- Email: [email protected]
The starting point: pathography
Homeopathy (2002) 91, 22–25 & 2002 The Faculty of Homeopathy doi:10.1054/homp.2001.0014, available online at www.idealibrary.com on
EDUCATION AND DEBATE
The starting point: pathography J Swayne1* 1
Faculty of Homeopathy, 15 Clerkenwell Close, London, EC1R 0AA, UK
‘The observation and description of what is before one’s eyes, unconditioned by preconceived ideas, is the starting point of all scienti¢c research’.1 The issues which have dominated discussion of homeopathic medicine hitherto are the e⁄cacy and e¡ectiveness of the medicines themselves and the problem of their mechanism of action. The resolution of these is of profound clinical and scienti¢c importance. But there is another aspect of homeopathic methodology that is of equal, and perhaps even more fundamental importance, and that does not depend on whether or how the medicines work. This is the detailed study, almost unique now in western medicine, of the disease process and the healing process; the evolution, manifestation and resolution of the illness in the individual patient. This paper reviews the epidemiology and the ‘pathography’ that are inherent in the homeopathic method, and discusses their implications for medical science and clinical practice, and their value to medical education; their importance to the identity of the medicine of the future and the doctor of the future. Homeopathy (2002) 91, 22^25.
Keywords: epidemiology; pathography; symptomatology; homeopathy
Introduction In the course of a televised debate on the plausibility of homeopathy some years ago, one of the sceptics on the panel spoke of reacting to the claims of homeopathy with a ‘profound sense of blasphemy’. These claims, he said, ‘require us to disestablish the entire cantilevered structure of science’.2 In the face of this strikingly unscientific attitude, we may be consoled by a quotation from the French writer, Albert Camus, that ‘every blasphemy is a participation in holiness’. I don’t know that homeopathy has any special claim to holiness, but it is certainly very much concerned with wholeness. At its heart is the unique individuality of every patient and the significance of the individual manifestation of every illness, and the importance of responding faithfully to them for the greater well-being of each individual. *Correspondence: J Swayne, Greys, Ditcheat, Shepton Mallet, BA4 6RB, UK. E-mail: [email protected] Received 24 August 2000; revised 22 December 2000; accepted 30 August 2001
This attitude is reflected in an essay on poetic criticism by George Orwell, in which he reflects that no analysis can do justice to the pleasure we take in reading poetry. He compares the process to scientific investigation, saying ‘Men of science can study the lifeprocess of a flower, or they can split it up into its component elements, but any scientist will tell you that a flower does not become less wonderful, it becomes more wonderful if you know all about it’.3 This synthesis of wonder and knowledge is the function of all good science. As doctors our job, too, is to study and enhance the life-process of our patients; and to do so in a way that increases our appreciation of the wonder of their unique lives. In homeopathy, our clinical method has the capacity to do this. By its detailed study of the ‘component elements’ of the problem, it has the potential to enrich the knowledge base of medical science, while enriching our appreciation of human nature. Mainstream western medicine has not got this balance right. It neither pays sufficient attention to the detailed evolution and manifestation of individual illness, nor sufficiently respects the wonder of human
The starting point: pathography J Swayne
23
nature. I do not mean that individual doctors do not have the right attitude, but that our conventional clinical methods do not encourage it, or even, sometimes, permit it. Abraham Maslow famously said, ‘When the only tool you have is a hammer, every problem begins to resemble a nail.’ There is a risk that the hammer of mainstream medical science is tending to treat human nature as if it were a nail. I am concerned that the balance has swung too far in favour of what EF Schumacher called ‘science for manipulation’ at the expense of ‘science for understanding’.4 I believe homeopathy can help to redress this imbalance.
