New Approach of case taking

New Approach of case taking - The Old Approach In "The System of Homoeopathy" I explained that an ideal case had four steps, which could be likened to four spheres each within the other and with a common centre. Each successive sphere was therefore one step closer towards the central state of the patient. With each step one obtained finer and more specific data till one finally reached the central point where the deepest mental and physical sensations, the miasm and the kingdom all converge to a sharp focus. This is the patient's delusion. With this approach, one lets the patient describe his problem: physical or emotional, and while the patient was allowed to speak the physician's focus would be on picking up peculiar symptoms and on getting to the bottom of the Mental State. The emphasis therefore was mainly on understanding emotional phenomena. Often this proved a difficult and confusing task, especially when one got lost in the story, rather than understanding the patient's feelings. The concept of Vital Sensation As I made progress with my study of the plant families I realized that the concept of the common sensation (refer Introduction) was not just confined to the plant kingdom. In the case of disease and remedy states from all kingdoms one can perceive this common sensation both, as a physical sensation as well as on the emotional sphere. With the old approach there had been a lot of emphasis on the mind state and mental symptoms. Having discovered the concept of the common sensation however I realized that the central state was not merely an emotion or feeling, but was this common sensation that connected the mind and the body. I call this common sensation the Vital Sensation as it is something deeper to the mind and body. What is the level is deeper to the mind and body? That is what I call the Vital Level. I used to think that the centre of the Mental State was the deepest point that we could reach, but I realized that the Vital Level is a step deeper than the Mental State. As for example when a person says that he feels jealous or suspicious or expresses something mental and emotional then we might ask him for the experience behind that. He may feel he is being attacked and is frightened. In this way an emotional situation is perceived behind the mental symptom, which is good enough, but if you want to take it one step further you ask him how he experiences the attack. At this point you come to the intersection or cross point where the mind and body meet. Here they may have the feeling that something is breaking or burning or twisting. This is the common point between body and mind (The Vital Sensation) and here he will describe his emotional symptoms and physical symptoms in the same terms. This is a very deep level and if you reach this point there is a much better chance of success. With this new understanding I saw the patient's delusion not only confined to the mind but also expressed on the physical sphere. In fact I could see that the Mental State is merely one expression of the Vital Sensation. And when I started looking for this common sensation or delusion or vital symptom in the physical sphere I realized that it was apparent right at the outset, with the chief complaint itself. Importance of the Chief Complaint I started concentrating on the various details of the chief compliant and I realized that here one always came across an element which had more than just a physical connotation and spontaneously connected to the mind state. Thus one could get directly into the center, to the Vital Sensation, from the chief complaint itself. In many cases when the patient expressed a physical sensation in relation to the chief complaint one could see the same sensation emerge in the emotional sphere. In other cases the effect of the chief complaint on the patient's life was an expression of this Vital Sensation. In yet other cases it was the modality of the chief complaint. With more cases it became definite that the chief complaint itself gives direct access into the central state of the patient. So now I was starting with the core of the case right from the outset and then examining other, more superficial areas, which are more like expressions of this core state. This was completely opposite to the earlier approach where I would start with broad and seemingly disconnected data and then go step by step into the center. With the old approach if we did reach the connecting symptom it was at the end of the case. The chief complaint itself was often neglected with the belief that we are not treating the pathology but the person having it. As a result one was impatient always to get over with the chief complaint and get to the nature or the mind state of the person. Further, many times we would simply get caught up in the mental phenomena without actually touching the sensation. In contrast, with the new approach one reached the common sensation by sticking to the chief complaint itself. And having unearthed this common sensation at the outset one could see that the whole case and expressions as branching out from this common core sensation. As I used this approach more and more I began to understand that the chief complaint represents the crystallization of the Vital Sensation. Hence it is the best place to locate the Vital Sensation. It is the fountainhead where all the vital phenomena are expressed in their raw form. It certainly cannot be neglected; rather it is the main support around which the case revolves. It forms the foundation of the case. I learnt then to stick to the chief complaint and examine it in its depth and this has revolutionized my case taking and yielded far better results in my practice. Sensation and reaction As I started looking for emotional and physical expressions of the sensation in remedies and patients, I could see sometimes that the sensation would be expressed directly. At other times it was expressed as a reaction that was always equal and opposite to the sensation (and this I made the first law that has been explained above). In some other cases it could be seen as compensation. I could also see that reactions were of two types, active and passive and they were both equal and opposite to the sensation (Refer Introduction). For example if the sensation is 'caught up' or 'stuck' the active reaction will be to want to move, the passive reaction will be being immobile or unable to move, while the compensation will be a person who is always on the move. The modalities essentially speak the same language as the sensation. For example, if the sensation is of being caught the modality is better from movement. If the sensation is of being tightened the modality is better by loosening. In this way the modalities will also confirm the sensation. While taking a case I would pay attention to the sensation expressed in the chief complaint and later in the dreams, interests and hobbies, fears etc. The sensations were of various types. In some cases throughout one sees nothing more than a particular sensation (for example, tied up); this means that the key issue for this patient is sensitivity (to being tied up) and such a person requires a plant remedy. If this sensation has to do with survival then the remedy required will be from the animal kingdom. If it is linked with structure a mineral remedy will be required. In this way the type of sensation gives an indication of the kingdom. The Miasm Often I am asked the question: In a given case if there is a feeling of 'being suffocated', is this the sensation described in the Rosaceae family or is it the suffocation of the tubercular miasm; how would one differentiate the two? Similarly the forced out sensation of the Liliflorae could be confused with the cast out theme of the leprous miasm; or the stuck feeling of Anacardiaceous with the similar theme of the malarial miasm. To re-iterate what I have already said above the vital sensation is what the patient feels. Take, for example, pain which one can feel as cutting, stabbing, pinching etc. The intensity, pace and depth of this sensation or how he copes with it indicate the miasm. In practice, if the patient says he feels suffocated or something suffocates him the physician must endeavor to understand whether: 1. The patient feels things to such a depth that it is suffocative. In this case the suffocation indicates the miasm and the area or issue connected with this suffocative degree will reveal his sensitivity. For example: If he is vexed and excited so easily and frequently that he finds it oppressive, then his sensitivity is in the area of easy vexation and excitement, (family Ranunculaceae) while the oppressive degree is indicative of the tubercular miasm; the patient probably needs the remedy Cimicifuga. 2. In every area of his life there is a sensation of being suffocated or pressed down. In this case he could perceive this sensation to any depth. He could feel acutely and dangerously suffocated (acute miasm, Rosaceae family), or he could feel suffocated to the point of being stuck (sycotic miasm, Rosaceae family) or he could feel so hopelessly suffocated that there is no way out (syphilitic miasm, Rosaceae family). In all these examples the suffocation is surely where his sensitivity lies and so indicates the family. The type of sensation is only one of the components of the disease. For example if the main issue in a case is the sensation of being injured we can say that the patient will require a plant remedy from the Compositae family. But this is not enough to help us select one remedy from amongst the many, many remedies of the Compositae family. We know the type of sensation, viz. Injured sensation, but we can also perceive in the case the depth and intensity of the sensation and reaction as well as the manner in which the patient copes with these. Sticking to the same example of injury there are different ways in which the patient may perceive the injury. He may feel he will be suddenly injured in which case he may panic. The suddenness and the panic suggest an acute situation and response. Another patient may perceive the injury as an acute crisis. He will respond by making a concentrated effort to overcome the crisis. The intensity of the injury (acute crisis) and the response suggest the typhoid miasm. Or then he may feel that he is persecuted by injury from time to time while being stuck in a situation. The feeling of injury suggests the Compositae family while the depth is of the malarial miasm viz. stuck and persecuted intermittently. So we can see from the above examples that the depth to which he perceives the sensation as well as the nature of his response determine the miasm. The miasm is the other component in the disease. So the disease has two components, viz. the type of the sensation and the depth of the sensation. The sensation and miasm together give the remedy. (Refer Introduction) In the first example given above where the sensation is injury and the miasm is acute the remedy will be Arnica or Calendula, depending upon the symptoms. The remedy from the Compositae family of the typhoid miasm is Chamomilla, while Cina and Eupatorium perfoliatum are the remedies