Communication in Homeopathic Case Taking

All of us, at one time or another, do not communicate effectively. Communication is an art which must be consistently practiced and improved upon. It should be a conscious act with thought and focus. Even under the best of circumstances, misunderstanding occurs. This is especially true between males and females. Each gender has their unique way of relating to each other and to their environment. In general, the female is able to utilize, more fully, both brain hemispheres. Whereas males rely mostly on the left hemisphere. Females are more aware of the internal dynamics of life. Males are focused upon the outer world. The male focus is more on problem solving while females are attempting to understand all aspects of an issue fully before making a decision to act. Healthy communication skills are essential for those in the health care fields. Simply, what we `say' and `hear' affects another's well-being. Particularly with homeopathy, what is `heard', what is `asked', and, how questions are asked, makes a critical difference in choosing the correct remedy. The well chosen remedy, as Hahnemann refers to, can only be as well chosen as the homeopath's well chosen words and questions to illicit full responses from the patient; and how well the homeopath hears the patient's responses. The ability to `ask, hear and speak' clearly, is further complicated by the different genders and how each processes information. This is especially true with a male homeopath treating a female patient.

A homeopath, male or female, must have a solid base in the knowledge of the remedies and rubrics. However, if the male homeopath can not effectively relate to the female patient, the training and knowledge is wasted. Even worse, potential harm can be done. A basic premise in all health care approaches, is not to add to the problem: do not create greater harm.

Confronted with the issue of not adding to the problem, each of us would fully agree. However, an individual sees the world through their own unique lens of reality, which is further influenced by gender. What is improper to one is acceptable to another. Throughout our human history, atrocities have been committed in the name of a philosophy, a belief system, or a religion. Each view believes themselves to be `right', even though emotional and physical pain has resulted. A health care professional, male or female, has an obligation to the people served, to be constantly checking for intimidating, disrespectful, abusive, or violating behavior. A homeopath, as a professional, is expected to behave with integrity, compassion and understanding without judgment. The male homeopath making assumptions about what the female patient has said bears a big danger for mis-understanding. The male homeopath must change his focus. He must become more conscious of her feelings and strive to understand her inner thought dynamics, since that is the basis of her perceptual world. Becoming a conscious empathic listener is essential to being able to enter her meaning system. By reaching for these depths within the female patient, finding the correct remedy becomes more probable, and more complete healing results.

All of us must continually clean our own lens through which we see the world. What clouds our vision are our own unresolved hurts and wounds which can gather and influence our decision making in treating a patient. We are not able to see the other for whom they are. Unfortunately, when the other is a female patient who is vulnerable, harm can be done by the male homeopath. A person seeks out a homeopath for healing and relief from pain. A great injustice occurs when the male homeopath's own disharmony or illness adds to the patient's problems.

A critical question which must be asked is, "When do we cross the line of unacceptable and hurtful behavior?" To help identify such behavior, the following is an example of an actual case where inappropriate communication techniques were used by a male homeopath. The case was taken during a homeopathic class. The female patient had volunteered to give the class opportunity to practice case taking. The instructor frequently brings patients into the classroom to give students the needed experience in the case taking process, which can generally be a great teaching tool. The class comprised about twenty students of both sexes, various ages and backgrounds. A few medical doctors and a psychotherapist were part of it, too. The instructor has a reputation for his extensive knowledge of homeopathic remedies and has been teaching for several years. The problem with communication did not come from the students. The case presented was of an infant girl, Faria, 1-year-old. Faria had been brought by her mother, Rehana. Faria had been born three months premature. With such an early birth, there were a number of complications which will continue throughout several years of Faria's childhood. During the first three months of life, Faria was in the hospital in intensive care. She survived one health crisis after another, which included constant antibiotics, several blood transfusions, breathing difficulties (apnea which could have led to Sudden Infant Death Syndrome), and potential brain damage. She was also given caffeine to stimulate her under developed nervous system. Each crisis meant a fight for life and death to this little girl.

Rehana uses alternative healing methods extensively and wanted to support her daughter's healing with homeopathic treatment. Rehana believed Faria's vital force could be greatly helped with homeopathic treatment to build up deficiencies and correct problems from the early traumas. It was with this intent that Rehana came to the class.

