The 3 Step Journey of the Case Witnessing Process

chauhan dec

An explanation of the Case Witnessing Process with a case example to illustrate.

Creating a new theory is not like destroying an old barn and erecting a skyscraper in its place It is rather like climbing a mountain, gaining new and wider views, discovering unexpected connections between our starting points and its rich environment. But the point from which we started out still exists and can be seen, although it appears smaller and forms a tiny part of our broad view gained by the mastery of the obstacles on our adventurous way up.

–       Albert Einstein

 

The question that bothers me is, are there any differences between old classical homoeopathy and modern classical homoeopathy?

Any new discovery in a true science doesn’t completely abolish an old known theory but rather improvises the old, enhancing it in the light of the new polished one. I believe that new is the further extension of the old one. Take for example the laws of physics. When new laws are derived in physics the old ones are not discarded. They still hold equally true. The fact is that the new laws nurture in the light of the old physics laws. This is true for all the universal sciences and so also is true for our homoeopathic science.

The new theories and new methods, discovered in homoeopathy do not throw away the age old theories and methods introduced by our masters.  New understanding which rests upon the basic laws of homoeopathy does not negate the old theories but rather enhances it further.

The question that comes to my mind is, what should be the basis of any new discovery in homoeopathy?

We know the three pivotal laws on which homoeopathy rests:

  • Individualization
  • Holism
  • Law of Similars

Any new scientific discovery in homoeopathy must be based on these 3 laws. These three laws are the pillars on which the entire system of Homoeopathy is based, whether it is understanding the human core, whether it is searching the similimum, whether it is case witnessing, whether it is posology, studying materia medica, repertory or proving, follow up criteria, healing awareness.

Dr. Hahnemann bases the essence of individualization on obtaining the PQRS symptoms; we understand that these PQRS symptoms can be at the local level, general level, and holistic level. The PQRS symptoms at the physical particulars, physical generals, mental general level, as well as the subconscious level i.e. holistic level, all together make up the individualistic holistic expression.

Individualization and holism is the key to everything in homoeopathy. And applying this to the law of Similars, we see that the Similimum is the one where the individualistic holistic expression of the patient matches with the individualistic holistic expression of the remedy.

Therefore the individualistic holistic expression must be the most important to understand:

  • In constructing the core of a human being, the Aim of Case Witnessing Process  (CWP) should be to bring out Individualistic expression at the holistic level.
  • Searching the remedy should be based on individualistic expression at the holistic level.
  • Study Materia Medica / Repertory / Proving and understanding the substance should be based on individualistic expression at the holistic level.
  • Follow-up Criteria should be based on individualistic expression at the holistic level.
  • Healing Awareness should be based on individualistic expression at the holistic level.

 

Individualization (PQRS) at holistic level is the perennial truth on which Homoeopathy is grounded and this is the level where both OLD CLASSICAL AS WELL AS MODERN CLASSICAL HOMOEOPATHS ARE CONNECTED.

Now the next question is, how should the case witnessing technique be done? 

I knew that case witnessing technique should be designed in such a way that it is based on the three basic principles of Homoeopathy. It should be a confluence of individualization, holism, and the law of Similars. Ultimately the entire aim of the case witnessing process should be such that it brings out the individualistic expression at the holistic level.

Be it a follower of any system or any school of Homoeopathy, he or she should be able to apply the case witnessing technique in his clinical practice. Hence it should be ageless, timeless, beyond personality. It should be integrative; hence it would go beyond the confines of any system approach or personality approach. Case witnessing should be systematic, scientific, something that is reproducible by all homoeopaths belonging to different schools of homoeopathic knowledge.

The aim of the CWP should also be that it is simple and easily reproducible, which means that, one should be able to standardize the entire process and apply it with every patient. The entire case witnessing process must be simple yet scientific, every step that goes further in the journey into the human core can be taken scientifically, the questions asked should not be according to the whims and fancies of the physician but rather put forth logically and systematically.

The entire journey of the case witnessing should be human-centric, which means it should be “according to the patient”. The whole process will be scientific and standardized, but in order that the whole journey is smooth and spontaneous, it will be designed according to each individual patient, so that the basic framework remains the same, but yet the process will be individualistic differing from patient to patient.

Hence, the case witnessing process is aimed only at understanding the unique individualistic pattern of the patient. It has to be a scientifically designed, individualistic, human-centric approach.

