Homeopathic Method

Review

This book review is reprinted with permission from Homeopathic Links.

Reviewed by Huib Wijtenburg, The Netherlands

In this study-book about the homoeopathic method, Jeremy Swayne, a general practitioner and dean of the faculty of homoeopathy in Somerset, UK, gives an extraordinary exposition on the basic principles, in accordance with which the homoeopathic therapist works or has to work.

In the clinical process we make two determinations: A) how to diagnose and what happens after the therapeutic intervention (inquiry and observation) and B) the therapeutic intervention/treatment in itself. This book discusses the inquiry and observation of what homoeopathic therapists call 'the homoeopathic method'.

The book opens the way for clinicians who can't imagine that an ultra-molecular dilution can work, because the author describes not only treatment but also what comes before and after treatment.

He uses the terms 'pathography' and 'holography', the description and study of the dynamis of illness and healing, which are the essential processes of medical practice and medical science.

The foreword of the book is written by Professor Conrad Harris, who works for the division of general practice and public health medicine at the University of Leeds, UK. He writes in his foreword, 'Pathography is not an optional extra for homoeopathic practitioners, but an essential part of their methods and is safe in their hands. I hope they will make their findings known outside their own literature as an important contribution to medicine'. In a highly scientific way, this book takes us along all the basic principles of the homoeopathic method, with a conceptual framework for observing and interpreting illness and the healing process. The book is not about treatment, but there is an explanation of how the homoeopathic therapist comes to a homoeopathic prescription. There is also attention paid to the placebo effect, about which he writes 'Proof of the activity of the homoeopathic medicines is not essential to the validity of the clinical observations that have been described. Their interpretation and significance do depend in some instances upon what we know about the actual link between the medicine prescribed, its indications and the outcome'.

Just as in rereading the Organon of Hahnemann from time to time, in this book, also, you can read about new things or topics that were too far away in the first reading. It was nice to reread about the facets of case-taking, about general issues of management in our practice, about constitution, etiology, treatment strategy, or topics like when to use homoeopathy, the response to the prescription, or a detailed description of the different meanings of the word 'delusion'.

This book inspired me to be even more accurate in my practice and strive to gain a better scientific understanding of my own work.

I think Hahnemann would be proud of this book because of the punctual and scientific style of the writing and also because this book reaches out to those who are more than critical of homoeopathy. I don't think it would be possible to be critical to the homoeopathic method, after reading this book.

I also hope that students and practitioners of homoeopathy will read this book, because it will help them to achieve better results in their practice by improving their clinical methods.

I will end with the words from Professor Harris. 'Fascinating and full of wisdom ... a further joy that the book is so well written. The way in which complexities are teased apart and crucial distinctions drawn is obviously the result of much reflection and hard thinking. I recommend this book to everyone who treats patients.'

Homoeopathic Links
Winter 1999
Volume 12, Number 4

This book review is reprinted from the British Homoeopathic Journal Vol 87, October 1998, with permission from Peter Fisher, Editor.

In this book aptly entitled Homeopathic Method, Jeremy Swayne provides an in depth analysis of an approach to understanding the meaning of symptoms in the larger context of an individual life. For this process he uses the phrase 'clinical method' as distinct from 'therapeutic method' with its emphasis on the therapeutic technique or agent used in treatment. Thus the focus here is on relationship rather than materia medica. This work is an attempt to examine the multifaceted dynamics that exist between doctor, patient, and illness and to elucidate and clarify them so that they may be clinically useful to a wide range of practitioners. It is a meritorious venture into difficult territory and reflects both the breadth of the author's experience and the depth of his insight into the currents which flow just below the surface of the daily experience of a practising homoeopath.

The book begins with an overview of clinical method, emphasizing that the art of history-taking, which was once the foundation stone of medicine, has been preserved and refined in the tradition of homoeopathy. This skill is in danger of terminal atrophy in the hands of technological medicine. The idea is put forward that the ennui increasingly prevalent among doctors is an expression of this atrophy.