from the malarial miasm in the same family. Although often one can determine the depth to which the patient perceives the sensation, usually the response to this is very clearly seen. For example one may be able to understand that the patient perceives the injury as an acute crisis, but this becomes clearer when we see the patient's response, viz. a concentrated effort to overcome it. This response therefore is the best indicator of the miasm. I also call this response the 'coping mechanism ' and this is best seen in relation to the chief complaint as the patient's attitude towards the illness. If his attitude is one of panic, the miasm in the case is likely to be acute. If it is hopeful, it is likely to be psora. If he adopts an attitude of resigned acceptance, avoidance or cover up it may be sycosis and if he feels hopeless and destructive it may be syphilis. This miasm can then be confirmed throughout the rest of the case as an action taken in response to the depth of the sensation perceived. Sometimes some expressions of the patient with regards to other parts of his case may point towards other miasms, but I usually only trust what the chief complaint as well as the areas of most stress indicate. The coping mechanism applies to the depth of the sensation as well as the reaction. I have already explained that the reaction can be active or passive or in the form of compensation. So if we take once again the sensation of being injured as an example, if the depth of the injury is to the point of destruction his reaction will also have the same depth: he will want to injure to kill. But if he reacts passively he may become numb and hopeless. If he is well compensated he can respond by becoming the tough guy and facing the most severe and destructive type of injury. If the sensation in the case is apparent then one can understand the miasm by asking the question, what does he do in response to the sensation? Or What is the action in response to the sensation? Does he panic, does he make a desperate, last ditch effort to overcome it, does he stretch himself far beyond his capacity etc. This will give the miasm in the case. In some cases one can see the action before one has actually understood the sensation. Here one can ask Where is the area of the action? or What is the issue related to the action? Is he panicking in response to sudden injury? In that case the injury will be the sensation. Does he stretch himself beyond his capacity to feel included? In this case the sensation will be that he is not included or left out. In this way in any case from the sensation we can find out the miasm and vice versa. Disease therefore has two components: the sensation and the miasm. Also when we study well proved remedies the most characteristic symptoms of the remedy are a combination of the sensation as well as the miasm. The most characteristic symptoms therefore point directly to the core of the remedy. The New Approach Step one: Elicit the chief complaint exactly. I have already emphasized the importance of the chief complaint. One should stick to it and examine all components thoroughly for the sensation and miasm. The sensation may be expressed directly, or one can see it through the modalities or the effect that it has on the patient's life. The chief complaint is the best place to look for the sensation and the miasm. One begins the case by asking for a detailed description of the main complaint and one keeps asking the patient to describe it further and further till one comes to a sensation that will have a greater connotation than just the presenting problem, or something that will lead into the Sensation. I usually stick to very simple questions at this stage, like "Tell me more about it." or "Describe it further, I don't understand . . ." or "What do you mean when you say . . . ?" or "What do you feel ?" If the patient gives a sensation one can usually confirm it from the modalities. I also ask the patient to describe the opposite of the sensation in detail as sometimes the patient will spontaneously connect this with images, situations, fears, or other aspects of his totality. As he is describing the chief complaint one also makes note of the pace and depth of the problem and the patient's response or attitude or coping mechanism. These indicate the miasm in the case. The miasm becomes apparent once the sensation is known and vice versa (Refer above). Some rules I follow: 1. I will never use a word that the patient does not use. I will always repeat the same word in exactly the same way and only tell him to describe further or tell more about it or ask about the sensation or feeling of it. 2. I will keep asking the same question in various ways till the patient leads me to the next question or step. This is reached when the patient gives another sensation that is more precise or more descriptive or deeper than the previous step. One needs a lot of patience and faith that the patient will express something deeper. Sometimes the patient can get frustrated from being asked the same thing repeatedly. One can therefore ask him the same question in different ways Often patients revert to the chief complaint and furnish you with more details about when it happens etc rather than answer what you have asked. In such cases I tell the patient that I understand when it happens, but what is more important for me is what is happening rather than when and why. With this sort of persistent and focused questioning there are two or three things that can happen. 1. The patient can give you a visual picture or an example. For example if he says he feels stuck to one point and you persist with asking him to explain what he means he can say that he is stuck to one point as if he is in the middle of a street and there is a car coming at him at full speed. "How one feels stuck in such a case", this is how he feels. 2. Or he can associate this with something else in his life or in his story. For example he can spontaneously describe an incident when was going in the street and he felt stuck in the same way. In either case what one has to get to is the sensation or what he experiences emotionally and physically when he is in that situation. 3. Or he may describe the sensation as a fear. Then the next question would be, "Where do you experience that fear?" or "How do you experience that fear?" Where the patient can express no more than an emotional feeling one can ask him how he experiences the feeling in the body or what are the physical symptoms he experiences at the time. This could lead to the sensation. In this manner by chasing the chief complaint one can come to the main feeling or sensation. Thus the presenting problem can be seen as an expression of the Vital sensation. Observation of hand gestures: With the emphasis on sensations I realized that in many cases these were best expressed by hand gestures, even better than words sometimes. The 'forced out' feeling of Liliaceae, the 'obstructed feeling' of Cruciferae or the 'pinched feeling' of Rosaceae can be well observed even when the words may actually be saying something else. These hand gestures are subconscious, involuntary and often not even noticed by the patient. Sometimes I stop the patient while he is gesturing and ask him what the gesture denotes. In one case the patient described her asthmatic attacks to have a sensation of being tightly twisted in her upper chest, like choked or strangled. She gave a picture of the sensation like a python strangling its prey. Later on in the case she spoke of being hurt when her husband admonished her. When I asked her to describe the feeling of hurt, she used the word sad, while at the same time her hands went towards her chest and were clenched, the same gesture she had used while describing the strangled, twisted feeling in the chest. What she could not express in words, her hands were speaking to us, even without her being conscious of this. So when thereís no hand gesture, no image, no connection then itís used casually and need not be followed. Step Two: Go to the areas of least compensation. Usually if we go in depth into the description of the sensation and persist in this area, the patient himself will lead us into all the significant areas of this life like vocation, relation and recreation. If he does not do this despite our best efforts and the case staking process is stuck at a point, then we may need to inquire into some areas, especially those which are likely to show the least amount of compensation. These include hobbies, interests, dreams, fears and childhood. Here the delusion is best expressed. Once one has derived the sensation and response or action in the chief complaint the next step is to confirm these in the areas of least compensation. The same sensation or its opposite will be found here, as also the action and one will come back to the same core undisputed. Step Three: Other areas Now one has the freedom to go into other areas, especially those that are seemingly disconnected and see how they connect to the common sensation. Step Four: Go back to the sensation that the patient has repeatedly confirmed and take the patient deeper till he gives a situation (actual or visual) where the sensation, miasm and kingdom concur. Or Go back to the areas of most stress and go deeper with the patient till a point is reached where the sensation, miasm and kingdom concur. It is important to note at which point in the case the local phenomenon becomes general or emotional, or at which point emotional phenomena become physical. This is the Vital Level, something that connects the mind and the body. Illustrative Case: The method will be better understood if illustrated with a summarized case. The method is explained in italics while the case is in normal type. P: Cough four to six times in the day. Q: Describe the cough some more. P: Blank out with the cough. Want of breath. Pulling sensation in abdomen, throat. It is worse when going out, from a draft of air. It comes on suddenly, especially when talking suddenly. So one can see that he has a cough which gets severe from time to time, and at such times he gets a black out. The cough gets worse when he is outdoors and so he cannot go outside the house. So there are two aspects to the cough: . blank out (sensation) . It comes from time to time and he can't go out of the house anymore (pace/miasm). Q: Tell me about 'blank out', describe it. P: It becomes black before my eyes, as if I am stuck to one point. Q: Stuck to one point meaning . . .? What is the feeling when stuck to one point? I have used only the words of the patient and keep up this questioning till he leads me to the next question. This could be a more precise feeling or a visual picture or something that comes up by association. P: It is as if I cannot move. Now this does not yield a finer description of being stuck at one point, nor has he given a picture of what it is like to be stuck at one point. You cannot go any further with this. So I will again ask about his feeling when he is stuck to one point. Q: What is the feeling when stuck to one point? He reverts back to the chief complaint. Now it is our job to keep him to track so repeat the same question