Homoeopathy according to Hahnemann? The paragraph 211 and the mental symptoms by Stefan Reis
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1 Homoeopathy according to Hahnemann? The paragraph 211 and the mental symptoms by Stefan Reis As a rule, a so-called classical homoeopath is distinguished by the fact that s/he prescribes his/her patient(s) a single, individually selected remedy (which is dispensed in a carefully chosen dose), after having conducted a detailed anamnesis, and having considered the totality of symptoms (not only the ones relating to the current disease). The added classical is meant to signify that no remedy mixtures are prescribed, that no suppressive treatment, which only focuses on one symptom or a disease name, takes place. Beyond that it is also intended to stress the reference to Samuel Hahnemann ( ), the founder of homoeopathy. How far modern classical homoeopathy is already removed from Hahnemann will be shown in this article by taking the example of the value of mental symptoms. The mental symptoms are generally considered to be particularly valuable in choosing the indicated homoeopathic remedy. Some homoeopaths go as far as to stress the mental symptomatology of their patients to such an extent that physical symptoms are purely confirmatory for the choice of the remedy. Many think that this extraordinary value of the mental symptoms is based on corresponding instructions by Hahnemann in his Organon of the medical art (ORG VI). In most cases the paragraph 211 is referred to as a piece of evidence. There it says: This pre-eminent importance of the emotional state holds good to such an extent that the patient s emotional state often tips the scales in the selection of the homoeopathic remedy. This is a decidedly peculiar sign which, among all the signs of disease, can least remain hidden from the exactly observing physician. First of all it should be pointed out that any quotation out of context is always problematic. Altogether the paragraphs deal wit the topic of the mental and emotional diseases. In order to understand Hahnemann s views concerning these, they all have to be studied. This again leads to a complete study of at least this particular work. Only in this way can we achieve an understanding of Hahnemann s viewpoints, which is as free as possible from interpretation and speculation. But even if we look at the paragraph in isolation, it would be difficult to interpret it in the way hinted at above. What follows is an attempt to show what Hahnemann really expressed. To begin with I would like to point out that this is not a presentation of my personal views. The comments orientate themselves merely on the exact wording of the text. A discussion is only possible once we have taken this step. (1) The emotional state of the patient. In paragraph 211 Hahnemann speaks of the emotional state of the patient. What is meant by this is not his personality, his character, but rather the pathologically changed emotional state, that which differentiates the current emotional state from his/her former
2 2 healthy state. Unfortunately, this paragraph does not make it as clear as we would like. He is more precise in paragraph 212, where he speaks of the altered (!!) mental and emotional state deviating from the healthy state, as this chief ingredient of all diseases, as well as the paragraph 213, where he stresses again the mental and emotional alterations. It is a fatal misinterpretation to declare every emotional state, the emotional mood per se, as a symptom, and to take it into consideration for the choice of the remedy. Because in this case either ethical and moral standards are applied to decide what character trait is pathological, or no differentiation at all is made, and every mood, even if it is the most normal and positive, is being taken as an indication for a remedy. One can only do this by totally ignoring the important footnote to paragraph 210: For example, one often encounters patients with the most painful, retracted diseases who have a mild, gentle emotional mind [ ].If the physician conquers the disease and restores the patient again [ ] the physician is often astonished and startled at the dreadful alteration of the patient s emotional mind. The physician often meets with ingratitude, hard-heartedness, deliberate malice and the most degrading, the most revolting tempers in humanity qualities that were precisely those possessed by the patient in former, healthy days. Therefore, at least according to Hahnemann, it is not permissible, to use clearly negative or unpleasant character traits as homoeopathic indications. Moral, social or cultural standards cannot be applied when it comes to a definition of what has to be cured (ORG VI, para 3). This makes sense, considering the constant change of values in our own culture and the different values in other cultures. Or are society structures per se curable? We can only take an emotional state into the symptom totality, which can clearly be identified as being different from the former healthy state. (2) The decidedly peculiar sign Hahnemann describes the emotional state, which often tips the scales in the selection of the remedy as a decidedly peculiar sign, which refers clearly to the paragraph 153 ORG VI, where he stresses the more striking, exceptional, unusual, and odd (characteristic) signs and symptoms. That means that an emotional symptom like any other symptom, can only be indicative for the choice of a remedy, when it fulfils the criteria of paragraph 153, which it doesn t do by being merely a mental symptom, but