AvdM: You have already mentioned a few times the repercussions of your approach on the anamnesis. Maybe now is the moment to recapitulate?
AV: All homeopathic teachers emphasize the importance of a good anamnesis and so do I. If a case is well taken, the remedy is clear or at least we know what characteristics the remedy should meet. This leaves us with the question: what is a welltaken case?
AvdM: What I have understood so far is that the worldview of the homeopath will determine how he defines health and disease. As a consequence this will influence what he is looking for, whether this is a conscious or unconscious process. We discussed in detail your approach, which is reflected in the five level diagram. This is a schematic representation of the source of disease as a disturbance of the vital sensation, giving symptoms on the four other levels. The art of case taking is to discern on these levels what is vital from what is local. But you mentioned that the homeopath should be in a certain state of mind to do a good anamnesis.
AV: Ideally, yes. The first condition is to be without any judgment. Hahnemann talks about the ‘unprejudiced observer’ and that is a very accurate way of putting it. It means that we as homeopaths should observe rather than think. In fact whatever the patient says we should receive without any value judgment. Of course we have to judge, sentence after sentence, if the information is useful for us or not. But that is another kind of judgment than interpreting the actions and thoughts of the patient as ‘good’ or ‘bad’, as ‘desirable’ or ‘undesirable’. We don’t know what the patient’s lesson in life is and we don’t know what a good, meaningful life is for him. It might be something completely different for the patient than for us.
AvdM: But there is something like a healthy life style and an unhealthy one.
AV: Sure, but that is just common sense. If a patient complains of headache in the morning and it turns out he drinks a lot of alcohol in the evening, the first thing is to stop the intake of alcohol and check if the problem disappears. If a woman suffers from the side effects of her birth control pills, this is not a ‘natural disease’, as Hahnemann calls it. When somebody’s lifestyle is clearly destructive it might be due to his syphilitic miasm. He won’t be helped by good advice but we take this as information on which we can prescribe.
AvdM: But we can’t help but think or judge that it is unhealthy.
AV: Since we are looking for the pattern of the patient’s disturbance, we take it into account as an expression of his disturbance, but we won’t make a psychological analysis that he is, for instance, destructive because he wasn’t loved enough by his parents or that he should learn to draw clear boundaries in his relationships and the like.
We assume that the patient is right in his point of view, which is not an absolute but a relative viewpoint. We try to follow his own logic and worldview, knowing that he can’t be any other way. And most important of all, we should keep ourselves in a state of not knowing.
AvdM: This is the hardest part! First you have to study endless hours for year after year, even for the rest of your life because homeopathy is a limitless, difficult and sophisticated healing system and the moment the patient walks in you have to act as if you don’t know nothing!
AV: You don’t have to act, you really don’t know! At least you don’t know what state the patient in front of you is in. He will have to tell you and the homeopath should keep himself in this mindset of eagerness to know, in a state of complete attention and being with the patient. This means that ideally the mind of the homeopath is quiet, there is no inner dialogue going on with worries about if one is looking capable or professional, whether the remedy will become clear, etc. If the homeopath is concerned with his ego dialogues, he is too distracted and will easily become defensive. We should never take anything personally the patient says but use it as interesting information.
AvdM: Again a difficult thing to accomplish, especially with those patients who are intimidating or questioning your skills.
AV: Although it is human to prefer the one patient above the other, I think we are, as healers, in a vulnerable position if we allow ourselves to feel flattered by some patients and intimidated by others. Some patients are more difficult for us but this is nothing but part of their state and this is what we try to heal and harmonize. In fact, we shouldn’t have preferences because this shows our own need for confirmation.
AvdM: But some patients are really impossible!
AV: Sure. Or rude, impolite, too familiar or too demanding… Of course we observe and define this for ourselves, but even that goes without judgment. The friendly patient is not better than the rude one and we try to help both. We have rubrics for their behavior: ‘rudeness’, ‘offensive behavior’, ‘playing antics’, ‘affectionate’, ‘yielding’, ‘cheerful’, ‘deceitful’, ‘malicious’ and this is what we use but we won’t give a Sunday sermon or condemn them for it.
AvdM: If we can be quiet and be with the patient, without any judgment about their way of being, is that it? Meaning, are we in the right state of mind then?
AV: It probably will sound soft but I’d say the best thing is to love your patient, whoever he is and whatever he feels or does. The very fact that you are willing to give all your attention and skills to listen to every single word of him for two hours with no other intention than to understand him fully, without any judgment and to help him the best you can, is a blessing in itself. In fact just that probably is worth the fee homeopaths charge!
AvdM: It sounds like the attitude of the homeopath is not a skill to be taught but rather something which comes with maturity.
AV: Mastering any art doesn’t come easy. We agreed on that when we talked about teaching and training homeopathy. It requires devotion and daily practice. Since homeopathy confronts the homeopath with fundamental philosophical questions, it is likely he will think about his own convictions and belief systems. And as the homeopath is allowed to look into the deepest of their patient’s souls it is almost inevitable he will feel understanding and compassion for his fellow man. As he is trained to observe the vital disturbance he will notice everybody is living in his own universe and is right in his own way. So homeopathy will help to develop this maturity and love. And of course the best thing is when the homeopath himself is treated and receives his similimum, and then his ego noise will not be in the way.