till he goes one step deeper. P: It is like you are in the middle of the street and car is coming at full speed. That is how I feel. Now this is a visual picture. It could have been an actual experience from his life. It is a window into the Mental State , one level deeper than the physical. Question him further and ask about his experience in this situation and one may be able to see a connection with the cough. Q: How does one feel when one is in the middle of the street and a car comes at you at full speed? P: It happened to me as a child. I felt the same way. We have to get to the sensation in that situation. Ask him now to describe the experience in emotional and physical terms. We started with the cough and then came to blank out and then to black before the eyes and then to stuck to one point then to the childhood situation. All this by sticking to the chief complaint and chasing it. P: The fear is I will be suddenly killed and so I cannot move. So in this manner by chasing the chief complaint one can come to the main feeling or fear which is that suddenly he is going to be killed and he is stupefied from this fright. Now you can see the connection with the cough. The cough comes suddenly from time to time and he cannot go out of the house. It gets black before the eyes and he is stuck to one point as if he is going to be killed. He is frightened and stuck to one point. Fright stupefies. The cough stupefies. He avoids going out of the house because he will get a cough. He avoids the situation that stupefies him but he still gets the cough from time to time. So this is the malarial miasm, Solanaceae family and the remedy is Capsicum . So the remedy became apparent from the chief complaint itself and could be confirmed in other areas in the case. Once you get the sensation you have to get the opposite. To get the opposite go to the area of least compensation or no compensation: hobbies and interests, dreams, childhood. For example in the case of a patient for whom I prescribed Mangifera needed to be in company. When I asked about her feeling when in company she replied that she feels things are moving and are not static. What does that have to do with company?! So it is this that she says which ties with the rest of the case. Mangifera is a sycotic remedy from the Anacardiaceae family. The main sensation in this family is of being caught or stiff or stuck. One can see the opposite in her hobby, i.e. not static and always moving. The beauty of this whole exercise is that you never know what comes up; as the case goes on the sensations and feelings unravel as a surprise. So, nowadays I concentrate on the chief complaint and in this way reach the center in all my cases. The old way was from outside inwards whereas the new approach is from within outwards starting with the chief complaint. The concentration should be on the chief complaint, whether the problem is emotional or physical. The chief complaint is the main support around which the case revolves. And instead of letting isolated emotional phenomena or physical symptoms mislead us the emphasis should be on the vital symptoms, or the symptoms that connect the mind and body. All this time instead of catching hold of the chief complaint and not letting it go till we have understood it clearly, we used to go all around to other areas in the patient's life. All that is clothed in the expressions of the emotional state becomes naked in the chief compliant. If we go to the other areas first we will only feel the tremors; if we concentrate on the chief complaint right at the outset we discover the volcano from where the tremors originate; we discover the wound that is most tender. If we focus our complete attention onto the chief complaint, its sensation and modalities, we understand the very core of the case right away. The body and the mind both express the same phenomena, same disturbance, and the same vital problem. If we understand the physical aspect first it may be more helpful and save us from getting ourselves lost in the mental phenomena. This new approach to case-taking was the beginning of an understanding of the various levels of perception and led to the discovery of the seven levels viz. Name, Fact, Feeling, Delusion, Sensation, Energy and The Seventh. In the medical terms, the first level has to do with diagnosis , the second level with the complaints, third with the feelings and emotions, fourth with the delusions and dreams, fifth with the sensation, sixth with the energy pattern and the seventh with what lies beyond. So far in Homoeopathy we could treat the patient with symptoms, pathology etc. 'The Spirit of Homoeopathy', introduced the level of delusion . This book introduces the idea of sensation. The idea of levels has been a big step for me and clarified not only case taking and analysis but also the vexed problem of potency. An extensive understanding of the levels and its practical utility will be dealt with in my forthcoming book entitled, ' The Sensation in Homoeopathy'

Case-Taking-Format

Case-Taking-Format For patient: it is advice to treat their illness by a good local homoeopath, with the help of our Repertorial analysis chart. Guide lines: The patient as well as physicians should always keep in mind that every case is quite new and also that Homoeopathy treats the patients, never the disease by nomenclature. One should not be puzzled to look at this exhaustive case taking Performa. This is meant for all ailments of humanity all over the world. He is to note only that point which concerns him and the rest may be left blank. It is cautioned that answer should be given after due deliberation never in a hurry, the wrong or confused answer will lead to wrong selection of a remedy, which will be harmful, to the patient as well as the physician. If the patient has difficulty in the filling up the Performa, he may take help from good local homoeopath. Confidential Name Age Date Sex Religion Occupation Address [present] Address [permanent] E-mail number History of present illness [Complaint, Location, How it aggravate & relived] Pathological State Report [if any] X-ray, blood test, urine test, ECG, Ultrasound, C.T. scan, MRI, memo graph, etc. Details of past illness & events [Give as far it is known] Family History [Indicate the main disease of family members] Mental Information Mental Traumas [write in details if any] Death of love own, loosing job, unemployment, money loss, hopelessness, honor wounded, frustration, domination, discord, envy, responsibility, family anxiety, carelessness from family members, divorce, indifference, love disappointment, after retirement, and any present problem or mental pressure. Mental State Present condition of – memory, concentration, anger [why and type of anger], consolation [agg. or amel.], maliciousness, remorse, fear [from which and why], weeping [why and which type], any anxiety, envy, discontented [from which], escape nature, sympathetic, depressed, fastidious [which kind], postponing nature, company desire or aversion [why], habits, hobbies, religious behavior, crowd and noise [how affects] Economical Status Family income, condition of business, future planning, social economical status, avarice, extravagance, satisfied or dissatisfied with his/her income. Observation Traits of character, constitution, diathesis, susceptibility, intolerance Sleep Nature, position, symptoms [before, during & after sleep], action sleep during [started, teeth grinding, talking, walking, urinating etc], pillow desire [ high, low etc] Dream Object, frequency, effect on the patient. Sex Continence, desire, aversion, satisfaction, masturbation, ejaculation, perversion if any, marital and pre or post marital relationship. Menses Menses appear [age, premature, delayed], cycle [regular, irregular, early, late], duration, character of discharge [colour, consistency, order stain], quantity [profuse, scanty], character of flow [normal, clotted, scanty, profuse, suppressed], symptom [before, during, after menses], alteration if any. Leucorrhoea Character [type, colour, order, stain, frequency] character of flow [before, during, after], concomitant. Symptoms [different part of the body] Vertigo [when, type] Head [pain, hair falling, hair gray becoming, tangled, split, lice, dandruff] Eye [discharge, pain, colour] Vision [foggy, blindness] Ear [discharges, pain] Hearing Nose [discharges, smell, dryness, sneezing, sinus] Face [dry, oily, colour, lips] Mouth [taste, smell, salivation, open sleep during, gums] Tongue [colour, moisture, coating, sides and under surface] Teeth [ carries, colour, sensitiveness] Throat, tonsil Stomach [appetite, thirst, digestion, eructation, nausea, yawning] Abdomen [gas, distended, hardness, ball sensation, liver, spleen] Rectum -- inactivity, piles, fistula, prolapses Stool [first urge when, type, frequency, satisfactory or not] Urine and urination [frequency, flow, pain, burning, retention, colour, order, sedimentation] Prostate, Breathing Back Respiration Cough Extremities [pain, restlessness, numbness, cramps, finger nails, hardness] skin [eruption, eruption if any, itching, discoloration, warts, tendency to suppurate, scars] perspiration [location, quantity, order, color, stain on cloth] Cold Fever [chill with, entrainment, thirst, restlessness] General symptom Which season patient like, dislike and why? How change of weather affects? Bathing [likes or dislike]? Likes open or close place? Clothing loose or tight? Which color attracts or why? How heat, light, humidity, sunlight, affects? Food - desire, aversion and aggravation. Child case taking format. Name Age Date Sex Religion Study NORMAL / CISSARIAN BABY Address [present] Address [permanent] E-mail number History of present illness [Complaint, Location, How it aggravate & relived] Pathological State Report [if any] X-ray, blood test, urine test, ECG, Ultrasound, C.T. scan, MRI, memo graph, etc. Details of past illness & events [Give as far it is known] Family History [Indicate the main disease of family members] Mental Information Mental Traumas [write in details if any] Death of love own, honor wounded, domination / excessive parental control, discord, envy, responsibility, family anxiety, carelessness from family members, indifference, any present problem or mental pressure. Mental State Present condition of – memory, concentration, anger [why and type of anger], consolation [agg or amel], maliciousness, remorse, fear [from which and why], weeping [why and which type], any anxiety, envy, discontented [from which], escape nature, sympathetic, depressed, fastidious [which kind], company desire or aversion [why], habits, hobbies, religious behavior, crowd and noise [how affects] Sleep Nature, position, symptoms [before, during & after sleep], action sleep during [started, teeth grinding, talking, walking, urinating etc], pillow desire [ high, low etc] Dream Object, frequency, effect on the patient. General symptom Which season patient like, dislike and why? How change of weather affects? Bathing [likes or dislike]? Likes open or close place? Clothing loose or tight? Which color attracts or why? How heat, light, humidity, sunlight, affects? Food [desire, aversion and aggravation].

