Creating Waves of Awareness
Every homeopath has his or her own style when it comes to case taking, and no style is inherently right or wrong. However, the following hints may help the student homeopath to avoid common mistakes in taking and analysing the mentals history, mistakes which often lead to the wrong remedy being prescribed.
I will also describe some techniques which I have found useful for eliciting information from the patient which is not immediately obvious or forthcoming; information which is sometimes vital in identifying the similimum. Let us begin by examining what information can be gained from the first impression of the patient as they walk in and sit down.
As always, first impressions can be misleading, but with experience, the discerning homeopath can gather much useful information from the first few moments of the interview, which can then be analysed in the context of the subsequent history. Obviously the appearance of the patient can say a great deal. A thin delicate woman with black hair is not likely to need Calcarea Carbonica, (although the homeopath must be flexible enough to realise that exceptions always exist).
The Cautious Type
The degree of caution or enthusiasm with which the patient greets you should be noted. The following remedy-types are likely to greet the homeopath with some degree of caution, fear or reserve; Arsenicum, Aurum, Baryta, China, the Kalis, the Natrums, Nux, Silica, and Thuja. Nux is not usually reserved, but is often suspicious of unorthodox practices such as homeopathy.
The types likely to greet the homeopath with enthusiasm, even on the first consultation, are: Argentum, Causticum, Ignatia, Lachesis, Medorrhinum, Mercurius, Phosphorus, Sulphur, (Natrum Muriaticum). The more extrovert Natrums can put the homeopath on the wrong track with their enthusiasm, which may hide misgivings about putting themselves in a vulnerable position.
Those patients who come in visibly irritated by being kept waiting for ten minutes are likely to be Arsenicum, Natrum Muriaticum, Mercurius or Nux. Observe the position that the patient adopts on sitting down. A patient who sits as far back as they can, or who chooses a chair more distant than the one meant for them is likely to be one of the cautious types listed above. Similarly, someone who leans forward in the chair, or even moves it forwards, probably belongs to one of the enthusiastic types, especially Phosphorus.
The clothes that the patient is wearing may provide much relevant information. A flamboyantly dressed patient is likely to need Argentum, Medorrhinum, Phosphorus or Sulphur. Certain types are more likely to wear black, particularly Ignatia, Natrum Muriaticum and Sepia. The emotional types Phosphorus, Pulsatilla, and Graphites often wear pink, (at least the females!). Slovenly, dirty or untidy dress sense favours Baryta, Mercurius and Sulphur. The woman who wears a rather manly suit is probably Ignatia, Natrum Muriaticum, or Nux.
Look for the formal, bolt upright posture of Aurum, the Kalis, and some Natrums. It will probably make you feel a bit tense yourself. During the taking of the physical case history observe the degree of detail with which the patient describes his or her symptoms. The following types are likely to be objective and precise in their descriptions; Arsenicum, Aurum, Causticum, the Kalis, Lachesis, Lycopodium, Medorrhinum, Mercurius, the Natrums, Nux, Silica, Sulphur, and Tuberculinum.
Look for the clearly hypochondriacal concern with which some members of the following types describe their symptoms; Arsenicum, Calcarea, the Kalis, Phosphorus and Natrum Muriaticum. Ignatia tends to dramatise whatever she says, and hence is likely to exaggerate, as are Sulphur and Phosphorus. If the physical history touches upon sexuality, look out for the reluctance of Thuja and some Natrums to discuss the subject, and if reluctance is found, consider exploring it further during the mental history. By the time one reaches the mentals history, one should already have some feeling for the personality of the patient, even if it is just a vague sense that one cannot identify clearly.
Often there is a sense of liking or disliking the patient, and this can be useful, since each homeopath will learn with time which types tend to attract or repel him or her. When taking the mentals history, I recommend asking patients to talk about themselves first, before asking them specific questions. Their initial few words often go straight to the point, reducing the possibilities to just a few remedies. For example, the patient may begin with, "Well, I'm really quite a reserved person," or, "I'm a very nervous person." Negative traits are usually more reliable than positive ones. Common positive remarks like, "I like people," or "I'm sociable" are virtually worthless, since they apply to so many types, even the more reserved ones, who have often learned to compensate. Having said that, patients who initially reply, "I'm creative" are usually Natrum Muriaticum, Sulphur or Nux constitutionally.
