Clinical Cases

Voluntary Detail – Its Meaning and Importance

The authors stress the importance of information offered spontaneously by the patient while you are “case receiving.”

Illustrated with a Case

If one follows every directive that Dr. Hahnemann expresses in the Organon, it will be clear that his emphasis is on voluntary detail (§ 84 to § 104). In § 84 Hahnemann says: ‘The patient details the history of his suffering; those about him tell what they have heard him complain of, how he has behaved and what they have noticed in him; the physician sees, hears, and remarks by his other senses what there is of an altered or unusual character about him. He writes down accurately all that the patient and his friends have told him in the very expressions used by them. Keeping silence himself, he allows them to say all that they have to say and refrains from interrupting them …’

(To mark our emphasis, we have made the appropriate words and sentences in bold and italics.)

This aphorism is an epitome in the annals of communication and language. If we understand this aphorism, most of our work, as to our perception and later our prescription will be solved.

By ‘the patient details the history of his suffering’ and ‘those about him tell what they have heard him complain of’ … our Master is guiding us to pay attention to the way a patient expresses himself, as well as to what the relatives and friends have to express about the patient. These words pertain to the voluntary details that he wants to emphasise.

Language is the dress of thought; a person’s individuality is expressed through the language he use,s and through it we reach to the innermost essence of where the individual is stuck … where his ‘state’ is stuck.

We would like to illustrate this through a case.

Illustrative case No. 1

This is the case of a man; age 49 years, who came to see us in the year 1990.

Observation: He is of average height and stocky. He is very frank, talks without hesitation and is very friendly and very social. He is a very confident, courageous, daring and bold person. He would not hesitate to do anything that he felt was right.

After a very traumatic incident that occurred four or five years ago he developed severe osteoarthritis (OA) of the knee joint … first the left then right. The incident was that his eldest daughter ran away with a Muslim boy when she was 18 years old. This made him very angry, especially because he hated Muslims. He said he had a ‘generational’ hatred towards Muslims and he hated them right from his birth. (He didn’t know why though!). After a lot of strenuous effort he got his daughter back, but she insisted on going back to the Muslim boy. He then talked to her as a friend and gave her the choice to do as she wished and she decided to stay with him i.e. with her father. But one day she ran away with the same boy! This affected him very much. With the help of the police he got her back again, but she signed a paper saying that she didn’t want to have any relations with her parents and that they were dead for her! He developed complete hatred for his daughter and to this day refuses to have her back, in spite of the known fact that she is now being tormented and tortured by her husband and her in-laws. His daughter is made to stay alone with her one-year-old child and has had to take on a small job to sustain herself. He says, ‘Now she is dead for me. Just listening to her name, I feel as if my body is on fire … so angry I feel.’

He is very industrious and has come up after doing a lot of hard work. After the partition of India he and his family lived in a joint family. At that time he was married but had no children. He used to give fruit, chocolates and biscuits to his elder brother’s children. One day the elder brother taunted him, “You are wasting money”. He felt very bad about this, as he was not doing this for his children. At that very moment he decided to separate from his family and started to look for his own home. At that time in his life he was literally out on the streets. His brother promised him a loan, but at the last minute backed out, which made him feel very bad. Still somehow he managed and now when his brother asks for money, he gives it to him to show him that – ‘See, you wouldn’t help, but I will help you’.

Previously he was very religious. Every morning and evening he would go to the temple, do social service and observe a fast on Monday. (It is Lord Shiva’s day). One day, he said, a distant relative from whom he had borrowed Rs. 15,000/- came at 11 p.m. to the temple where he had gone to say prayers and offer service, and asked him to return the money immediately. He said, “Where will I get so much money at this time of the night?”, but the relative wouldn’t listen. So he went home, took his wife’s jewellery and got the money by mortgaging it, which he then gave to the relative. He felt very angry, went home and asked his wife to prepare food for him, as he was going to break the fast there and then. He felt, “I do so much for God and see what he does to me”. He stopped going to the temple and has never observed a fast since.

