Dichotomy, ‘the division or contrast of two opposing things’, seems to be one of the basic phenomena of existence. Black & white, in & out, up & down, left & right, positive & negative, yin & yang, conservative & liberal, capitalist & socialist. The list goes on and on. Even our modern cyber world is built on the contrast of 0’s & 1’s. The ancient Chinese understood dichotomy as the basic operating principle of the world: from the great Unity came the separation into Two, and from the continued force of separation the 10,000 things of the world came into being.
A few thousand years later, German philosophers of the 19th century revived the Greek term ‘dialectic’ as a metaphysical term describing the inevitable existence of opposing forces, concepts and actions that creates contradictions as well as the process leading to their resolution. Marx and his communist successors picked up and tweaked this idea a bit with the moniker ‘dialectical materialism’.
In the development of homeopathy over the last two centuries, there have been two great dichotomies, one mostly historical and the other quite contemporary, which have had far reaching effects on its evolution and the way it is practiced. The first was the division between the low potency and high potency prescribers during the mid to late 1800’s.
‘Potency’, in the homeopathic context, is used to describe the extent to which a medicine is diluted. The basic notion being that the more a medicine is diluted during the preparation process, the greater medicinal strength or ‘potent’ it will become. This quite counterintuitive concept was not a hypothetical postulate, but rather was the direct result of experimentation and clinical evidence.
Over a period of some five decades beginning around 1790, Samuel Hahnemann, the founder of homeopathy, investigated into various methods and degrees of dilution for his medicines in order to further enhance their curative powers. Early in his homeopathic career, the medicines were diluted by factors of 1 part in several thousand or millions. Although to most laypersons, this seems extraordinarily dilute, it was in fact, a quite modest beginning. By the latter part of his career, he began to use medicines that were diluted by factors of many billions, trillions and beyond. These were diluted to such an extent that no molecule of the original substance could possibly remain.
Hahnemann himself had the breadth of mind to perceive that the action of the medicine was based on the nature and purity of the energy that was transferred from the substance into the medicinal solution, and not the extent to which the substance itself was present. He understood that in point of fact the dilution process enhanced their medicinal action. But there were those amongst his followers who accepted and used medicines of lower dilutions but balked at the idea of these extreme dilutions, perhaps thinking that the old man had gone off the proverbial deep end.
These were the original ‘low potency prescribers’. A generation later, this dichotomy became even more pronounced when some homeopaths started to make and prescribe much potent medicines that were diluted to degrees that Hahnemann himself never considered. And again, there were those in the homeopathic community who considered this an outrageous corruption and misapplication of the basic principles of homeopathy.
In the United States, this split rendered asunder and weakened the entire profession, and became a key factor in the demise of homeopathy in the early 20th century. Although does still existing today to a certain degree, the difference between the two camps has to a great extent been resolved. This is basically due to the fact that there is a consensus in the profession that remedies of different potencies have different have differing actions. Put another way, the same homeopathic remedy in two different potencies will act differently.
While there are many disparate schools of thought about exactly how that difference is best defined, generally speaking, most would agree that lower potencies, which are relatively speaking closer in form to the substance from which they are derived, tend to act more at the level of the physical tissues. They are used more for ‘organic illnesses’ where there are clear changes in the structure of a particular tissue or organ. An example might be an enlarged thyroid gland or kidney disease where cellular destruction has occurred.
Higher potencies tend to be used for what are called ‘functional illnesses’ where a function or physiological process is disturbed. Complaints with a strong mental or emotional component tend to also fall into this category. A chief complaint of high blood pressure or anxiety would both be examples.
With this perspective, a modern homeopath need not choose between one camp and the other, but can make appropriate potency selections based on the patient and the illness. Thus, the ‘dialectic’ of low and high potency comes to a very satisfactory resolution.
While the first splintering of the American homeopathic profession chiefly centered on the question of how dilute the medicinal solutions ought to be, that was not the only matter of contention. It also fell along a growing divide between constitutionally oriented homeopaths and those more concerned with pathology.
The former group, who ended up becoming a small minority, strictly upheld the founding doctrine much emphasized by Samuel Hahnemann that the diseases manifested by a patient must be treated by understanding a complex of characteristics related to the physical and mental nature of the person. The latter were more focused on using remedies that had known effects on certain symptoms, tissues or organ systems, but not taking into account the overall state of the person.
