Installment 3 of a series on case analysis
© Will Taylor, MD 2001 (bio)
Characterizing Dimensions of the Totality of Symptoms
Part 2: On the Characterizing Dimensions of a Mental/Emotional Symptom
Presented at the March 2001 meeting of the Homeopathic Medical Society of the State of Pennsylvania; and published in the Summer 2001 issue of the journal Simillimum.
On the Observation of Uncompensated/Decompensated States
A number of opportunities arise for us to examine uncompensated moments or periods of a person's life, including:
Major life events
Vacations, change of venue
Movies, Books, Stories - loved or despised
Historical events - strong feelings of association for or against
Who do you not like? What personality characteristics do you despise?
What would be the Worst Thing that could happen?
Jarring of compensation by life events: e.g., The tubercular patient after a move or change; the sycotic patient with a new, genuinely unconditionally accepting partner
Dreams are a potentially rich source of uncompensated images; and are useful not in the exhibition of interpretable symbolism, so much as for uncompensated imagery and the associated feeling-states.
Dynamic Tension in Compensation
When two apparently contradictory situations coexist, there must be a narrowly defined truth that holds true throughout (we'll call this Taylor's first rule of contradiction - though I'm sure someone else must have described it more eloquently).
Often we can identify polarities, or divisions of apparent conflict in a case. These can be incredibly valuable, as they often point out the primary disharmony and its apparently contradictory compensation. Yet, as these both arise out of the same disharmony, there must be a thread of commonality that runs through both.
MILDNESS < -> ANGER - throwing things around
-- through which the disattunement of Staphysagria runs without real conflict or contradiction.
Strategies for Use of the Dimensions of M/E Symptoms in Case Analysis
Boenninghausen has demonstrated that robustness in case analysis is assured by distributing our analysis over the full dimensionality of a complete disharmony. To account for the dimensions of Locality, Sensation, Modality, and Concomitance for the physical symptom complex, and being certain to match the mental/emotional state of the patient with the proving symptoms in the primary Materia Medica. In doing this we spread the legs of our milking-stool wide and provide a firm base for our understanding of a case.
This dissection/recombination of symptom elements allows ease of reference in our repertories - as seen in the somatic sections of our historical and contemporary repertories - which is yet to be appreciated in the mental/emotional sections. Computerized literature allows us to make up for this to some extent by sophisticated searching for images and other symptom-dimensions.
The recombination of symptom elements by analogy - as introduced by Boenninghausen for somatic symptoms - can also be applied to symptoms in the mental/emotional realm, once these are appreciated in their component dimensionality. We need to exercise caution regarding errors of inclusion in doing this, but we gain some tremendous strength in avoiding exclusion in repertorial analysis in this manner.
By similarly establishing a dimensionality of mental/emotional symptomatology, we can extend Boenninghausen's model across the mythical mind/body dichotomy. Mental/emotional symptoms can be incorporated into case analysis using an integrated model, with attention to the unique differentiating dimensions of mental/emotional symptoms. We assure a robust appreciation of the differentiating/characterizing mental/emotional state of the patient when we reconstruct a totality that incorporates symptoms of Stimulus, Response, and the "moment of choice". When this latter takes into account Perceptions, Beliefs, Feelings, and Images, when these are available. When we take into account exceptional conditions of peripheral nervous system processing; and when we are aware of Compensation and investigate this both with regard to its inadequacy, the threads that run through its apparent contradictions, and its failures in decompensated states.
Applying the Concept of Dimensionality in Case Analysis
As Stuart Close describes in The Genius of Homoeopathy, a stable case - as a stable milking-stool - rests on at least 3 legs. The first order of business, then, is to make certain, in case-taking and case analysis, that we have at least 3 symptom-dimensions represented in our case.
Using a different metaphor, a dog has a dog's nose, a dog's tail, and a dog's body. We will demand this as well of our simillimum - it should have the sensitivities of our case, the responses of our case, the distortions of the moment of choice of our case, and, where present, the compensations of our case.
For those using computer repertory programs, there are some elegant ways of organizing a case for analysis, taking the characterizing dimensions of a complete totality into account. I'll consider below the treatment of a case where the center of gravity rests strongly in the mental/emotional sphere.