Natural history, pathography and research Conventional medicine has been very successful in identifying the common characteristics of specific disease processes. Epidemiology has helped us to understand the common elements in the causation of disease, clinical medicine, the common symptoms, signs and syndrome patterns, and pathology, the common manifestations in body tissues and structures. We are now also gaining knowledge of common cellular and molecular characteristics of disorder and their genetic foundations. These advances have been accompanied by progress in our ability to control and manipulate various stages in the disease process to our considerable advantage. The precise detail of this process is nowadays chiefly conveyed in a profile produced in the laboratory or by some other technological analysis. The progress of treatment is similarly charted by the elimination or correction of these changes. The focus of attention is the pathogenic agent or the pathological process. Information that does not have direct relevance to these often has only marginal importance. Where a technical diagnosis of the presence or absence of physiological disorder is readily available there can be a temptation to bypass much of the clinical process altogether. The consequence of this kind of analysis is that one pathway of discovery in medical science has almost petered out. This is the study of the natural history of illness, and of the healing process. Because medicine has lost interest in individual detail and individual difference it has sacrificed the opportunity to achieve new insights into the phenomenon of illness and healing which this might provide. This retreat from detailed clinical study of the natural history of our patients’ state has deprived medicine of an essential perspective of the whole phenomenon. Perhaps the ever-narrowing focus on pathological detail, down to the molecular level, has blinkered us to a more complete, and perhaps more effective, understanding of illness and disease. Perhaps we are seeking increasingly intriguing and sophisticated answers to the wrong
questions. But it is certain that the vital role of the natural historian is neglected in contemporary western medicine. A detailed study of the natural history of the individual patient’s problem is one of the most distinctive and important characteristics of homoeopathy. It embraces all the subjective and objective manifestations of the condition. It takes account of the whole equilibrium of the individual. The observations required to yield this detailed description of what is going on are not intrinsically different from those required in conventional medicine. They were precisely the kind of skills and observations on which the early reputation of modern medicine was founded. This is exemplified in a quotation from the 17th century physician Thomas Sydenham, who has been called the father of modern clinical medicine. His reputation is said to have rested on ‘his empiricism, . . . his determination to observe and examine each individual patient with the open mind of a natural historian’. He taught us to ‘listen intently and question the patient minutely about the march of events in the development of disease.’5 These skills were critically important in the development of the art and science of medicine until it became increasingly possible to take short cuts by virtue of easy investigation of underlying patho-physiological processes. This brings me to my title. It is from a paper by Conrad Harris, until recently Professor of General Practice at Leeds University. In it he says ‘The observation and description of what is before one’s eyes, unconditioned by preconceived ideas, is the starting point of all scientific research.’1 He makes an eloquent plea for a return to the natural historian’s role for contemporary doctors, particularly general practitioners. But all that he says applies even more to homeopathic physicians. First he warns us that: ‘What we expect to find is powerfully conditioned by what we have learned. This sets the limits of what we ask our patients about and the extent to which we are prepared to ignore anything they tell us that is not required by, or does not fit, a pattern with which we are familiar.’ He then goes on to say: ‘It is easy to forget that every patient presents us, in a sense, with a research project . . . There are no clinicians better placed than the doctors of first and continuing contact to observe and describe the common ills, and what is associated with their onset and their changes over time. The role of the natural historian is ours for the taking. It is but an extension of our daily work . . .’ ‘There is an old medical word for the descriptive task I have in mindFpathography. There is no shortage of work for pathographers, for in no condition has a final version of the natural history been written.’ In fact, there are no clinicians better placed than homeopaths to do this work, and as pathographers there is much for homeopathic clinicians to do. Homeopathy
The starting point: pathography J Swayne
24
Pathography and epidemiology in homeopathic medicine Our work precisely fulfils Sydenham’s prescription. We not only, I hope, observe, examine, listen and question intently and minutely, but we do so both in respect of the manifestation of the illness in the individual, and of ‘the march of events in the development of the disease’ and, what is more, of the healing process. Most of the debate about homeopathy focuses on whether the medicines have any real biological effect, so at this point it is essential to be quite clear that the validity of the observations we are concerned with here does not in the least depend upon the efficacy of the homeopathic medicine itself, or our understanding or interpretation of its role in the therapeutic process. We are concerned only with observations made during homeopathic case taking and follow-up: of the patient’s health history and biography, of the state of the patient, and of those changes of state which have occurred over time, both before and after the homeopathic consultation and the administration of the homeopathic medicine. When changes of state occur during or after treatment we do not need to know whether or how the medicine itself has effected the change, or whether it is due to other aspects of the therapeutic process. We have to be sure that our observations are accurate and truthful. If they are, then they are valid data, irrespective of what therapeutic activity stimulated the change. They are valid starting points for research; for seeking new understanding of disease processes, their evolution, their manifestation and their resolution; their pathography, and their distribution and determinantsFtheir epidemiology.