As it turns out, the division between these two approaches for the most part fell along the same lines as the split between the ‘high’ and ‘low’ potency homeopaths described earlier. Constitutional homeopaths tended to use the high potencies while the pathologically oriented homeopaths used the lower ones.
As was previously mentioned, this is due to the fact that as homeopathy developed over time, it became clear that both high and low potency remedies were both effective in their own right – but that they acted in different ways, even if they were derived from the same substance. Generally speaking, low potency remedies were more effective when there was a condition where there was significant organic tissue change while the high potencies seemed more effective in cases of functional and mental disease.
Thus, the chasm between the two schools of thought – the constitutional versus pathological, was less one of who was correct, but more one of treatment emphasis. In a case with significant organic tissue changes, a constitutionally oriented homeopath may choose to prescribe low potencies based on the pathology itself. Likewise, a more pathologically oriented homeopath may chose to use higher potencies when dealing with functional or mental problems.
In the last quarter century, there has arisen yet another controversy that has threatened to divide the homeopathic community. As in the questions of potency and the constitutional versus pathological perspective, on one side there is a more traditionalist camp claiming to be more fully aligned with the original doctrines of Hahnemann while on the other are those who believe they have fostered an evolution in the philosophical and therapeutic horizons of homeopathy.
In essence this latter group feel they have maintained the progressive, experimental outlook that so characterized Hahnemann’s career without contradicting the underlying principles of his work. They have introduced a great many new remedies into the homeopathic material medica and prescribed them without necessarily relying on the experimental symptoms elicited during a “proving”.
A proving is basically an experiment during which a single remedy is administered to a group of healthy volunteers, and observers compile the resulting symptoms. The resulting set of symptoms is analyzed and compiled into a drug picture. Classically, it was only based on these proving symptoms and the resulting drug picture that homeopaths can prescribe a remedy to a person matching the drug picture.
But the ‘progressive camp’ (this is my term used as a matter of convenience) to incorporate a great many new remedies into the material medica – some of which were proven, but many of which were not. They also began to understand the action of remedies, whether well proven or not, by analyzing their place in the natural world, grouping them together in families based on scientific classifications such as the periodic table and the taxonomy of living organisms.
Extrapolating from this type of information and by various consultation techniques, it became possible in a great many cases to make a correspondence between the constitutional nature of the patient and the nature of the source material from which the remedy was derived.
To a great extent, what they had done was to incorporate and integrate a post-Freudian perspective on the human psyche, with data accessible via computer analysis and scientific information readily available via the Internet.
While the traditionalists claim these techniques undermine the very foundation of Hahnemanian homeopathy, positive clinical results for patients whose remedies where prescribed in this manner.
A woman I’ll call Irene came for a consultation about one year ago for unremitting chronic pain she was experiencing throughout her body. Irene was slightly built and when she spoke, her voice sounded hoarse and raspy. A little shy of 60 years old, the pain began about five years earlier. Her condition was originally diagnosed as a collapsed vertebrae in the lower back and although surgery to fuse two of the vertebrae did help somewhat, she found it difficult to stand or move without severe pain.
Later, she was told that she had spinal stenosis (a narrowing of the space in the spine, causing pressure on the nerves) that was responsible for pain and tingling in her arms. But no treatment provided any relief. There were other pains too that were undiagnosed such as the sharp stabbing she felt under her skin – ‘ like broken glass’, as well as double vision and that distorted voice. The cumulative effect was debilitating and, in fact, was now on total disability.
Irene appeared to be of a gentle nature, yet she expressed frustration with her how her condition had been handled. In fact, she dates the dramatic exacerbation of her pain to a diagnostic procedure known as a ‘discogram’ or discography’ done five years before which entails the injection of x-ray dye (x-ray contrast) into the discs of the spine. It was performed by a resident physician who was no very practiced in the technique and kept missing the disc when inserting the needle.
A registered nurse herself, she was familiar with most of the procedures, therapies and medicines, but felt that there was neither a comprehensive understanding of her condition nor any further options available to her. She added, “I’m also sick of being treated as if it is my fault!”
Aside from possible nerve damaged caused by the poor execution of the discogram, the pathology of her condition was not anymore apparent to me than it was to her physicians. But fortunately, my understanding of her case would not be defined by the pathology but by her experience of the pathology.
