Installment 12 of a series on case analysis
© Will Taylor, MD 2001 (bio)
The Story Board
A First Sketch of the Case - the symptoms
The initial sketch can be a simple listing of symptoms of the case. This can be as linear a list as you left brain likes, or as floral as you right brain might prefer. Note that the Story Board has no margins or ruling lines! You can even purchase round dry-erase boards, if rectangles threaten to cull your creativity.
I liken this first stage to a brainstorming session - there are at this point, no wrong answers. Which is why the need for a good eraser - we will make ample use of it in a moment.
I'm a big fan for lean, mean repertorizations; I'm happiest when I can describe a case in 6-8 rubrics, and when I can get it down to 2, I'm in heaven. I find that most often, when I feel I need more than 10 rubrics to characterize a case, it is because I do not truly understand the case. But this is not yet the stage for such brevity - rather, this is the stage where we lay the groundwork for a succinct understanding of the case.
A First Refinement of the Sketch - the characterizing symptoms of the case
A first refinement of your sketch of the disease at hand could be to cull out the characterizing symptoms of the case. Hahnemann tells us in aphorism 153,
…the most striking, exceptional, unusual and odd (characteristic) signs and symptoms of the disease case are to be especially and almost solely kept in view. These, above all, must correspond to very similar ones in the symptom set of the medicine sought if it is to be the most fitting one for cure. The more common and indeterminate symptoms … are to be seen with almost every disease and medicine and thus deserve little attention unless they are more closely characterized.
The value in including in our initial listing of symptoms such common and indeterminate symptoms as 'Anxiety' or 'Headache', is that at this stage - before we simply erase them as not useful to our purposes - we can look back at the case and the other symptoms collected from it, to see if we can refine this all-too-general symptom into something more useful for our purposes.
Perhaps some of these all-too-general symptoms can be further characterized when we look back at the case:
I'm a really anxious person[not terribly characterizing]
I worry a lot about little things that no one else might even notice
Or retained as headers to more characterizing symptoms:
I'm a really anxious person [not terribly characterizing]
Recurring dreams of robbers in my house
Money is a constant stress in my life
Obj - Feet and ankles are in constant restless motion during visit
There are some screening questions I like to ask myself at this stage, to differentiate those symptoms that will be useful in characterizing the case and those that are all-too-general in nature. The most basic of these, are:
1. What identifies or differentiates this person from the rest of suffering humanity?
2. If I had to prepare a succinct description of the disharmony of this person so that anyone could recognize them at a train station, what features would I emphasize?
…and to keep myself honest, close to the patient's own words, and away from speculation,
3. Could I take this description to court? Could there be any opposing arguments to the way I am describing this symptom?
There is some confusion around aphorism 153, which leads many to suggest that the common symptoms of a disease-entity are not useful, and should be disregarded, in repertorization. I will tackle this issue in depth in a future installment, but for now, will suggest that the coherent portrait of a case of disease needs to represent both the general pathology of the disease, and the unique presentation of the individual.
A remedy for a case of scarlet fever needs to cover both the commonality of the red sandpaper rash, the sore throat, and the fever (which separate this pathology from other pathologies of suffering humans); as well as the symptoms unique to this individual such as a thin, excoriating nasal discharge, which separates this presentation from others humans suffering from scarlatina. A remedy for a chronic Psoric case needs to cover the individualizing symptoms of the patient, as well as the general features of Psora in the case.
A preview-peak at the Repertory can sometimes be helpful in discerning what symptoms bear characterizing value, as described in aphorism 153. In a case where the patient is profoundly fatigued, can we consider Fatigue to be a characterizing symptom? A quick query of the Synthesis Repertory in RADAR for ?fatigue sends us to Generals - weariness, with 282 remedies listed in the Millenium view; telling us that this symptom is all-too-general, "seen with almost every disease and medicine and thus deserving of little attention unless ... more closely characterized."
At this point, I cross out a lot of the collected symptoms, make ample use of the eraser, move things around and begin clumping symptoms under more general headings, and begin underlining the symptoms that appear to be of greater value in differentiating the unique disharmony of the case before me.