AvdM: What a relief to know one doesn’t need superhuman qualities to be a homeopath!
AV: Of course not… but it helps!
AvdM: Of course! Maybe you can talk a bit more about the practical implications of your approach?
AV: The heart of the matter is how to spot this vital disturbance? What do you have to ask to get it? My first recommendation is to follow the patient and I’m radical in that. The more the information comes spontaneously, the more reliable it is. Whenever the homeopath is choosing the subject, picking a word, asking for something particular to elaborate on too early in the case, he is making a case. This may seem very skillful and proves he knows his material well, but it has nothing to do with the patient.
AvdM: Some patients take off for three quarters of an hour to answer the first opening question: “What can I do for you?” Shouldn’t the homeopath discourage this?
AV: Normally when the patient needs such a long time to introduce his problem to define the territory, as we say I would just let him talk. Even when there is a lot of psychological explanation as to why he has this certain difficulty and what this person said about it and that person said about it, I would just stay attentive to define the territory in the first place. At the same time I’d try to get an idea of what kind of patient I have in front of me. This is ‘the context’ of the information, complementary to the content: the general impression he makes, the way he talks and relates to me. In the first minutes of the consultation, the patient will show you ‘what kind of person’ he is, he can’t hide himself! This will be expressed in every possible way: by way of his clothing, his way of greeting you, the way he sits down, the tone of his voice …
AvdM: We have all heard this many times but it seems that the importance of it hasn’t seeped through yet. Or maybe we don’t see any practical use of it in daily practice?
AV: Maybe because we think it is superficial information or we judge it by psychological interpretations or even evaluate the patient in function of the impression we make on him!. The importance is the ‘surprise effect’, which will diminish the longer we are together with the patient. In this surprise effect lays his individuality; it is exactly that what makes him different from all the others. When we have done a few consultations with him we won’t be surprised anymore. On the contrary: we ‘know’ the patient and we expect a certain behavior. The Strange, Rare and Peculiareffect is lost then.
AvdM: Could you give a few examples of the importance of the behavior?
AV: All patients act in an ‘individual’ way, they can’t do anything else. For instance: a 40 year woman might come in with a remarkable red blouse, a short skirt and a red shawl, or with a very sophisticated combination of dress, shawl, earrings, hat and handbag. In the first case the patient I’m describing needed a Snake remedy and in the second case the patient belonged to the Cancer miasm. An example I gave before is the 50yearold man with the colored hair. He entered my office and told me that my haircut was nice. It turned out he needed Lac caninum and indeed, immediately from the moment he came in the consultation room he brought this animal feature of ‘looks are important’ and the “I am male, you are female” message. He was making these flattering comments to my assistant as well. Some patients excuse themselves before they come in for whatever reason: for being too early, having to use the bathroom, didn’t know which bell to choose from, etc. Other patients don’t say anything; they just do what they are told: “Please, come in, sit down”.
AvdM: All very common things! Which ones should be taken into account?
AV: Very often when you go back to your notes to study the case afterwards, you’ll notice to your surprise that the patient actually gave you almost all the information in the first paragraph. For instance: “I have this horrible terrible pain for seven years, and I can’t control it with anything.” There is the chief complaint: ‘Pain’ and the need to control: ‘Cancer miasm’. Now we have to look at the Plant families with Pain.
AvdM: You make it sound easy but in practice it doesn’t come through that clearly.
AV: I know and one of the problems is that we are looking for something deep, something special and we don’t pay enough attention to what the patient is telling us from the very first words he speaks. Another problem is that we sometimes drown in the waterfall of words, words, words.
AvdM: Especially if we shouldn’t interrupt the patient per your advice and let him rave for three quarters of an hour!
AV: Yes, but that is the first round, remember? If the patient goes on like this, then we must take advantage of the first occasion he takes a breath and tell him we understood perfectly what he is telling us and what the problem is and what happened but we need to understand a few more things to be able to prescribe. Then we can invite the patient to describe how he experiences the difficulties he has just told you.
AvdM: I see, this spontaneous report is mainly in the first part, the ‘Defining the Territory’ part. Later you actually can interrupt and lead.
AV: You can and you should. Besides staying in this state of full attention, unprejudiced and not knowing, the other important thing is to know at every moment in the consultation what you are doing: we are looking for the expressions on every level that come from the vital. If this is not revealed spontaneously, we can carefully ask for it.
AvdM: I must admit that it is not always easy to be at all times aware of what you are doing in a consultation.
AV: I know. The way we were trained was more or less to let the patient tell whatever he wants and hope something useful would come out. This resulted in a lot of stories from which we skillfully tried to mold a case. Depending on the knowledge of rubrics and the talent in rhetoric, the one homeopath made a beautiful Lachesis case while the other saw a textbook Lycopodium in the same.
AvdM: And you showed us in class: Lycopodium fits everybody.
AV: Yes, I believe it has more than 11,000 symptoms listed. It has about all the common human feelings and this on both sides of the spectrum: what more do you want?