only if it is also a peculiar sign. If, on the other hand, it is common and indeterminate (also this is stated in paragraph 153!), it lacks that which is characteristic, striking, individually distinguishing. Fear, for example, is not at all striking or indicative of a remedy, if it is not individualised by a strange modality or a striking irrationality or its inexplicability. But even a closer description alone does not make this fear necessarily striking. Fear of poverty, for example, is widespread these days. But not because there are particularly many cases of Calcarea, Psorinum, Sepia etc., but simply because there are so many people who have a good reason for this fear, and therefore this fear is explicable and of nearly artificial nature. To be a decidedly peculiar sign, it would have to be like in the case of Dagobert Duck, the multi-billionaire from Duckburg, who lives continuously 2
3 3 in the absurd and irrational fear for his beloved thalers. This does indeed meet the demands of the paragraph 153 and is decidedly striking. (3) That, which can least remain hidden Hahnemann describes the mental situation, which leads to the choice of a remedy, as a symptom, which can least remain hidden from the exactly observing physician. He expresses himself in a similar way in paragraph 230, when he describes the mental state as the main symptom [which] comes to light with unmistakable distinctness. He must therefore mean a symptom, which strikes one immediately, that must be accessible objectively, more obvious than any other symptom, for example a strange sensation, a pain or something similar. Therefore nothing which we have to dig out laboriously in hour long examinations, nothing which we first have to interpret through body language, dreams or drawings as a central theme. Hahnemann must have meant mostly cases of genuine insanity, psychosis, split, etc. (4) Materia Medica I From dealing with personality structures of our patients as described above, results a common mistake, which can have serious consequences for our materia medica. When a remedy has been given successfully, especially one which has been hitherto unknown with regard to its type (because it was a small or new remedy), there is a tendency to ascribe all the data from the anamnesis as belonging to the remedy. When, for example, the remedy X has cured the asthma in a patient, who is sensitive and easily moved to tears, one likes to conclude that the remedy is a remedy which is sensitive and easily moved to tears. Let us assume the case of a patient, who receives the news that he is suffering from a malignant tumour. Who would be surprised when this patient is worried about his/ her recovery? Is that possibly a symptom of the natural disease? Does this fear distinguish the patient from others who have had to make similar devastating experiences or is this reaction not totally normal? If this patient would be cured, what would be more explicable than a fading of these fears? Can one put it down to the therapy used or the remedy prescribed? is it permissible to view the symptom fear of recovery as a symptom of the remedy? Many colleagues do unfortunately not reflect on these issues: they enrich our materiae medicae and repertories with doubtful indications and blunt our tools in a way, which if the trend continues like this will become useless in the foreseeable future. Hahnemann s demand of a pure materia medica, which is free from any speculation, is clearly acted against in this instance. (5) Materia Medica II A further aspect, which has less to do with the status of the mental symptom in the patient, but rather with its relative value in the materia medica, was mentioned by Clemens von Boenninghausen. He writes in his foreword to the Therapeutic Pocket Book, which was published in 1846, that our pure materia medica (i.e. the list of symptoms of our remedies) does contain nowhere more secondary effects than among the mental symptoms. (p.xii) Secondary effects are a pharmaco-dynamic problem, which Hahnemann had already extensively examined in his Organon (see the paragraphs 62pp and ). While a direct medicinal effect occurs after a medicinal substance has been 3
4 4 taken, the organism tries, as a reaction to this stimulus, to eliminate this artificial disease by creating the opposite or at least a normal state again. Coffee may serve here as a plausible example: In its primary action it produces liveliness, but to an un-physiological, pathological degree, which is a clearly altered state compared to the one the prover has been in before taking the coffee. The organism now works against this liveliness by producing the opposite state exaggerated tiredness. While the primary action belongs to the medicinal substance, and is therefore, according to Hahnemann, a pure effect of it, the secondary effects cannot be counted among the medicinal symptoms. When examining toxicological reports Hahnemann had to be painstakingly careful not to include secondary effects into the symptom list of the remedy. While it might have been relatively easy to do this in relation to the physical signs, it seems, at least according to Boenninghausen, that numerous secondary effects slipped especially into the mental symptoms, which ideally should be eliminated from the symptom list. The most beautiful symptoms of the patient are useless for the choice of a remedy if we cannot find an equivalent, viz. a similar symptom in the materia medica. This obviously applies also to the mental symptoms and seems to be particularly difficult in their case. One has to qualify