Strategies of Case Taking

Strategies of Case Taking by George Vithoulkas At times in the case-taking process it is of essential importance to disregard the suggestions that have been made by the computer and ask some basic case-taking questions such as: "Is this person really healthy on the emotional level? For example, is he/she able to express his emotions with strength and clarity? Is he flexible or rigid? Is he finding creative solutions to problems or getting more trapped? Does he have a strong sense of purpose, value and meaning in his life, or is there apathy and indifference? How much strength of individuality is in his identity or is he weak and unassertive? What is his balance between selfishness with a strong boundary and the overcaring, oversympathetic and too selfless individual who ends up as a victim? Did he/she pass through the developmental stages easily? What stages is he still trapped in? What negative emotions are there? What are the positive ones? Finally, is his health based on freedom to make choices or does the pattern of the "subconscious" make decisions for him and restrict his freedom?" How are the symptoms connected to the patient's life and his development as a person? What exactly was the way the patient perceived the stress she encountered? How did she react to it? Has this reaction become a rigid response? How has this reaction continued and developed? Do I really understand this person and her basic life dilemmas? How and why did she get sick? What is to be cured in this patient? What is her basic limitation to health and happiness? What is her inner conflict or central disturbance? What is basically wrong with her? What is her nature? For example is it rough, delicate, sensitive, expansive, contracted, evasive, open, closed, irritated easily, still, heavy, light, colorful, bland, restless; or peaceful? What impression does her body type make? What clothes does she wear? How quickly do they answer the question? Can she look me in the eye? What are her hands doing? Is there tension in the face or does she sit erect or slouch? What can one feel from the patient? Is it neutrality, acceptance, judgement, anger, sympathy, rigidity, sexuality, anxiety, suppression of emotions, or is it a type of anxiety, a fear of some sort? Is it anger suppressed with sadness on the surface? Or anger suppressed with fear? Write down your impression without thinking of any remedy. Try to understand the basic intention of his life, the false beliefs and what affects these are having. The basic conflicts he carries with him and the deep patterns that shape his life. Where did these patterns of adoption arise from and how are they in conflict with their present situation? What is the mindful reaction of the vital force itself and why has it chosen to make this reaction? These are often the thoughts one must hold without judgement to create an environment in which the patient will tell you their deepest thoughts and feelings, leading to factual information that allows one to truly understand that personís life and thus the crucial symptoms on which to base the repertorization. Of course every case is different and this information is sometimes not available because the person is healthy and has no deep conflicts or is unable to open up and tell you.

Case Taking with Homoeopathic Facial Analysis

Case Taking with Homoeopathic Facial Analysis - - Grant Bentley Case Taking with Homoeopathic - The argument between the academic and the practical - Different roads leading to the one place? - Being ideologically promiscuous - Homœopathic Facial Analysis (HFA) – strong and unchanging - The two modalities that exist in every chronic disease - The mentals – not the key to unlocking the remedy - Generals – more discriminating than mentals - Physical form is unique – the human condition is not - 90% of valid information is non verbal - The body is a vault that keeps past memories alive - Nature has our best interests at heart - Our facial features have molded into a design most beneficial for our individual needs A former patient of mine who has studied homoeopathy for more than twenty years, described HFA as the most usable system she has ever known because of its straight forward simplicity. In any walk of life, professional or technical, there is an age old argument between those who are practical and those who are academic, and in homoeopathy it is no different. Accountants often disagree with economists, while builders shake their heads as they look at the drawings of the architect. There has always been a difference between theorists and those at the coalface. My patient was stating that HFA is coalface homoeopathy. It is designed for the clinic because it comes from the clinic and its membership is dominated by working practitioners whose bottom line is ease and reproducible results. This does not mean theory is irrelevant, but the argument about whether it is practical, is too important to be overlooked. During a discussion I once had with an Osteopath who also studied homoeopathy, he mentioned how there were so many theories in homoeopathy by comparison to other modalities. I replied, 'Wouldn't that be a good thing? After all doesn't this show a thinking profession?' His reply was 'No, it shows a profession that has too much time on its hands!' The problem for him when it came to homoeopathy was not the system itself, but the multitude of competing theories that kept emerging in reference to practice. Most disturbing is how many different theories are adopted by practitioners, as if they are interchangeable and saying the same thing. Some of these theories have entirely different opinions on miasms, remedies and even pathology. Some do not focus on miasms at all while for others they are the central core. Some have different ways of prescribing, different modes of delivering the remedy, different potency scales and different ways of taking a case, yet they are all being viewed by some practitioners as if they are different roads leading to the one place. Many homoeopaths act in a manner that is ideologically promiscuous, sacrificing quantity for quality in a search to repeat the rush that comes from being 'amazed'. Promiscuity never delivers the comfort and depth we instinctively crave. Promiscuity is a short term fix to an insatiable need for stimulation. But a constant need for stimulation comes from a lack of sustainable fulfillment. This is the difference between eating porridge and chocolate. People don't crave what is nourishing and satisfying because satisfaction is the opposite of craving. Cravings occur when satisfaction is momentary but unsustaining, which causes our desire for more. Regardless of whether it is food, drugs or knowledge, jumping from one to another is neither healthy nor productive. It is not professional development that is in question, but the search for the thrill that comes from 'insight' which can be addictive and even dangerous. It is addictive in the way any thrill is addictive, because it leaves you wanting more. This makes some research authors feel pressured into churning out 'discoveries' because of public demand. It also often makes continuous or annual discoveries look suspicious to other researchers, who know how much time it takes to research a project thoroughly. Theories that come out annually will be judged rightly or wrongly as more concerned with supply and demand, than advancing real understanding. This is a practical reality of life; supply and demand drives everything, including homoeopathy, but the problem as always is that anything mass produced often sacrifices quality for quantity. HFA is not a market driven system, because once you know it – you know it. The system itself has remained virtually unchanged since its conception, which shows the strength of its foundation. While the philosophy continues to evolve and expand, getting progressively deeper yet simpler at the same time, (see Appearance and Circumstance and Soul & Survival) the process of applying HFA in the clinic remains fundamentally strong and unchanging. When a patient enters my clinic, there is nothing to differentiate the HFA system from standard classical homoeopathy. In the beginning the consultation centres around the patient's presenting complaint, examining the type of pain they experience including times, aggravations and other factors. Once this has concluded, the consultation extends into the patient’s life story. Generally this takes place easily and naturally because it is rare for any chronic disease not to have two primary modalities. The first modality is that the patient and their symptoms are worse when they are tired. The second modality is that the patient and their symptoms are worse when they are stressed. While these two modalities seem obvious, the ramifications that come from understanding why they exist in every case of chronic disease is so broad they change homoeopathic philosophy completely, and yet still we ignore them. Stars exist in the night sky; they are obvious and have always existed. As a result we don't pay them much attention and treat their existence with the contempt that comes from familiarity. Chronic disease with the modalities - worse when tired or stressed, is in the same position as the stars in the sky. Stars are not just little lights that twinkle when it gets dark, they are nuclear powerhouses that drive the material universe, and by understanding stars we can understand the origins and make-up of how life began. Accepting “worse when tired or stressed” without thinking, is the same as seeing the stars but not understanding their significance. Understanding why every chronic disease is worse when the patient is tired or stressed has the potential to reform homoeopathic philosophy and create the next leap forward - but it is must be properly understood. (See Soul & Survival for more about personal energy). This is the first big difference between HFA and contemporary homoeopathy. Once a patient understands the link between personal energy levels and disease, it is easy to take them to the next step and review the impacts life has had by discussing their personal history. This is the second major difference between HFA and other contemporary methods. Contemporary homœopathy uses life stories to find the inner core of the patient. For some it is an attempt by the practitioner to uncover a subtlety to distinguish one remedy from another, a necessary process for those who practice 'personalised drug picture' type prescribing. In another approach, life stories are used as a way of getting the patient to delve into their pain until they reach the point of a primal scream and open themselves up to an epiphany. This approach is psychoanalysis dressed in a new suit. The process is not unsound, but psychological medicine was forced to drop this technique in favour of more practically based methods, because the process took far too much time and results were simply not proportional to effort. In HFA however, life stories are used as a