Homeopathic Case Analysis and First Prescription
Thus far we have discussed the process of case-taking and the general principles involved in grading symptoms and their listing according to homeopathic importance. We have also considered in a general way the organization of the Repertory and how an individual symptom can be studied in it. Now we are in a position to go into more depth about how a case is analyzed, and also how the first remedy is chosen.
Throughout this narrative, it will often seem that the analysis of a case and the choice of remedy are routine or mathematical judgments based upon concrete rules. This seems to be true because of the necessary difficulties of trying to translate a very complex process into language which is clear and understandable. The laws and principles involved in choosing a remedy, as described in Section 1, are definite and verifiable. However, their application to each individual case is a complex matter; the judgments involved result from a fusion between art and science. The reader should not get the idea that this process can be accomplished by thoughtless or computerized routines. Nor should the conclusion be drawn that prescriptions made by advanced prescribes are made somehow by psychic intuition or magical processes. There is a definite process involved which is soundly based upon solid laws and principles and yet which is also artistic in individual application. The homeopath uses a wide spectrum of information from the patient, plus a broad knowledge of homeopathic principles and Materia Medica, and then fuses all of this into a "gestalt" understanding upon which the prescription is based.
This process requires a great deal of mental effort, a highly penetrating insight into the individual patient, and a massive amount of studying. Because of this, it can be expected that few will have the necessary motivation and patience to apply such a standard of homeopathy. There will always be a tendency on the part of prescribers to attempt shortcuts, to find "keynotes" which can be used in a routine manner, and to develop computer methods which can reduce the time and energy demanded of the homeopath in arriving at a correct prescription. Thus far, however, such attempts have in the long run yielded disappointing results which can only damage the public image of homeopathy. Very early in the career of any homeopath, a decision must be made as to whether strict and demanding standards are going to be applied — or not. Those who attempt shortcuts will obtain some results, but will be more and more frustrated by the confusion created by incomplete prescriptions. Those who, on the other hand, apply themselves to learning and applying the highest standards will discover a steadily increasing rate of success, and moreover they will find themselves truly knowing what is happening in each case. A career dedicated to such standards is indeed highly satisfying, not only for the patients but for the homeopath as well.
Practical questions frequently arise in the minds of beginning prescribers: "Can I make a living while applying such standards?" "Since it requires so much time with each patient, how can I possibly see enough patients to make a living?" It is true that each case takes a long time, and therefore the patient is charged a relatively high fee compared to what, say, an allopath might charge. However, it must be remembered that the results in homeopathy are far better than those in allopathy. Patients perceive this fact and are willing to pay for results. In the long run, homeopathic patients spend far less for their medical care than do allopathic patients, because as their health improves, the visits are spaced farther and farther apart, the medication is far less costly, and the need for laboratory tests and hospitalization is drastically reduced. Once a homeopath has mastered the highest standard of prescribing and is demonstrating reliable and consistent results, he or she can make an excellent living and be assured of a busy practice.
Initial Prognostic Evaluation
During the initial interview, one of the most crucial decisions which must be made regards the actual seriousness of the case. In the course of a day, a homeopath sees a variety of types of patients. Two patients may come to the office complaining of similar symptoms — say, stiffness of the knees. One patient with this complaint, after having the complete case taken, is found to be relatively unaffected on other levels in the totality. The patient is living a full and creative life, quite unencumbered by any problems except this occasional stiffness of the knees. The past history of the case is negligible, and all the parents lived to old age without difficulties and died quickly without prolonged illness. This person can readily be judged quite healthy, and the homeopath may be assured that such a case is likely to proceed smoothly and quickly to a complete recovery.
