First presented at the Society of Homeopaths Annual Conference at the University of Nottingham in September 1990. Published Volume 11, No 2, 1991. Miranda Castro wrote, at the time the transcript was published: The purpose of my article is to stimulate thought. I have not written a definitive article, complete in itself, and I hope that you will feel at the end supported or challenged, relieved or puzzled, pleased or even angry. I hope to give you an opportunity to affirm your own beliefs but above all, I hope to stimulate discussion, and not a few questions
Patients’ Expectations: A Parent, A Teacher Figure
I want to look at the issue of power and ethics in the consulting room. I want to start by looking briefly at the dynamics of this patient/practitioner relationship, because a patient who comes for help has invested in their time and their money and their hope – to be healed. We represent a very important person for them, we represent a parent figure, a teacher figure. Each person brings to us a different expectation of how we should behave from their past experiences – either positive or negative. This is mostly an unconscious process. We sit or stand on varying heights of pedestal; we have varying degrees of whiteness of coat, whether we are wearing one or not; we grow varying sizes of horns for people who have had a bad experience previously either with their parents or with previous medical practitioners.
I am sure that you can all identify with that feeling of unease, of anxiety or fear or even terror as you walk through the dentist’s door. You may have been feeling relatively strong and in charge of your life and then you walk through that door and lie down on the dentist’s couch and – suddenly feel smaller. I know that I feel about five years old. I lose my power in that position – I feel like a child, I am frightened and intimidated. Interestingly, when I met my dentist at a party recently (he is a friend of a friend) I felt quite different about him. He was the same person – in a different role.
When you are lying there on that couch you are helpless. And you are childlike because of the helplessness. The dentist has all the power and the knowledge, the technical knowledge.
A friend of mine was in this position once when her dentist put his hand on her thigh and moved it up her leg and he did not say anything. She was young. The shock waves from this particular inappropriate action of his left a wound that took many, many years to heal.
Although we know we are in a consulting room, our patients do not. Their relationship to us and their feelings are quite different because of our role as homeopath, as healer and because of the invisible hat that we are wearing. This makes them feel very vulnerable, which in itself gives us an enormous amount of power.
The Child Within Us
When we look to another for help the child within us comes to the surface and he or she is looking to be taken care of, is looking for a parent figure. This will bring up different issues for different people. You may wish to take just a moment to reflect for yourselves on what it is you feel as a patient in this position. Do you feel anxious, fearful, a bit resentful that you are having to go and ask for help, suspicious, accepting, relieved when you visit your dentist, your homoeopath, your doctor? We all take different feelings into these caring relationships. Think now for a moment whether the feelings you have in the consulting room are similar to feelings you experienced as a child in your family or with your doctor.
As far as I am concerned, we have a position of authority whether we like it or not. It is there and it is our responsibility to uphold and respect this position. Our patients will do almost anything to please us so we can cure them.
A Close Shave
I have heard a lot of stories of ex-patients becoming intimately involved with their practitioners, becoming lovers, and this is an area of special concern to me. I had a close shave once. It was my last patient on a Friday evening. I was working from home and it was a weekend when my son was with his father, so I was alone and I had not planned a lot for myself for the weekend. It was winter; dark, cold, wet and drizzly, as I recall. The sort of evening where you feel like lighting a fire.
My last patient was a man, a professional man the same age as myself. He had a chronic complaint that the medical profession had given up on… could offer no treatment for. He was desperate and desperately ill. He had not worked for six months. I took his case and we got to the emotions – the inner man, and he mentioned a trauma from his young adulthood that he had not healed, that was still raw for him, still unresolved. It was a betrayal of friendship, his best friend. He mentioned a town and a university and a first name. I put two and two together and asked him the surname of his friend. Amazingly his friend was the same person that I had an intimate relationship with who had betrayed my friendship in a similar way, at the time still unresolved. It was very hard for me to carry on with my job because of the feelings that surfaced within me. I fought them back however, and carried on with taking his case. But my perception of my patient had changed – my inner perception. He had moved closer to me. I actually had a fleeting question about him being available, about whether he was in a relationship. When he mentioned his lover, I noticed that I had an inexplicable moment’s disappointment. I decided not to prescribe but to work on his case in a less charged moment, and said I would ring him the next day.
I took my dog out for a walk at the end of my day. I found I was having quite curious thoughts and fantasies about this patient. I could feel a rising tide of attraction to this patient who had suddenly become handsome, soft, vulnerable – and very interesting. I watched my thoughts and feelings with amazement and horror. I rang a friend of mine who is also with the same supervisor, and I decided not to sleep on it. I rang my patient that evening and explained that talking about our mutual ex – friend had brought up unresolved feelings for me and I was unable to separate the two men – to separate him from this ex – lover of mine; that I felt attracted to him, had strong principles, wouldn’t be acting on my feelings, but wanted to say that I thought it would be best if I found a suitable replacement, so that he could get the homoeopathic help he needed and deserved; that I did not feel I could do a good enough, objective job as a homoeopath.