He told us about another incident. His elder brother with whom he is not on good terms had arranged a party. They were invited by his elder brother’s daughter who told the patient’s daughter, “See that you don’t make a fuss like usual when you come”. This hurt him a lot, but on the insistence of his wife he went to the party. At the party glasses were given as token of fond remembrance to all the guests. When the patient’s family was about to leave the elder brother asked the patient’s daughter (who was in-charge of distributing the glasses) to get some glasses. The poor girl had to do a lot of running around and instead of bringing two glasses brought three (so that she would have to run less). These two glasses were actually for the patient’s family but the girl did not know this. The elder brother said, “Ok! Take three glasses instead of two!” At this remark the patient became wild, angry, enraged and on his way home shouted at the top of his voice. It was nearly 1 a.m. and people who were sleeping in the buildings near the road were awakened and watched this angry man blow his top. He was abusing, scolding and shouting at his poor daughter for no mistake of hers. This continued even after he returned home.

He said, “I have a strong feeling that I have supported everyone but everyone has bitten me like a snake”! He gets angry if anybody does anything against his wish or without his knowledge. When he gets angry he abuses, becomes violent, throws and even breaks things; he feels so enraged that he feels like shooting that person. He says, ‘Why hit anybody… just shoot them!’

Even during the interview he spoke dirty (three and four letter words) abusive words freely. (These words were very dirty-third grade-words that one never speaks in the presence of a female doctor).

PHYSICALS:

  1. Severe pain in the left knee more than the right, aggravated by climbing.

O/E: Knee-joint crepitations, severe pain in both joints on movement.

  1. Severe acidity and nausea aggravated at night, especially aggravated after eating fatty food.

  2. Very severe cough since 8 months, aggravated at night (no cough during day), aggravated going to bed; aggravated 3 a.m. (cough comes in paroxysms and he sometimes vomits).

4. He has left sided sub-mandibular lymphadenitis.

Note: We have shared with you the patients’ narrative as close to verbatim as possible … the patient was only asked to tell us everything about himself and not many questions were asked. One has to receive a case and not take it … this is exactly what Dr. Hahnemann means when he says, the patient details the history of his suffering. These are voluntary details not prompted ones and therefore one can enjoy the language and the connection. Every case is made up of multiple frames of references and together they form a complete frame of reference. If we are accurate in our case receiving, many times the connections flow and the remedy is sitting right there in front of us.

Our Analysis:

One has to understand what is the most peculiar aspect of his personality. What is his strongest feeling? He said, ‘I have supported everybody but everyone has bitten me like a snake!’ What does he want to express by this statement?

This is a very involuntarily statement, an analogy that he has used to describe his innermost feeling and if we interpret this accurately we will have the remedy sitting right there in front of us. It is an unguarded statement that comes right from the bottom of his heart. Our interpretation should be accurate without the slightest theory. There is spontaneity, intensity and clarity to this understanding of his about his world and his surroundings.

What does he mean? We too had to ponder this a lot, after which we came to the understanding that he feels he has been cheated … the expression … ‘bitten by a snake’ is very important. He says he feels he has helped everybody but everyone has bitten him like a snake! His language, his feeling reveals to us his identity … the identity of his state. He said bitten by a snake. Why a snake and not any other animal? He could have said ‘bitten by a dog or a parrot or an elephant’! Why a snake? Do you know how a snake bites? It doesn’t say, ‘Oh! come my dear I want to bite you!’ It bites you by deceiving all your observations. If you have seen the movie African Safari, you will see how the actor- director catches a snake. He keeps the snake distracted by a stick and then suddenly with a very quick snap catches it. In reality the snake bites in the same way. Its hood is always swaying and you never know when it is going to strike. It deceives your observation and bites. This is the other way around.

What do we learn from the temple incidence? … Poor God is blamed for cheating our patient. God is in no way responsible for us. It is our faith in Him. But our patient feels otherwise. He feels, ‘I did so much fasting and praying and service and see what God has done in return. He had to be in an awkward situation right on His doorstep … and what did he do … he stopped fasting. He broke the fast then and there and stopped going to the temple. He felt cheated here also. But has God cheated him? NO! It is his delusion.