Individual symptomatology Here are five key examples of the observations we make, and of the questions that arise from them that offer the possibility of such new insights. They concern: (i) the significance of differences in individual symptomatology, (ii) the existence of distinctive constitutional types with characteristic susceptibilities to illness, (iii) the existence of apparently new categories of disease process, (iv) the phenomenon of change in multiple coexisting symptoms and syndromes from a single intervention in one patient, and (v) the apparent manifestation of a consistent set of principles that govern, or, perhaps more properly, reflect the healing process. Firstly, we observe that patients with the same diagnosis, that is, the same pathological condition, show great variety in the details of their individual symptomatology and general and emotional reactions to the illness, over and above its pathognomonic features. The way in which any illness is expressed by any one patient (except in epidemic states) is highly Homeopathy
individual. But there are certain recognisable patterns within this variety. For example, a patient with streptococcal sore throat may experience pain predominantly on the right side or the left, which may be soothed by either hot drinks or cold drinks, or aggravated by both. Two recurring patterns involving these few symptoms are right-sided sore throat soothed by hot drinks, and left-sided sore throat aggravated by hot drinks and soothed by cold. A further ramification of these patterns is the inclusion of variations in the patient’s emotional and physical reactions to factors other than those which impact directly on the local disorder, such as sympathy, noise, or weather. These individual differences would be of no significance for conventional diagnosis and treatment, but are they a meaningless accident? And if not, what do they mean? Do they, perhaps, reflect significant physiological differences in susceptibility or response to illness, such as a distinctive immuno-neuro-peptide response? If they are real, consistent and significant, how might they enhance our understanding of the dynamics of health and illness? Secondly, patients are found to have patterns of habitual body function and reaction to psychosocial and environmental factors which can be classified into different ‘constitutional types’. These types show susceptibility to certain characteristic patterns of illness or disorder. Again we have to ask, what does this mean? Are these types and their particular susceptibilities an epidemiological reality? If they are, what can we learn from them, and what preventative possibilities might they provide? Thirdly, certain patterns of disorder, and of the pathogenesis or development of disorder, are found which do not correspond to conventionally recognised disease processes. In homeopathy these patterns influence our perception of what needs to be cured in a patient, and what needs to be prescribed for the purpose. For example, a family history of tuberculosis may repeatedly be associated with a pattern of illness, respiratory disorder or chronic lymphadenopathy perhaps, in the current generation, characteristic of the tubercular diathesis. Or, in the absence of this history, such a pattern of disorder may respond to treatment with tubercular nosode, a medicine derived from tubercular disease products. Can these patterns, too, be confirmed by systematic epidemiological study? Could our knowledge of them be of any predictive or preventative value, beyond their use as indicators for homeopathic prescriptions, or further our understanding of susceptibility to disease and disease processes? Fourthly, homeopathic practitioners commonly observe concurrent or sequential change in separate syndromes coexisting in the same patient from a single homeopathic prescription. Again, it must be emphasised that the nature of the intervention, the role of the prescription, or any other cause of the change, is not the issue here. The issue is the concurrent, and in
The starting point: pathography J Swayne
25