Rehana held Faria and sat in front of the students. The students began asking questions about the pregnancy and the first year of life. Rehana gave the medical history and shared her concerns for Faria. Included were Rehana's own fears and traumas of the past year. Knowing at any moment, day or night, that her child could die kept Rehana in a constant state of hyper-vigilance and fear. What Rehana and Faria both needed were understanding and gentle health practitioners. At the conclusion of the case information, the instructor asked the class what remedy considerations came to their minds. The students threw out ideas about possibilities. The instructor rejected the suggested ones. The instructor began to pace throughout the classroom. He was becoming very annoyed with his students for not thinking clearly. He accused them in a loud voice of being lazy and stupid. He charged them with limited thinking by not considering the possibilities of remedies in the strange, rare, and peculiar categories. After several minutes of humiliating his students, he stated, "Okay, I will give you a break and tell you."

The instructor then pointed out the different shape of Faria's head. It was larger than the rest of her body. He referred to the shape of it as looking like an `extraterrestrial alien', from another planet. He stated that because of her unusual appearance, an uncommon remedy should be considered. Based upon two other considerations, one being difficulty with breathing, he decided the remedy should be Latrodectus mactans, the Black Widow Spider, at 30C. He stated both the mother and child should be given the remedy at the same time since they were still very closely connected and both had issues.

Rehana asked the instructor for more information about the remedy and the reasoning for it. The instructor responded with some information. Rehana continued to ask further questions. The instructor turned to her and stated in an angry tone, "Do you want a remedy? Then don't argue with me!!!" He repeated these words several times, still, in angry humiliating tones. Rehana attempted to explain her desire to understand. He continued not to answer and warned her off again, repeating: "Be quiet, be quiet." Rehana suddenly became quiet with the appearance of being hurt, angry, confused and humiliated.

Seeing she was angry, the instructor pointed out to the class that Rehana was becoming upset. He then made an analogy that like the Black Widow, she was attacking the male.

After class, for several weeks and months, Rehana felt the humiliation, and yes, anger from the session. She decided not to take or give the remedy to her daughter. She felt that since it had been such a negative experience, she could not trust the remedy to be correct since she felt no trust toward the prescriber. Rehana did not want to subject her daughter to yet another health crisis.

Some months later, Rehana happened to meet the female psychotherapist who was one of the students. The psychotherapist asked if she had taken the remedy or had given it to her daughter. Rehana replied, "No." Rehana was then asked how she had felt about the session. Rehana expressed her feelings of disappointment and injury. The psychotherapist commented and agreed that the instructor's behavior was destructive and abusive.

Rehana did continue in her search for a homeopath who could help her daughter. She did find a second one who was also male. After taking Faria's case, he prescribed the remedy Tuberculinum at 1M potency. A few weeks after taking this remedy, Faria was admitted to the hospital with pneumonia. The second homeopath was not abusive and did have a sincere desire to help. However, he too was not able to hear what Rehana had said about her daughter's symptoms. Was the view from a male perspective again interfering? Should questions have been asked differently? There were indications in Faria's case that Tuberculinum could be helpful in the future. It was simply not the right time for this remedy or the powerful potency.

A third homeopath was then consulted, a female, who took Faria's case. The remedy chosen was Silica at a potency of 30C, one dose. Faria was underweight, with no interest in food, and had difficulty in sleeping. After taking Silica, she began eating, started gaining weight, and her sleep was no longer as disturbed. Silica is excellent for under-nourishment and is used to help build up a depleted system. It also strengthens connective tissue. Faria needed to be supported and a foundation needed to be built before any type of constitutional treatment could be effective. Latrodectus mactans, the first prescribed remedy, could have created enormous complications. The third homeopath addressed Faria's basic needs first. This homeopath had the broader view of the steps which needed to be taken first instead of jumping ahead. As with any building or house, the foundation must be there. The primary focus for help with Faria was to give her stability, which she never had since coming out of her mother's womb. The female homeopath was able to assess and hear the needs of her patient. With the first and second homeopath, it appeared that the needs of the patient were overlooked. The essence of the child was not addressed. An infant with Faria's medical history required the basics of life to give her the boost she needed. Clearly, whether in a classroom setting or on an individual basis, it is essential for health practitioners, regardless of gender, to develop better communication skills and to understand the perspective of their patient. It is obvious in the above case that by letting personal ego issues arise, harm can be done by missing the remedy and/or by traumatizing the patient during the case taking process. Neither Faria nor Rehana needed further trauma. They had a lifetime of it in the past year.

With the male homeopathic instructor, his statements to his students and Rehana were not healthy. They were violating and abusive. In the role of a healer, should he not have considered the level of trauma that Rehana had been through with a premature birth? She had been at the brink of life and death for twelve months. The instructor's behavior shows his lack of understanding of women's issues, particularly connected to the birthing process and the associated emotions. How clearly did he truly see Rehana if he could not see her degree of pain? She was still feeling post traumatic stress. To traumatize a vulnerable patient further suggests that the instructor has many wounds and power issues fogging his view of patients and life. How could any trust be built between practitioner and patient? No healing benefit could be expected from this type of scenario.

