BHA

Patient-centred healthcare

Obstacles to cure

Brian Kaplan discusses how the effects of homeopathy may be compromised.

Throughout its 200-year history, homeopathy has encountered challenges in the treatment of chronic diseases. It is clear from his own writings that Hahnemann, the founder of homeopathy, recognised this and tried to do something about it.

Hahnemann left the university town of Leipzig for the more remote Koethen after a Catch 22 situation in his battle with the apothecaries had left him with little option. They refused to manufacture homeopathic remedies but threatened him with prosecution if he broke the law and made his own medicines. In 1927 he summoned two of his most important students, Dr Stapf and Dr Gross to Koethen to reveal to them his discovery – the cause of chronic diseases. This, as we know, was his addition to homeopathic literature, the miasmatic theory of chronic diseases which culminated in the publication of Chronic Diseases in and considerable revisions to his masterpiece, The Organon.

Although Hahnemann’s theory of chronic diseases has had considerable support from homeopathic writers such as Kent and many others, it has not been without controversy. There are those who believe that while the law of similars and the advent of succussion and potency of medications is a huge contribution to medicine, miasmatic theory is a bridge too far. Anthony Campbell in The Two Faces of Homeopathy makes the point that similia similibus curentur is scientific in that it has the element of Karl Popper’s falsifiability (The Logic of Scientific Discovery) while miasmatic theory is more metaphysical because it does not.

Ultimately there is a division in homeopathy between those who feel that the word of Hahnemann is sacred and those who feel free to pick and choose from his work – bearing in mind that he himself did not shirk from revising The Organon five times.

Aphorism 260 (sixth edition)
In relation to obstacles to cure, let us first look at what the founder of homeopathy had to say: “Hence the careful investigation into such obstacles to cure is so much the more necessary in the case of patients affected by chronic diseases, as their diseases are usually aggravated by such noxious influences and other disease-causing errors in the diet and regimen, which often pass unnoticed¹.

1. Coffee; fine Chinese and other herb teas; beer prepared with medicinal vegetable substances unsuitable for the patient’s state; so-called fine liquors made with medicinal spices; all kinds of punch; spiced chocolate; odorous waters and perfumes of many kinds; strong-scented flowers in the apartment; tooth powders and essences and perfumed sachets compounded of drugs; highly spiced dishes and sauces; spiced cakes and ices; crude medicinal vegetables for soups; dishes of herbs, roots and stalks of plants possessing medicinal qualities; asparagus with long green tips, hops, and all vegetables possessing medicinal properties, celery, onions; old cheese, and meats that are in a state of decomposition, or that passes medicinal properties (as the flesh and fat of pork, ducks and geese, or veal that is too young and sour viands), ought just as certainly to be kept from patients as they should avoid all excesses in food, and in the use of sugar and salt, as also spirituous drinks, undiluted with water, heated rooms, woollen clothing next the skin, a sedentary life in close apartments, or the frequent indulgence in mere passive exercise (such as riding, driving or swinging), prolonged suckling, taking a long siesta in a recumbent posture in bed, sitting up long at night, uncleanliness, unnatural debauchery, enervation by reading obscene books, reading while lying down, Onanism or imperfect or suppressed intercourse in order to prevent conception, subjects of anger, grief or vexation, a passion for play, over-exertion of the mind or body, especially after meals, dwelling in marshy districts, damp rooms, penurious living, etc. All these things must be as far as possible avoided or removed, in order that the cure may not be obstructed or rendered impossible. Some of my disciples seem needlessly to increase the difficulties of the patient’s dietary by forbidding the use of many more, tolerably indifferent things, which is not to be commended.”

In this footnote, Hahnemann shows great insights into health. One way of looking at this paragraph is to see Hahnemann as a major advocate of naturopathy. He might be actually saying that these natural things we can do for our health are obvious and how can we expect to get better without doing them. In the context of this part of The Organon though, he is also saying that the effect of a homeopathic remedy is subtle and can easily be antidoted – which is how this footnote is usually interpreted.

However even those disciples of Hahnemann who believe that his every word is gospel do not prohibit their patients from eating celery, onions and asparagus with long tips or tell them that contraceptive-free sex or celibacy is mandatory if they want to get better. Many do forbid coffee though so it seems to me that all homeopaths feel free to pick and choose with regard to this particular paragraph.