If the patient's first remarks are a denial of a negative trait (which has not been brought up by the homeopath) one should suspect the opposite of what the patient says. When asked about relationships in general, one rather proud Lachesis man said, "I'm not a jealous type," telling me immediately that jealousy was an issue for him. (This was confirmed on further questioning.) If you suspect that the patient is not being entirely accurate, further detailed questioning often helps to clarify whether or not your suspicion is correct. Never take the patient's words at face value. This is the surest way to the wrong prescription.
Once the patient has exhausted his or her self-description, it is time for specific questioning. This should continue until the similimum is clear. After this, further questions tend to obscure the issue (at least for myself), since you may not be able to see the wood for the trees. I find that a useful initial question is, "What would you like to change about your personality?" This often gets to the heart of the weaknesses that are so useful in identifying the remedy. If the patient cannot think of a single thing that they would like to change, they are either perfect or they belong to one of the proud types, which include Arsenicum, Lachesis, Lycopodium, Nux, Platina, Sulphur, and sometimes Natrum and Tuberculinum. If the patient's main concern is lack of self-confidence, one should think of Alumina, Argentum, Baryta, China, Graphites, Lycopodium, Pulsatilla, Sepia, Silica and the Natrums. Ask the patient in which situations they feel this lack of confidence. If they reply, "In groups of people," the Natrums are particularly likely. If the answer is "All the time," think of Baryta, Lycopodium Argentum and Alumina.
Shyness on first meeting people, which soon disappears is typical of Pulsatilla and Silica, whereas shyness which remains is more characteristic of Baryta and China. Anticipatory anxiety, the dread of failure before an important event that demands something of the patient is most often seen in Argentum, Lycopodium, and Silica. (These three are very different personalities and should be relatively easy to distinguish.)
If worrying is the patient's main complaint, ask what the worries are about. If the reply is, "everything," think of Alumina, Calcarea, Lycopodium, the Kalis, Natrum Carbonicum, Phosphorus and Sepia. The patient whose worries center around work is especially likely to be Lycopodium. Worries about health that are not realistic are found in the hypochondriacal types listed previously, and less commonly in Lachesis, Lycopodium and the Natrums. The patient who worries excessively about the health and welfare of relatives is often Calcarea, Natrum or Phosphorus. Financial worries are common, but if they are clearly unrealistic think of Arsenicum.
I always ask about the patient's fears and phobias. Many Lycopodium patients report a fear that their lives will amount to nothing. Natrum Muriaticum fears situations in which they do not feel in control, such as flying in an aeroplane, or a blind date. Claustrophobia is most commonly seen in Natrums, but also in Argentum and Stramonium. Lachesis has a kind of claustrophobia which occurs when the air supply is poor, or when the mouth and nostrils are partially obstructed, such as in the operating theatre when a mask is put over the face. Medorrhinum often has a fear of going insane, as does Stramonium. Paranoid fears can be subtle, but are very useful when spotted. An example is a tendency by the patient to assume that people are talking about them or laughing at them on frequent occasions. Another common paranoid symptom is the fear on seeing a policeman that they will be arrested. Paranoid fears are most often seen in Anacardium, Argentum, Arsenicum, China, Hyocyamus, Lachesis, Mercurius, Natrum, Stramonium, Veratrum and Thuja. Most people are afraid of snakes, but if the sight of a snake on the television makes a patient's heart pound, this suggests that the patient is most probably needing Lachesis or Natrum Muriaticum. Fear of the dark is commonly seen in Baryta, Graphites, Medorrhinum, Phosphorus, Pulsatilla, Stramonium and sometimes in Natrum Muriaticum and Arsenicum. Fear of death is most often seen in Arsenicum, and manifests as a reluctance to even think about the subject, or else as an intruding fearful thought. It is also common amongst Natrums. An excessive fear of catching a contagious disease is seen in Arsenicum, Calcarea, and Syphilinum. Fear that a loved one will die is especially common in Ignatia and Natrum Muriaticum, and these remedies also have a strong fear of abandonment.