way of ascertaining stress, exhaustion and repeating circumstances. Biographies sometimes yield good rubrics but not always, which is why in Homoeopathic Facial Analysis the mentals are not regarded as the key to unlocking the remedy. Life themes are repeating patterns and HFA practitioners take them literally without interpretation. For example, if a patient came from an alcoholic background and made the decision that they themselves would never drink because of the damage they had seen alcohol do, but their partner or child drinks more than they should, then alcohol becomes a rubric because it is a repeating life theme. I do not ask how they feel about alcohol or what physical sensation it causes, I just accept the impact this substance has made and note it as an influential stress. Some may find it unusual at this time to go against the tide of mental’s prescribing. Most current methods attempt to come up with ways of precision focusing on feelings or beliefs. HFA is the opposite and this is its third major point of difference. To describe why the mentals are not as discriminating as generals is a book in itself, but physical form is unique where as the human condition is not. The aspirations desires and needs of most human beings are similar and therefore not distinct, and certainly not as individual as a physical feature like fingerprints. The theory has always been that mind and soul forms physical form but I am not so sure that is true. Other people's attitudes, attractions, opinions, repulsions, suspicions, friendliness, openness and sexual desire are driven by how we look, and what feelings our looks evoke in them. This in turn shapes how we view the world because of the people and attitudes that have come our way. A sexually vulnerable looking woman like Marilyn Monroe will have different experiences and beliefs about human nature than a woman whose looks are stronger, and as a result has not shared the experiences caused by having those looks. Men will act differently around these two women because of the feelings each create. Not everyone acts in the same way to the same person because looks interplay with life experience bringing forth different reactions depending on personal history. In one man, a woman's vulnerability may bring out a predatory side, while in another that same vulnerability can make some males protective or even paternal. Experts agree that 90% of communication is non-verbal. One study at UCLA indicated that up to 93% of communication effectiveness is determined by nonverbal cues. So why are homoeopaths not using or embracing such vital information, particularly when clinical effectiveness is totally dependent on gathering the facts? The reality is that up until now it has been impossible because we didn't have the right tools, but with Homoeopathic Facial Analysis there is now an effective way of gaining this vital information. The reason we need to dig and delve to look into the labyrinth of the unconscious mind, is because we are only getting ten percent or less of the information we need, the rest is hidden in our body. Ninety percent of the facts are missing because they cannot be verbally acquired, regardless of intellectual promises to the contrary. Homoeopathic Facial Analysis solves this problem, because it is the only available homoeopathic system designed to read facial structure in a clinical and exclusively homoeopathic way. This is one of the reasons why its success rates are so high. The body expresses more than pain. It is a vault that keeps the memories of the past alive to be used in the present when necessary. That is the purpose of evolution, to adapt to the constant stresses of the past so the present has a better chance of survival. But what homoeopathic system caters to this jewel of nature apart from Homoeopathic Facial Analysis? – None. Chronic disease is hardly ever a disease in the infectious sense of the word. There is no asthma virus or cancer germ because chronic disease is an outcome. It is a result of all the events and stresses that have come before it. Chronic disease tells us the story of the patient, how they have lived and what they have endured. The body is designed to store memory. How can new life be created without the physical transference of memory via genes? Over time ducks evolved webbed feet because they spent so much time hunting in the water. As a result benevolent nature decided that the duck would benefit if its feet were webbed. Because we know how to read the signs, we can tell that any animal with webbed feet spends a lot of time in or around water. We don't have to intellectualise this information because we accept that physical form in animals remembers, and adapts to consistency or stress. Why do we think human beings are any different? Why would nature be less benevolent to us than to a duck? Have you ever tried to convey an emotion to another person while keeping a deadpan and unchanging face? Try conveying real anger without intonation or facial expression. It cannot be done and do you know why? Because the human face is specifically designed to be the main conveyor of emotion. Not just the emotions we feel but also as a medium of communicating what emotions we need to get from others. Every practitioner knows that certain patients keep attracting the same type of people and this is why. Not only do we instinctively and unconsciously through our face display our emotional needs, we are also unconscious experts at reading what others through their face are asking of us. Some who respond will do so with honour but others will capitalise on this request. This is the fourth major area of difference between HFA and more contemporary methods. HFA knows how to read this unspoken facial language and its practitioners can read what memories are locked in the patient’s unconscious. After the patient has finished their story, what we call a “top to toe” examination is verbally conducted, asking the patient a totality relating to any pathology or pain they may experience. This is called a top to toe because we start with the head and work our way down. Starting with the head my questions will be * Do you suffer from headaches or migraines? * Do you have any skin condition of the scalp? * Is there any problem with your hair? When there is an affirmative reply, a check is made to find any modality that accompanies the symptom. Once all the information about this symptom is found further areas of the body are checked – this involves a lot of leading questions * Do you have any problems with your eyes? * Are you prone to conjunctivitis or any other repeating infection? Once this process is complete the physical generals will stand out. The headache was worse of the right and at night, so too was the knee pain. The liver pain is a constant problem ( Because the body is designed to adapt, being able to read it is vital. When a body builder trains in a gym their muscles adapt to the heavy weights, gaining size and mass. If that same person decided to take up marathon running instead, their body would become a different shape, shedding fat and bulk in an effort to make them lighter for long distance running. The same happens inside the brain. The more we focus our attention on a subject or skill, the more the neurons in our brain break past links to create new ones. The key to what happens with the body and brain is frequency. Nature is a system that ensures that physical form adapts itself to need. In the past whenever human beings concentrated on a task, either physical or mental, it was because that task was important to survival. Nature helps us with important tasks by allowing our body to readjust and adapt quickly to any repeated task. This is why practice makes perfect and why habits and addictions are difficult to break. The human face is part of nature's adaptable make-up and plays a vital role in acquiring need. Most of the time we don't need to be told that our patient is anxious, exhausted or tense, it shows itself in how they carry themselves but even more, it is etched on their face. The process of evolution is remarkable and it shows that nature has our best interests at heart. But evolution and adaptation are long term processes that rely on holding the memories of the past. Snow leopards for example, have changed their coat colour to better suit their surroundings. In the jungle the yellow and black of a large cat’s coat is perfect for the sun and shadows. In the snow this jungle coat would be a hindrance not a help, so nature allows the coat to change into white so the leopard can now blend with the snow. However these adaptations are only useful provided the environment doesn't change. If the snow leopard suddenly moved to the jungle its coat would be a hazard because it is the wrong reaction to the environment. Human beings have these same forces of nature and we also adapt to our most stressful and dangerous environment. However, before nature commits to any physical change, the stress or conditions in the environment must be long-term and stable. Every one of us has physically adapted and evolved to suit the changing needs of survival, and the area where this physical change has been most prevalent is on our face. This is because our most consistent threat comes from the group we live in. Human beings are less shaped by weather than other animals although obviously environment plays a part, especially with blue (syphilitic) people but that is a much longer story (see Soul & Survival). While Africans look different to Europeans or Asians we are anatomically all the same. Weather is less of a physiological impetus because we can build shelters and fires. Our peripheral body does not have to continually adjust to life in the elements because that is not where our greatest threat to survival comes from. Our body does however have to adjust and find a survival edge to life in a group. Like all group animals each human being's greatest threat is the person next to them, because individuals within groups must always compete for resources (see Soul & Survival). Evolution is only successful when it adapts and stores the challenging circumstances of the past. Evolution is playing the odds with the snow leopard, betting that the cold and icy conditions of the past will continue to be the prevalent stress in the present. Human beings have also faced generations of tribulations and have adapted to the physical demands of living in groups. Our body language and facial features have molded and etched themselves into a design that is most beneficial to our individual needs. Homoeopathic Facial Analysis not only helps us select a remedy, it helps the HFA practitioner recognise each person's basic requirements for survival within a group. Human communities survive by individuals performing different niches and these traits along with emotional needs are displayed, as one would expect, to anyone who knows how to read them. Now let’s return to facial analysis in the clinic. After completing the physical examination I then