Let us look at some of the advice given here with the advantage of having had nearly 200 years further experience of using homeopathic remedies.

Coffee
Here is the big one. Some homeopaths forbid it and some don’t. Few homeopaths will maintain that coffee inevitably antidotes an accurate homeopathic prescription – only that it can do so. Others say it does not antidote homeopathic remedies or may only do so when the patient is consuming huge quantities. Yet others say that it only antidotes homeopathic remedies with a similar drug picture to Coffee.

No convincing trials have shown us anything about this issue. My personal view is that a cup or two of coffee a day does not antidote homeopathy and that if a patient is consuming much more than this he should be encouraged to stop because it is not good for his health anyway.

Other foods
Hahnemann has not had much support for his banning of other forms of foodstuffs because they antidote homeopathic prescriptions. We may even be amused by the many prohibited foods he lists. However, while Hahnemann’s instinct (and what else could he have used to compile such a list?) might have been a bit too strict here, he immediately shows how insightful and ahead of his time he was by warning against the excessive use of sugar, salt and alcohol and “excessive eating”.

My conclusion here is that time has shown us that there is no need to ban so many foods as far as antidoting homeopathic remedies goes and Hahnemann has some good advice about healthy eating. Modern medicine is finally recognising the dangers of overeating and obesity while naturopaths have long insisted that overeating causes toxicity in the body which can lead to many chronic diseases. In fact they insist that unhealthy living is the cause of chronic disease and healthy living the obvious cure.

Lifestyle
If Hahnemann has had minimal support for his admonitions about food, he surely has had even less support for some of his advice about lifestyle. I have yet to meet a homeopath who routinely bans all forms of contraception, masturbation, “woollen clothing next to the skin”, “prolonged suckling”, “a passion for play” or “reading while lying down”.

However once again the master shows himself to be insightful in recognising long before most the dangers of a sedentary life and the importance of regular exercise. That he possibly incorrectly classified smoking as a “tolerably indifferent” activity is probably due to the fact that he enjoyed smoking a pipe himself.

Other medications
There are many who believe that if a patient is taking orthodox medicines, this is a major obstacle to cure by homeopathy. In fact this is one of the major criticisms of homeopathy by purely orthodox medical doctors who cite case after case of some homeopath taking the patient off all prescribed drugs with disastrous consequences.

Do orthodox drugs actually prevent a homeopathic remedy from acting? In the case of oral steroids or immunosuppressive drugs the hypothesis that they do, might make a certain amount of sense. These drugs suppress the natural immunity of the body – the very thing homeopathic remedies are trying to stimulate. However my experience and that of many of my colleagues is that a correctly prescribed remedy often works in these adverse conditions – some advocating that it be repeated more frequently than it would have had to be, had the patient not been on this sort of medication.

In the case of other medications the issue is more controversial. Some see antibiotics as “suppressive” while others see them as only having the disadvantage of killing off some of the body’s natural and healthy bacteria. In my view the main problem with patients taking long-term medication is not that they antidote homeopathic remedies but that they distort the clinical picture a patient presents in the consulting room.

A patient on antidepressants is not easily going to be able to give a clear picture of his mental symptoms as they were before he started taking the medication. Even if he is able to do so the homeopath cannot totally trust his own assessment of the patient’s mental state as it is obviously being modulated by the medication being taken. He must then look for other clues and keynotes to find an appropriate homeopathic prescription – which as we all know is seldom easy.

Having looked at Hahnemann’s view of obstacles to cure we can now discuss other possible reasons why patients who have apparently received an accurately prescribed medicine do not get better.

Severe disease
There are some diseases that are incredibly difficult to “cure”. I hesitate to use the word incurable because I’ve seen some amazing things happen in medicine over the years. However the truth is that although I’ve seen one or two cases of Parkinson’s disease improve, I cannot remember a total cure. I have seen multiple sclerosis go into long remission, but I’ve not seen a case of schizophrenia cured by homeopathy – although I’ve heard an anecdote about one.

