Editor: This is Part II of this article. If you have not read Part I, Please read it first here.
Towards Individualization: Case History
Interrelation of Remedy and Case History
In homeopathy, as taught by Hahnemann, there is a similarity between remedy and case history. This relationship is purely one-sided: an already known (proven) remedy is prescribed to an unknown patient who is similar in one way or another. The contrary relationship, that the patient’s experience helps define the theme(s) of the remedy, is never analyzed or critically examined. It is common in seminars, that homeopathic “gurus” will present a remedy on the basis of a “typical” case, without a comprehensible rationale for the remedy selection, and with insufficient observation of the case to justify their postulate. In our daily practice, such an intuitive approach may be quite justified. However, we don’t permit poorly examined or analyzed cases to infiltrate the Materia medica. Neither should uniquely appearing symptoms from such case histories make their way into the repertories.
If we now submit both the collection of symptoms and the case history to a strict, always identical analysis according to the Masi model, it becomes possible, with all appropriate caution, to draw conclusions from patients to a remedy-hypothesis. This was already done in 1996, when the Materia Medica Homoeopathica had been published , in which hypotheses of Citrus vulgaris, Calcium arsenicosum, Toxicophis and Vipera berus could be worked out thanks to long-standing cases from different homeopathic offices. Even today we work absolutely in the same manner, especially if too few detailed proving symptoms are available. This way, we succeeded recently to revise Sambucus nigra and Bufo, because in both cases many years of case histories where available.
A third kind of interrelation, which is of special importance to the work by Masi, is the correction of the remedy’s hypothesis, which can be carried out with the help of a patient’s case. This way, in the case of Cenchris, quite different hypotheses had been published by the French group AFADH  and in Materie Medica Homoeopathica . A Cenchris case of many years ultimately supported the hypothesis of the AFADH .
Another example happened recently during the run of a lecture, when the remedy picture of Sabina could be reviewed with use of a long-standing case history. When we made the preparations it appeared, that the old hypothesis of 1996, which was fully based on Thomistic philosophy, today seemed to be too “cracked”, too little held in concrete terms, too close to the real symptoms. It was obvious that we first had to rework the old revision one more time, and we succeeded in building a new “more true-to-life” hypothesis, which then in the re-inspection fitted better to the available case history.
A different anamnestic technique
In the search for the primary Psora of the individual patient, we need an anamnestic technique which asks more about the motivation, the inner motives and the background of the person. A common head-to-foot-examination with the help of papers derived from questionnaires or of a technique focusing on repertory-rubrics doesn’t suffice. Rather, it is necessary to perceive the patient in a deeper, more meticulous way.
Prerequisites of a successful Anamnesis
Here, a detached fundamental attitude and an open formulation of the question are of crucial importance. Participation in training courses in interaction focused on themes, in guiding conversation and in active listening, e. g. by Thomas Gordon or Carl R. Rogers are highly recommended. The time frame for a deepened anamnesis has been postulated by Masi as unlimited. He thought about an anamneses of eight hours, visits to the patients’ houses or even joint visits at pubs. There’s no need to explain that this can’t be done in a homeopathic practice. Therefore, it must be possible to record the two-hour interview with the patient as much as possible verbatim, in order to gain sufficient materials this way.
Spontaneous Report by the Patient
Primarily, there are the spontaneous reports by the patient, as well as the exact grasp of all complaints. One of the most central misunderstandings regarding the “Masi-method” is the assumption that it would be interested only in mental symptoms. In truth, especially conspicuous physical symptoms, modalities or individual sensitivities can be important guidelines when writing the patient’s hypothesis.
Asking for the cause often leads to the mental level. In this area, we focus mainly on the motivation behind human reaction to joy, grief, anger or fear. E. g., if a patient reports that his complaints had begun with a divorce, to many homeopaths the rubric “mind – love disappointment, unhappy, ailments from” might light up. But if we inquire in an open manner, about what along with the divorce has hit him, he might tell us that it has been a huge disgrace, because all of his friends have known that his marriage was going downhill. Or, since the divorce he had no chance to express his sexuality which is difficult at his age (and dangerous in a time of AIDS). So we can see that different psychological backgrounds can lead to very different remedy-hypotheses.
What is the Focus of the Patient’s Inner Attention?