His reply was totally unexpected. He listened courteously to what I had to say and then replied by saying he had consulted homoeopaths before and I was the first one he had complete confidence in. He felt very good about the session he had had with me and he was sure that I could help him. He paused and asked me if there was somewhere I could take my feelings, someone who could help me with my feelings so that I could carry on treating him (!).
Well, he had a good point. I did take my feelings elsewhere and I dealt with them because they did belong elsewhere i.e. not with him and I healed a hurt that was long overdue. And you know what, he was right. I was able to help him and he got better and as he became healthy, he became less attractive to me.
Ethics: Unintentional Abuse And Homoeopathy
Because of the time constraint, I am not going to be able to go in depth into this topic but I want to bring up some of the issues, some of the ethics of how we handle sex in the consulting room. I hope that my talk will provoke you into thinking about this area of our work so that you do not fall into the trap of unwittingly abusing your patients, because it is all too easy.
I want to look today at how we, as homoeopaths, can abuse our patients – without intending to, and ways we can avoid this. Some things we do because that is how we have been taught; or because that was how we learnt by example, by someone else’s example; or because that is what was done to us and we did not question it – because we did not have the information and because nobody said “Hold on a moment. Is this right?”
The area of sexuality, of sexual abuse, is a fast evolving one for all of us. It seems that within every walk of life the issue of sexual abuse is being thoroughly examined – in the family, within the medical profession, the teaching profession, the church and so on.
These are indeed, extraordinary and exciting times. I personally, am thrilled to be here, to be alive now, at a time when so much is coming out into the open and being discussed within a framework of mutual support. There has always been the pain and suffering of sexual abuse, it just has not been talked about. It has been locked away in peoples’ bodies where it has formed an abscess which has not been visible. Now we are seeing it – it has come to the surface and it is nasty. We did not know it was there and now we do. A lot of people are not wanting to see it still. But I think it is foolish not to care for it, now that it is suppurating. It is more than foolish; it is wicked to ignore it, to deny its presence. This will create more ill health and more suffering.
I believe we need to care for this abscess, clean it up and tend to it, with the compassion of a fine healer. It needs to be aired to heal. If we neglect it, if we put a plaster over it so we do not have to look at it, it can ulcerate and become septic.
I am going to tell some tales today, tales of sexual abuse in the consulting room, which I have ‘doctored’ in order to protect the identity of the people concerned – both the patient and the homoeopath.
Some of these stories will resonate with you, will be familiar in terms of your own personal experience, or in terms of stories you have heard about other health care practitioners. I have found that every single person I talked to can tell a tale of professional sexual abuse; from either a dentist, a doctor, an alternative health care practitioner, a social worker, a psychotherapist or a psychoanalyst. This is too many stories.
But is it true? Do we really abuse our patients? Surely not. I am afraid it is true. We are vulnerable too, only being human that is. The point is that any professional involved in a one to one relationship with a patient, which is by definition an intimate relationship from the patient’s perspective, is capable of abuse.
I want to just list the different ways that we as homoeopaths can abuse our patients:
* We can sexually abuse our patients physically by touching them inappropriately.* We can sexually abuse out patients verbally by asking intimate questions about their sexuality inappropriately or stupidly or needlessly.* We can sexually abuse our patients by projecting our sexual values on to them, by laying a sexual perversion trip on them.* By assuming or implying that they should be having sex if they are not, that is to say, if they have chosen celibacy.* By assuming or implying that they should be having sex with another person if they are not i.e. if they have chosen to have an intimate relationship with themselves, have chosen masturbation.* That they should be having sex with a person of the opposite sex if they are not, if they have chosen someone of the same sex.* We can sexually abuse our patients mentally by having sexual fantasies about them when they are in the consulting room.* We can sexually abuse our patients by ignoring or doubting or denying what they tell us, especially what they tell us about their own abuse.* We can sexually abuse our patients by playing sex therapist, without telling them that that is what we are doing, without having the training to do so.
This list may not be complete. I hope it is.
I went to a homoeopath many years ago with a painful knee that the osteopath had not been able to help. He asked me to undress, in spite of the fact that I did not need to; and he examined my breasts as well as my knees. A friend of mine went to a hospital recently with a skin rash on her leg. She was asked to undress and the doctor examined her breasts as well as her skin rash. Neither of our medics asked us – they told us. Neither of them told us why they were doing it. We both felt it was wrong, unnecessary and we felt bad afterward; tense and anxious – especially about going back, and we did not go back.
