Recently we have been hearing and reading a good deal about psychosomatic medicine which is the study of sick human beings using the knowledge of both internal medicine and psychiatry.
The following editorial +Editorial, “Philosophia Medici,” The New England Journal of Medicine, Vol. 239, No. 4, July 22, 1948, pp. 153-4. appeared recently in a leading allopathic medical journal:
“For this,” he said, “is the great error of our day in the treatment of the human body that physicians separate the soul from the body”.
After nearly twenty-five hundred years, this comment from Plato is still an apt criticism of the medical profession. Now the advocates of psychosomatic medicine proclaiming the truth again deserve well of their patients and of their fellow practitioners for their effort to correct this “great error of our day,”. . . The beginning student of medicine asks the question “what is medicine all about?” The reply by contemporary medical education is not satisfying. It shows him great accomplishment of science in the past, active progress in the present, and promise of greater things to come. But what answer does he receive if he goes on to say “I want a philosophy of medicine.” Perhaps a cynical smile and a science is to be your life.” If he is offered more, it is likely to be a materialistic philosophy… The great need in medical education today is not to direct less attention to the science of medicine and to its training and development of specialists but to make a new vigorous effort to foster in the student a wise philosophy of the science and of the art,, in the hope that there may result therefrom the fairest of all gifts that the physician can possess, an understanding heart.
Homoeopaths, on the whole, should be sympathetic to this welcome change in allopathic thinking. The disciples of this new view warm against the idea that the human being is merely a point in a statistical curve, a blood pressure reading, or a positive laboratory finding.
This is an interesting and long overdue admonition and has been familiar to homoeopaths for years. It indicates that allopaths themselves have their misgivings concerning their “time dishonored” approach to medicine and are sadly lacking in a comprehensive philosophy of medicine which will unite the arbitrary fragmentation of medical knowledge.
The followers of this “new look” in medicine warn that physicians must get the emotional life of the patient into a biological frame of reference along with the organic data they were accustomed to consider. They must learn to think of various emotions as something just as real and just as pertinent to the clinical picture as a diastolic murmur.
They state that emotions can produce complaints affecting any or all organs of the body, complaints not adequately accounted for by the findings in the physical examination and that pain is real whether we can demonstrate its anatomical basis or not. Emotions have “nerve endings” too.
They assert, and rightly so, that too much reliance is placed on laboratory studies and not enough on the human being as a whole.
We must remember, they say, that we are not treating an electrocardiogram or a high N.P.N. finding, but an individual with an abnormal electrocardiogram or elevated N.P.N. The tendency in medicine to think of unitary cause and effect relationship in the etiology of disease is false. There is nothing in nature that is simple as that. All of this, of course, is ancient history to homoeopaths as is the following “new technique” in history taking.
The most important pointer in history taking, they advise, is the attitude of the physician.
Listen to the patient. Allow him to tell his story in his own way. Interrupt only when you have to, if the patient is garrulous. Guide the conversation rather than lead it. The patients story is important but how he tells his story is equally important. Give the patient a sense of undivided and unhurried attention. Stress the attitude that you are one hundred and one percent in sympathy with the patient in his present trouble. However, one must never put it in words, because words are too patronizing and may retard the establishment of the all important doctor-patient relationship so essential in doing good work.
While psychosomatic medicine may be revolutionary to hitherto materialistically physicians, from a homoeopathic point of view this new concept of orthodox medicine is neither new nor fundamental.
These “pioneers” would do well to read the Organon several times. They would clearly perceive, if they are sincere and open minded investigators, how superficial psychosomatic medicine really is. It doesnt even begin to scratch the surface of the true answer to the questions of the hypothetical “beginning student of medicine” in the previously quoted editorial.
The first discrepancy in psychosomatic medicine that arrests the attention of the homoeopathic observer is the great schism between its philosophy and its application, between its word and its deed.