Even banal statements can indicate the individual focus of the patient. During anamnesis it is important not to fall into the trap of considering reactions as “normal” too early. The risk exists especially when the patient’s history has a strong similarity to our own lives. That’s exactly when we regard reactions as ordinary, which therapists of a different nature might find outstanding. For example, if a patient begins to talk about the current stress of having to get up every night because of her little children, then, at the first we may consider it ordinary, missing the chance to inquire further. To such a question she may answer that she awakes several time a night in panic, one of her kids might have suddenly died. Or we learn that the youngest never sleeps more than half an hour straight, and so we know, that this symptom requires the treatment of the child, not of the mother.
Evaluation of the Course of Treatment
As had been explained earlier in the theoretical part, a person is healthy to us, when he succeeds in moving between the different miasmatic phases, that is, when he can react appropriately to the ups and downs of circumstances.
Recognizing the Miasmatic Dynamics
In tertiary Psora, flexibility between these reaction-mechanisms is disturbed. Blockades are built up and the person remains in a compensatory state. He claims not to have any problems aside from those tiresome physical complaints (Egotrophy). Or he only looks on the dark side and sinks into a deep depression (Egolysis). Or he blames other people for his suffering (Alterolysis).
Process of Recovery – Evaluation of the Psoric Crises
Opposite to these dynamics runs the healing process when a person gets a remedy which is very close to him. While physically Hering’s Law of Cure is still valid, cure on the mental level develops in the opposite direction than postulated by Classical Homeopathy:
The coping by the patient breaks apart and he may pass through a period of fears, despondency and insecurity. In the same time, he has to experience an improvement of his physical complaints. The contents of this psoric crisis absolutely have to be in context with the basic ideas of the remedy given and with the biography of the patient. If we perceived a “senseless” crisis at this moment, it would point to an involuntary remedy proving. During the psoric crisis different reactions can arise: a person becomes angry because of his fate; he can get in touch with his existential fears, or he suddenly feels insecure in areas where previously functioned properly. Frequently, a violent exhaustion may appear, following the compensatory attitude of “letting go.” . It is also possible to remember traumas and fears from childhood. But he also experiences euphoric phases of confidence – until finally everything settles down in a healthy balance. In other words, healing occurs from tertiary to secondary Psora. In an ideal case, the person even partially recognizes his blind spots and finds a creative way of handling them.
Signs of “wrong” Prescriptions
After inexact prescriptions, we can often see that persons feel mentally stronger but the physical complaints stubbornly persist, or shift to a different organ. In this case a so-called egotrophization is in progress. Also a shift of the course of disease to another phase of tertiary Psora is possible. So, a patient e. g. may fall into a depression or he may react with inappropriate aggression. The latter especially is viewed as a development from inside to outside (Hering’s Law?) by homeopaths or as “liberation” – mistakenly from our point of view. Thanks to the “miasmatic dynamics” we therefore can judge the process of recovery much more reliably.
Palladium -Revised by the Masi-Method
In the following we want to use Palladium to demonstrate how the study of a remedy can be done by using the so-called “Masi-method”. In a first step the proving symptoms are collected, if possible, in the original language and unedited by a subsequent author: in the case of Palladium we used the symptom collections by Allen, Hering and Clarke [1, 4, 6]. A first analysis of Palladium is the construction of the list of themes. In this article, for the sake of brevity, we use only in extracts. The original list of themes consisted of six pages Din-A-4.
Step 1: Drawing up a list of themes
Pl. ???? let untouched the original list of themes! An abolition of the enumeration and a regrouping are confusing, because we will refer to the numbers of teams again and again in following chapters! Also, the putting together of small teams to a larger one is extremely problematical, because the work by Masi is centrally about the contents of the symptoms, not about traditional groupings.
