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Finding the real patient
FINDING THE "REAL" PATIENT - The value of totality
By Grant Bentley, September 2009
Contemporary clinical thinking is entrenched in the idea that in order to understand the true nature of another person, we must move beyond the presenting personality to uncover the inner true character, which is separate from the false external veneer. But it is limiting to assume that a person's initial presenting personality is somehow not as real as the personality that unfolds over the course of time. Both aspects are just as real and as honest as each other. The deeper aspects of character that unfold over time and develop because of trust are more revered than the more observable exterior temperament but that does not mean it is more authentic.
The cliché of another person dropping their guard so 'the real you' can come out, is a misunderstanding of the multi-faceted social nature of human character. How a person behaves is always genuine and true to their nature. If they are light in demeanour at first meeting but deep once you get to know them, that totality is their character. If a patient is easy going most of the time but angry occasionally, both aspects are their true nature. The deep is not truer than the surface nor is single positive trait more the real person than other behaviours. If we accept the idea that only the deeper more intimate aspects of character are the ones that are true and genuine, our picture of a person becomes just as distorted as only taking the lighter parts of them.
Everyone has the drive to be accepted and to be understood and we all have fears. But people are more than the sum of their fears. It is true that many people have an underlying self belief that is negative and often impacting, but to focus on one aspect of temperament is to misunderstand the holistic character of nature.
Nature uses repeating patterns to create individual structures that in turn create the whole. If Mother Nature is anything at all, she is productive, thrifty and economical. She uses the same building blocks in different numbers, patterns and forms to create living and non-living matter. For example, differentiated cells take on specific functions yet primarily each cell is the same. Protons, neutrons and electrons make up all matter regardless of how simple or how complex the end structure. In the human body each cell is tagged and marked irrespective of function and importance. The cells of our liver, kidneys or lungs are marked with the same identification tag as our skin hair and teeth.
The idea that the hidden and internal is somehow more important and unique is not in keeping with observations we make every day. In reality our external is just as unique and as identifying as our 'deep inner self'. For example finger prints are just as unique as any aspect of our character and are used in many situations to identify an individual. Another identifying part of who we are is our face. Our face is external and on the periphery yet nothing physically expresses or connects us to other people more than our face. In a crowd we can spot our family and friends from a sea of other people because of the unique character of the face.
The hermetic tablet states as above so below and the simple foundations of nature confirm this truth. In reference to nature's workings and rules, what applies to one applies to all. This means the outer is no less a display of our whole and truthful nature as the deeper more hidden aspects of self. If this was not the case holism as a concept would be irrelevant and the law of similars wouldn't work.
The law of similars is the bedrock of homeopathy. For the law of similars to be realized totality must be the key priority. Only through totality of single elements can the whole picture be discovered. When we repertorise it is important to remember that each symptom represents in its own language the whole. Understanding this concept means acknowledging that no symptom is ever irrelevant.
Sometimes valuable rubrics are ignored in the search for something the practitioner perceives is deeper and more meaningful. However each rubric is an expression of the same underlying stress. Symptoms show different body systems expressing the same pain. This is why totality in remedy selection is so valuable and effective. Remedy choices made on single symptoms may give the impression of being more 'core' and accurate, but is this true holism? Single rubric selections can sometimes be as effective as totality if the core of the case is properly understood - but they are not more effective than the whole.
This principle also applies to the mentals of the case. The trend of going beyond what is obvious and presenting can be quite detrimental to the clinical process particularly in reference to time. Going beyond the obvious, mainly in regards to the search for mental rubrics, can turn what should be an hour long constitutional consultation, into a case taking marathon of two or three hours. This does not mean all the effort is in vain but do these long consultations achieve results any better than taking a case properly in an hour? If the same result can be achieved through a shorter and more straightforward process it is in the best interests of both the patient and the practitioner.
So the question now becomes, how can the energetic crux of a case be uncovered in a shorter space of time? And the answer lies in the patient's biography.
A patient's biography will quickly uncover a pattern of stress. The sum total of events that have occurred in a patient's life has formed who they are. Stress and its impact is never subtle. Stress is like a workout at the gym; the less the workout - the less the result, the harder the work out - the greater the result. A ten minute lazy walk has a different impact on the body than running for an hour. A daily routine of yoga or weights influences and shapes the body, each in its own unique way, the occasional push up does not.
When a patient comes into the clinic afflicted with a chronic disease, it is important to remember the natural law of cause and effect. This means pathology will be in direct proportion to the stress that created it. In cases where the pathology is strong and a dominant feature of the case, there is no need to search for the hidden or subtle. The laws of nature mean equal and opposite regardless of whether it is in relation to the physical - like the laws of motion or the metaphysical like karma. In health and illness the same rules apply. When a patient presents with a pathology - the cause will be in proportion to the illness; the more obvious the pathology - the more obvious the stress.
Physical form is shaped in accordance to the pressure exerted on to it. Too much food and we grow fat in proportion to how much we have eaten. If we do weights our muscles are sculpted, if we stretch we become supple and if we run our aerobic fitness improves in proportion to effort. When physical form is altered by disease the outcome will be in proportion to the cause. If the symptoms of a chronic disease are subtle so too will be its cause but if the chronic disease is destructive and obvious the cause will be evident.
A simple way to identify the cause of a chronic disease is to get the patient to recount their biography. Stress in their life will often repeat and the more it is repeated the more impact it will have had. A patient presenting with a severe chronic disease will commonly have a history of a repeating stress. The early childhood home may have a story of violence or addiction, which is then repeated in adult life. If a patient's life pattern revolves around alcohol then 'alcoholism' is a meaningful mental rubric, if their life stress is underpinned by violence then the rubric 'violence' is chosen. Whenever a repeating pattern occurs, that pattern becomes a rubric in the case because that pattern is the cause of the stress that in turn is the cause of the chronic disease.
If a repeating stress isn't obvious sometimes a single extreme stress will have commenced the progress of the patient's illness and still be the maintaining cause - a never been well since situation. But more commonly stress is part of an ongoing pattern. Stress can come in different forms and may be a mental stress, an emotional stress or a physical stress.
Rubric selection can be straight forward and obvious - in keeping with nature's laws. If we move away from these laws or try to outsmart them, the real person can elude us making the clinical process infinitely more difficult.