Both these frames of references are congruent with each other and translate to us the same feeling. So we took the rubric delusion deceived being… but we didn’t find it anywhere. Yet it was the innermost feeling of our patient (then we didn’t have synthesis nor the Complete Repertory) … so we searched the other repertories and found the exact expression in Phatak’s repertory under:

Imagination: illusion, fancies and delusions, deceived being. (Drosera and Ruta.)

Now we take his other frames of reference. The glass incident showed us another component of his. His brother had just said, ‘Ok, take three glasses instead of two glasses’ casually and what was his feeling? He felt persecuted.

Delusion, persecution

He is very obstinate and pertinacious (Pertinacious means holding firmly to some purpose, belief or opinion.)

These two rubrics, obstinate and pertinacious hold true as far as his daughter’s situation is concerned ; he is not ready to accept her … he says, ‘ She is dead for me, her name creates a sensation of fire in my body’.

He is courageous.

All these components are also seen in other rubrics:

Plans, carry out, insist on

Obstinate, execution of plans

Anger irascibility

Violent vehement

Irritability

Offended easily

Clarke says about Drosera … pertinacity in executing resolutions. We have to understand each and every word that he has so beautifully written … pertinacity/ executing / resolution – what does it mean?

Pertinacity: holding firmly to some purpose, belief or opinion. Syn. Obstinate.

Executing: to subject to capital punishment, to carry out.

Resolution: firm determination. Syn. Courage.

When you have the innermost feeling you have struck gold. With this understanding of him we gave him the remedy Drosera. It is this Drosera state in him that makes him express, ‘I have done so much for everybody but everyone has bitten me like a snake’. Only Drosera will say this. But we also have to relate this to his body.

Cough aggravated 3 am. (Not given in the repertory but in Kent’s Lectures on Materia Medica.)

Aggravated only at night. (Kent’s Lectures on M.M.)

Successive paroxysm

Cough ending in vomiting

Acidity and nausea aggravated at night, fatty food (Clarkes’ Dictionary of M.M.)

We gave him Drosera 200, single minimum dose on 25th March 1990.

Follow up after 2 weeks:

The patient felt better in the pain in the knees and also his cough had disappeared.

Follow up after a month:

His pain in the knees is totally gone. On examination of his knee there are no crepitations in the knee joint. He said he literally climbed 12 floors of stairs without any pain.

Given S.L. for a month.

Follow-up after a month.

Cough since 2 days because he smoked. The pain due to lymphadenitis has disappeared. There is no pain in the knees.

He complained of a severe sinusitis developing with pain and tenderness above the eyebrows and a green discharge from the nose (this complaint he had for 30 years and this would recur every summer.)

During this follow-up he expressed something very interesting and important about himself. As he was leaving the consulting chamber when we were casually talking he said, ‘My brain is like that of Hitler!” Here again we see a comparison. He compares himself to Hitler.

If you read Dr. Dorothy Shepherd’s ‘The Physician’s Posy’ she writes on page 58 … “ its idle to speculate, and too late now. The harm was done, but Hitler was a Drosera patient and should have been given it years before.” She writes this after quoting from a book and quoting from a book that described Hitler thus … “ This man is filled with an immeasurable hatred and seems to feel the need of something to hate. Almost anything may suddenly inflame his wrath and his anger. The transition from anger to sentimentality or enthusiasm may be quite sudden. Especially among intimate friends he lets himself go. The slightest contradiction throws him into a rage. I often heard him shoot and stamp his feet. His technique is well-timed fits of rage, to throw his entourage into confusion and thus make them more submissive.”

He often sits in morose silence and then joins in the conversation, and soon talks himself into a rage. Even at a very early period, he dislikes hearing anything not calculated to strengthen his own convictions. He is never told any uncomfortable truths. A policy grew up of keeping anything from him which might excite him. His excessive fits of rage tempted few people to provoke such a storm … Amid the ecstasy of his speeches or in his solitary walks, he feels he possesses the qualities of a supreme magician, much superior to and outdistancing his qualities of a great statesman. In the many vacant hours of his lethargy he feels weak and humiliated. Then he is irritated and tries to acquire the semblance of creativeness by endless talks. For this he wants an audience. He sees his own remarkable career as a confirmation of hidden powers. He may sit for hours in apathy without speaking or without even looking up. No real conversation is possible with him.”