Feels best in company and wants to be flattered. He 1.18
Forgets every pain in society, but is agg. next day; attaches great weight to other people’s opinions; likes to be flattered. Cl 1.10
Feeling of Neglect
Imagines herself neglected; wounded pride. He 1.8
Suggestibility, the Opinion of other People
They set great store on other people’s opinion, and attach great importance to what others think. Hence they are very excitable in company and their complaints are worse next day. He 1.5
The symptoms are induced or aggravated by wounded pride and fancied neglect; irritability which often finds vent in violent expressions. Cl 24.4
He 1.11, Cl 1.10
Amiable , yet Obstinate
She tries to appear as amiable as possible, but is obstinate. He 1.14
They set great store on other people’s opinion, and attach great importance to what others think, hence they are very excitable in company and their complaints are worse next day. He 1.5
Mental excitement, particularly in company, also walking, aggravates her troubles in right ovary and groin; she is particularly agg. the day after a musical evening or party. He 1.16
Feels best in company and wants to be flattered. He 1.18, Cl 1.10, 12, 16.13
The Day After
Mental excitement, particularly company, also walking, aggravate her troubles in right ovary and groin; she is particularly agg. the day after a musical evening or party. He 1.16
Forgets every pain in society, but is agg. next day; attaches great weight to other people’s opinions; likes to be flattered. Cl 1.10, He 1.5
While walking it seems to him as if he had grown much taller; the feeling recurs repeatedly. The symptom did not return later either when lying down or walking. A 123
When walking in street in evening, it seems to him as if he had grown taller He 1.3
Time seems longer
Time seems to pass more slowly. He often looked at the clock and less time seemed to have passed than he expected. A 2
Dreams of Houses
Dreams every night, particularly towards morning, of houses or buildings, beside which he stands, or in which he stands before a window, or walks over wide stairs through many rooms. A 152, He 37.5, Cl 26.5
Sat three hours in church, in the evening, listening to a tedious sermon and dull exercises, which gave her a pain in the back, but no headache. Another time, this would not have failed to come. A 91
In the evening she went to church, and walked home rapidly, when the menses reappeared. (…) A 75
Extremely fatigued in evening; feels mentally gone; is averse to speaking a foreign language which at other times he speaks fluently; it is too much of an exertion, he is tired of it. He 1.1
Though usually tired in the evening, feels mentally “gone”; is very awkward in speaking English, it is too much trouble, he is tired of it. A 6
Aversion to any effort to exercise; must lie down. Cl 24.2
Unusually sleepy in evening; very much exhausted and indisposed to work, he takes first chance to lie down. A 148, A 75, 122
Is so tired that he reels on coming into a room. Cl 2.1
He 1.1, A 6, 121, 148, 150
Unusually sleepy in the evening, while riding in the carriage and seeing patients, not after coming home. A 149
Feels heavy, tired in the limbs, inert, and undecided, in the morning. A 121
Depressing news makes all her symptoms worse. He 1.15
Feels sore in abdomen after menses, with fear and apprehension that something horrible will happen. Cl 16.3
Irritable: in evening; and impatient, from headache, could “knock people’s heads off”He 1.9
Very impertinent; makes a face like a savage. He 1.10
Can’t bear anything
She’s in a disagreeable mood; feels as if she could not bear or put up with anything, without anything having occurred. The child is the only one with whom she is not impatient. A 5
She is in a disagreeable mood; feels as if she could not bear or put up with anything, without anything having occurred. The child is the only one with whom she is not impatient. A 5
Soon after rising, between 6 and 7 A.M. most violent, sharp, knifelike pains in the lower portion of the abdomen; she seldom had anything similar. It was so severe that she could not hold the child, but passed off after a passage. Two slight attacks after breakfast, with inclination to stool; nothing passed, however, but wind. A 52
During the night pain in the back across the hips, perhaps because the child was restless. She was anxious about it, but not impatient. A 92
She had a dreamy headache, more in the upper and back part of the head, different from the headache she had had in the last few days. A 24
Tottering, Swaying, Back and Forth
A dinner, pain in vertex, a violent pressure, causing a numbness, as from great heat or cold. Between 2 and 3 P.M. the headache became severe; she had to lie down. She felt as if her head were being swung to and from, from behind forward, not from side to side. Slept one hour, then the headache was better. A 23
Slight fullness in forehead and a sensation as if the brain were being shaken; lasted for thirty-six hours, but was not unpleasant. A 15, Cl 2.2, 2.4
Sensation as if a weight lying on centre of brain; each expiration = sensation as if the weight were pushed from occiput to forehead. (…) 2.3
Heaviness, like a weight in pelvis. Cl 16.8, Cl 16.13, 14, A 16
Growth of Beard
Growth of whiskers more slow. Cl 6.6
He thinks he notices a marked diminuation of growth in his beard. A 37
Special Sensations in the Teeth, Foreign-Body Sensation
Sensation as if incisors were elongated and projecting, interfering unpleasantly with lower lip. Cl 7.1
Peculiar pain in throat when swallowing, as if something were hanging in the region of the hyoid bone, as if breadcrumbs had lodged there; the pain disappears for several minutes, then returns suddenly, while the muscles of the throat are in a passive state, a disagreeable, tickling sensation, as if an awn had lodged in the throat. A 41
Since several days, and particularly noticeable today, there’s a sensitiveness of the second left upper incisor, and a feeling as if it were a dead foreign body. A 38, Cl 7.2, 9.2, 3, 5
Is troubled at times with symptoms of tapeworm. Palladium seemed to have a special effect upon it. Sensation as if the abdomen were enlarging very quickly. Several stitches in the left side, in the region of the hip-bone, but more inward; in the intervals a peculiar pain, as if air-bubbles pressed forcibly upward through the intestines. The stitches and the peculiar feeling in the intestines returned, and extended to the right side.