On the one hand its advocates say that we must treat the individual as a whole not his bodily symptoms and mental symptoms separately. Then they go on to say that the physician, whether he is treating an acute or chronic illness, must be aware that he is always dealing with two situations, one the personality of the patient who is ill and the other the disease from which the patient is suffering.
In other words, while the patient is being drugged with large physiological doses of empirical drugs to cure his bodily disease and thereby suppressing it and rendering it incurable, as well as adversely affecting the personality of the patient, that same personality is still further treated with psychotherapy and an occasional “mild” sedative.
This obvious discrepancy stems from the sad fact that orthodox medicine arrogantly chooses to be blindly unaware that it is possible to treat the patients disease as well as the patients personality with one and the same single, dynamic, potentized remedy. Psychosomatic medicine hasnt progressed that far.
While we sincerely admire the ingenuity of the psychological explanations of human behavior in their causation of bodily disease; we must never lose sight of the fact that these explanations, no matter how brilliantly conceived, are not the gospel truth. They are only theories. We must ever be on the alert to distinguish shadow from substance.
Theories of human behavior are varied and numerous. They are as subject to change as the styles in womens clothes. To be sure, we must have theories because the human mind “abhors” unexplained phenomena and always seeks as explanation for them.
But allopathic thinking seems to have selective blind spots in its choice of what of explain and what is beneath its consideration and to be left contemptuously unexplained.
Tremendous amounts of money and human energy are being expended in the pursuit of those ever-elusive specific treatments for the equally bizarre man-concocted disease syndromes. But very little investigation has been done on such enormously more important and fundamental problems as immunity, susceptibility, and suppression.
All these vital, perplexing gaps in our knowledge are dismissed by the long words “idiosyncrasy” or “idiopathic”, which is not even an attempt at an explanation. Even if such things were honestly and diligently studied by orthodox medicine, it would only make interesting reading and nothing more because allopathic medicine lacks a comprehensive philosophy to put this new knowledge to practical therapeutic use.
We, homoeopaths, must remember that no matter how convincing these psychological explanations of the causation of disease may be, they cannot compare with our Law of Similars which in its proper application is comparable in precision to a mathematical formula. For a certain totality of symptoms plus the similimum will invariably equal cure in curable diseases or excellent palliation in incurable ones.
The homoeopathic materia medica is full of drugs which have been well proved on human beings, not on laboratory animals, and have been verified on countless occasions on sick human beings. These drugs are capable of exerting a curative influence, not only on the body but on the patients personality as well. They can be used equally well in functional diseases as in organic maladies. Moreover, the Law of Similars makes no such absurd distinction between functional and organic disease because the former untreated is invariably the precursor of the latter.
It has always puzzled me how any one can tell with absolute certainty that a certain complaint is purely functional, solely on the strength of normal laboratory findings and a negative physical examination. It seems to me that all diseases before they localize themselves in some organ or tissue where they can be definitely labelled “Nephritis,” “Heart Disease”, etc., go through a functional state first.
The patients complaints, at the onset of the disease process, are usually vague and indefinable. His history may contain a lot of rare, strange and peculiar symptoms which have meaning to homoeopaths, because these queer sensations may indicate a clue to remedy selection while thy are absolutely meaningless to the allopaths.
It is just such conditions that the allopathic physician, imbued with the new spirit of psychosomatic medicine, will give the patient a “mild” sedative for his “nerves” and plenty of assurance and consider himself practicing real, “scientific” medicine, when in reality he is only postponing the day of reckoning. He is doing the patient a lot of harm because he is treating the patient only partially. And it is just as harmful to treat the psyche without the soma as it is so treat the soma without the psyche.
There is, however, much to be learned from psychosomatic medicine in spite of its shortcomings. Homoeopaths, as a group, should consider nothing common or unclean and should be quick to utilize any and all sources of knowledge, the better to enable them to practice their Art, provided of course that this knowledge is not in conflict with the fundamental tenets of their philosophy.
Most of what is to follow good homoeopathic prescribers already know and have used, albeit instinctively, since Homoeopathy came into being. But it is worth while repeating.