conventional terms, surprising change in different systems and syndromes from that one intervention at the same time. Asthma and eczema are a simple example. They commonly coexist in an atopic patient, and would not both be expected to benefit from one single conventional intervention (except, possibly, the use of corticosteroids as a short-term measure in a severe case). They might be treated concurrently as different, though related pathological states, and benefit separately from different pharmacological agents, used, almost inevitably, continuously or repeatedly. But other than the possibility of their concurrent spontaneous resolution over time, we do not expect them both to resolve from the same intervention. In homeopathic practice, whatever the mechanism, they are seen to do so. Simultaneous or closely sequential improvements in many other permutations of coexisting, but in conventional terms, pathologically distinct disorder are also seen. What is the significance of this? It appears that it is possible systematically and simultaneously to stimulate lasting change for the better in pathologically different disorders in different body systems that we usually treat conventionally as different disease processes requiring different interventions. The implications are that in all these cases the disease processes are not separate entities, but manifestations of a common disease process (such as the separate manifestations of Systemic Lupus Erythematosus), which resolves in the face of a single healing process; just as asthma and eczema may resolve spontaneously as the child grows older. The knowledge that the intervention is not pharmacological, whatever else it may be, suggests that the outcome is the result of some self-regulating or selfhealing mechanism. That the organism can heal itself of multiple disorders in this way is exciting, to say the least, and demands more systematic study and investigation. Finally, certain patterns of change are recognised in patients responding to treatment which are predictive of a good outcome. For example, the primary importance of an improvement in emotional wellbeing and energy; the transient return and resolution of old symptoms, treated only palliatively and suppressed, perhaps, in the past; the initial exacerbation and subsequent resolution of more superficial symptoms (e.g. eczema), while a coexisting but more deep-seated condition (e.g. asthma) resolves. These principles are known as the ‘laws’ of the direction of cure, though research is needed to establish their validity fully. Again we have to ask, are these phenomena, so frequently described in homeopathic case notes, true manifestations of the healing process, and if so, what
do they mean? Are they induced by other therapeutic methods as well? What do they tell us about the body’s self-regulating and self-healing mechanisms? How might our understanding of them help us to use those mechanisms more effectively?
Conclusion This is a subject that requires much fuller examination, and concerns matters that require much fuller investigation. Suffice it here to draw attention to three things: the neglect of a systematic approach to pathography from which contemporary western medicine is suffering; the opportunity which homeopathy presents to remedy this neglect through its clinical method and its clinical material; and some examples of the intriguing, and potentially important questions we need to ask of the material. This is a big epidemiological challenge. The material is there to be studied in many thousands of case notes, but seldom recorded systematically enough to collate it and study it. Some groups of practitioners are attempting this, and computers are beginning to help in the task. But a far more determined attempt to communicate and investigate the significance of what we are seeing in our patients every day is required. It is quite apparent that where human nature is concerned, and its behaviour in health and illness, we still know very little about it. We have a responsibility to undertake the critical analysis and research that our work as pathographers permits in order that we may know more. The observation and description of what is before our eyes, unconditioned by preconceived ideas, is the starting point of this research. Its goal is to ensure that the implications of this subject are taken up by medical science, medical practice and medical education, so that patients of the future benefit from the new insights gained, and that both they and the doctors of the future are no longer victims of the ‘hammer and nail’ syndrome which Abraham Maslow described.
References 1 Harris CM, Seeing sunflowers. J Roy Coll Gen Pract 1989; 39: 313–319. 2 Miller J. After dark. Channel 4, 3rd September1988. 3 Orwell G. The Collected Essays, Journalism and Letters of George Orwell, Vol 2. Harmondsworth: Penguin, 1970. 4 Schumacher E. A Guide for the Perplexed. London: Vintage, 1995, pp 64–66, 70, 118. 5 Marinker M. The Chameleon, the Judas goat and the cuckoo. J Roy Coll Gen Pract 1987; 28: 199–206.