On the other hand, another patient may present exactly the same complaint, but the interview reveals an entirely different picture. Although the patient has learned to live with them, it turns out that there have been many anxieties, low self-esteem, periodic depressions, and a progressive process of introversion spanning a period of twenty years. As the patient talks, it becomes clear that his ability to express his inner emotions is greatly obstructed. He claims that he has enough energy to live his daily life, but further questioning reveals that he purposely limits his activities because of a lack of stamina and a need for an afternoon nap every day. In the past history it becomes clear that the patient was very sensitive as a child and then suffered a variety of severe disappointments. Over the years, everything became stressful: meeting new people, applying for a job, contemplating a move from one apartment to another — all have been felt as major stresses from which the patient requires days for full recovery. The family history reveals a strong history of cancer and diabetes, and a few relatives had been institutionalized for mental disorders. To a homeopath, such a case is very quickly recognized to have a poor prognosis. Even the best laboratory examinations might reveal merely "osteoarthritis." Yet the homeopath knows that within a matter of years, such a patient is likely to develop a serious pathological ailment; even good homeopathic treatment will be fraught with difficulties. In such a case, a partial prescription, or one which is timed incorrectly, may create such havoc that later prescriptions become almost impossible to discern.
The patient looks to the homeopath not only for a prescription, but also for information as to what to expect, whether the condition is curable, how long it will take, etc. If expectations are falsely raised so that the patient looks forward to dramatic relief within a few months, later stages of expectable problems experienced on the way toward cure may become profoundly disappointing. In such a circumstance, the patient may become discouraged enough to abandon homeopathy altogether.
Therefore, it is important to begin the study of a case with a judgment as to its seriousness. In the first example presented above, the homeopath may be confident that good prescribing will result in rapid and lasting relief of symptoms. In the second example, however, the prognosis is much more guarded; the patient must not be misled into believing that progress will be quick or easy. The patient should be taught to expect some difficulties, to learn patience, and to respect the necessity of conforming strictly to the laws of cure. Such a case will present many problems during the process of cure, and indeed the ultimate result may not be as complete as can be expected in the first example.
How exactly can a homeopath arrive at such a prognostic judgment? Basically, the following factors tend to signal an adverse prognosis:
1. A limited degree of freedom of expression in life. Even though a patient's original complaints are relatively minor, if the overall ability to live a happy and creative life are restricted, there are likely to be strong predispositions to chronic disease. Creative and selfless people, in general, can be expected to have good prognoses. People who have limited their horizons, who have purposely protected them selves from stress, or who isolate themselves from relationships with other people — such people carry a relatively less favorable prognosis.
Often, a homeopath can spot such tendencies from the earliest moments in the interview. Observation of the degree of openness of expression, the willingness to discuss sensitive subjects, the posture of the patient, the ability to make human contact with the interviewer — all of these are clues. In addition, simple clinical observations offer useful hints — color and texture of the skin, general muscle tone, clearness in the eyes, condition of the tongue, the sheen of the hair, etc.
2. The center of gravity of symptoms. If the center of gravity is mostly on the mental or emotional levels, a relatively poor prognosis can be expected; such patients commonly move toward cure only slowly and with much difficulty. On the other hand, people with very few limitations on the mental or emotional spheres and with problems restricted to the physical plane can be expected to recover more quickly and more easily. The deeper the center of gravity, the worse the prognosis.
3. The degree of hypersensitivity to stimuli. People who are sensitive to every change in the environment, who are overly affected by suffering and violence, who react strongly to slight ridicule or rejection, who cannot tolerate confrontation, who must constantly watch the food they eat, who catch a cold very easily, etc. — such patients are more likely to have a poor prognosis. Their systems are unable to maintain a stable equilibrium, and the defense mechanism must be brought constantly into play in order to restore balance.
4. The past history and the family history. Patients with a history of deep and serious diseases, or who have had a great deal of suppressive therapy are more likely to encounter problems on the way to cure. Also, patients arising out of families with many deep miasmatic influences — i.e., deaths at early ages from serious pathological changes, relatives with chronic debilitating diseases, severe mental disturbances in the family, etc. — can be expected to have more difficulty during the course of treatment.
If any of the above factors are observed in a given patient, the index of suspicion should be raised immediately. Even one such factor should be taken as a clue to potential difficulty, and further questioning must be carefully directed to comprehend the depth of disease in the patient. Occasionally, a patient will exhibit only one of the above factors without carrying a strongly adverse prognosis. Usually, however, if one of these factors is present, the others tend to be there as well. Patients with all four aspects, no matter how minor the presenting complaint, should raise a "red flag" in the mind of the homeopath. In such cases, the minor complaint may be the "tip of the iceberg," and much time and energy will be required to bring such a patient to a reasonable degree of health.