Homoeopaths can obtain a better totality of symptoms and thereby do better work, if they attempt to understand the personality of the patient. Some patients may seem outwardly calm and serene and overpolite when they are actually ranging inwardly–a situation very characteristic of many hypertensive patients and obsessive-compulsive neurotics.
It is also important to not that speech is not only a means of communication, but it is also a means of hiding vital symptoms or minimizing their importance, because it pains the patient to discuss them with the doctor. Therefore the doctor note not only what the patient says, but how he says it. We must be alert to see through a verbal camouflage. Also ascertain what the patients symptoms mean to the patient.
With patients who find it difficult to relate their symptoms without hedging, it is sometimes better to leave the history taking for later and do the physical examination first. Patients on many occasions will want to talk and give a better history after the physical examination than before. The physical contact which the physician makes with the patient during a physical examination seems to accelerate the establishment of a rapport between patient and doctor.
There is a certain group of patients whose complaints need no remedy.
All they want to do is discharge some of their pent-up feelings. The interview with the doctor serves as a means of relief of emotional tensions. In such cases the understanding physicians the best remedy. All he has to do is be a sympathetic listener and steer the emotional torrent of words when it lags. Such people have a great need to unburden themselves. They need a friend and they need support.
This brings us to the last and most important lesson we may learn from psychosomatic medicine and that is the meaning of the doctor-patient relationship.
Many times patients come to us with their troubles and we try our best to prescribe for them and somehow we fail to relieve them of their conditions. This is so because we either have not obtained the whole of symptoms or a proper evaluation of them. It may also be that we dont know enough materia medica or that we have forgotten to remove some obstacle to recovery. Yet these same patients keep coming back to us and we wonder why. The reason is that we have established a certain relationship with the patient without understanding its meaning. Sick patients are like little children, say the psychiatrists, they regress to a childish dependence on the doctor. This is the basis of the doctor-patient relationship. To put it in another way,the physician may take the place of a good father or a father figure. When the patient is ill he becomes anxious and is being anxious he is more dependent, less mature, and therefore his relationship with the doctor who is going to help him is not that of an adult to an adult. It is more like that of a child to a parent. The doctor patient relationship is determined emotionally.
It is important for us to remember that a positive spiritual comradeship must be established between ourselves and our patients before we can ever hope to obtain a good through anamnesis. Because once this liaison is formed, the patient will want to unburden himself and we shall, therefore, be able to obtain a better history of the case and consequently do better prescribing. We shall also be able to hold on to our patients better.
The patient-physician relationship is also the basis of psychotherapy. In its essence, psychotherapy consists of reassurance, relieving anxiety, and discovering the motivations for the patients behavior and making the patient perceive them. I believe homoeopaths will enrich and enhance their Art, if they consciously and purposely utilize this form of treatment as far as possible in conjunction with the indicated remedy.
In conclusion, I should like to say that homoeopaths, as a group, are far better suited to practice the tenets of psychosomatic medicine than are the allopaths.
The idea that a patients bodily ills as well as his personality, should be treated as a unit is second nature to homoeopaths. Good homoeopathic prescribers are invariably good listeners. They do not give the patient the impression that they are in a hurry. They are always sympathetic.
The very nature of a homoeopathic history, the manner in which questions are phrased and the subject matter they touch on tends quickly to establish and cement the all important doctor- patient relationship.
The patient suddenly becomes aware that this doctor is different. The doctor is not only interested in the patients complaints, but he is also interested in the patient as an individual.
The many “sensations as if”, and the strange, rare and peculiar symptoms which patients may relate to the homoeopathic physician strike a responsive chord in him. They have meaning for him and the patient senses it. “Why you are the first doctor I ever told this to!”, is a very common remark. Here at last the patient has met a physician who understands hi, who doesnt look at this fidgety, anxious individual as though he were crazy when he relates these peculiar sensations and symptoms. Here is a physician who, it may be truly said, has “an understanding heart”.