Boenninghausen s misgivings by pointing out that the reliability of the materia medica with reference to the mental symptoms has been substantially increased through numerous clinical verifications (confirmations); but these misgivings are still valid with reference to yet unconfirmed proving symptoms and presupposes, of course, the correct observation of the verification. (6) Conclusion: Hahnemann s viewpoint When we summarise the above mentioned arguments and facts, the following viewpoint Hahnemann s emerges: Paragraph 211 refers to mental and emotional diseases, and can therefore only be used in a limited way as an instruction of how to deal with mental symptoms in general. Fundamentally, there is no difference between these and how we deal with physical symptoms. Any statement with reference to the mind of the patient has to be examined according to whether it has anything to do with the disease which has to be treated. A sure indication is the chronological appearance of it either at the beginning or after the onset of the disease. It is less a question of whether this state fulfils general criteria of pathological, but rather whether it is a state which clearly deviates from the prior state (meaning: the state before the start of the most recent disease). We have to exclude from this criterion congenital diseases and those, which cannot be clearly traced back to a beginning (in these cases it is difficult anyway to classify a phenomenon as a symptom in the homoeopathic sense). But this is not enough: A mental phenomenon might be for the time being clearly pathological, but if it stemmed from faulty upbringing, bad habits, perverted morality, neglect of the spirit, superstitions or ignorance (ORG VI, paragraph 224, compare also paragraph 77), it is still not part of a natural disease, which is to be treated. The human psyche is also influenced by exogenous factors, like education and conditioning, which makes finding a genuine mental symptom far more difficult than a pathological physical state. As we can see, there are unfavourable factors, which make the identification of a genuine mental symptom difficult. Hasty decisions can have far-reaching consequences (viz. wrong prescription and faulty interpretation of how the case progresses). 4
5 5 But if one has identified a mental state clearly as a symptom, despite these unfavourable circumstances, it is certain that it has to disappear during the cure, respectively it has to change back into the former (although possible unpleasant) state. But to use it for the choice of the remedy, we also have to examine, whether it is a leading indication or characteristic according to the paragraph 153, or whether it is rather common, banal, of little individuality, easily explained or even artificial. This is the way how we deal with mental symptoms in homoeopathic practice if we adhere strictly to Hahnemann. Whoever deviates from this by, for example, taking into account healthy personality traits for the choice of a remedy, or by ascribing these in retrospect to the remedies as their characteristics, cannot refer to Hahnemann. Obviously this is nothing bad in itself and far away from blasphemy and a wrong way to proceed. But if one goes a different way one has to examine whether it is compatible with the other principles, leaving alone that it has to stand up in practice. The nowadays common method to base the prescription, if at all possible, on the mental state of the patient, has to be seen as a deviation from Hahnemann. James Tyler Kent is mostly responsible for this changed evaluation of mental symptoms, who, in his Lectures on Homoeopathic Philosophy, as well as in other writings, considers the mind the key to the patient. He also refers repeatedly to paragraph 211 to support his idea. But this view by Kent is not based on a particularly deep understanding of Hahnemann, but rather on the so-called doctrine of correspondence by the Swedish scholar and mystic Emanuel Swedenborg ( ). In the United States it was common among homoeopaths to be a follower of this New Church. What was special about Kent was that he transported Swedenborg s ideas into the homoeopathic teachings and combined the two. Among other things Kent ascribed to the mental symptoms, and in some places also to the personality of the patient an absolute value. This shows also clearly in his lectures on materia medica, in which he personifies the remedies ( Lycopodium is ), as well as presenting the people who fit the different remedies more as persons than as patients. Due to lack of space we can only hint here at the incompatibility of many of Kent s ideas with the homoeopathic teachings of Hahnemann. The critical reading of the primary literature is strongly recommended so that the reader can form his/her own picture. Possibly Kent and his theory would not have found a wide audience if it would not have been for Pierre Schmidt, who, at the beginning of the twentieth century, imported this homoeopathic school of thought into a Europe, which was dominated by so-called critical homoeopaths (those who prescribed on fixed indications in low potencies and complex remedies). But in this way Kent s homoeopathy became the dominant homoeopathic school. Other classical methods, like that of the Hahnemann student Clemens von Boenninghausen, for example, disappeared from the scene or led a shadow existence, partly, no doubt, because they clearly conflicted with Kent s views. Most other contemporary modern approaches, on the other hand, developed out of the Kent school. That many depart from and thereby dilute the original Kentian homoeopathy may only be pointed out as an aside. It is enough to mention Rajan 5