When the case witnessing process is designed in such a way, the patient experiences a mirror image of his inner being right in front of himself, and this itself acts like a similimum for the patient. So our aim is to develop a CWP which is diagnostic as well as therapeutic to the patient. Also during this journey the physician’s subconscious vibrates along with the patient’s core, and has a healing effect on the healer too!!

Now, why do I use the term “case witnessing” rather than “case receiving” or “case taking” or “case examination”? The answer lies in the meaning of the verb “to witness”. A witness is a close observer, one who gives firsthand account of something seen. In relation to the legal system, a witness is the one who does not add to or subtract any details from what he has seen. A witness just observes and provides information, as it is. Every case that comes to us requires one hundred percent witnessing in order to understand the patient as he is. If we can witness our cases, only then will we refrain from superimposing the colours of our fixed knowledge and ideas on the real holistic understanding of our patients. That is the reason I feel it is important to use the case witnessing process with our patients and not just the case taking process! With the above aims in mind, the next question was how should I design the case witnessing process to fulfil the above aims?

As I was continuing my search subconsciously and consciously towards designing the case witnessing process, I knew that this process had to be a universal phenomenon, so I started observing other universal phenomenon in nature and I came to the conclusion that, be it meditation, be it love making, be it hunting by the bushman tribe in Kalahari desert, or be it the Ashtang yoga (divided into Bahirang yoga, Pratyahara, and Antarang Yoga) all universal phenomenon happen in 3 steps.

 

The centre is only three step inwards.

Go inwards to the centre

Like an arrow

 

The three step model of case witnessing process is divided into:

  • The Passive Case Witnessing process
  • The Active Case Witnessing process
  • The Active-Active Case Witnessing process

 

This notion of the foundation of Three Steps in everything we do, became a strong belief of mine as I saw it reflected in almost everything. It pertained not only to learning how to drive a car but to learning anything, for instance in children learning how to speak a language. Initially, they just babble, this is followed by making efforts towards speaking a few words, then one fine day effortlessly the whole language flows. This is how the whole journey of the case witnessing process goes, it starts from scientific effort and then becomes intuitively effortless.

In the Passive Case Witnessing process we put in scientific effort, and the journey becomes intuitively effortless in the Active-Active case witnessing process. The entire process of case witnessing travels from a divergent approach to a convergent approach.

We understand the meaning of a divergent approach: “It is when you need to explore and find new things, you use divergent approaches. This is a process of looking for options, new ideas and so on. Some people prefer diverging, as it means the potential of a wrong decision is never reached. Also in this approach we are being open: An important first step of divergent thinking is to be open. As a cognitive state, it involves temporarily suspending judgment and deliberately opening yourself up to new thoughts and ideas.” “Convergence is the opposite of divergence. When you are thinking convergently, you are seeking a conclusion, an answer, and closure on the topic in question.”

Similarly, during the passive case witnessing process, we keep a broad divergent approach, exploring every area of the patients life, from current ongoing situations, childhood, interests and hobbies, fears, dreams, etc… to find a common thread running through these areas. Here we give ample space (and we ourselves are open and unbiased) to the patient and let him travel to any aspect of his life spontaneously until we find a focus. In the active case witnessing process, we start zooming in on the focus, but here we also remain open, to see if anything peculiar is coming up, so we confirm our focus in the active part. In the next step, which is the active-active part we totally become convergent, focusing only on one point, till we completely understand the entire phenomenon from centre to periphery. In active-active we do not let the patient wander off from the centre; our view is concentrated around that one central point around which the entire story of the patient revolves.

 

Passive Case Witnessing Process:

It forms the basis of the entire case witnessing process, it is the initial phase of case witnessing, during which we collect all the information about the patient. Without altering the flow of the patient we passively listen to all the individualistic expressions of the patient. During the passive phase the physician is non-judgemental, acting like a spectator, flowing alongside the patient, observing the steps he is taking. Here we make note of all the isolated, fragmented data, all the PQRS symptoms at the local, general and holistic level.

 

AIMS of the PASSIVE case witnessing process:

The first aim is to pay attention to all the fragmented, isolated, verbal and nonverbal expressions (as it is), that are:

  • out of place
  • out of order
  • out of flow
  • out of content
  • out of proportion
  • out of physician’s and patient’s knowledge

 

All this data will be initially non-co-ordinated and non-connected; but here we will see that in this there are spurts of “common peculiars” that we observe. These will be the most characteristic expressions of the case and form the important threads of the case which will connect all the beads together into a whole necklace.