The chapter on Basic Principles is a good summary of the underlying principles of homoeopathic practice written in a way that makes them understandable to doctors who might be reading about this method for the first time. This is followed by a section entitled General Issues of Management. The information presented here deals in depth with issues related to quality of patient contact, both in terms of time spent, the scope of investigation and the 'attentiveness' required of the practitioner. The experience of the author is clearly evident in this section and study of the principles he lays out will be of benefit even to the experienced doctor. 'Having let the patient tell the tale in their own words, the process of enquiry ranges widely over the issues raised by the patient and also over many other facets of their life. This approach helps patients to see themselves more as a whole, and their symptoms or problems less as some separate and hostile entity. It allows sensitive and difficult matters, often psychological, to be approached gently and within the balanced context of the whole. This obviates the uneasiness that can accompany discussion of what is and what is not psychosomatic. It avoids the unhelpful duality of mind and body, and the temptation to take a one sided organic or psychological view of the illness.' Helpful handout type information on "What Is Homeopathy" and "The Course of Treatment" as well as advice on how to introduce the topic of homoeopathy to your patients and what sorts of illnesses are good candidates for treatment are included here.

Case Taking naturally merits quite a bit of discussion ranging from the 'small but significant shift in the way we see our work' which underlies the difference between homoeopathic and conventional case taking, through an exposition on 'Language and Meaning' to advice on how to take notes and keep electronic records.

The title of the next chapter is 'Symptoms'. Emphasis is placed on the difference in attitude between homoeopathic and conventional medicine. 'Symptoms are taken seriously in homeopathy whether or not they are recognized features of a previously known condition or of the known materia medica of any homeopathic medicines. In fact the greatest contrast between the conventional and homeopathic use of symptoms is that in homeopathy the most valuable symptoms are those that are not typical of the underlying pathology. In conventional medicine the reverse is true.' The latter is most certainly true, but of the former experience demonstrates that symptoms which cannot be understood in terms of one or another remedy are much less helpful than those which can. The discussion on types of symptoms, while covering the essential material, leaves one with a feeling of irresolution. The distinction between particulars and generals could have been more simply stated to emphasize the fact that whatever affects the whole is clearly of more import than that which merely touches on some peripheral part.

This section illustrates one of my fundamental critiques of this work. Clarity is sometimes sacrificed to an attempt at presenting an intellectually objective viewpoint. Too much thought and too little feeling leave one with a sense of confusion about what is really important and what is not. On the other hand when the author writes from his own direct experience the message is clear and helpful.

The difficulties and pitfalls of evaluating symptoms are nicely illustrated by a case of lymphoma in which the prescription turned on the presenting symptom of splenomegaly. This case grounds the discussion and serves as a springboard for further clarification of what does or does not serve as a really useful symptom. 'The most valuable symptoms for the differential diagnosis of the homeopathic medicine are those that are most complete in their description and that most vividly express the individual character of the illness.'

The experience of recurring themes in the history is a most important observation. The idea that "Recurring themes within the materia medica of a particular medicine or a patient's history are sometimes described as their 'essence'" is an interesting one. Whether one agrees with this as a definition of 'essence' does not minimize the significance and utility of the existence of themes. In any chronic case no effort directed towards the elucidation of the 'theme' or 'story' which underlies the individual life will go wasted. Although it is not easy to say more on this topic I wish the author had given more prominence to this method of case analysis.

Symptoms From The Past touches on one of homoeopathy's great strengths. The ability to see and discriminate a movement towards health in the unfolding of the case. The return of old symptoms as a movement towards health must be understood to avoid untimely intervention and derailing of the healing process.

An entire chapter is devoted to the concept of 'Constitution'. Although in a work such as this it is necessary to address this topic in some detail, my personal view is that the concept of constitution and all its attendant associations serve to confuse, to add a further intellectual barrier between practitioner and patient. Notwithstanding this view, the distinction made between clinical and constitutional pictures is a useful one and the topic is intelligently and clearly covered.

Aetiology is an important factor in understanding a case and is rightfully given prominence. It is my personal experience that even in cases where aetiology does not enter directly into the prescription, if the causative factors for the illness are truly hidden from view, the case will be extremely difficult to solve. The concept of aetiology is taken rather broadly in this chapter and includes such diverse headings as family history, personal history and diathesis, miasms, infection, immunization, allergies and physical and psychological trauma.

