Installment 12 of a series on case analysis
© Will Taylor, MD 2001 (bio)
The Story Board
Stuart Close, in The Genius of Homeopathy, expands on Hahnemann's aphorism 7 eloquently:
The Totality of Symptoms means all the symptoms of the case which are capable of being logically combined into a harmonious and consistent whole, having form, coherency and individuality...
The word use here [referring to Hahnemann's aph.7, above] is significant and suggestive. A picture is a work of art, which appeals to our esthetic sense as well as to our intellect.
Its elements are form, color, light, shade, tone, harmony, and perspective. As a composition it expresses an idea, it may be of sentiment or fact; but it does this by the harmonious combination of its elements into a whole - a totality. In a well-balanced picture each element is given its full value and its right relation to all the other elements.
So it is in the symptoms picture, which is technically called the Totality. The totality must express an idea.
The 'Totality' is not; therefore, a mere haphazard, fortuitous jumble of symptoms thrown together without rhyme or reason, any more than a similar haphazard collection of pathogenetic symptoms in a proving constitutes Materia Medica.
The 'Totality' means the sum of the aggregate of the symptoms: Not merely the numerical aggregate - the entire number of the symptoms as particulars or single symptoms - but their sum total, their organic whole as an individuality.
As a machine set up complete and in perfect working order is more than a numerical aggregate of its singe dissociated parts, so the Totality is more than the mere aggregate of its constituent symptoms. It is the numerical aggregate plus the idea or plan that unites them in a special manner to give them its characteristic form.
As the parts of a machine cannot be thrown together in any haphazard manner, but each part must be fitted to each other part in a certain definite relation according to the preconceived plan or design - 'assembled', as the mechanics say - so the symptoms of a case must be 'assembled' in such a manner that they constitute an identity, an individuality, which may be seen and recognized as we recognize the personality of a friend.
The true Totality, therefore, is a Work of Art, formed by the mind of the artist from the crude materials at his command, which are derived from a proving or from a clinical examination of the patient.
Stuart Close, The Genius of Homeopathy
Chapter XI, Symptomatology; pp.153-155
The time for the Story Board comes between Taking the Case and the opening of the repertory. This is where we will create our "work of art … from the crude materials at [our] command … derived from ... clinical examination of the patient".
We will take the aggregate of characterizing symptoms of the case and unite them in a special manner to create a picture of the characteristic form of the disattunement of the organism; we'll attempt to give each element its full value and its right relation to all the other elements.
In doing this we will carry with our collection of symptoms an idea of form and composition, so that we can demand that our simillimum bears not only a collection of matching symptoms, but as well, the form and composition of the Totality of our case.
The Patient's Own Words
It is important at this stage to remain with the words of the patient, and avoid a premature translation of their expressions into your own language or the language of the repertory.
As in case taking, The physician ... writes everything down with the very same expressions used by the patient... (Hahnemann, aph.84).
Similarly, this is not a time for speculation or interpretation. We may feel strongly that we understand the reasons for a patient's feelings or actions; but we need to realize that we cannot see the world with the patient's eyes, and that our speculations and interpretations are about our cases, and not that of the patient. Hahnemann reminds us,
The individualizing examination of a disease case ... demands nothing of the medical-art practitioner except freedom from bias and healthy senses, attention while observing and fidelity in recording...
Organon, aphorism 83
Sometimes a colleague will open her mouth only to have Hahnemann's words fall out; at a recent conference, Judyth Reichenberg-Ullman stated succinctly "If it isn't in the words of the patient, whose case is it?"