 

The second aim is to find the focus of the patient:

The focus is the entry point to the whole centre of the patient. It is that peculiar expression which consciously or unconsciously comes into the centre in every area that the patient talks about. The expressions can be verbal or nonverbal and will be repeated in more than two different, unrelated areas of the patient.

 

The third aim is to find out the patient’s Level of Experience (LOE), which is his experience of the inside and outside world at that given moment of time:

–       Is the patient just naming his / her problems or describing plain facts about him / her? NAME AND FACT level of experience

–       Is the patient just talking about common emotions or common situations? EMOTION level of experience

–       Is the patient in touch with the imaginary world or his / her delusions? IMAGINATION / DELUSION level of experience

–       Is he actually experiencing the sensation physically and talking about it? SENSATION level of experience

 

The level of experience at the end of the passive phase will decide how we would frame our questions for the evolving journey. Also knowing the LOE of the patient will help us decide the time that will be taken by the patient to reach the centre. It will decide the potency and probability of the repetition of doses that will be required by the patient.

 

Active Case Witnessing Process:

 

Active represents the in between transition period between the passive peculiarities that will form the complete pattern or picture of the source in the active-active. Here the flow is directed inwards, towards the altered pattern to get the whole phenomenon. The isolated individualistic expressions get connected slowly. The surety of the focus is established in this step. In cases when focus is not obtained in the passive process, the focus is first found and then confirmed in the active process.

 

AIMS of the ACTIVE case witnessing process:

 

The first aim is to find the focus, if not obtained in the passive process:

Many times the patient is unable to give the focus of the case by himself. Here the physician takes the patient into different areas, yet remaining open ended, he makes note of the common peculiarities observed in these areas to find the focus of the case.

The second aim is to confirm the focus obtained:  The focus is confirmed by asking about it actively. When the focus is correct the patient starts connecting the focus with other out of place expressions of the case and also with other general and vital areas of his life.

With the Active process we have a specific aim in mind and do not wander in any direction as we do in the passive phase. It gives us surety about the focus of the patient and determines whether or not the journey is on the right track. During the active step we also observe defences thrown up by the patient, because it is the first time that the centre of the patient has been touched. When we observe such defences, the surety of the focus is doubly confirmed. In a broader perspective, it clears the path for the Active-Active Case witnessing process.

 

Active-Active Case Witnessing Process:

 

In this process we zoom in directly, converging to a single focal point, and keep the patient at this point until the entire non-human pattern from the sensation, kingdom, sub-kingdom, miasm, reaction, and source is crystal clear in front of us. All the scattered uncoordinated individualistic expressions of the patient get connected into one single pattern. It takes us completely in the realm of non-sense bringing a deep healing in both the patient and the physician.

 

AIMS of the ACTIVE-ACTIVE case witnessing process:

 

The first aim is to take the focus towards the complete altered pattern of the patient:  We ask the patient to talk about the focus in as much detail as possible, allowing him to just be in touch with the experience. The more he slips into the process, the clearer the picture will be of the surfacing pattern. Gradually, all the isolated, scattered, verbal, and nonverbal expressions that spilled out during the passive and active case witnessing processes get connected in a single phenomenon. Our case will be complete here when all the PQRS symptoms are connected from centre to periphery.

 The second aim of AA CWP is to understand the kingdom and subkingdom:

The Active-Active phase of case witnessing is the right place to think about the kingdom and subkingdom, since the entire nonhuman specific phenomenon will be understood in its entirety here. If we prematurely start analyzing the kingdom and subkingdom in the passive or active process, the journey is sure to take a wrong turn. Here we are also clear with the miasm, and the reaction of the case.

In some cases during this phase we see that the patient reveals the source to us. The entire process becomes so evolving for him, we see the whole altered pattern coinciding with the source.  Sometimes the patient identifies with the source itself. But here it is important to be cautious and confirm the source and not mistake just one peculiar image given by the patient as the source.

The third aim is to confirm the similimum; this is done by confirming whether the centre of the patient matches with the description of the remedy in materia medica, or provings, or repertorial rubrics. Are there any peculiar craving, aversion, aggravations, ameliorations which confirm the simillimum for us?

 

PRACTICAL ILLUSTRATION OF THE CASE WITNESSING PROCESS

 

(Note: D: Doctor, P: Patient, Italics: Consultants commentary, Bold: Pertinent portions in the case, HG: Hand Gestures)

 

Preliminary data:

A lean, emaciated 10-year-old girl of dark complexion coming from lower middle class family consulted us on 23rd July 2012 for PUO (pyrexia of unknown origin and USG s/o of hepatosplenomegaly) since 4 months.  Her main complaint was recurrent fever which used to recur every week, with loss of weight; she used to get fever with chills especially in the evening.