Some patients admit to experiencing very little or no fear in their lives. They are usually either fiery types (Causticum, Lachesis, Nux and Sulphur), or two of the more intellectual types, Medorrhinum and Tuberculinum. Lycopodium may claim to be free from fear, but this usually an example of bravado and wishful thinking on his part.
Patients often complain of a difficulty in relating to other people, which is more then just shyness or lack of confidence. It is a barrier that they put up automatically to protect themselves, which prevents them from experiencing intimacy with other people. This is typical of Natrums, but is also seen in Alumina, Arsenicum, Aurum, Ignatia, the Kalis, Lycopodium, Mercurius, Sepia, Staphysagria, and Thuja.
Guilt feelings are common, but become particularly persistent and damaging in Natrum Muriaticum, Lachesis and Thuja. The patient who feels responsible for everyone else is more often than not Natrum Muriaticum. The latter is so common that I routinely ask certain questions to identify Natrum Muriaticum when the remedy is not easy to spot. These include; "Have you had any bereavements in your life?' and if the answer is yes, "and how did you react to them?" "Do you find it easier to give than to receive?" (Most Natrums emphatically answer, "to give." Others that may give the same answer, though usually less emphatically, are Lycopodium, Sepia and Staphysagria.) "Do you suffer from depression, and if so, do you prefer company or solitude when depressed?" "Are you a perfectionist, and if so, in what way?" (Other perfectionist types include Arsenicum, Silica, and Nux.) "Are you able to cry when sad?"
Anger is an important aspect of life which I usually enquire into if the patient does not mention it. Many patients are prone to feelings of anger and irritation, yet say they are not, since they do not express their feelings. If a patient says, "I don't get angry very often," it is worth asking, "But do you feel angry inside?" This gets an affirmative answer far more often. Since expressing anger is generally not socially acceptable, even the more volatile types like Nux and Sepia tend to keep much of it inside. Because of this I find that the degree of anger felt is a better guide to the remedy type. Types that tend to feel anger and irritation relatively easily include Alumina, Arsenicum, Ignatia, Lachesis, Mercurius, Natrum Muriaticum, Nux, Sepia, Sulphur, Syphilinum, Stramonium, Thuja, Tuberculinum and Veratrum. The kind of situations which bring forth anger help to differentiate between these types. Thus Arsenicum is irritated by untidiness, but also by people who are unreliable, whilst Ignatia is particularly sensitive to any form of rejection or criticism, and will react angrily as a defence. Nux and Sulphur, the natural leaders, are angered by anyone who gets in the way of their plans, and Sepia is often resentful towards men who try to give her orders, or who neglect her.
Tuberculinum and Lachesis both love freedom, and will not take kindly to being restricted in any way. Those patients who do flare up in a temper fairly regularly are likely to be one of the following volatile types; Alumina, Anacardium, Ignatia, Lachesis, Nux, Mercurius, Sepia, Sulphur, Stramonium, and Veratrum. Some Staphysagria people are also very prone to anger, though only the "wild" type (see chapter on Staphysagria) is likely to express it.
In general, the more sophisticated a patient is, the less they will admit to weaknesses. Patients who have changed consciously through their own efforts, or with the help of therapists, tend to deny negative traits that they possessed until quite recently. If you suspect that a person is a particular type, but they deny having the weaknesses of that type, ask if they used to possess them. Very often the patient will willingly confirm this. Personal growth does not change the constitutional type, hence previous characteristics can be used in the homeopath's assessment.