take photos of my patient (see Homoeopathic Facial Analysis). This is major difference number five between HFA and contemporary homoeopathy. After taking my pictures I leave the patient in the waiting room while I examine their facial features for shape, size and symmetry (see Homoeopathic Facial Analysis). Each facial feature is then classified into a designated colour group of yellow, red or blue, each colour group represents a miasm; yellow is psora, red is sycosis and blue is syphilis (see Appearance and Circumstance). Homoeopathic Facial Analysis determines the dominant miasm of my patient. While Hahnemann focused on finding the dominant miasm within remedies, analysing the dominant miasm in people has not received the same attention. Once my repertorisation is complete and I know the dominant miasm of my patient, all that remains is to give the repertorised remedy with the same dominant miasm to my patient. Normally a repertorisation based on the generals will leave up to twenty remedy possibilities, but if I know my patient is syphilitically dominant and Mercury, Conium and Aurum are in my repertorisation, my choice of remedy shrinks from twenty possibilities to three. If my patient is blue (syphilis) then so too must the remedy otherwise we don't have a perfect similimum - and that is how Homoeopathic Facial Analysis is done. With the HFA method, practitioners no longer have to struggle over essence or wait like Kent suggested for ten years or more, just to become proficient. Many graduates can achieves results of 80% and upwards after studying Homoeopathic Facial Analysis for only a year even in the most difficult cases of chronic disease. Developing Homœopathic Facial Analysis (HFA) has been a rewarding journey for both myself, my fellow practitioners and my students. Clinical success is consistent and the insight attained through studying the link between behaviour and facial features has opened my eyes to universal laws and how homœopathy taps into this phenomena. -------------------------------------------------- Grant has been working and studying in various fields of natural therapies since 1987. Grant’s qualifications include Homœopathy, Naturopathy, Clinical Hypnosis and a Post Graduate Diploma in Eriksonian Psychotherapy. Grant is the current Principal and senior lecturer of the Victorian College of Classical Homœopathy, a position he has held since 1995. His first book, Appearance and Circumstance(2003) details the nature of miasms and how facial analysis can be used to determine the patient’s dominant miasm. Homœopathic Facial Analysis (2006) continues this work with detailed descriptions and examples of facial analysis. Soul & Survival (2008) defines how miasms influence us in our daily lives and define our individuality. Grant has lectured in Australia, New Zealand, the Middle East, USA and Europe. Further information about Grant Bentley’s research and his books can be found on the Victorian College of Classical Homœopathy website http://www.vcch.org/miasm.html and the Soul & Survival website http://www.soulandsurvival.com/ Osho on Therapy We are the cause of our own suffering. All therapies are Toys to Calm the Anxiety in our mind and relieve tensions from the Body. Therapies do help us for a while but they are not a permanent solution. We need to go to the root cause of the Disease and most of time it’s our life style and our Vision towards Life. When we do any wrong act then our soul immediately intervenes but if we ignore that voice again and again, slowly that voice of our soul gets feeble and feeble and one day we cannot hear it. When ever we suppress anything, that feeling is stored in our body at a particular place, over the period of time will lead to disease. It does not mean that we should hit other person when we are angry but we need to be more meditative. Meditation is the only solution. We seek for Quick Remedies for a problem. They are certainly quick to show result but they are definitely not the Solution for that problem. As one goes deep in meditation, slowly, slowly, feelings of jealousy, anger, hatred decreases. In short, the control of mind over us decreases and we become the master of our life for the first time. All meditative therapies like “Osho Mystic Rose”, “Osho No-Mind”, and “Osho Born Again” are techniques to be in touch with our real nature. In these therapies all those hurtful feelings and emotions which we have suppressed in ourselves gets released and we feel very lighter. We become younger and fresh. As these suppressed feelings are released, we get glimpses of our real nature and the joy which we used to feel as a child. Our spirit become alive like a child and the body looks younger in numbers. Whenever the garbage our mind is carrying is thrown out in these meditative therapies and a deep silence is the next outcome of these therapies. This is one of the reasons that Meditation is the essential part of these therapies. Osho has designed them very scientifically. First the catharsis of suppressed emotions is done which is followed by Meditation. Therapies are also wonderful in relieving disease and dealing with emotions. But at the same we should not become dependent on them and should change our life style that is causing the disease. No therapy can give us permanent change unless we co-operate with it. Because, old patterns of life style and mind come back again. So to stop falling to old patterns of life one needs to be more meditative. All therapies should be followed by Meditation. Nature is the Best therapy. Early Morning walk, Fresh Air, Lush Green Garden, Nutritious food prepared with Love, Sight of Sunset with beloved, sound of Rain drops and flowing water is all heals us. Any thing that connects us to our real nature or brings us close to nature can act as a therapy. The Healer The whole is the healer. To be healed means to be joined with the whole. The function of the healer is to reconnect it. The healer touches the body of the ill person and becomes a link between him and the source. The patient is no longer connected directly with the source so he becomes indirectly connected. Once the energy starts flowing, he is healed. Healing is one of the most delicate dimensions. And the delicacy consists in the healer not doing anything in it. To be a healer really means not to be. The less you are, the better healing will happen. The more you are, the more the passage is blocked. Posted by homoeopathy analysis centre at 5:13 AM 0 comments Psychosomatics in Homeopathy ________________________________________ By Gina Tyler DHOM. For thousands of years, various cultures have known the connection of the mind and the body that illness and disease originate not only from external chemical toxins, but from the traumas within the emotional and mental states. Modern medicine has relied on suppressive mood altering drugs to combat the extremes to allow humans to be "perfectly flawless" in society. This includes the suppression of anger, grief, fears, hyperactivity, melancholy, obsessions, sexual urges, depression, mood swings, etc.. What if these suppressions were causing the illness, as we find with simple suppressions of a bad cough or fever? If the avenues of elimination are blocked we suffer the secondary consequences. We logically think of our bowel movements, urine, sweat, mucous, and tears as toxins that are abundant in an illness needing to be eliminated (so we eliminate them modern medicine has found a way to suppress these symptoms). Thinking about the person as a whole meaning the emotional, mental, physical, and spiritual states, is a method used by many ancient cultures. Why have we strayed away from this thinking? Because "science" cannot do a double blind study? Because allopathic doctors have no time for all this soul searching (what can you accomplish in a 5 - 10 min. doctor visit)? This is where homeopathy has made a small dent in the massive scheme of things. Homeopathy looks at disease from the point of the baby's conception, and before birth, and the patterns of inherited genetics. And not only at the present illness, but the complications prior to the onset or "cause" of the illness or imbalance. The psychosomatic aspect forms a portrait of the illness or disease. By using the homeopathic materia medica, pieces of a huge puzzle start fitting together. This is why homeopaths spend 1-2 hours on the first visit with each patient. Not only is the illness of importance, but the temperament, likes and dislikes, cravings, dreams, habits, fears, peculiarities, childhood traumas, appetite, and of course, the objective observations such as body language, how the patient smells, their energy, and their "chi" or "prana" (vital force). "Disease" is a disturbance of this vital force -- an imbalance . The body has always been able to heal itself by building up it's immune system and it's vital force. Herbs can detox the physical body and physical manipulations, meditation, yoga, and chiropractors can realign the energy flow that is blocked. Yet none come close to the healing powers of homeopathy, reaching into the depths of traumatic toxins not released for decades. You might think that if homeopathy has such great force, what are the side-effects? As we all know in modern allopathic medicine, each prescription drug has pages of dangerous side-effects. From aspirin (which causes excessive bleeding) to drugs that induce sexual functions (causing heart attacks). Homeopathy has no side effects. When it works, it awakens the imbalanced vibrational force through dynamic energy. So, when a person comes down with chronic stomach problems, or chronic headaches, and they have already been to several doctors, had tests after tests, x-rays, taken drugs to help the pain, yet still have no answers, there must be another avenue of escape. It is obvious to a classical homeopath, after taking their case, that the illness is related to a psychosomatic history. These do not show up to an "allopath" on a physical level. The phenomenon of the mind when it comes to disease (or illness) is baffling. A homeopath finds out soon enough that treatments with remedies eventually fail if only the physical ailments are addressed. One hundred people can have sinusitis and each person must be looked at as an individual that has a history of imbalance. So, each will need a completely different remedy. It is the trademark personality (or constitution) that signals the homeopath the mental state and it's traumas, the disposition of the mind, and it's subconscious acts to the individuals state of being. If you really look deep into each person, opening up their life like a book, turning each page one at a time, unfolding the layers of suppression, deception, and survival mechanisms then you will finally find a matching homeopathic remedy. To not properly address these would mean no cure. Yes, a homeopath or allopath may "palliate" an illness or pain, but this never comes close to regressing the origin of imbalance. Psychosomatic illness is stored in memory. Even though the physical body externally might be perceived as balanced, beautiful, or put together, there is an ongoing festering volcano waiting to boil over inside the mind. Allopathic mood altering drugs will suppress these urges from ever surfacing but they do not "cure" the imbalance and turmoil. 