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Methods of Case-Taking at NYSH

At the New York School of Homeopathy we run a school clinic. It is a great opportunity to offer very inexpensive or free (if need be) homeopathic care. It is also the very best way to learn homeopathy; it’s real life, real health issues (both physical and mental), and real case management.
 
During our monthly clinic weekends, we see follow-ups on Saturday mornings and a new patient at 2 pm. An advanced student is the “homeopath” of the day. That student will take the case with me- the director and senior homeopath at NYSH- standing by to make suggestions and if necessary, take over the case. As much as I’d like to allow the student to take the case completely on his/her own, my first obligation is to the patient. And so, if need be, I am ready to make sure we get the right remedy even if I have to take over the case.
 
Once the case is taken, all of the clinic students go home on Saturday evening to analyze and write up the case; they select and defend their remedy choice and they select a potency. This makes for a rather grueling Saturday night once a month, but the experience is unparalleled for a student.
 
On Sunday morning as a group we read the case together, and we point out the most important things the patient said. Then we all enthusiastically (!) defend our remedy choices. After we have carefully listened to one another’s explanations, we are usually open minded enough to come around to one opinion. We then decide where the remedy can be purchased and what potency to use. The student homeopath informs the patient the following day, does follow-ups by phone at least once a week, and reports back to the group via email reports. We see the patients for live follow-ups every 2 months or so, or more often if necessary.
 
Casetaking with the use of a Repertory
 
The method of casetaking is up to the student homeopath. Our students learn a range of methods. Of course, first they all learn how to take a basic case, select rubrics, and choose a remedy.
 
This method is often useful because some patients are only able to express themselves in a very basic way, or possibly they are too timid to loosen up and let go during the first intake. It sometimes requires an initial prescription, of a similar remedy, to help the patient feel well enough and relaxed enough to open up and reveal the true simillimum in a future retake. Other types of patients actually reveal the simillimum beautifully in a kind of rubrics language and symptomatology, as if they have studied our materia medica. Those are delightful cases because they back up all of the old information that we have learned in our foundation studies.
 
Unfortunately though, not all cases reveal so easily. This is why most homeopaths, including Hahnemann, have continued to improve on the old system and have sought different methods of casetaking that can facilitate the process of helping a patient reveal their remedy.
 
What is “Classical Homeopathy”?
 
However, before I discuss more progressive methods of casetaking, I feel it is important to note that there seems to be a wide spread misunderstanding in our community that there is some connection between “classical homeopathy” and the use of a repertory. At NYSH, we learn from the first lesson onwards the difference between the principles (laws) of classical homeopathy versus rules (theories) that are set forth by homeopaths. In other words, we learn to differentiate the laws of nature that govern the action of homeopathy as a medical system, from the opinions about homeopathy that are held by one homeopath or another.
 
The Principles of Classical Homeopathy
 
1. The Law of Similars- like cures like.
 
2. Totality- treating the whole person on all three levels; physical, emotional and mental.
 
3. Individuality- every person is unique.
 
4. Potentization- dilution and succussion.
 
5. Minimal dose- the least amount of medicine required in each individual case.
 
As for the “classical” part of the title, these definitions below are representative of the online definitions of classic:
 
-Of or adhering to an established set of artistic or scientific standards or methods
 
-Representing an exemplary standard within a traditional and long-established form or style
 
Therefore, “classical homeopathy” can be defined as the practice of homeopathy as laid forth by Samuel Hahnemann, which follows the principles (laws) that govern it’s action.
 
Is Repertory work part of “Classical Homeopathy”?
 
I am making a deliberate point here- on examination of the term “classical homeopathy”, nowhere do we find the use of the repertory as a principle of homeopathy. The repertory is simply a database of symptoms and remedies, and it is very useful in some cases, but it is only a tool, and it has been mistakenly connected to the term “classical homeopathy” by many homeopaths. For years it was the most effective way to solve many cases, but nowadays it should be thought of as only one of the tools in our toolbox, NOT the only tool. We can only imagine how thrilling it was in the early days of homeopathy for practitioners to obtain a data base. Up until then, one had to memorize all of the information and keep and share copious notes. But it is important to remember that Hahnemann never used a repertory. One must conclude that the repertory has nothing to do with the principles that govern homeopathy, but instead falls under the category of a “tool”. The principles behind homeopathy are what we must follow, while the tools we use to practice homeopathy, and the rules we choose to follow, should be carefully selected in each individual case.
 