6 6 Sankaran and his central delusion, or the Athens School, initiated by George Vithoulkas. They all have in common that they stress the importance of the mental symptoms, without clearly distinguishing between symptoms and non-symptoms. There are even schools who believe that physical symptoms are irrelevant, at times even misleading and that only mind and personality matter. When a potentised remedy is then given, all changes, also those in the mood of the patient, are ascribed to the effect of the remedy. What is totally overlooked is that such, to a great extent, marginal changes can equally be the effect of the placebo effect or of the consultation. Such an intensive and intimate talk is often sufficient to markedly influence the mind of the patient. Not everything which happens is due to the influence of the remedy. Since there are already striking deviations from Kent to Hahnemann, it is clear that they will be handed down by Kent s students and successors, but without them being necessarily conscious of it (after all, Kent never tired of referring to Hahnemann as his basis). Before one labels oneself a Hahnemannian one should ask oneself to what extent one is really based on Hahnemann s teachings. This question is not alone decided by dealing with mental symptoms these are only one example how homoeopathy has turned its own back on its foundations. A cautious estimation of mine would be that no more than 5% of all practicing homoeopaths (medical and otherwise) practice strictly according to Hahnemann s instructions. All the others practice usually a mix of disparate, often incompatible methods. A final question arises: who is right: the Hahnemannian or the Kentian? Is there a wrong and a right homoeopathy? Are there different prospects of success in practice? After all both parties claim success in their own practice. It seems that the Kentian homoeopathy has asserted itself against Hahnemannian homoeopathy, but not because it has been more successful, but because of the support by Pierre Schmidt, Kuenzli, Flury, Voegeli, Eichelberger and all the others. Don t get me wrong: Grey is all theory. Also in my own practice are clear mental symptoms (those which fulfil the criteria of paragraph 153 of ORG VI) the key to the remedy. But usually the patient gives us a lot of information regarding his mental state, which has nothing to do with his disease. (This is obviously also very dependent on our case-taking technique). And if Hahnemann s demand to take into consideration the totality of symptoms is correct, we can under no circumstance ignore the physical symptoms, on the contrary: when, even in chronic cases, characteristic mental symptoms are lacking, many physical symptoms, especially those which are striking, can point to the indicated remedy. Homoeopathy is after all an individual therapy, which means: The information the patient gives us has absolute priority. Any kind of interpretation or speculation on the part of the homoeopath makes everything more uncertain. We have to work with the information we get. Sometimes it is difficult to determine a simile with it, sometimes it is easy. In many cases we need a whole series of successive remedies, sometimes a chronic disease can be 6
7 7 cured with one remedy. When the patient shows definite changes in his mental state, and if we find a remedy, which is similar to these, we can take them into consideration for the choice of the remedy, not otherwise. But homoeopathy is also a method, which can be taught and learned. It is important that it remains like that also in the future. Some trends seem to want to make of it some kind of secret science, which is only open to a few initiated people. Sometimes it seems that independent learning and study are not encouraged, which in turn leads to a closer tie to a teacher, which is usually very lucrative for the latter. Apart from the topic of the mental symptoms, which served in this article only as an example, many problems concerning the method and theory of homoeopathy can be at least made clearer by referring back to the sources, for example the question of suppression, anti-doting etc. In order to avoid misunderstandings and being dependent on what an author or teacher says, it is indispensable for the homoeopath to acquire a solid basic knowledge. To do this, it has proven worthwhile to study the available sources rather than to rely on the interpretation, the understanding or experience of a third party, although this is much easier. A solid foundation gives much more support and confidence than a conglomeration of different, often contradictory and sometimes misleading opinions and viewpoints. It is very satisfying to be able to assess critically individual views, further developments or innovations. One can also save a lot of money in this way. Without the ability of being critical and self-critical each practicing homoeopath will quickly hit his/her own limitations with his patients. References and literature: (1) Hahnemann, Samuel: Organon of the Medical Art, edited and annotated by Wenda Brewster O Reilly, Washington (2) Boenninghausen, Clemens von: Therapeutic Pocket Book, Reprint edition 1997, Jain Publishing House. (3) Kent, James Tyler: Lectures on homoeopathic philosophy, Memorial edition, Ehrhart & Karl, Chicago Author: Stefan Reis. First published in German in Comed, edition 12/2000. (Translated from the German by Ralf Jeutter, UK) 7
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