In this regard, I find that an enquiry into the personality of the patient during childhood is often very helpful. As people get older, they learn to compensate for their weaknesses, to control their excesses, and to hide traits which are not socially acceptable. The personality of the child is relatively unmodified by such adaptations, and often reveals the constitutional type very clearly. Only Pulsatilla and Calcarea children are likely to change types as they grow older. Just as patients often possess the trait which they go to great lengths to deny, so patients who are determined not to be like their father or mother often share the same constitutional type with this parent. Thus I sometimes make enquiries about the personality of such parents.
The person who showers her child with love and attention, determined not to be like her cold mother, is likely to be Natrum Muriaticum, whilst the man who drops out from society, and professes to be indifferent to what others think of him, probably belongs to the same type as his Lycopodium father, who tried hard to make it in the world, and always courted popularity.
A patient's profession can reveal a good deal of useful information, and should not be ignored. Arsenicum and Natrum Muriaticum have good organisational skills, and are often to be found in administrative positions. Counsellors and therapists are often Natrums, being very good at listening to others, but not so keen to talk about themselves. Calcarea is often to be found in jobs that are either practically oriented, such as a mechanic, or else in clerical and secretarial roles. Calcarea tends to avoid taking on too much responsibility, and often accepts work well below his intellectual capabilities. Lycopodiums are often to be found in scientific and computing positions, in salesman jobs and also in businesses of their own. They are also common in the teaching professions. Artistic skills are seen most commonly in Lachesis, Natrum Muriaticum, Phosphorus, Sepia, Ignatia, Silica and Medorrhinum. Sulphur and Nux Vomica are natural leaders, and are unlikely to remain in subordinate positions for long. If they are not at the top of an institution, they are likely to be self-employed. Sepia is often attracted to the healing professions, particularly to nursing, physiotherapy, and other 'hands-on' therapies. Pulsatilla, if she works at all outside the home, often chooses one of the caring professions, whilst Tuberculinum seeks either mental stimulation from his work, or adventure.
There is a saying amongst homeopaths that one should never believe what the patient says. Whilst this is deliberately provocative, and overstates the case, there is some truth behind it. Not only do many patients try to hide their weaknesses from the homeopath, many more succeed in hiding them from themselves. Hence one should not expect patients to give accurate accounts of themselves. Often the way a patient says something is more important than what they say. I remember an interview with a young campus religious minister who was seeking treatment for post-viral malaise. He appeared open and friendly, and professed to being relatively liberal and progressive as ministers go. There were few helpful mental features, and the physicals were also rather non-specific. It eventually became clear that the most noticeable aspect of his personality was a certain formality and politeness that was more commonly seen in his grandparents' generation than in his own. Furthermore, his very position as a religious minister on a university campus, surrounded by predominantly boisterous and hedonistic students (who were of the same age as he, or only slightly younger) served to emphasise his formality and 'squareness'. It was this stiffness of character that led to the prescription of Kali Carbonicum, rather than the words he chose to describe himself.
Very often the impression that patient gives is more useful than the content of his speech. Thus the patient who is very matter of fact, and is visibly impatient at having to discuss his emotions, when all he wants is treatment for his backache, may well be Nux Vomica. Similarly, the patient who denies being fastidious or prone to anxiety, but who observes the homeopath throughout the interview with an air of wariness or suspicion, and wants to know exactly what side-effects to expect, is likely to be Arsenicum.
With experience, the homeopath learns to give as much importance to the non-verbal cues as to the verbal ones. Sex is a subject that many patients and homeopaths avoid, yet it can reveal a lot of helpful information, and is worth inquiring into when the remedy is not clear. Again, the attitude with which the patient responds is as important as the words they use, or more so. An obvious reluctance to talk about sex is common with Natrum Muriaticum and Thuja, both of whom are prone to guilt feelings. On the other hand, an easy and even enthusiastic approach to the subject is often seen in Causticum, some Ignatias, Lachesis, Medorrhinum, Mercurius, Phosphorus, Sulphur and Argentum. The rest tend to be in-between. Lycopodium men often have issues about virility, which can lead to one of several approaches to talking about sex. If they are aware that they doubt their virility, they may brush over the subject, saying simply, "There's no problem there." Alternately, they may boast of their sexual prowess, either directly, or using their tone of voice in the manner of a men's locker-room exchange, "Well, there's CERTAINLY no problem on THAT account."