The section on When To Use Homeopathy appears to be aimed mostly at General Practitioners who will use remedies on some occasions and addresses many concerns of immediate relevance in the UK. While I agree with the author when he states "There is a tendency to elitism among some practitioners of homeopathy who regard its in-depth study as the only proper course and its off-the-cuff use in general practice as a travesty. This is a grave mistake.", the perceptions underlying this elitism have some merit. A clear differentiation should be made between the practice of homoeopathy and the dispensing of homoeopathic remedies. The failure to recognize the vast gap between the results of mediocre practice and the full possibilities of the homoeopathic system of medicine is in itself a grave mistake. Even the author himself, a homoeopath of significant experience and merit, steers dangerously close to this error. "The question is often asked 'would you treat acute appendicitis with homeopathy?' or Would you treat a heart attack?' The answer is 'Yes and no'. We might ask 'Would you treat a heart attack with Aspirin?' The answer is 'Yes and no' for the same reason. Aspirin has an important contribution to make. We would now be negligent not to give it. But it is not by itself the proper management. This is the way to regard the role of homeopathy in many acute situations that require emergency care." I understand that a point is being made, but to compare the potential benefits of the correct homoeopathic remedy in an acute, potentially fatal situation to that of Aspirin is just the attitude which I am sure pushes the 'elitists' over the edge. Of course one would treat acute appendicitis with homoeopathy. A single dose of high potency on the way to the hospital might resolve the issue before surgery. To compare the potential action of the correct remedy in acute myocardial infarction to Aspirin implies to the uninitiated that there is no difference in battle between a firecracker and a hand grenade.

The chapter ends with the question of Difficult Cases and Difficult Patients, with the author's own experience providing a solid foundation in the differentiation between pathology and patient. The key points summary at the conclusion is a useful device and might have been employed more freely throughout the text. Treatment Strategy includes a discussion of strategies for acute and chronic illness as well as prevention and prophylaxis. The most important section for a practising homoeopath deals with intercurrent acute illness during chronic illness. This area (like failure to recognize the Law of Cure in the return of old symptoms) is one is which the healing process is easily disrupted. The advice given is solid. "Changes arising from a previous prescription that indicate a favorable response should not be interfered with if at all possible. If they do require intervention palliative conventional treatment may be preferable to homeopathy." This last point is very important. There is nothing that interferes with the action of a homoeopathic remedy as effectively as another homoeopathic remedy. Conventional palliative treatment is much more superficial and consequently much Jess disruptive. A useful device employed here (and well used throughout the book) is to end the chapter with a discussion relating the deeper psychological dynamics involved in doctor-patient interaction and their integration into the treatment strategy. The author quotes Kafka who has an old country doctor say "To write prescriptions is easy but to come to an understanding with people is hard."

The penultimate chapter, The Response To The Prescription, is straightforward, concise and packed with practical information on what to do after you have given a remedy. Arriving at a prescription is just the first step of many subtle therapeutic decisions. The book ends with a section entitled Implications which serves to summarize what has been stated in the body of the text, to indicate directions for future research and to highlight certain areas where the results obtained for the use of homoeopathic medicines tear rents is the tightly woven fabric of the conventional medical world view. Emphasis is placed on the current and potential benefits to medical science from the disciplines of 'pathography' and 'holography'. "Pathography is drawing or writing the disease process; telling the story of the disease, depicting the disease. Holography is a term we might coin from hologram and holograph for the act of describing the process of making whole or healing." It can be justly claimed that in these areas the practice of homoeopathic medicine has and will continue to make great contributions to the art of healing.

As a venture into difficult territory the expedition must be applauded. The exploration, however, is far from complete and I hope a revised edition will be published. The attempt on the part of the author to address such a wide audience results in a little bit for everyone all mixed in with-a little bit for everyone else. The book should really be in two sections. The first a simple laying out of the basic theory and facts of experience, the diagrams replaced by clear point form summaries, and this information referenced in the second to the well rounded in depth descriptions. Despite the author's skill and insight in these descriptions there are places where the writing is overly intellectual and produces complexity where simplicity is needed. Many of the diagrams may have been useful for the author in sorting out his own ideas but they added nothing to my understanding of the material.

Overall this is a book which needed to be written and will serve well those who are able to study it carefully. It is an unusual work in that it deals almost exclusively with what might be termed 'practical theory'. The detailed information presented here was previously unavailable in a form which could be digested by those for whom this work is intended. It is not merely a restatement of previously written books but a genuine contribution from the life and work experience of a senior practitioner.

JONATHON SHORE

British Homoeopathic Journal
October 1998