Homeopathy
EDUCATION AND DEBATE
The starting point: pathography J Swayne1* 1
Faculty of Homeopathy, 15 Clerkenwell Close, London, EC1R 0AA, UK
‘The observation and description of what is before one’s eyes, unconditioned by preconceived ideas, is the starting point of all scienti¢c research’.1 The issues which have dominated discussion of homeopathic medicine hitherto are the e⁄cacy and e¡ectiveness of the medicines themselves and the problem of their mechanism of action. The resolution of these is of profound clinical and scienti¢c importance. But there is another aspect of homeopathic methodology that is of equal, and perhaps even more fundamental importance, and that does not depend on whether or how the medicines work. This is the detailed study, almost unique now in western medicine, of the disease process and the healing process; the evolution, manifestation and resolution of the illness in the individual patient. This paper reviews the epidemiology and the ‘pathography’ that are inherent in the homeopathic method, and discusses their implications for medical science and clinical practice, and their value to medical education; their importance to the identity of the medicine of the future and the doctor of the future. Homeopathy (2002) 91, 22^25.
Keywords: epidemiology; pathography; symptomatology; homeopathy
Introduction In the course of a televised debate on the plausibility of homeopathy some years ago, one of the sceptics on the panel spoke of reacting to the claims of homeopathy with a ‘profound sense of blasphemy’. These claims, he said, ‘require us to disestablish the entire cantilevered structure of science’.2 In the face of this strikingly unscientific attitude, we may be consoled by a quotation from the French writer, Albert Camus, that ‘every blasphemy is a participation in holiness’. I don’t know that homeopathy has any special claim to holiness, but it is certainly very much concerned with wholeness. At its heart is the unique individuality of every patient and the significance of the individual manifestation of every illness, and the importance of responding faithfully to them for the greater well-being of each individual. *Correspondence: J Swayne, Greys, Ditcheat, Shepton Mallet, BA4 6RB, UK. E-mail: [email protected] Received 24 August 2000; revised 22 December 2000; accepted 30 August 2001
This attitude is reflected in an essay on poetic criticism by George Orwell, in which he reflects that no analysis can do justice to the pleasure we take in reading poetry. He compares the process to scientific investigation, saying ‘Men of science can study the lifeprocess of a flower, or they can split it up into its component elements, but any scientist will tell you that a flower does not become less wonderful, it becomes more wonderful if you know all about it’.3 This synthesis of wonder and knowledge is the function of all good science. As doctors our job, too, is to study and enhance the life-process of our patients; and to do so in a way that increases our appreciation of the wonder of their unique lives. In homeopathy, our clinical method has the capacity to do this. By its detailed study of the ‘component elements’ of the problem, it has the potential to enrich the knowledge base of medical science, while enriching our appreciation of human nature. Mainstream western medicine has not got this balance right. It neither pays sufficient attention to the detailed evolution and manifestation of individual illness, nor sufficiently respects the wonder of human
The starting point: pathography J Swayne
23
nature. I do not mean that individual doctors do not have the right attitude, but that our conventional clinical methods do not encourage it, or even, sometimes, permit it. Abraham Maslow famously said, ‘When the only tool you have is a hammer, every problem begins to resemble a nail.’ There is a risk that the hammer of mainstream medical science is tending to treat human nature as if it were a nail. I am concerned that the balance has swung too far in favour of what EF Schumacher called ‘science for manipulation’ at the expense of ‘science for understanding’.4 I believe homeopathy can help to redress this imbalance.