We have to accept that some disease processes might well be irreversible. The body may simply not be capable of having the strength to fix everything, no matter how accurately it has been stimulated by the prescription of a homeopathic medicine.

In acute cases we must realise that there is a point of no return in medicine. Take the example of acute meningitis. The patient’s cerebro-spinal fluid may be swarming with meningococci with imminent destruction of the host (the patient) in sight. To insist that the correct treatment is purely homeopathic in such a case is inane, dangerous and criminal. The body is losing the war against the bacteria and no stimulus be it homeopathy, acupuncture or anything else is likely to save the patient. The mandatory course of action is to declare war on the bacteria with powerful intravenous antibiotics. After annihilation of the bacteria, homeopathic treatment of the patient’s constitution is a sensible option.

Lifestyle
Dis-ease might be the organism’s way of telling you that you need to make some changes to your lifestyle. To use an extreme example, someone consulting a homeopath who does not advocate such changes and treats his or her obesity exclusively with remedies such as Calcarea carbonica, Ferrum metallicum or Graphites should not really expect any dramatic loss of weight.

It is reasonable and in the spirit of Hahnemann, to ensure all patients eat reasonably healthily, are moderate in their consumption of alcohol and at least do some moderate exercise on a regular basis.

Another very important lifestyle factor is relaxation. Most GPs say that approximately 50 per cent of the patients they see are suffering from diseases that are either caused or exacerbated by stress. And yet little is done about this! It’s not good enough telling patients to relax more; they need to be instructed in exactly how to achieve this. Meditation, Jacobson’s progressive relaxation and the superbly taught autogenic therapy are all methods of achieving stress management which often leads to huge changes in health. This is particularly true in diseases known to be stress-related such as irritable bowel syndrome, peptic ulcers and chronic headaches but it is the experience of many doctors including myself that patients who learn and incorporate a method of relaxation into their daily life, can rid themselves of many troubling illnesses, syndromes and unexplained symptoms. It is important that the primary health practitioner takes responsibility for ensuring that the patient does actually do this – and unfortunately this is seldom the case in modern medicine.

Psychological factors
Since the time of Hahnemann, there has been a wealth of information on the body-mind connection or psychosomatic medicine. We now know that the mind affects the body and vice versa. This resonates with Hahnemann’s view that a homeopathic prescription must fit the symptoms of the mind as well as those of the body. But helping such people may take more than a homeopathic prescription.

There are people who actually seem to need their illness or symptoms to acquire what is called “secondary gain” in psychotherapeutic language. The symptoms may be uncomfortable but they do confer some other social or other advantages for the patient. Severe pain of any type may be the only way to force a workaholic to take an urgently needed rest. Extreme obesity may be a particular type of woman’s “defence” against unwanted sexual predators.

Having listened to patients’ stories for over 25 years of homeopathic practice, I’ve heard many patients volunteer what they think is the psychological or social causation of their illness. In my opinion these factors are major obstacles to cure – in as far as curing exclusively with a homeopathic remedy. It is poor medicine simply to use this information as symptoms to be repertorised in order to find the right remedy. Patients who may be unconsciously acquiring “secondary gain” from physical illness need to be treated with empathy and warmth as they are encouraged to come to terms with some of the issues that are preventing them from getting better.

We homeopaths are well-equipped to deal with the psychological factors that act as obstacles to cure. My mentor, Dr Eric Ledermann, insisted that it was poor medicine just to record that a patient is tearful without trying to understand much more about her tears. Our art behoves us to understand the subjective experience of illness and life of our patients, about which we take a detailed and comprehensive history. This is needed to find a remedy for any patient but it is also vital information that allows us to understand our patients’ lives and issues and empowers us not only to prescribe but also to have conversations with our patients that may persuade them to make the changes in their lives that could lead to profound healing.

Brian Kaplan MBBCh FFHom has practised as a homeopathic doctor for over 25 years. In 1987 he co-edited (with the late Marianne Harling) D. M. Gibson’s Studies of Homeopathic Remedies. 2001 saw the publication of his critically acclaimed, The Homeopathic Conversation, a textbook on taking the case, and in 2005 he contributed to Passionate Medicine – Making the change from conventional medicine to homeopathy.