(Edited by Linda Nurra –PhD)
“Listen to the patient; they are telling you the diagnosis” is a much-quoted aphorism. Keen observation, careful listening and skillful probing play a key role in understanding the patient’s diagnosis. That said, in homeopathy what exactly is a diagnosis? Does it refer to the medical terminology for a pathological condition – for example, “herpes zoster” or “shingles”? No. In homeopathy the patient’s “diagnosis” is the remedy. The homeopathic diagnosis refers to the complaints affecting the patient’s routine, which are his or her main concern. This brings to light the patient’s adaptation to the problem or the manifestation of the deranged vital principle. This knowledge helps us to identify the patient with a remedy in the materia medica and arrive at the simillimum, all thanks to the patient’s words. The history of the ailments helps us get to the core of the disturbed harmony. We can then expect immediate relief from the present predominating and persistent symptoms revealed during case taking.
Additionally, case taking involves understanding the patient in relation to his environment. A natural, free-flowing and spontaneous conversation between the homeopath and the patient in his or her individual pattern, reveals the patient’s unique adaptation to stress perceived in the environment. The continuous, uninterrupted flow of case taking also uncovers the patient’s subconscious state. The patient’s symptoms, feelings and reactions during a state of discomfort or disease emerge in their words, tone and gestures.
In the following three cases, we can see these principles at work to uncover variations on the theme of celibacy in relation to a common remedy.
A 33-year-old lady visited me with her mother-in-law (MIL). She was dressed in jeans and a snug, form-fitting T-shirt with bold print on it that read “I am not being rude. You are just insignificant”. She sat with an erect posture, exuding an air of superiority and authority!
Patient: I have just begun the ninth month of my pregnancy. Of late, my body starts to swell up. This swelling is variable. It increases at times and, at times, there is no swelling at all. My blood pressure has also shot up in the last couple of months. I experience frequent dizzy spells. My gynaecologist suggested that I be on bed rest the entire month to avoid any complications, such as preeclampsia, etc.
Homeopath: Yes, you should be getting good rest now, as suggested by your gynaecologist. What brings you here to me today?
Patient: Doctor, I am scared to take allopathic medicines during pregnancy. I feel that it can be harmful for my kid.
Homeopath: But the gynaecologist will only put you on medications which are perfectly safe to be consumed during pregnancy.
Patient’s MIL: Doctor, she is a very famous gynaecologist here in the city. We know her well but my daughter-in-law is basically scared to take any allopathic drugs.
Homeopath: Why so?
Patient: I know that these allopathic drugs do carry certain side effects. I want to stay away from them. I do not even give any such meds to my son. Moreover, I cannot put my unborn baby at risk.
Homeopath: What causes the dizzy spells? Are they related to food or any sort of stress?
Patient’s MIL: No, doctor, she is very careful with regard to her food habits. Her problem is that she takes a lot of stress.
Homeopath: What kind of stress?[Upon hearing this question, the mother-in-law started crying.]
Patient: My husband passed away when I was just one-month pregnant with this second child! A vehicle suddenly hit him while he was travelling and it all happened so unexpectedly as a terrible accident. My fate was bad. I lost him. My world shattered with this news. He was everything for me. Now, I often worry how I should manage myself and my kids.
Patient’s MIL: Doctor, we always support her and make her understand that no matter what, we are always with her, but yet she keeps worrying. She is constantly thinking about something or other all the time.
Homeopath: I believe that you should try to come out of this pain by helping yourself to relax.[The patient did not respond at all to this, as if she did not hear what I just said!]
Homeopath: Why don’t you try watching some movies or hang out with some friends of yours. It is very important for you to be stress-free for now. You have already stepped into your last trimester! You are about to deliver in just a couple of weeks!
Patient: I fear going out. What if I land up with seizures during labour just like my sister did? Moreover, I do not like spending time with my friends anymore.
Patient’s MIL: Doctor, she hardly steps out of the house these days. In fact, she fears going out especially during the evening hours or after dark. Any sad scene or news on TV makes her terribly scared so we do not even allow her to watch any TV now.
Homeopath: In most South Indian families, the woman goes to her mother’s house for delivery. Why don’t you go visit your parents now? That would be a great change for you.
Patient’s MIL: Yes, we all did ask her to do so; in fact we even forced her to go, but then she becomes all the more worried and anxious if we tell her that. Her mother stays close to us, but she just does not want to be with them.
Homeopath: How is your sexual desire?
Patient: Yes, I do miss my husband a lot. He loved and pampered me a lot! My first pregnancy was the best phase of my life; he showered me with surprises and gifts every now and then! He did everything to ensure the safety, well-being and healthy growth of our first child.
Patient’s MIL: Doctor, just help her get rid of the tension that she always carries with herself. Destiny is not in our hands. We cannot change it, but at least we can help each other during this crisis. Her nervousness makes me and my husband all the more sad and worried. She spends the entire day only thinking about the past.
Homeopath: You are blessed with such loving and caring in-laws. You have a great support system. What is it that makes you so nervous?
Patient: I don’t know! I just cannot sleep at night due to these thoughts.
Patient’s MIL: She is a very caring daughter. She does a lot for all of us and it’s really painful for us to see her moving around the house all through the night and not being able to sleep. She gets angry at me if I sit up at night only to accompany her.
Patient: I do not need any company doctor. How can I sleep? My whole life has turned upside down. I feel so devastated. I just cannot imagine a life without my husband around. How can I live without him? I can do nothing without him.[At this point, the patient broke down and wept bitterly.]
Analysis and Evaluation of the Case
Careful listening and skillful intervention helped this woman to express her disposition and her mental state. According to aphorism 211 in the Organon, the patient’s disposition often determines the selection of the simillimum. This refers chiefly to the mental state. Master Kent also stated that a single mental general can supersedes all physical generals. The man in disease, while narrating the mental state, is best perceived through his adaptation, which in turn is best understood through mental generals. The woman in the case above spoke about her own individual pattern of adaptation to the deviation caused by the stress of her beloved’s death. The PQRS mental generals were evident so further probing into physicals was not required.
Let us go step by step and analyse this patient.
The woman is not bothered about her diagnosis during the case taking. She is only talking about her concerns. That is her problem which needs to be addressed.
She came in and sat as if showing off a feeling of superiority. The manner in which she sat in front of me gave me a feeling of her arrogance. The subconscious mind constantly communicates through the medium of gestures, facial expressions and postures. Observing these helps to elicit the state of the patient’s subconscious mind. The body adapts to the inner subconscious state of haughtiness in the form of eye rolling, smirking and walking with the nose held high. The patient gave the impression of having a satisfied sense of attachment towards herself, a fulfilled feeling of belonging, an independent self-reflection and self-praise. As an inwardly directed emotion, her haughtiness was subtle although evident.
The bold print on the snug T-shirt she wore while she visited me in the clinic indicated the rubric
- HAUGHTY, clothes
Her tone was loud. The chemistry between her mother-in-law and her indicated to me that the decision-making power is all hers and not her mother-in-law’s. I had the impression that she does not allow anyone else to question her decisions. She pretended to be her mother-in-law’s friend only to get her way. The mother-in-law seems to be more submissive and caring.
Her husband’s sudden, unexpected death has left her in a total state of shock. This loss has traumatized her and emotionally and physically drained her. She still has very loving memories of the days spent with her husband, especially during her first pregnancy. All her glorious and happy days are no more. Her life was turned upside down. She is still grieving this loss and has not been able to cope up with it. Her world was suddenly destroyed by an accident.