Natural history, pathography and research Conventional medicine has been very successful in identifying the common characteristics of specific disease processes. Epidemiology has helped us to understand the common elements in the causation of disease, clinical medicine, the common symptoms, signs and syndrome patterns, and pathology, the common manifestations in body tissues and structures. We are now also gaining knowledge of common cellular and molecular characteristics of disorder and their genetic foundations. These advances have been accompanied by progress in our ability to control and manipulate various stages in the disease process to our considerable advantage. The precise detail of this process is nowadays chiefly conveyed in a profile produced in the laboratory or by some other technological analysis. The progress of treatment is similarly charted by the elimination or correction of these changes. The focus of attention is the pathogenic agent or the pathological process. Information that does not have direct relevance to these often has only marginal importance. Where a technical diagnosis of the presence or absence of physiological disorder is readily available there can be a temptation to bypass much of the clinical process altogether. The consequence of this kind of analysis is that one pathway of discovery in medical science has almost petered out. This is the study of the natural history of illness, and of the healing process. Because medicine has lost interest in individual detail and individual difference it has sacrificed the opportunity to achieve new insights into the phenomenon of illness and healing which this might provide. This retreat from detailed clinical study of the natural history of our patients’ state has deprived medicine of an essential perspective of the whole phenomenon. Perhaps the ever-narrowing focus on pathological detail, down to the molecular level, has blinkered us to a more complete, and perhaps more effective, understanding of illness and disease. Perhaps we are seeking increasingly intriguing and sophisticated answers to the wrong
questions. But it is certain that the vital role of the natural historian is neglected in contemporary western medicine. A detailed study of the natural history of the individual patient’s problem is one of the most distinctive and important characteristics of homoeopathy. It embraces all the subjective and objective manifestations of the condition. It takes account of the whole equilibrium of the individual. The observations required to yield this detailed description of what is going on are not intrinsically different from those required in conventional medicine. They were precisely the kind of skills and observations on which the early reputation of modern medicine was founded. This is exemplified in a quotation from the 17th century physician Thomas Sydenham, who has been called the father of modern clinical medicine. His reputation is said to have rested on ‘his empiricism, . . . his determination to observe and examine each individual patient with the open mind of a natural historian’. He taught us to ‘listen intently and question the patient minutely about the march of events in the development of disease.’5 These skills were critically important in the development of the art and science of medicine until it became increasingly possible to take short cuts by virtue of easy investigation of underlying patho-physiological processes. This brings me to my title. It is from a paper by Conrad Harris, until recently Professor of General Practice at Leeds University. In it he says ‘The observation and description of what is before one’s eyes, unconditioned by preconceived ideas, is the starting point of all scientific research.’1 He makes an eloquent plea for a return to the natural historian’s role for contemporary doctors, particularly general practitioners. But all that he says applies even more to homeopathic physicians. First he warns us that: ‘What we expect to find is powerfully conditioned by what we have learned. This sets the limits of what we ask our patients about and the extent to which we are prepared to ignore anything they tell us that is not required by, or does not fit, a pattern with which we are familiar.’ He then goes on to say: ‘It is easy to forget that every patient presents us, in a sense, with a research project . . . There are no clinicians better placed than the doctors of first and continuing contact to observe and describe the common ills, and what is associated with their onset and their changes over time. The role of the natural historian is ours for the taking. It is but an extension of our daily work . . .’ ‘There is an old medical word for the descriptive task I have in mindFpathography. There is no shortage of work for pathographers, for in no condition has a final version of the natural history been written.’ In fact, there are no clinicians better placed than homeopaths to do this work, and as pathographers there is much for homeopathic clinicians to do. Homeopathy
The starting point: pathography J Swayne
24
Pathography and epidemiology in homeopathic medicine Our work precisely fulfils Sydenham’s prescription. We not only, I hope, observe, examine, listen and question intently and minutely, but we do so both in respect of the manifestation of the illness in the individual, and of ‘the march of events in the development of the disease’ and, what is more, of the healing process. Most of the debate about homeopathy focuses on whether the medicines have any real biological effect, so at this point it is essential to be quite clear that the validity of the observations we are concerned with here does not in the least depend upon the efficacy of the homeopathic medicine itself, or our understanding or interpretation of its role in the therapeutic process. We are concerned only with observations made during homeopathic case taking and follow-up: of the patient’s health history and biography, of the state of the patient, and of those changes of state which have occurred over time, both before and after the homeopathic consultation and the administration of the homeopathic medicine. When changes of state occur during or after treatment we do not need to know whether or how the medicine itself has effected the change, or whether it is due to other aspects of the therapeutic process. We have to be sure that our observations are accurate and truthful. If they are, then they are valid data, irrespective of what therapeutic activity stimulated the change. They are valid starting points for research; for seeking new understanding of disease processes, their evolution, their manifestation and their resolution; their pathography, and their distribution and determinantsFtheir epidemiology.