I remember another visit to another homoeopath. He asked me about my sex life and I answered honestly and openly because I wanted to be helped and then he really started delving and asked more and more personal questions. At the time I can remember feeling uncomfortable but completely unable to say no. I wanted him to find the right remedy. I was scared not to answer in case this jeopardized my cure. I felt exposed and ashamed afterwards. I did not know why I had been asked such personal questions. I was scared he was making a pass at me or that he would pass this information on (and in his case that was not an unreasonable assumption I am afraid) and I never went back.
Talking About Sex
Our sexuality is a most private and vulnerable part of who we are. It deserves a special attitude. We do not in general socialize our sexuality; we do not discuss it over the kitchen sink – not really discuss it. People in this country grow up not having talked about sex, never having heard their parents talk about sex, or hearing it talked about within the framework of smutty jokes, or hearing the cold, biological facts of mating from a biology teacher.
Some people have never talked about sex. Their parents never talked about sex. Or barely. They may never have discussed ‘it’ with a lover, husband or wife. We have a fine tradition in the country of intimacy which is swept between the sheets at night, with the lights out and the eyes shut tight. You just do it and don’t say anything. You do not ask for anything and you do not complain. This is not the only sex we have in this country but it makes up a significant proportion.
I want you to imagine a patient who has never talked, and let us put her or him in a consulting room with one of us, and let us imagine how our questioning will be received.
I have a friend who visited a homoeopath some time ago. She went with a urinary tract complaint which she had treated successfully herself with rest and herbs. However, she was left with a feeling of unwellness and a feeling of weakness in the area of her bladder. It had not quite gone. She had more frequent urination but she was not particularly ill either. The homoeopath she consulted asked her about herself, her urinary difficulties, and then he moved onto her bowels. This, she said, was all fine: what she expected. He then spent quite a long time looking things up in his books. “What was he looking at?” she asked me afterwards. And after a while, he looked up and said, “Do you masturbate?” She answered him. He then asked her in detail how she masturbated, how often, whether she had fantasies, what fantasies. He did not say anything in response. He prescribed and then he told her to ring him if she wasn’t better in a week or so.
She rang me in distress two weeks later – she was very confused and had a lot of questions about her experience. Her first one was, “Is this right Miranda? Why did he ask me those questions?” Then she went on to describe the effect of what had happened. She said that at the time she could remember feeling shocked, but had assumed that he knew what he was doing, because he was in charge. She was keen to be well and so knew that she had to be honest and open, so he got the information he asked for, that he needed to cure her. Right? And so she answered, but she did not feel quite right and afterwards she felt very shaky. Exposed and vulnerable. At the time she rang me she was feeling ill again and on top of her previous complaints she had not slept well for those two weeks. She kept saying “Why did he do it? Is that what homoeopaths do? Was he getting off on me?”
People are very sensitive in this area. People who have been shocked by the intrusiveness of a homoeopathic case-taking say: “Why did he need this information?”
Homeopathic Case Taking
I think that the homeopathic case-taking is the most thorough of any case-taking – apart, maybe from the acupuncturists. We can all acknowledge that the case-taking alone can be a profound healing experience in itself, because as you all know, we ask questions that delve into every area of a person’s life and so at the end of that initial interview, a person may have a sense of themselves as a whole person, with all the facets connected up – albeit loosely – maybe for the first time ever. This is profoundly healing in itself. We must never underestimate the value of our first consultations.
Patients put their trust in us – we need to respect this trust – it is very delicate and special and deserves tender, loving care. Our patients are entitled to expect their health care practitioners to behave with integrity.
Acknowledging Sexual Abuse
There are no degrees of sexual abuse. All abuse has an effect. There are degrees of effect. It is the breaking of that trust that affects a person’s self-esteem and their ability to trust, and it creates another wound that needs healing.
It is scary looking at sexual abuse, dealing with it, acknowledging it. Some very unpleasant facts are coming out of the closet, or rather being dragged out, because the disbelief and denial is so great that it is proving a block to acceptance, understanding and therefore a block to action, to healing.
I have a friend who participated in a sexuality workshop and at some point memories began to surface of an early sexual abuse by her father. She felt distressed and stirred up and went to her homoeopath for help because the distress had affected her physically. Her homoeopath pooh-poohed her memories and suggested that it was her imagination, that as she had no evidence she was on rather shaky ground and didn’t she know that all daughters have unresolved sexual feelings towards their fathers? My friend described the conflict that then ensued within herself; because the major part of who she was wanted to believe that she made it up.