This case clarifies what is not acceptable in relating to patients. In this confusing world filled with mixed messages it is difficult to know what is appropriate communication at all times. However, there are basic guidelines to follow, which will enhance listening and understanding between the male homeopath and female patient, or a female homeopath and a male patient. In the homeopathic case taking process there is a great amount of patient information to be gathered before a remedy can be found. Questions must be asked. Phasing of questions should be in an open-ended format. Open-ended questions require more explanation by the patient which will give the homeopath more information.

Here, for example is a closed-ended question: "Have you ever had a broken arm?" This can be better phrased in an open ended way like this: "Tell me about any broken bones you have had." The closed-ended question will have a "yes" or "no" as response. With the second inquiry all information about broken bones will be given. Simply, limit the number of questions which require a simple yes or no answer. After receiving the information from the open-ended question, ask: "What else?", or "Tell me more." These are wonderful prompts which allow the patient to go deeper on issues if there is still more to tell. Another very important aspect of communicating is active listening. In case taking, listening to the patient is essential. Many may think that listening is easy. However, most people listen while running their own inner dialogue. The result is either important pieces of information being missed, or judgments and assumptions being made prematurely. One of the greatest causes of misunderstanding is assumption. In the role of a homeopath, if there is something unclear about what the patient has just stated, ask for clarification and more information. Assumptions can lead to incorrect remedy selection. In the case presented, assumptions were made by the instructor which could have lead to harm for the patient.

A component of good active listening is asking relevant questions about what the patient is saying. This helps to establish rapport with the patient and reassures the person that the homeopath is interested in helping. During this phase, rephrasing of an important point made by the patient gives the message that the homeopath is understanding what has been communicated. This strengthens the bond of trust between practitioner and patient. It is obvious that a major element of effective communication between a homeopath and a patient is establishing trust and confidence. Our society is geared toward the male holding the power and authority. Additionally, the act of a person seeking help automatically implies a powerless position. It, therefore, becomes the responsibility of the male homeopath to equalize, as much as possible, the imbalance of power. Healing is about empowering the patient. In the classroom example from above, no empowering took place, instead, the opposite occurred. Obviously, anger and loud outbursts only created greater imbalance. All homeopaths must come to terms with their own shadows buried in their psyche. Otherwise the unresolved issues are often projected out in life and onto the patients where they might do further harm.

To summarize, healthy communication techniques are:

1. Ask open-ended questions.
2. Use phrases of, "Tell me more", or "What else?", to illicit deeper information.
3. If anger or shouting are present, no effective healing can occur. The patient should leave immediately.
4. Actively listen to what is being said. Stay focused and hear what the person is saying.
5. Rephrase parts of what the person has stated and repeat them back.
6. Ask relevant questions.
7. Avoid making judgments about was said.
8. Do not make assumptions of what was stated.
9. Attempt to equalize the imbalance of a power position if it exists.

These techniques can be used in any setting where people are trying to relate to each other. By using these suggestions, rapport, trust, and a caring atmosphere will develop. Unconditional acceptance of others is one of the greatest tools for healing.

Before closing, let me make one last comment concerning power. In a patriarchal society such as ours, males have authority and power. The female gender has the second position. A process of cultural conditioning already begins before a child's birth. This imbalance of power helps recreate and adds to the illness of the society we live in. Additionally, people in authority such as doctors and lawyers are automatically given power. Anyone who is perceived as having greater knowledge is imbued with being greater better. It happens in our daily lives to all of us. The problem which often arises, is that a person of perceived power may become abusive, intimidating, and/or degrading. However, because of their status they don't have to face up to the consequences of their actions. Their dysfunctional and hurtful behavior continues unchecked. The instructor in the classroom in our case was abusive and degrading both to the patient and to the students. Twenty students and this writer, a friend of the patient, did not confront him on his behavior. Of the students, several were more educated and held higher degrees than the instructor. But since we saw him as the one in control, the one with power, he was not reprimanded for his violations to others. Abuse is an insidious part of our everyday world. It can occur before we even notice it. As each of us seek out homeopaths or other health care providers, we must actively guard against being violated by those who are supposedly healers. If a patient feels degraded, humiliated or violated by a homeopath, this is the time to change homeopaths.

As students and peer professionals, what course of action should they take when professional ethics are obviously violated? In this example the students, too, were caught in the abuse cycle. Intimidating behavior will only stop when the person is confronted. Is it not time to break the silence of abuse to bring balance and healing back into our society?