This is so for nearly every homeopathic diagnosis. The understanding and selection of the medicine derives from how the patient perceives their condition – physically, mentally and emotionally. Ten or a hundred or a thousand people might complain of pain, but all of them relate to it, experience it, in a different manner. And all of them will need a different prescription.
For a homeopath, an unelicited, spontaneous and somewhat incongruous statement is often a gift. It can lead to a generalized, or ‘globalized’ , understanding of the case. That is, while I had no idea whether anyone had ever really blamed Irene for her problem, while we were discussing the pain, without any prompting she spontaneously provided a hint as to how she experienced her condition, and by extension, how she experienced her life: treated as if were her fault. So, I was alert to the possibility that this feeling might be applicable to other aspects of her life
Proceeding with the consultation, I further asked her to tell me what the worst thing about her condition was and how that affected her. The pain fatigued her, she replied, and it made doing anything an effort. Once she was an independent, functional and productive person, but now she was not contributing anything. She was useless, a failure.
“I feel trapped. I need to stay at home, be patient, bide my time. Its like a rat trapped in a labyrinth that can’t find it’s way out… And somehow, I feel this is my fault, that I’ve brought this onto myself. No one else is owning up to anything, so it must be me.”
Again she had come back to the same feeling and this time added another dimension to it: she was trapped and it was her own fault. This was a purely subjective perception of her condition, what some homeopaths might call her ‘delusion’. For homeopaths, this is not a pejorative term because we can recognize these subjective ‘delusions’ are very much part of the human condition and can be seen in all our patients to one degree or another. It is the clear perception of the nature of a particular person that often is the key to unlocking the case and finding a deep acting, curative remedy.
From a homeopathic perspective, the delusion is quite useful. Homeopaths are always looking for the ‘strange, rare and peculiar’ – that bit of information that is unusual or just doesn’t make sense. This is because those illogical or contradictory parts of a case are points where the individual vital force makes itself known. One could call that the signature of the vital force.
So, while it would be common for a person who feels cold to want blankets, the person who feels cold yet throws off the covers is experiencing something illogical and relatively unique. That shows a very peculiar signature of the vital force and as such is a valuable to gift to the homeopath searching for a remedy. (Homeopathic Camphor is just such a remedy well know to throwing covers off despite feeling extremely cold.)
So, ‘trapped and my fault’ expressed something significant about Irene’s individual nature on a mental/emotional level and as such seemed a key to opening the case further in order to make an effective prescription. I asked her to explain it a bit further.
Irene described how difficult it was for her to accept the pain at the beginning because she was used to being useful and productive working as a nurse. “I had developed the capacity to put pain out of my mind – a ‘dissociation syndrome’. I’d just make it so the pain wasn’t me. I never was one to spend too much time in my body anyhow.”
It turns out that Irene had a history of pervasive abuse during her childhood at the hands a number of family members and during her first marriage. To survive, she learned how to dissociate from the trauma, becoming a remarkably industrious, functional adult. But that activity too appeared to be another dissociative mechanism because if not busy working, she’d be overcome with a sense of failure and guilt.
Irene had a strong sense of responsibility raising four children on her own after leaving the first marriage and, later taking in a sibling - one of her former abusers - who had become disabled. This was despite her intentions of becoming a travelling nurse once the children were out on their own.
But there was another side to Irene, also: a part of her that yearned to be free of the compulsion to be busy, free of responsibility, and free of guilt. By the manner in which she described her life’s story, it became clear that on a very deep level Irene felt trapped by it all.
To compound that feeling, Irene found herself living in close proximity to a former abuser, thereby denying herself of the opportunity to realize long held plans. It could hardly be a coincidence that it was around this time that her pains began.
The longing to be free was not new for her. Even as a child who felt hopelessly repressed and enslaved, her goal was to gain her independence, to earn money as soon as it was possible and leave home. Unfortunately, she gained her independence from home by way of a marriage that ended up being another form of entrapment.
When I asked Irene what she imagined freedom – freedom from her pains and from her responsibilities - might be like, she described it as a sense of flying upward, being above everything and floating wherever she wished. Falling into a near trance-like state, Irene envisioned passing over mountains and valleys, of the warmth of the sun shining on her as she navigated the air currents.