1. In some cases chemical toxins have caused this imbalance, such as vaccinations. Vaccines given to a child can cause extreme havoc to the brain (violent seizures, ADD, ADHD, hyperactivity, learning disorders, violence, chronic illnesses, immune deficiencies, respiratory problems, and death). ( www.909shot.com for more info). To give the child anti-seizure medication suppresses the convulsions, but does not address the cause of the convulsions. Homeopathy can remove these toxins permanently. When a child has ADHD, ADD, or hyperactivity, prozac and ritalin are prescribed. Thousands of children are turning into zombies and making the drug companies filthy rich. Does it help? NO! The cause is due to a "chemical toxin" like vaccines or aspartame (in nutra-sweet, equal, and diet sodas). More info from www.dorway.com. These toxins are extremely deadly yet the doctors and the FDA allow the use of them. Why? Think about it ... greed and money...billions of dollars are made from this vicious circle of chemical toxins. Brainwashing every parent into thinking that the safety standards are looking out for their child's welfare. 2. With the other cases it is severe trauma as a child. Abuse, molestation, abandonment, and grief, keeping it all suppressed, secrets, deceit, denial...all of these kept inside, locked away for no one to see. The body does remember no matter what survival mechanism is used, causing extreme stress and turmoil within the emotional and mental states. Wait long enough, and you have the physical illness that mirrors these states. A person can live in denial forever and get used to the situation, allowing the imbalance to grow into a multi-headed monster within, slowly affecting all their relationships, reacting with mistrust, jealousy, suspicions, depression, panic, fear, anger, irritability, violence, and suicide. Nothing makes sense but the "onset", the "cause" of the original problem. This is what classical homeopathy looks at: the psychosomatics behind all illness. Disease imparts blockades within the life force. Restricting the flow of life, living in a delusional state of "darkness". This darkness needs to become light, when you fill yourself with knowledge and the state of awareness, the delusions will vanish. This in turn will conquer the physical ailments of a particular disease. The chronic pains, cysts, hair loss, obesity, fatigue, nausea, dizziness, acne, and back pain will disappear. There is no way to stop or destroy energy, you can only redirect it or block it. The energy "inside" vibrates like a matching homeopathic remedy. To cure by dynamics means to cure "pure consciousness". Homeopathy is based on "nature's law of cure". For a classical homeopath to take a case, it is not merely the asking of several questions that matters, it is the observations, to feel what the patient feels, to become that person, to step into their shoes and to find the "disposition" of the patient. Posted by homoeopathy analysis centre at 5:05 AM 0 comments Communication skills in case-taking - Dr. Ajit Kulkarni (This lecture given by the author before Homoeopathic Research Institute, Satara has been transcribed by his students). “In every art there are few principles and many techniques.” - Dale Carnegie Introduction Today I am going to talk on a fundamental subject of communicating with our patients. Our syllabus at undergraduate (BHMS) level or at Post – graduate (M.D.) level doesn’t contain the subject of communication although we get very few points on case taking. Case – taking in homoeopathy is a multi-dimensional complex process, which demands the full exploration of a human being. It is not merely gathering of some symptoms through a certain frame of questions. To be frank with you when I began homoeopathic practice, I was unaware of the depth of case – taking and communication skills. My entire interview was based on questions alone and I was bombarding my patients with innumerable, stereotyped, successive spells like Rawalpindi Express of Shoab Akthar. I was concentrating not on length and accuracy but on speed. This resulted in many fours and sixes as there were many ‘Sachins’ in my patients. I lost many matches and yet I was confused: why I lost? Why were there drop-outs? I started looking seriously and I found that communicating with patients has a heavy bearing upon physician – patient interaction. Now I realize that communication is a critical component of all medical interaction, it is not “just talking” and that communication is the keystone of the doctor-patient relationship. Communication: Meaning The term communication is grossly overworked. Everything from billboards, encyclopedias, to television, to holding hands is communication. However, exchange of words only doesn’t constitute ‘communication.’ The word ‘communication’ originates form Latin term “communicare” or “communico” meaning TO SHARE. When a patient communicates his grievances, his complaints, his painful experiences from his life, he is actually SHARING with the physician. SHARING involves a deeper process of human interaction, of human relation. Webster dictionary defines communication as “the interchange of thoughts or opinions.” Interchange: to inform, tell, express, or show in order to get a reaction or a response. It also means to listen, understand, weigh or evaluate. Charles Estes defines communication “------ the reception, digestion, and transmission of meanings, attitudes and feelings through words, gestures and symbols.” Communication has a basic attribute of enlargement of feelings, facts, attitudes and ideas. So when a physician starts interrogating a patient, a patient is unearthed, unfolded and then he appears to him as a living vibrating individual whose facts are known, whose inner feelings are brought onto the surface, his attitudes and inclinations are understood and his ideas are known. Communication is not a momentary event; in fact it is a momentary intensification of a continuing, cumulative process that starts even before actual communication takes place and continues even after it has occurred. Communication is not merely transmission of meaning from one person to another through symbols. It involves the pathway Source ---- Sender -----Sent------Received ------Receiver-----Result “The success of communication is measured in terms of not only the effective transmission of the message but also the achievement of intended result.” This sentence indeed gives the crux. Only concentrating on sending the message, a physician shouldn’t get relaxed; he must concentrate also on what is the net result of communication. This net result is the feedback which every patient gives to a physician. Key – communication skills There are two critical skills - Active listening and Feedback. Listening I give pivotal importance to listening. A homoeopathic physician who sits on a chair with holistic philosophy in the mind, who has to deal with the patient from totalistic viewpoint, who has to keep his awareness fully to focus on emotions, on every body movement, gestures, postures, speech modulations etc., has to be a good listener. It is said that knowledge - seeker has to be a good listener. The process of case taking is a knowledge-seeking process. Ultimately it is the patient who gives knowledge to a homoeopathic physician. Major difference between ‘hearing’ and ‘listening’ must be understood. Hearing alone is not listening. Hearing means merely picking up sound vibrations while listening means making sense out of what we hear. Hearing is related with ‘ear’ functioning while listening is related with ‘ears, brain and mind’. “Active listening is an important way to bring about changes in people. Despite the popular notion that listening is a passive approach, clinical and research evidence clearly shows that sensitive listening is a most effective agent for individual personality change and group development”( Rogers and Farson). To be an active listener, following skills will help a homoeopathic physician. X Make eye contact X Exhibit affirmative head nods & appropriate facial expressions. X Avoid distracting actions or gestures X Ask questions X Paraphrase X Avoid interrupting the patient X Don’t over talk X Make smooth transactions The Second critical skill is Feedback. The process of interview evokes innumerable responses from a patient. Some responses may not be likened but a physician has to keep his mind balanced. A physician must remember, “Positive feedback is more readily and accurately perceived than negative feedback.” Skills for feedback i) Focus on specific behavior ii) Keep feedback impersonal iii) Keep feedback goal-oriented iv) Make feedback well-timed v) Ensure feedback positive vi) Direct forward behavior The word feedback relates to the reflection of a patient. When the interview is continued, the dynamic interaction occurs. Varied responses are evoked by both the patient and the physician. The feedback is of 6 points. 1. Focus on specific behaviour There are 3 questions, why, how and when? Let us take an example. A flatterer is sitting before you as a patient. He is pleasing you. “How wonderful! Doctor you are great, what a nice interview”. These are the statements of a patient. What doctor should do about this? Instead of engaging himself in appeasement of his own ego from the emotional overtone, the physician should focus on the specific behaviour that is flattery! 2. Keep feedback impersonal:- A physician is one who has to keep balance between his subjectivity, his emotionality, and his professionalism. He must be able to look at the patient as he is. It is here that Hahnemann expects from him the state of being unprejudiced. In the above example of flattery, a physician should not feel himself great and excited. He must look at it impersonally. It’s like not getting carried away. Keeping the feedback impersonal is reflective of maturity on the part of a physician. Finally his goal in practice is to treat the patient as a person and this goal must not be forgotten. Let us take another example: Interview begins and patient starts abusing the medical profession, “You all are blood suckers”. The physician should not take this statement in the personal context. He should understand that a patient has strong antipathic notions against the medical profession. The hostile attitude of a patient should make a physician to find out his disposition. He should find out why a patient is hatred. The phenomenon of development of this hatred feeling may itself unlock a case. For the selection of a similimum, it is extremely important to find the inner personality characters. 