Author: Gajanan Dhanipkarn
A Synergistic approach to case-taking
by Gajanan Dhanipkar
The art of Homoeopathy lies entirely in understanding the patient, and a good case-taking forms a bedrock to it. There are many aspects which form the basis of a good case-taking, and the most fundamental requirement from the homeopath is an unprejudiced observation. One question that haunts many a senior homoeopath is how to go into the experience of the patient. How does one choose the entry point to enter deeper towards experience of the patient? How does one know if the patient’s expressions are temporary or are they fundamental to the patient? Is it important to find out what is holistic to the case, to see the common theme in patient’s expressions?
Often, when a patient is talking, he will give you fifteen or twenty symptoms, speak about his emotions, about his job, and about a number of intense situations in his life. In the course of such a listening process, it is important to select what is holistic to the patient. The energy in the case could be intense either in the chief complaint, in some emotional aspect, and in several other places in their story. The remedy selected should also reflect who the patient is. Let us understand this aspect through a case.
This is a case of a 25-year-old girl who came with the complaint of recurrent styes on 6th March, 2013. The complaint first started two years ago, when she was under stress owing to her exams, and she had to use a laptop for long hours. The styes were painful and itchy. She got a weird sensation in her eye, feeling as the affected area was being stretched. The pain was better by warm applications. The styes kept recurring, and she felt that they may be contagious as her roommate also suffered from it once. She had to be operated for a stye on the left lower eyelid, which would not easily go away. The styes also affected her appearance; she felt that she did not look good because of them.
Until now, we have an understanding of her chief complaint and scant modalities. As the case progressed, she was asked about the situation in life that affected her most. She described that she was in a relationship during her under-graduation years. She was very close to her boyfriend and was completely dependent on him. He took good care of her and supported her. She was very heartbroken when their relationship ended and felt that she should not have been in the relationship. She was dependent on her boyfriend for care and love. She felt she had made a wrong choice and felt guilty about it. She would often think of this and feel sad.
With this understanding, we can easily think of Nat-mur or similar remedies due to ailments from disappointment in love and the following narration. What we have to bear in mind, however, is the important part of understanding if this was only a circumstantial reaction or whether it is a part of her pattern, whether it really is a part of who she is as a person.
The patient was then asked to describe her nature. The patient said that she was applying for her PhD and she was anxious whether she would secure an admission. It was very important to her as she felt that she should measure up to her parents’ expectations. She always felt that her parents expected that she would have a good qualification. There was always a fear that she had made a wrong choice, if she was not able to succeed in her chosen task. She felt that people would not accept her and love her if she did not keep up to their expectations. These thoughts made her very insecure. She was very low in confidence and felt that she was not good enough, so she would keep studying. If the patient was not good at something, she would feel very bad for not being an all-rounder. The persistent feeling would be of not being complete and of an inner lack.
She was extremely sincere about her studies and used to anticipate quite a bit a few days before her examinations; she would be sleepless at night. Despite studying well, she always felt that she was lacking in some subjects and should put in more effort. There was a constant anxiety that if she did not perform well during exams, she would not get her dream job and she would not be accepted by her parents. This would again feel incomplete or as if she was lacking something, which brought on a lot of insecurity. So, she was very sincere and extremely dedicated to her studies.
The patient would always seek her father’s approval which meant everything to her; he was her role model. She wanted to achieve and be successful like him. For this, she felt that she had to possess all the qualities that he had. It was a must for her to measure up to her parents’ expectations.
She always felt the need to be balanced in her life, be balanced between her work and her family life and her studies. The patient had a strong urge to set a good example for her brother and be the ideal that her brother could look up to. She felt that she should be the one to bring her family together and keep them united.
There was marked anticipatory anxiety before and during exams and presentations. Despite being able to mingle with people well, she would be anxious before a presentation and would be very conscious about what she said, fearing that she should not make any mistake and that people should not have a wrong image about her. With anxiety, her palms become. As a person, she is very timid and would just accept things without opposing and would be neutral or unaggressive during a confrontation, being of the opinion that doing otherwise would just spoil the situation.
She was always a good girl in the eyes of the society and strived to keep up this image. She co-operated with everyone, so that her image should not be tarnished. People generally thought of her as a very agreeable and obedient girl. The patient then said that people’s opinion was very important to her.
Besides, the patient also complained of a very oily facial skin, especially during summers. She also suffered from acne on her face, some of which was quite painful. When asked about her dreams, she said that she was offered proposal for marriage by a boy, but the boy did not accept her as she was not humorous and bright. She felt very low because of that. She is chilly and feel cold quite easily.
In this case, we have to see what is the thing which is true to her as a person, what describes her as she is. We see issues of low self confidence, image, being dependent, and a inner lacking. These are the issues of Mineral kingdom. Once the kingdom is clear, we have to see which series the patient belongs to. We see issues of image, low confidence, of care, love, identity etc. These are the issues of third series of the periodic table. Also, this patient feels that she is lacking in confidence and that she is not good enough. The remedies to the left of the periodic table feel that they lack and that they have to be dependent on someone else for their completion. There is a fixed idea, that she should be good and sincere so that people accept her and so that her image is not spoilt and she measures up to other people’s expectations. This with the anxiety and the anticipation clearly indicate Silicea. Also, when we repertorize the important symptoms of her case, we get:
We see that Silicea stands out most clearly. We see that this is yet another example of the system and symptom blending effortlessly to give efficacious results.
Prescription: Silicea 200C one dose
Follow-up, 14th August, 2014: she is much better. New styes had stopped appearing within a few months of starting treatment. The stye on the right lower eyelid, which was long standing, has considerably reduced in size. She is doing better, even as regards her mood. Her anxiety and anticipation are a lot better and she is not any longer bothered by what people think of her. Overall, she reported to be better by about 85%. She was on in infrequent doses of Silicea 200C.
It is important to remember that the remedy we select is the one for the patient – for who he really is. It is for what is fundamental to the patient. Often in a case we get symptoms of the basic characteristics of the patient mixed with many expressions which arise in certain special circumstances, but the expressions are not basic, they are circumstantial. They can be prominent and characteristic but they do not show who the patient basically is – they only show how he reacted in a special circumstance. Very often the primary state – the real person - is reflected in the chief complaint.
Case written and edited by Sneha Vyas
Rajan Sankaran, Synergy, The Synergy in Homoeopathy – An Integrated Approach to Case-taking and Analysis, First Edition, 2012, Homoeopathic Medical Publishers
Rajan Sankaran, Vital Sensation and the Kingdoms, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers.
Rajan Sankaran, Row 3, Structure: Experiences with the Mineral Kingdom – Volume 1, First Edition 2008, Homoeopathic Medical Publishers, Mumbai
Keywords: recurrent styes, desire for perfection, anticipatory anxiety, role model, image