After 11 A.M. transient pain in the lower portion of the intestines, on the right side, as if the testicles were squeezed. About an hour later, after a meal, the above-mentioned stitches returned, but were of short duration. They returned several times, first on the left side, then less severe on the right; often single stitches, or more accurately, bites, as if an animal were snapping and tearing off little bits from the inside. Flatulency and distension of the abdomen. Sensation as if the intestines were strangulated and twisted in different directions, more in the upper than lower portion. Frequent passage of flatus. Painful stitches in the left side, followed by cutting, more right than left side, almost unbearable, lasting some minutes; returns after a short interval and lasts longer (first day). Stitches in the abdomen (second day). Unpleasant sensation in the groins, painful to pressure, feeling as if emptied of viscera (third day). The prover had no more symptoms of tapeworm for more than a year afterwards. A 53
Cl 12.5-7, 13, 15
Erections every morning, but none in the evening and at night, even none from excitation. A 73
Crawling as of fleas, and itching on various parts of the body, on the back, arms, abdomen, thighs, and ankles. A 143, A 117, 139, 144
Sensation as if he were getting a stiff neck, especially on both sides, above the first dorsal vertebrae; immediately after in the lower portion of the scapula, and at the same elevation in the spinal column, a pressing pain as if a dull object were being slowly pressed against the spine. This is followed by a repetition of stiffness in neck. 86
In the afternoon, dull pressing backache, as from sitting up stiffly too long. A 90
While sitting still, constant painless twitching, which crooks the fingers, particularly the index finger, until twelve o’clock. A 108
On the following days she has a sensation as if the articulating ends of the thigh-bones expanded or were pressed out of their sockets, especially on the left side; she did not notice it while walking, but when pressing down as if for a stool. A 114
Itching over the whole body, while undressing, in the evening. A 145
Step 2: Dividing up into the miasmatic dynamics
In the second step we examine the list of themes according to the symptoms of the suffering (secondary Psora), the compensation (Egotrophy), the withdrawal (Egolysis) or the attack (Alterolysis) and we draw up a new listing on the basis of these rubrics which then, in a third step, should lead to a central theme.
When Palladium suffers from his condition, he will complain about being impressionable Th 3. For every daily affair he takes advice and help and can’t make his own decisions. He believes he is not able to get on with the difficulties of daily life on its own; feels excessively exhausted from his problems Th 12, 13, 21. In an effort to effect others, he describes his pains and problems in a very flowery, dramatic or drastic way Th 28-32.
Another point of suffering is when he has the feeling of not getting enough recognition. He longs for dramatic appearances, for applause and for being loved. This is why he likes to stay with a group of people Th 5. However, the day after, he sinks into an extremely gloomy mood, feels exhausted and emptied Th 6. He very easily feels being rejected and his pride is hurt Th 2. Since he wants to be worshipped and admired by the other people, he is often bored, most especially in church. Th 10.
Behind this, there is a hidden inner emptiness, a lack of personality. In anamnesis, we may notice his superficial answers or the fact that he digresses repeatedly from his problems to reports of the many compliments he had been paid here and there. He also can behave impertinently, because he is sure of his effect – he looks like a savage Th 20.
In compensating his experience of loss he makes an effort to be charming Th 4. This way he gains the wanted acceptance and can even fill in the missing connection with other people. He adapts himself to the mainstream and knows how to present himself properly in the moment. Clothes may be an equally important topic of conversation, including jewelry, make-up, cosmetic surgery etc.
