed towards effective action, it demands of the learner a readiness to change. Change is a painful process under the best of conditions. Therefore we need to minimize resistance to change, if learning is to reach a take off stage. An individual through the influence of his early personal and social experience evolves a value system that guides his perception of events and reaction to them. Group learning demands: 1. Spirit of enquiry 2. Willingness to collaborate with fellow members 3. Integrity in his dealing with himself and others 4. A perception of the role of authority that is untrained by his past experience 5. Concomitant to truth and hence to the process of learning 6. Sensitivity training and resolution over a wide range to enable the evolution of the capacity to perceive reality in its full dimensions, subjective as well as objective. 7. Ability to generalize, conceptualize, and think along logical lines working from an adequately built database. 8. A will to develop all these capacities and put them into action in a situation that may differ significantly from one in which they are developed. Case: Mr. R.I. average built South Indian person was coming for his daughter’s treatment since June 2001. He was more restless than his wife whenever their daughter fell ill. He is concerned for her health more than his wife is. During that visit, he enquired about the scope of homeopathy for Diabetes Mellitus. Then one day the wife came along with the daughter for follow up. Interaction with wife: Wife told the physician that her husband is suffering from sugar problem. The report is at upper borderline, but his father was suffering from diabetes so she was a bit worried. The physician asked her if there were any stresses recently. Wife replied that he is on antipsychotic drugs since lat 7-8 months for his depression. Physician: what is the problem? Wife: He is very irritable, when talking in every bad language. Sometimes he is absolutely silent. If asked about something, he would shout or throw things. Then, in 2-3 days his condition worsened. H was shouting at his subordinates telling than that he is the boss. He also shouted at one of his colleagues who shares the same post with him. Physician: Are there any stresses at home or at work? Wife: He used to tell me he gets nervous whenever a fault comes, also feels that he cannot work that efficiently as his co-worker. He also avoids facing his boss. It will be obvious from his face that it was a bad day for him. Physician: Does he share these issues with you? Wife: Initially he used to but I felt that it was all so small matters that it is common to all working people. So I tell him that it happen to all and he is not the only person. Physician: Can you tell me his liking and disliking in general? Wife: (after a brief pause, with a smile on face) Doctor, really speaking I have never focused myself on that line. Physician also smiled and handed the history form with an appointment for the next week, and asked the wide to write down her own comments about the patient. They came after 2 months with a written history. On inquiry, the patient said that he does not want to recall the past. He chose to write the history form in this manner peculiar to him:
Notes of Learner 1: Really very interesting case material was made available by the physician and the observer. After a long time, I myself was involved thoroughly in the session and found the group very enthusiastically involved – reminding me again of my initial sessions at Girgaon. The discussion has been so wonderful that even at 11.45 pm there is energy to write a session report. Discussion and clinical sessions at the institute are our most important strengths. From the beginning, group members resonated at various levels with the patient, encountered at various junctures during the interview. The supervisor importantly maintained discipline throughout the session. The husband-wife concept, father-son relationship, love concept were highlighted. Group members came out with various own concepts which were interesting. The supervisor was in full flow with ‘life and living’ concepts with the co-supervisor playing different roles and taking different stands. The conduct of the interview and physician’s stability and clarity of concepts made the case click. So ultimately it is the physician that makes a case or spoils it. All group members were active. Notes of Learner 2: An interesting interview by the presenting team about the husband-wife relationship and the role of a marriage counselor: A history which indicated ‘n’ number of openings and questions really made me anxious anticipating a whirlpool of information from the patient, taking the physician round and round (as voiced by learner 3) ultimately leading to total chaos; how to manage such a situation efficiently while trying to get a totality? The beautiful interview showed how, with the minimum number of questions, without ever cutting short the patient, it is possible to get an assessment of the totality. The supervisor was today’s hero. He started the session very efficiently without letting the group wander off. And knowing the various roles consciously played by us from time to time while interacting in a clinical session and also in one’s own life. After many ears today was a session where almost all the group members were involved immensely and participated whole heartedly. Notes of Learner 3: A good experience shows importance of the observer. There were many twists and turns in the interview. So it was good enough to show that how our prejudices develop and they are dangerous in the interview the interview technique was something to learn. Group members did not stress on the clinical diagnosis and went on to the presentation. Physician also channels his life experience. A good experience: it showed how difficult it is to counsel and how physician should keep himself balanced which is necessary. Notes of Guide: Session started at 5 pm. I was tensed for presenting in the new group. But co-supervisor was starting the case and every group member was participating freely. Supervisor led the group and he has helped me a lot to understand my own world; how to separate our own world from the world of the patient. His concept of ‘life and living’ is just marvelous. This is a different experience from the earlier group as that group was a new one while here members were quite matures to participate freely and it’s a lot of learning to me, thanks to the supervisor and co supervisor. A long pending case has finally taken its round. My expectation from the group has been fulfilled as a guide as a good amount of analysis has been done. Specific location of the physician was important as it was for the first time in the group. My own conflict had given color to the case. In return I was able to stabilize on myself in my relation with family. Concepts of man, love marriage, power of the physician are discussed and highlighted efficiently. Supervisor and co-supervisors help had given the case a meaningful experience to me and the observer. In fact my approach to life and changed since the session. All group members were actively participating. Resonance was available in the group. Time was constrained but still it was a fruitful session. Depth of understanding is going more and deeper. “If one believes in oneself, one can do anything”. Observers’ sharing of the experience was appreciable. Self was open to the group. Conclusion: Here we see how individual learning was guided by a supervisor. Each person was touched at their points of conflict and understanding. They were able to face their issues and work at them when they were made aware of them through the group discussion. This is an important aspect of sensitivity training required of every homeopath to become less ‘prejudiced’ and function more efficiently with the patient. It requires, however an openness and willingness to change, but within an environment of mutual trust where the supervisors have the learners and groups best interests in mind. There is a commitment from all participants to the truth and to the process of learning. (This article is an extract from a Dissertation on the same subject by the author.) References: Dhawale, ML (1981); Life and living; Institute of Clinical research, Mumbai ICR Symposium Volumes (2003), Papers H1,H4, H5, H6 Hahnemanian Totality Dhawale ML (2000); Perceiving 1; 2nd Ed; Mumbai: institute of Clinical research Dhawale ML (2003); ICR Operational Manual; 2nd Ed; ML Dhawale Trust, Mumbai -------------------------------------------------- Dr. N.L. Tiwari, MD (Hom) Director, Rural Health Services |
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