He will speechify… he will walk restlessly up and down, interrupt constantly, and jump from one subject to another, as if unable to concentrate. He has states which resemble persecution mania and a dual personality. He wakes up in the middle of the night and wanders restlessly to and fro. Then he must have light everywhere and then sends for young men to keep him company during these hours of anguish. He wakes with convulsive shrieks, shakes with fear, stuttering confused, un-intelligible phrases.”

He is exacting, avaricious, greedy; incapable of working unremittingly and continuously; he gets ideas, impulses and must feverishly achieve them in order to get rid of them.” “He rarely reads a book through; he only begins it and then throws it away. He hears voices in his solitary walks and recognizes nobody there who meets him. He is timid and sensitive. He used to complain for weeks at a time, blaming the ingratitude of his followers, or the unkindness of fate for his own inactivity, and is fond of posing as a martyr.” “Then the other side, the sudden activity; but everything is jerky; he is without balance; full of resentments. Visitors have been completely dumbfounded at the sudden transition from obvious good will, to violent scolding for some imagined slight.”

The troubled dreams of the past and the torturing doubts of the future are with him. Then he must have company when he is convulsed by sudden paroxysms, which are near to insanity. He walks up and down restlessly, while the young men in his entourage are roused from their beds in order to divert his thoughts. He is afraid of everything, is well protected, whenever he goes abroad, for fear at attacks on his precious person, and even his bed can only be made by special trusted servants, for fear of being poisoned in his sleep.”

She further writes…

This is the picture drawn by a quondam friend and follower and close companion of Hitler’s- Rauschnigg, in his book called Hitler speaks.

Does this picture not illustrate what Hahnemann has drawn as the mental characteristics and psychological ideas of an individual who required Drosera to cure him of his ‘weltschmerz’, his deep inner sufferings?

What would have happened, if some physician versed in the new art of medicine could have had hold of this pathological misfit, this psychopath, and given him Drosera years ago?’

But there is a caution that we would like the readers to observe here – what was Hitler’s remedy we cannot comment on … this is a speculation and Dr. Shepherd very well starts her comparison with that. We wouldn’t like anybody to have a picture of Drosera as that which Hitler was. It is nice to study history and historical personalities and see if the many beautiful remedies are personified in their lives … but this is not the truth. It can mostly be called a misadventure. Many of us usually take help from the bits of life histories of these personalities to make our presentation more animated and lively. Here we have first to remind ourselves what Hahnemann has said in aphorism 6, where he cautions us against speculating!!

There’s another thing important about the importance of delusions. In the Materia Medica Pura Hahnemann writes “…restlessness all day long, uneasiness of disposition and anxiety, full of mistrust, as if he had to do with none but false people. Extremely uneasy, sad disposition, all day – he imagined he was being deceived by spiteful, envious people … Anxiety, as if his enemies would not leave him quiet, envied and persecuted him.”

Hahnemann further writes, ‘very peevish, a trifle puts him out of humour. He takes insults very resentfully, not without vexation … An unimportant circumstance excited him so much, that he was beside himself with rage. (The glass incident is expressive of what Hahnemann has written.) …Obstinate prosecution of resolutions he had formed.”

The prover’s expression in the proving is … ‘as if’ or ‘imagined’ and therefore in the repertory it appears under delusions. These delusions are pretty intense, they make you feel the whole thing, and when you get the same expression said spontaneously, intensely and clearly in the patient, it means that this relates directly to the state of disposition or mind of the patient.

We gave him Drosera 1M and asked him to follow-up after a period of one month. He reported being consistently better. We followed up this case for a period of 6 years and there was a consistent and long lasting improvement. Not only did he improve physically but emotionally. Also his sensitivity changed for good. There was a general transformation of his state. He has received Drosera 10M and 50M infrequently and in the minimum dose. In the later part of his treatment he received Sulphur as the totality of his changed state. Here we are reminded of what Dr. Hahnemann has written in aphorism 248 … ‘if the balance of the disease appears in a group of altered symptoms, then anotherone more homoeopathically related medicine must be chosen in place of the last…’

Conclusion:

This case taught us many things.