The first response to abuse is denial. It goes so deep that not wanting to believe that someone we have trusted and loved can betray our trust can hurt us so thoroughly. Denial is the self-preservation mechanism that suppresses the pain and the hurt and is often accompanied or followed by amnesia because this makes life half-way bearable.
Anyway, back to my friend and her sticky consulting room situation. She knew something was wrong and then fortunately her homeopath told her a tale about her own childhood; how at some point in her growing up her father had warned her not to get too close to him, because she had become attractive to him and he did not know what he might do, that he might lose his self-control. My friend, who was training to be a psychotherapist, spotted that her homoeopath had an unresolved sexual abuse from her own childhood, the denial of which had kept her from validating her patient’s experience of sexual abuse.
This story is interesting because it illustrates what happens if the patient spots the game; in this case my friend said that she put her own feelings in a safer place to deal with elsewhere. This is an abuse of a different type; this swapping of roles, where the patient looks after us, and it was not intentional, but as professionals we do have a responsibility to deal with these situations if they arise.
If you doubt your patient’s experience you add insult to injury. It is imperative that you validate your patient’s experience however whacky. They may be suffering from a delusion. You have to be seen to be believing them, otherwise they will dam up and lump us with the rest of their world that did not believe them or abused them. It is by believing them that we can get their case, that we can start the process of healing.
OK folks! It’s confession time now. In my first year in practice I did not ask about my patients’ sexuality and I did not have any highfalutin’ ideals and principles about not asking them. Oh no! I was just plain embarrassed. There were many words I could not say without going red. Without having a hot flush. Words like MASTURBATION, ORGASM, SCROTUM, LABIA, CONDOM. Some words I could say if I said them very fast like PENIS or VAGINA. These words had not been used in my family. They were wicked, wicked words, and I was once punished for bringing one of them home from school. I learnt that talking about sex was wicked. It was years before I understood what all the words meant. Oh, sure I learnt to do it, but I had learned not to talk like many others. So I kept my mouth and my eyes shut too!
As a baby homoeopath, if my patients talked and in talking offered, of their own accord, details about their sexuality I wrote furiously and made listening noises and hoped and prayed I would not blush and then I moved on once they had finished, and breathed a sigh of relief.
So I took myself rather urgently in hand and completed the Spectrum Sexuality Programme. Spectrum is a psychotherapy centre in London. I sorted myself out and got myself educated and learnt to talk, learnt what is normal and what is a true perversion, what is healthy and what is diseased; with regard to sex, with regard to myself and sex, and with regard to others and sex. I discovered there is a lot of rubbish talked about sex, that does not take the individual into account.
Sex In The Consulting Room
And you know what, now I can talk about sex and now that I like to talk about sex, I still very rarely ask my patients questions about their sexuality. Firstly because I have found that I can prescribe effectively without having that information, but more importantly because I know when to ask those questions; when it is appropriate, and that is a learnt skill. Generally speaking, however, I am an effective prescriber without bringing sex into the consulting room.
Sometimes patients initiate talking to me about sex and then I am happy to listen and ask questions and I will respond appropriately, with reassuring statements, and an appreciation of the trust that has been confided in me. I may be able to build their sexual difficulty into my prescription, in which case I say so. It may be that my patient needs a referral to a counsellor or a therapist who specialises in sexuality. Sometimes I am able to affirm a patient’s ‘normality’. Many people do not know what is normal, are too frightened to find out, and carry myths from their childhood like sacks of cement.
Sometimes I do ask about a patient’s sexuality and then I put my questions in a context. I believe it is deeply intrusive to ask questions about a person’s sexuality without firstly putting them into a context. A professional context.
The first person I question is myself. Why am I wanting to delve into this area? Is it important or relevant to my prescribing to find out about my patient’s sexuality? If it is, I share my thoughts with my patient. I make clear statements about why it is relevant. To educate him or her about the way I work. I create a safe boundary. I may reaffirm that the consultation is confidential, that nothing that is said will go beyond these four walls.
I ask questions like, “Is it OK with you if I ask you some questions about your sexuality?” (or sex life). If I know a person is in a relationship I may ask, “Is there anything that is bothering you in your relationship? Are you happy with your sexual relationship?” You may already have some information about a patient’s intimate relationships that you can build on carefully. Once you have opened the door, people will volunteer information and you can take it from there. We do need to start out with a non-threatening question that leaves it up to our patients to pick up the threads.
So, with regard to your own practices, I suggest that you check out your patients’ willingness to talk with you about their sexuality. If there is the slightest hesitation, do not do it at that point. You can ask them again, as and when trust develops. Or offer them the choice of coming back to it in their own time.
What we are wanting to do is find out if sex is working for a person at this point in their life. Is there disease, pathology that relates to this area that we can prescribe on? Is this person limited by their own sexual dysfunction? If so, how?