An honest and direct third approach is also seen quite often. Some types are rather shy but still relatively straightforward when talking about sex. These include Alumina, Baryta, Calcarea, China, the Kalis, Phosphorus, Silica and Staphysagria. They will probably exhibit some embarrassment when asked about their sex life, but this will not usually stop them from speaking about it. I like to get some idea of the strength of the patient's libido. One way of doing this is to simply ask, "Would you say your sex-drive is high, low or average?" Most people reply average, but those with a particularly high sex-drive usually say so, especially Argentum, Hyoscyamus, Lachesis, Lycopodium, Medorrhinum, Nux, Platina and Sulphur. A low sex-drive is reported by worn-out Sepias, and also by China, and by those Natrums who are having difficulties in relating emotionally to their partner.
If, for some reason, I doubt the accuracy of a patient's reply, I may enquire further, asking, "In a good relationship, how often would you ideally like to have intercourse?" Often during a difficult case I find it helpful to narrow the personality of the patient down to one that is primarily mental, emotional, intuitive or practical.
Once the case has been narrowed down to a few remedies, selective questioning can be used to rule out all but the correct remedy. Thus, if the choice is between Causticum, Medorrhinum, Lachesis, and Phosphorus, an enquiry into the patient's sense of social justice may help to support or eliminate Causticum, whilst a specific question about "spacing out" may help to identify Medorrhinum. Sometimes it happens that the physicals seem to favour one remedy whilst the mentals favour another. In my experience, in chronic conditions the mentals tend to be more reliable in helping to find the correct remedy when the two don't agree. This is partly due to the enormous overlap in physical characteristics between the remedy types, and also to the fact that the list of possible physicals for each polychrest is so vast that it cannot be comprehensively learned, or even covered thoroughly by the repertory.
There will always be physical symptoms of any given remedy that are not familiar to the homeopath. Obviously, if the physicals of the case are keynotes of one remedy, and the mentals only vaguely fit a different remedy, the physicals should be given more weight. There are atypical cases of just about every type from the mental point of view, which can mislead the homeopath. In such cases, the essence of the personality, if it can be divined, may be more useful than the particulars. The essence is a theme that runs through every aspect of the personality, such as the physical insecurity of Arsenicum.
In other cases, a single strange, rare or peculiar mental trait can reveal the correct remedy. The hand-washing compulsion of Syphilinum is a good example. Every homeopath must realise that information that is volunteered by the patient is far more reliable than that which is given as a response to a specific question, especially if it is a leading question (one that can only be answered by "yes" or "no"). For example, I have found that patients who volunteer that they get the feeling that someone is behind them when out walking at night are almost always Medorrhinum, whereas those that say "yes" when asked if they get this experience may belong to any of the constitutional types.
As a compromise, if the patient does not volunteer a particular keynote, an open question can be asked to try to flush it out. For example, one might ask the patient if she is prone to sixth-sense feelings when out alone at night, or whether her imagination tends to be very active when alone at night. If she says yes, asking her to elaborate will usually reveal Medorrhinum's characteristic symptom if it is present. It is extremely important to begin the interview with as much of an open mind as possible. Although a remedy or two will usually occur to the homeopath early on in the interview, he must be flexible enough to abandon it at a moment's notice if new information changes the picture.
There is another saying that during a good homeopathic interview the patient will laugh and cry at least once. Although not literally true, it expresses an important point; that the interview should be of sufficient breadth and depth to reach the heart of the patient. All too often homeopaths obtain a superficial and misleading impression of the patient's personality by failing to delve beyond the immediate replies that are given. This may be due to laziness on the part of the homeopath, but it is just as often due to fear of embarrassing not the patient, but himself, and to feeling uncomfortable with the expression of painful emotions. The more a homeopath is in touch with, and comfortable with his own self, the more easily he will win the confidence of his patients, and discover the real person that lies beneath the appearance.