Firstly, don’t interrupt the patients’ chain of thought. A homoeopath should be a master communicator, in that the more casual the interview, the more easily the patient forgets he is talking to a doctor and the most beautiful expressions come up when the patient forgets that he is talking to a doctor. These are spontaneously expressed… there is an inner flow to these expressions, an inner connection, the patient then is not telling you but is expressing his innermost feelings. There are many techniques that a homoeopath should learn, to make him proficient in case receiving.

The language a patient uses reveals his innermost feelings and Delusions is very important as it lead us to these innermost feeling, where the state is stuck.

Another important thing is to persist until you get the exact or the best possible and accurate expression of the patient in the repertory or the text.

Lastly, when we have understood, studied and prescribed a remedy, we have to see to it that we unlearn it immediately, as the next presentation is never going to be the same. They say, ‘you can never enter the same water twice’, but we have improvised on this; we say, ‘you can never enter the same water once … the moment you enter, it has already changed’!!

 

About the author

Prasad Shetye & Falguni Khariwala

Prasad Shetye & Falguni Khariwala

Dr. Prasad Shetye has been a consulting Classical Homoeopath for 14 years. His ability to dream resulted in the birth of the “Classical Homoeopathic Research Centre©” (CHRC) and that of Nyanga©” the ‘educational trust to disseminate and propagate advanced studies in Classical Homoeopathy’.  He teaches in Bombay, Pune, Goa and Nasik. At CHRC with sister Dr. Falguni, he is intensely involved in teaching a training program designed for doctors and interns in India and abroad. He and Dr. Falguni edit ’Homoeopathy First’ the newsletter of Classical Homoeopathic Research Centre© (CHRC). He is dedicated to ‘Classical Homoeopathy’ and is very vocal against speculative homoeopathy. He is an avid admirer of Dr. Hahnemann and the way he illustrates Organon makes Organon come alive.

Dr. Falguni Khariwala has been a consulting Classical Homoeopath in practice for the last 16 years. Along with her brother Dr. Prasad Shetye, she has been invited abroad to give Seminars and under their trust ‘Nyanga’ they regularly conduct Seminars in Bombay. She was instrumental in sowing the seed of the Training Program in Classical Homoeopathy. Together with her brother, she edits ’Homoeopathy First’ the newsletter of Classical Homoeopathic Research Centre. They have written a series of seven articles that were published in Homoeopathic Links-International Journal for Classical Homoeopathy. She is very experienced also in the treatment of infants and children.  Dr. Khariwala is a Classical Hahnemannian in her thought, word and deed as far as homoeopathy and life is concerned.

7 Comments

  • My first Homeopath, my Master, as it were, was Dr. Thomas Marsteller who practiced with his wife, a team. He studied at Hahnemann Hospital in Philadelphia, PA before it was overtaken by the AMA. At the time I became his patient his wife had passed on (1973). Dr. Marsteller also spent months in India with Mahatma Ghandi and learned his techniques of fasting, dietary regimen etc. Dr. applied the use of high colonic irrigations and chiropractic adjustments on all of his patients. Many were the consults when one heard the Great Soul come through. He died in 1986.

    • When I was 11, Dr. Marsteller became my “grandfather “.
      My mother worked in his office, and I spent the evening in his house.
      I was to young to really understand what he was all about. …but I KNEW that he was a GREAT man. I loved him so much!
      He used to tell me a story about how he was stolen by gypsies when he was a baby. He always made me laugh.
      I think of him often, and miss him so much.
      I have no clue where to find information about him. I try often. Is there any way that you know of?
      I would appreciate any help you could give me.
      Thanks
      Tricia

  • Whats a great job don by both respected drs, its true that we emphisis on case taking instead of CASE RECEIVING, if we adopt such technique IT WILL EASE US TO SELECT SIMILIMUM!

  • We should all learn to receive, it is an art and perspective, you appear to be doing the same thing when observed externally, but the intention is very different and the results. Brilliant, thank you.

    Thank you for the illustration. You make it clear about the physical, although was he agg at first or not? and it would be very interesting to know how his mental changed – the process of the vital force being released allowing it to reign supreme in its domain (CD preface)
    Best wishes from

    Jamie

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