3. Keep feedback goal oriented:- The goal of the interview is to seek A2 : that is Accurate and Adequate data. The goal is to understand the patient as he is. For example, in the flattery example the goal is to know the dimensions of flattery i.e. why he developed this disposition? What are the consequences of this as far as his family and social interactions are concerned? There should be pertinacity in achieving the goals. For a physician who has trained himself in making the vision of totality clear, this becomes easier as goals are known. 4. Make Feedback well-timed:- A patient takes an appointment and is very punctual, but anyhow he has to sit for a long time. A patient expresses his resentment. Now the physician should take this feedback into consideration and should honor the punctuality of a patient in the subsequent follow-ups. 5. Ensure Feedback Positive:- Once the goal is fixed and it is understood that the feedback should not be perceived in a personal way, it is possible to ensure the feedback positive. In positive feedback the physician acts more as a learner, as a care-taker and as a trustworthy human being. Example: Mother-in-law and daughter-in-law are at cross with each other. New daughter-in-law behaves arrogantly and in the interview mother-in-law expresses the agony and goes to the extreme to knock out DIL out of the house. The physician advises her not to take an extreme stand. MIL sarcastically expresses, “It is better for you to give an advice by just sitting on a chair”. The physician should take this statement lightly. He should try to understand the dynamic relations, try to explore the personality profile and in the subsequent follow-ups should make a statement in a laughing tone, “I am just giving you an advice by sitting on a chair.” Ensuring the feedback positive helps to develop favourable attitude. 6. Direct forward behaviour: The physician must be greedy in eliciting the data. A patient often becomes disorganized, wanders here and there, doesn’t stick to any specific issue and doesn’t narrate the totality. It is here that direct forward behaviour has to be followed. The reflective technique of communication often is very useful in forwarding the interview in a right manner. Communication skills are not innate or fixed. They can be learned or improved and consequently the physician can improve the health outcomes. Adherence Every physician has insecurity in his mind. Whether my patient will stick up to me or will he leave? Insecurity hovers. Anxiety state develops. And the reaction develops “today’s patients do not adhere.” Remember that “poor adherence can be attributed to patient characteristics” is a myth. In fact no consistent relationship has been shown between adherence and v Age v Gender v Social / economic status v Marital status v Personality traits (introverted, gregarious etc.) Then what does affect adherence? v The patients’ perception of the seriousness of the disease v The patients perception of the efficacy of the treatment v The duration of the treatment and illness v The complexity of the regimen v The relationship with a physician Skills for improving Adherence v Demonstrate compassion v Communicate: Ø Personal concern for the patient Ø Personal interest with patient’s well being Ø Activate patient’s motivation Ø Share responsibility with the patient Ø Discuss the patient’s beliefs Barriers to communication When I started practice I was not aware of ‘barriers’ to communication. I found that there are some patients to whom I was unable to communicate. In some patients I was right at selection of remedy or at repetition, but not knowing how to handle the patients through positive communication. Subsequently I understood that good communication skills are required not only in the first interview but also in follow-ups. The dropouts in my practice taught me to see the barriers, which are collectively termed, as Noise. These are as follows: Ø Absence of a common frame of reference. Ø Badly encoded messages. Ø Disturbance in transmission channel. Ø Poor retention (esp. in face to face communication). Ø Inattention by the receiver. Ø Premature evaluation of the message. Ø Unclarified assumptions. Ø Mistrust between sender and receiver. Ø Different perceptions of reality Ø Semantic difficulties. Ø Vagueness about the objectives to be achieved. Ø Misinterpretation of the message. Ø Clash of attitudinal nuances of the sender and receiver. Ø Psycho - physical factors. Ø Selection of wrong variety of language. Now I focus on the factors, which produce the Noise, and I see that the communication is barrier-free and smooth. Homoeopathic interview: qualities desired Ø Well-defined ego and not to be over involved Ø Healthy attitude towards patient Ø Empathy, sensitivity and sensibility Ø Sufficient intelligence to understand and co-ordinate in a coherent way Ø Interview skills for warm and effective communication both verbal and non-verbal Ø Maintaining professionalism, open and trusting way Ø Ability to create supportive climate in interview to be able to make patients express their true feelings and honest opinions without fear of rejection or censure Ø Knowledge of related subjects: clinical, para-clinical, homoeopathic, social, psychology etc. Ø A calm, quiet, balanced mind and yet alert Ø Jovial, charming, cheerful communication Ø Awareness and observational eye Ø Precision of mind Ø Asking the right question(s) at right time Ø Appropriate use of memory box Now if you think that you know the basics of communication, you know key communication skills and now you are in a position to take an interview, you may face a lot of difficulties; for, you must know communication techniques. These are as follows- 1. Facilitation - Verbal or non-verbal communication that encourages the patient to elaborate. 2. Open-ended Questions - Requests stated in general terms for non-specific information. 3. Direct Questions - Are those that ask patient for specific information. There should not be leading questions; they should give a graded response than yes or no. 4. Support - Indicates physician’s interest and concern and his willingness to help the patient. 5. Empathy - Communication that expresses understanding of and sympathy for the patient’s feelings. 6. Silence – Expresses a range of responses from total disinterest to active concern. It gives the patient a chance to explore and express deeper. 7. Reflection – A response from the physician that repeats, mirrors or echoes a portion of what the patient has just said; useful in eliciting both facts and feelings. 8. Clarification – A response that asks the patient for further information and explanation for the sake of clarity. 9. Confrontation – A technique that brings the patient face to face with the patient. Should be used with caution. 10. Hypothetical – If patient is not coming out with hard facts, this technique may help in selected cases. 11. Summation – Reviews the information that has been given by the patient. 12. Interpretation – Formulation by the physician of data, events or thoughts into terms that make the patient aware of their inter-relationship. I briefly outline some of the qualities needed on the part of a physician for homoeopathic interview. Some questions discussed in the lecture 1. Absence of Common frame of reference The frame of reference relates to the environmental setting in which the interview take place. The concept is that the environment must be congenial for the free ventilation of patient’s narration. The patient should feel that the environment in the clinic is favourable and there are no obstacles. Example: The sitting posture between a patient and a physician must be face to face. If a physician is looking at north-west and a patient at south-west, it is not a congenial frame of reference. Strong smell coming from slums can be an irritating experience for both a patient and a physician. The word common represents at least the prescribed notions of the expected environmental settings. 2. Badly encoded messages:- It is the fundamental right of a patient to get all the message of a physician in clear terms. Many physicians have the habit of talking in a rapid way or they talk as if muttering with themselves. The coding of message must be in the format which is digestible by a patient. 3. Disturbances in transmission channel:- This relates to the interferences that are from various sources. Frequent ringing tones, vehicles on the road, T.V. or radio in the clinic making big sounds, receptionist interrupting, the students asking questions in between etc.etc. 3. Semantic Difficulties:- The language is the prized possession of a human being, but it is the complex way of communication. Each word has many meanings and both – the patient and the physician must have at least working knowledge of the meaning of words. Example: A patient from Tamilnadu speaks in Tamil language with a Maharashtrian physician who doesn’t know tamil. This will be the semantic difficulty. Sir, in communication techniques, what do your mean by “OPEN ENDED QUESTION?” (Requests stated in general term for non-specific information). Example? Answer: Open ended questions give a wide platform to talk with free association. Example: A patient is telling about pain in abdomen and open ended question is “Tell me more about your pain?” A patient is narrating grief incidence but in a brief way then O-E-Q is- “Tell me more about your grief”. The benefit of O-E-Q is that there is no bombardment of questions and a physician does not restrict a patient in the golden cage of questions. The ventilation of patient’s thoughts and emotions occur spontaneously, freely and adequately. Hypothetical: In order to explore the true portrait of the patient’s mental state, an imaginary situation is produced by a physician. e.g. In order to understand what exactly happens when a patient develops anticipatory anxiety, physician puts up the scenario before the patient, like a patient undergoing an air-travel for the first time or a patient is caught in an accident etc. Summation: It’s like summing up in a concise way and again asking the patient to comment. Summation is useful for facilitation and classification. The major barrier to communication is the self-concept. We know that whatever concept an individual has of himself, he clings to, shutting out data that are not congruent with it. One more major barrier to clear, undistorted communications results from the role relationships, or status differences, of individuals involved in inter-personal communication. Credibility of the source also affects communication. Generally speaking, individuals of high status are accorded greater credibility. We tend to believe people who we define as “experts.” No communication is free from emotions, either on the part of the sender or the receiver. Emotions form part of the “modifiers” system that screens transmissions and inputs. I briefly outline some of the qualities needed on the part of a physician for homoeopathic interview.I have applied all these techniques and knowledge in my interview chamber and I have found them extremely beneficial. 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