Even before this point of the consultation, the class of remedy that Irene might need was coming into focus. But the clarity and depth of her trance was a strong confirmation. This altered state is sometimes referred to as ‘going to source’ because the patient actually manifests a state of being reflecting the very substance of his or her own constitutional homeopathic remedy.
This phenomena does not occur during every consultation, but when it does, it is not only a strong indication of the necessary remedy, but also a powerful, somewhat transcendent experience for patient and homeopath alike.
While in conventional medicine a drug with a 10 year track record might be considered an ‘old timer’, in the homeopathic world, where many of our remedies originated in the early 19th century, a medicine with only a 10 year history would be considered a veritable newcomer. As a matter of fact, there are many homeopaths who resist using newer, non-traditional homeopathic remedies.
The incorporation of these newer remedies, in fact, is a great source of debate amongst two camps of homeopaths in general. Broadly speaking, on one side are the traditionalists who generally wish to prescribe remedies experimentally proven and therapeutically applied over many generations. On the other side are the non-traditionalists who actively seek to broaden the scope of treatment by incorporating newer remedies into the homeopathic pharmacopeia.
In working with Irene, the woman who sought out homeopathic treatment for disabling chronic pain whose case I have detailed in previous columns, it was rather clear to me from our first consultation that the homeopathic remedy she would need did come from a relatively new class of medicines developed over the last decade.
Not only was her chief complaint of chronic muscular-skeletal pain quite typical for these remedies, but also the way she expressed being trapped by her symptoms. Now, while many people might complain of feeling trapped by a disabling or painful illness, in Irene’s case this experience of ‘being trapped’ manifested over and over in her life. It seemed an inescapable pattern for her starting from childhood, continuing through her first marriage, then after divorcing, with her responsibilities of caretaking both her children and afterward a disabled sibling, and finally, with the disease itself.
An effective prescription necessarily needed to address this repeated pattern as well as the opposite – her yearning to be free, to float or fly above her pain and entrapment. This is a perfect description of ‘bird remedies’. That is, these are homeopathic medicines prepared from some tissue, usually either a feather or a drop of blood, of various birds. As research and clinical experience accumulates, there is an ever-increasing variety of this class of medicine made from falcons, eagles, parrots, crows, hummingbirds and a host of other aves.
While as a group all the bird remedies or, more accurately, the people who need bird remedies, experience their lives as conflict between being trapped and the desire for freedom, each particular species expresses this conflict in a somewhat different way. For instance, in the homeopathic proving of Columbus palumba – commonly known as the Wood Pigeon or Ring Dove, there arises a strong sense of being a gentle soul trapped in a harsh world full of violence and pain. The proving of Ara- macao, the Scarlet Macaw, brought up a sense of being trapped between the need to be part of a social unit, the family or society, and the need for self- expression.
In Irene’s case, the overwhelming sense of responsibility identifies the particular species as Buteo Jamaicensis, the Red Tail Hawk. Paraphrasing Dr. Jonathan Shore, who more than anyone has conducted research and written on birds: There is a conflict between freedom and obligation. They cannot live in community and not have a sense of responsibility. They are obliged to care and support. In essence, trapped in responsibility.
Irene’s response to Buteo-jamaicensis was quite immediate. Her pains begin to lessen and her moods improved. Now, nearly a year after beginning treatment, though by no means cured, she feels her pain has diminished by 75% and she is starting to consider re-entering the work force. Interestingly, during a recent follow-up visit, she expressed that her main concern about getting off disability to resume her career was not whether she could physically do it or not, but that she didn’t want to take on the responsibilities that it entailed.
It had become clear, she said, that her illness had been the only way to avoid the overwhelming responsibilities of life. Without knowing much about homeopathy or anything about the remedy she was prescribed, Irene had put her finger on the exact essence of the Red Tail Hawk.
Cases like this are a constant reminder to me how remarkable the homeopathic process truly is. The Vital Force of every individual and every substance constantly expresses itself, but we need to be perceptive and persistent enough to recognize it. But even if we can understand the person’s Vital Force, what if we don’t have the appropriate medicine, the homeopathic ‘similar’ that matches that Vital Force?
Before the bird remedies were available, Irene would probably not have received the same degree of benefit from homeopathic treatment. It is even possible that she may have not received any benefit at all. While extremely respectful of homeopathic tradition and the classical remedies used for many generations, my experience with patients like Irene also makes me appreciative of the need to expand our horizons as well.