Therefore, NYSH students learn the use of the repertory, along with other tools. But even when one is working with the repertory, it is still best to start with big ideas, kingdoms and groupings, in my opinion- (please see the article here, Big ideas, Kingdoms and Groupings). If we begin by clearly determining what kingdom a patient is speaking from, we can effectively reduce our choices to one third of the materia medica. To explain this idea in a very simplistic way, patients who need plant remedies tend to speak of their sensitivities on every level, patients who need mineral remedies speak of the structure that they strive to achieve in their lives, and patients who need animal remedies speak of survival. Of course, kingdom differentiation is much more subtle and difficult to discern than it seems after that simple explanation, and we spend years discussing the subtle ways that a patient may reveal the kingdom. A great deal of our understanding of kingdoms in homeopathy has come from the teachings of Rajan Sankaran.
 
Big Ideas, Kingdom and Groupings
 
From kingdom selection we go to groupings and sub-groupings. By looking at the big ideas of the case, and comparing these to the big ideas of a remedy, we can often select a remedy without needing to do a repertory analysis. For instance, a patient may come in speaking quite aggressively, but also displaying a fearful demeanor and a lack of self confidence. She has a fear of snakes and all creepy crawling things, and she also has a strong anxiety about her health. She has hormonal issues; intolerable pain before the menses with swollen and painful breasts. She had a difficult childhood; her father was verbally abusive to her and to her mother which made her feel very insecure. She says that sometimes she feels disgusting and hateful and cannot imagine anyone liking her. She describes feeling disconnected and sometimes experiences dizziness or vertigo with a feeling of floating, as if her feet are not touching the ground. She vacillates between feeling powerless and victimized and feeling rage and anger. She says she gets to a point where she can only protect herself by screaming at someone.
 
In this kind of case there is no need to repertorize. Any 2nd or 3rd year homeopathy student at NYSH should recognize these as the big ideas of Lac caninum, dogs milk. If she also gives us the keynote of loving black pepper or spicy food it’s a bonus confirmation. But before jumping to Lac caninum we must first be certain that she is speaking from the animal kingdom if we are to  consider this remedy. Her description of being victimized, attacked, and powerless along with the rage and anger that she uses to protect herself (or survive), helps us see that she needs a remedy from the animal kingdom. The sub-grouping would be mammal, and the sub-sub grouping would be domesticated mammal. (These ideas are discussed in more depth in our animal case articles).
 
(Again, please keep in mind that this kingdom discussion is an over-simplification of a complex idea.)
 
A case such as this Lac caninum case is actually a “repertory” case even though we skipped the use of that tool by using the big ideas approach instead. The casetaking method would be similar to what we think of as a standard casetaking (ie. looking for specific symptoms that can be translated into rubrics). So, our big ideas, kingdoms and groupings approach should produce the same results as repertorization- but it is easier to find the remedy this way, if one has studied materia medica in this manner. This means that grouping remedies in a way that facilitates the recognition of the grouping, which is then followed by the differentiation of the individual members of that grouping, helps one select the specific remedy that is needed. For instance, by learning Lachesis muta we end up learning the basic characteristics of snake remedies, but snake remedy patients may need any of the various snake remedies, and these choices must be differentiated. Otherwise everyone would be receiving a bushmaster snake from Surinam while they might be needing the copperhead snake, Cenchris, or any other snake remedy. (And this is one of the reasons the repertory has limitations as a tool- Cenchris would never come up more highly than Lachesis because Lachesis is more famous.)
 