Individual symptomatology Here are five key examples of the observations we make, and of the questions that arise from them that offer the possibility of such new insights. They concern: (i) the significance of differences in individual symptomatology, (ii) the existence of distinctive constitutional types with characteristic susceptibilities to illness, (iii) the existence of apparently new categories of disease process, (iv) the phenomenon of change in multiple coexisting symptoms and syndromes from a single intervention in one patient, and (v) the apparent manifestation of a consistent set of principles that govern, or, perhaps more properly, reflect the healing process. Firstly, we observe that patients with the same diagnosis, that is, the same pathological condition, show great variety in the details of their individual symptomatology and general and emotional reactions to the illness, over and above its pathognomonic features. The way in which any illness is expressed by any one patient (except in epidemic states) is highly Homeopathy
individual. But there are certain recognisable patterns within this variety. For example, a patient with streptococcal sore throat may experience pain predominantly on the right side or the left, which may be soothed by either hot drinks or cold drinks, or aggravated by both. Two recurring patterns involving these few symptoms are right-sided sore throat soothed by hot drinks, and left-sided sore throat aggravated by hot drinks and soothed by cold. A further ramification of these patterns is the inclusion of variations in the patient’s emotional and physical reactions to factors other than those which impact directly on the local disorder, such as sympathy, noise, or weather. These individual differences would be of no significance for conventional diagnosis and treatment, but are they a meaningless accident? And if not, what do they mean? Do they, perhaps, reflect significant physiological differences in susceptibility or response to illness, such as a distinctive immuno-neuro-peptide response? If they are real, consistent and significant, how might they enhance our understanding of the dynamics of health and illness? Secondly, patients are found to have patterns of habitual body function and reaction to psychosocial and environmental factors which can be classified into different ‘constitutional types’. These types show susceptibility to certain characteristic patterns of illness or disorder. Again we have to ask, what does this mean? Are these types and their particular susceptibilities an epidemiological reality? If they are, what can we learn from them, and what preventative possibilities might they provide? Thirdly, certain patterns of disorder, and of the pathogenesis or development of disorder, are found which do not correspond to conventionally recognised disease processes. In homeopathy these patterns influence our perception of what needs to be cured in a patient, and what needs to be prescribed for the purpose. For example, a family history of tuberculosis may repeatedly be associated with a pattern of illness, respiratory disorder or chronic lymphadenopathy perhaps, in the current generation, characteristic of the tubercular diathesis. Or, in the absence of this history, such a pattern of disorder may respond to treatment with tubercular nosode, a medicine derived from tubercular disease products. Can these patterns, too, be confirmed by systematic epidemiological study? Could our knowledge of them be of any predictive or preventative value, beyond their use as indicators for homeopathic prescriptions, or further our understanding of susceptibility to disease and disease processes? Fourthly, homeopathic practitioners commonly observe concurrent or sequential change in separate syndromes coexisting in the same patient from a single homeopathic prescription. Again, it must be emphasised that the nature of the intervention, the role of the prescription, or any other cause of the change, is not the issue here. The issue is the concurrent, and in
The starting point: pathography J Swayne
25