Using the RADAR software package, I devote one rubric clipboard to the Stimuli/Sensitivities of the case; a second clipboard to the External Behaviors/Responses of the case; and a third for distortions of the Moment of Choice. Compensatory symptoms would go into a fourth clipboard. Characterizing Physical Particulars and characterizing General symptoms would go into a fifth. I then use the Herscu module for analysis. This will focus the analysis on those remedies that come through in at least one rubric per clipboard (i.e., in at least one rubric in each dimension taken into consideration).
In an analysis such as this, I deviate from my usual tendency to create a "lean" repertorization; my goal here is to be inclusive for each dimension of the case. Brevity is accomplished by focusing on the characterizing dimensions of the case, but within these, it is best to err on the side of being inclusive rather than exclusive. Here is the analysis of a case presenting with "migraine" headache, but dominated by a strong mental/emotional center of gravity (rubrics were selected from the Synthesis repertory):
Clipboard 1 - stimuli
MIND - AILMENTS FROM - contradiction
MIND - AILMENTS FROM - honor; wounded
MIND - AILMENTS FROM - indignation
MIND - AILMENTS FROM - scorned; being
MIND - REST - cannot rest when things are not in the proper place (combined with:)
MIND - ANGER - objects are not in their proper place; if
MIND - ANXIETY - trifles, about
Clipboard 2 - responses
MIND - ABRUPT, rough - harsh
Clipboard 3 - distortions of the "moment of choice"
MIND - DELUSIONS - persecuted - he is persecuted (from recurrent dreams)
MIND - DELUSIONS - injury - about to receive injury; is (from recurrent dreams)
MIND - DELUSIONS - people - pranks with him; people carry on all sorts of (feelings from work)
Clipboard 4 - compensations
MIND - AMBITION - increased - competitive
MIND - DUTY - too much sense of duty
MIND - BENEVOLENCE
MIND - GENEROUS; too
Clipboard 5 - characterizing physical particulars
HEAD - PAIN - accompanied by - vomiting
HEAD - PAIN - jar - any jar; from
HEAD - PAIN - motion - head, of
HEAD - PAIN - Occiput - extending to - Neck - Down back of neck
HEAD - PAIN - Sides - one side
To complement the analysis of the above, there is an interesting "apparent contradiction" in the case, that creates a polarity or dynamic tension worth examining, between:
AMBITION - increased - competitive <-> BENEVOLENCE / GENEROUS; too
Here is an analysis of this caselet, using the Herscu module of RADAR to organize the analysis across dimensions, leading to the successful prescription of Nux vomica.
Summary of the Dimensionality of a Mental/Emotional Symptom:
Stimulus -> [Afferent gain] -> "Moment of Choice" -> [Efferent gain] -> Response
Distortions/restrictions of the "moment of choice" (="core delusion") May be modified by personal compensation - mirroring the same disharmony. Our window to this comes through the patient's descriptions of:
Compensations mirror the original disharmony, as an attempted patch originating from the same restrictions and distortions of choice. Look for decompensated moments and behaviors, and for the threads that run through <-> polarities or dynamic tensions.
Modalities (general, generalizable, and particular)
Concomitants (other characterizing mental/emotional symptoms, and/or characterizing generals and physical particulars)
- "A Contribution to the Judgement Concerning the Characteristic Value of Symptoms" Allgemeine Homoeopathische Zeitung, Vol. 60, p. 73; translated by LH Tafel in the Lesser Writings of Boenninghausen.
- Constantine Hering, Guiding Symptoms of our Materia Medica; vol. 1, introduction
- Samuel Hahnemann, Organon of the Medical Art; ed. O'Reilly, trans. S.Decker
- J.T. Kent, "Use of the Repertory"; prefaced to the contemporary printings of Kent's Repertory
- J.T. Kent, "How to Use the Repertory"; reprinted in Kent's Lesser Writings
- Samuel Hahnemann, ibid, footnote to aphorism 214.
- Victor Frankl, Man's Search for Meaning
- George Vithoulkas, The Science of Homeopathy, vol.2
- All quoted rubrics are taken from the Synthesis Repertory, vers. 7.0; via RADAR, vers.7.3
- Ananda Zaren, Materia Medica of the Mind, vol. I
- Rajan Sankaran, The Substance of Homeopathy