 
 
Experiential Casetaking
 
There are other ways to approach a case, and the one that we particularly appreciate is what we at NYSH call “experiential homeopathy”; that is, helping the patient reveal the source of the remedy they need. Some patients “live” in a place that can be described as being almost consciously aware of the source of the remedy they need, and they reveal their source very easily. One could say that their subconscious awareness is almost as strong as their conscious state. Once we ask them to close their eyes they begin describing, in a nonsensical and fantastical way, the environment and characteristics of the source of the remedy they need. All homeopaths have experienced some of these amazing cases and though I love to write them up and share the experience, I take no credit for clever casetaking. I always joke with my students that even a non-homeopath could take these cases if they simply are quiet and allow the patient enough opportunity to describe what they “see”. These patients are at the 10m level or above.
 
However, our task as homeopaths is to help all the patients, not just patients who are 10m or above. Most of our patients will need a lower potency, most commonly 30c, 200c or 1m, because they live more in their conscious minds than in the subconscious. Our work with this casetaking tool is based on the work of Divya Chhabra who teaches homeopaths how to help any patient “Leap to the Source” through the five senses, as she calls it. Divya comes to teach in NYC usually once a year and her seminars help us learn her technique that enables almost any patient reveal the source. Her technique has propelled homeopathy forward in a profound way. I remind my students that although Divya’s work is amazing, they must find their own way when using this system. If we believe in individuality for the patient as a principle on which homeopathy is based, we have to accept the fact that as individual practitioners, we will all have to find our own way of helping the patient reveal the source, even if the system is based on Divya’s method. Many of the cases in this issue are good examples of patients revealing the experience of their source, but as you will see, each homeopath’s style varies. A couple of these cases are typical of the 10m type of case, while other examples display the technique or tricks that were necessary to help the lower potency patients reveal their source as well. The most  important thing is to make the patient feel relaxed enough to allow themselves to say foolish things and describe what they see without self-editing. This sounds easier than it is- years ago I had my case taken by Divya with fantastic long lasting results, but because of my own self consciousness and my own self-editing, she had to take my case three times before I was able to reveal the source! Thankfully I am probably more stubborn and more difficult than most patients, and thankfully she had the patience and tenacity to put up with my resistance and get a result. Two things are important to remember; one is that you can always retake the case so just relax and do your best, and retake if necessary. The other is that the results are worth the trouble. A true simillimum is a profound and indescribable experience. I teach my students from the start that there is indeed a true simillimum for each patient (it is NOT a myth as some homeopaths suggest), and our intention must be to find that special remedy. We cannot be satisfied with a partial result when profundity is within our reach.
 
The Homeopathic Toolbox
 
All of this work at NYSH is taught along with the study of and practice with the repertory, and the study of acute prescribing. Repertory work is mandatory at NYSH and the students are tested on the repertory at mid-term and final exams each year. In the clinic, students are allowed to analyze the case with whichever method they prefer to use. But it is crucial for everyone to learn all of the casetaking methods, so they can select the proper tool to use in each case. In some cases the patient cannot go to the “experience of the source”, so using symptoms which can be repertorized and combined with big ideas will be the only way to find the correct remedy. Conversely, if a patient can close his/her eyes and describe the remedy they need through their sensual experiences in life and dreams, of course we would embrace this result.
 
We have heard that the New York School of Homeopathy is sometimes incorrectly labeled a “sensation” school, because we embrace newermethods of casetaking. First of all, sensation is not a word used even by Rajan Sankaran anymore, even though it was he who had developed that system in the 1990s. He now calls his method of working “Synergy”, meaning he combines all of his knowledge and experience together with the experience of homeopaths throughout history. We should all be working synergistically by using the tried and true information from the old masters and current colleagues, while embracing new methods of case taking and analysis.
 
There is a great deal of criticism and resistance regarding the new methods of casetaking. This comes from critics with a more fundamentalist view of homeopathy and homeopathic education, who have not experienced the profound success that occurs when a patient reveals the “experience” of the source of the remedy. At NYSH we believe that students need to learn all methods of case taking and analysis in order to be prepared for working with real, live, patients. I see no point in withholding information from students in the name of “Classical Homeopathy.” I am certain that Hahnemann would be embracing the new work that many of us do in order to find the true simillimum or “to cure as it is termed.” The medical art of homeopathy, and homeopathic education, should always be growing larger, not smaller, and needs to be expansive in scope, never restrictive.

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