conventional terms, surprising change in different systems and syndromes from that one intervention at the same time. Asthma and eczema are a simple example. They commonly coexist in an atopic patient, and would not both be expected to benefit from one single conventional intervention (except, possibly, the use of corticosteroids as a short-term measure in a severe case). They might be treated concurrently as different, though related pathological states, and benefit separately from different pharmacological agents, used, almost inevitably, continuously or repeatedly. But other than the possibility of their concurrent spontaneous resolution over time, we do not expect them both to resolve from the same intervention. In homeopathic practice, whatever the mechanism, they are seen to do so. Simultaneous or closely sequential improvements in many other permutations of coexisting, but in conventional terms, pathologically distinct disorder are also seen. What is the significance of this? It appears that it is possible systematically and simultaneously to stimulate lasting change for the better in pathologically different disorders in different body systems that we usually treat conventionally as different disease processes requiring different interventions. The implications are that in all these cases the disease processes are not separate entities, but manifestations of a common disease process (such as the separate manifestations of Systemic Lupus Erythematosus), which resolves in the face of a single healing process; just as asthma and eczema may resolve spontaneously as the child grows older. The knowledge that the intervention is not pharmacological, whatever else it may be, suggests that the outcome is the result of some self-regulating or selfhealing mechanism. That the organism can heal itself of multiple disorders in this way is exciting, to say the least, and demands more systematic study and investigation. Finally, certain patterns of change are recognised in patients responding to treatment which are predictive of a good outcome. For example, the primary importance of an improvement in emotional wellbeing and energy; the transient return and resolution of old symptoms, treated only palliatively and suppressed, perhaps, in the past; the initial exacerbation and subsequent resolution of more superficial symptoms (e.g. eczema), while a coexisting but more deep-seated condition (e.g. asthma) resolves. These principles are known as the ‘laws’ of the direction of cure, though research is needed to establish their validity fully. Again we have to ask, are these phenomena, so frequently described in homeopathic case notes, true manifestations of the healing process, and if so, what
do they mean? Are they induced by other therapeutic methods as well? What do they tell us about the body’s self-regulating and self-healing mechanisms? How might our understanding of them help us to use those mechanisms more effectively?
Conclusion This is a subject that requires much fuller examination, and concerns matters that require much fuller investigation. Suffice it here to draw attention to three things: the neglect of a systematic approach to pathography from which contemporary western medicine is suffering; the opportunity which homeopathy presents to remedy this neglect through its clinical method and its clinical material; and some examples of the intriguing, and potentially important questions we need to ask of the material. This is a big epidemiological challenge. The material is there to be studied in many thousands of case notes, but seldom recorded systematically enough to collate it and study it. Some groups of practitioners are attempting this, and computers are beginning to help in the task. But a far more determined attempt to communicate and investigate the significance of what we are seeing in our patients every day is required. It is quite apparent that where human nature is concerned, and its behaviour in health and illness, we still know very little about it. We have a responsibility to undertake the critical analysis and research that our work as pathographers permits in order that we may know more. The observation and description of what is before our eyes, unconditioned by preconceived ideas, is the starting point of this research. Its goal is to ensure that the implications of this subject are taken up by medical science, medical practice and medical education, so that patients of the future benefit from the new insights gained, and that both they and the doctors of the future are no longer victims of the ‘hammer and nail’ syndrome which Abraham Maslow described.
References 1 Harris CM, Seeing sunflowers. J Roy Coll Gen Pract 1989; 39: 313–319. 2 Miller J. After dark. Channel 4, 3rd September1988. 3 Orwell G. The Collected Essays, Journalism and Letters of George Orwell, Vol 2. Harmondsworth: Penguin, 1970. 4 Schumacher E. A Guide for the Perplexed. London: Vintage, 1995, pp 64–66, 70, 118. 5 Marinker M. The Chameleon, the Judas goat and the cuckoo. J Roy Coll Gen Pract 1987; 28: 199–206.
Homeopathy