He may also enjoy spending time with children Th 23, because he can get their admiration and recognition by his charming nature.
A further way of compensation for Palladium is by espousing the development of inner values. He would wrap himself in sackcloth and ashes, he would so obviously pay every attention to supporters, so that the masked egotrophy can be recognized.
Everything is too demanding for him, he grows tired of things, does not like to entertain, doesn’t want to go out, does not want to take care of himself or seek to help anybody.
An irritable, violent character of Palladium shows up when he has the feeling that others don’t give him the recognition he believes he has earned. His wounded pride rises defiantly, he feels so angry that he could chop off the people’s heads. Th 18.
Step 3: Primary Psora – What is the Individuality of the Person?
On the basis of the reorganization of the symptoms according to miasmatic dynamics, we finally search for a “central theme”, a leitmotif or basic concept of the corresponding remedy. With that, we proceed accordingly to a constant formulation of the question.
Which “Conditio humana” does he neglect? Where does he seek perfection?
In order to gain acknowledgement and prestige from other persons, we have to possess values on which there is a social consensus. It can have to do with inner qualities like intelligence, personal integrity, social competence, etc. Or it may relate to external values like youth, beauty or wealth.
Palladium does not like to make an effort developing an inner personality. He does not like to work for intellectual-mental values. Rather he is interested in image and dazzling appearance. He wants to be flattered Th 1. The term flatter is derived from French â€šflatter’, in Latin flaccus, and it means to make limply, to soothe, to caress. Consequently, Palladium wants to gain happiness and well-being from his obliging, charming manner. Th 4. He considers the outwardly presented persona as crucial. Appearance is more important to him than reality.
Where does he experience insufficiency.. a loss because of that?
Because Palladium puts his full attention on external things, he looses the quality of the inner personality. He becomes very easily influenced. Th 3. The only thing what is interesting for him is the opinion of other persons about him.
He can’t get in close touch with anybody. This he experiences especially “the day after” – for example after a social event – as morning-after feeling. Nobody is here anymore who is flattering him or who applauds to him, which is what he is striving for. Th 5, 6. On the sexual level, being without any relationship leads him to impotence. Th 33.
He is directed to external things so much, that he loses the inner synchronicity with things. The correct sense of time gets lost, time seems to take too long and it is empty Th 8. Especially in the morning, he is indecisive Th 17 – and because he has no inner goal, he also cannot find anything externally, which may be the focus of his interest.
Following rejection, what does he experience as threat or as punishment?
Palladium has no inner personality structure to oppose the events which come up to him. Therefore, he is afraid, he might not be able to endure anything Th 21.
He is afraid that something terrible might happen Th 16 and depressing news aggravates all of his symptoms Th 15. A woman gets anxious when her child is restless. Th 23.
What is the focus of the inner attention?
Palladium exclusively is interested in the effect he has on the external. He wants to make himself liked, show a spruced facade, wants to appear charming, wants to gain approval and applause from others. He wants to be praised and honoured like a God.
How could conscious dealing with the fundamental problematic nature appear?
If Palladium succeeds in evaluating his inner values, he will begin to examine his reigning concepts of values. He becomes aware that superficial applause alone does not lead to long term happiness, and therefore he can endeavour to seek true relationships. He accepts the needed effort to develop an inner personality.
His practiced eye for external effects would still stand in good stead, for example in professional window dressing or in image-consulting.
In a last, often used step, we go through the list of themes once more and think about which peculiar single signs we now can understand anew in the light of our hypothesis, and how we can interpret them on the basis of their symbolic, mythological and linguistic contents:
Interpretation of single themes or signs
Palladium dreams of houses, buildings, in which he had been or beside which he was frequently standing; dreams he were standing at a window, going up- or downstairs, walking through different apartments. Th 9. This kind of description makes us suppose that it has to do with empty rooms in which he walks around or through the windows he watches. These dreams describe the inner emptiness of Palladium. One can even discover a parallel to the substance, which is porous and permeable like a house with empty rooms.
Maintenance of the external posture
The sensation, as if he will get a stiff neck, and as if a blunt object slowly would be pressed against the spinal column Th 36, or backache as from prolonged stiff upright sitting Th 37, suggest the idea of a person who sits with a corset or with a stiff white collar. A picture of external correctness and “countenance”. The appearance should be kept up at all costs.