 

PASSIVE CASE WITNESSING PROCESS:

 

D: What is happening now?

Father of the patient: Now there is nothing specific, no fever, was not eating much, weakness, after every 15 days she use to get fever.

D: Tell me about you?

P: Sometimes when I eat there is pain in the stomach. I don’t like to eat anything then, many weird thoughts come to my mind and I don’t like it.

It was already about 5 minutes into the case and this child had only spoken a few lines. This for me meant that she needs to be given more time and space so that she could connect with her own individualistic expression.

D: Tell me more about yourself, what you like and dislike?

P: I don’t like to eat dal and rice. If I eat anything more, then feels nauseating.

D: Tell me more about yourself what do you like to do? Tell me how is your nature?

P: I like to do painting and drawing.

D: Tell me more about yourself so that I can understand you well?

No answer.

D: What else do you like to do?

P: Nothing more.

Since the child was not speaking much I had to be more active in asking questions, but the questions were more broad ended ones which would help me to understand her area or sensitivity or focus as I call it. Throughout the case I observed that she would say a few sentences, then there was a pause.

D: Tell me more?

P: I am scared to cross the tracts. If someone hits me it hurts on hands.

D: Tell me more?

P: I like to see pictures which are there in the books.

Since I felt that the child was not coming out with her expressions on her own I had to become active and go in different areas and see what is the focus that comes up.  I asked about the fears and tried to understand the peculiarities of her subconscious mind. Here we begin the active case witnessing process with the aim of finding the focus.

Observation: the manner of her answering was very slow.

 

ACTIVE CASE WITNESSING PROCESS WITHOUT FOCUS:

D: What are your fears?

P: I am scared of ghosts and aliens.

D: Tell me more?

P: I am scared of insects also.

D: Think more and tell me what else you are scared of?

No answer.

D: Tell me more about your childhood, do you remember?

P: I got burnt in my childhood at abdomen area.

D: Think and tell me.

P: I was scared to cross the roads.

D: More?

P: Can’t go out in night, scared to go alone at night.

We tried to explore her fears as much as possible and once I felt there was not much she could say, I thought to move into the area of dreams and see what is in her subconscious mind.

D: Tell me about your dreams?

P: I get dreams of ghosts. Sometimes I get good dreams. Once there came a ghost at our place and we were scared. We tried to hide but the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.

D: Tell me more about your dreams which used to come earlier?

P:  Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

What we see here is:

  • If someone hits then she is hurt
  • Memory of being burnt in childhood has had an impact on her consciousness
  • The feeling of being hurt with a knife by some bad people and getting hurt when the ghost was shaking his legs

 

Here in different areas the feeling of injured/ hurt is coming up again and again. Therefore this becomes the focus of our case. Now we begin the journey of active-active case witnessing process to zoom into this focus and understand the depth of it to arrive at the kingdom and subkingdom.

 

OUT OF PLACE AND OUT OF ORDER TILL THE END OF ACTIVE CASE WITNESSING PROCESS:

 

Many weird thoughts come to my mind and I don’t like it.

I am scared to cross the tracts, if someone hits me it hurts on hands.

I am scared of ghosts and aliens.

I am scared of insects also.

I got burnt in my childhood at abdomen area.

I was scared to cross the roads.

I can’t go out in night, scared to go alone at night.

I get dreams of ghosts, sometimes I get good dreams, once there came a ghost at our place we were scared and we went and hide and the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.

Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

 

ACTIVE-ACTIVE CASE WITNESSING PROCESS:

 

D: What do you mean by this, I didn’t understand?

P: He was hitting everyone.

D: How?

P: With his hands, he was carrying us and throwing us.

D: What do you mean by this?

P: Hitting us.

D: What more ghosts do in your dreams?

P: They hit.

D: How they hit?

P: I don’t know.

D: Are you scared of ghosts?

P: Yes.

D: Which things of ghost you are scared of? What will they do?

P: Hit us.

She cannot go beyond this point so now I go into another area which was peculiar and understand her experience.

D: What was the dream of bad people?

P: They were hitting.

D: How they were hitting?

P: By knife.

D: How they were hitting?

P: (HG) like this.

D: You are scared of crossing the roads and railway tracks. What do you mean by this?

P: If I am crossing the railway track and then suddenly train will come then.

D: Then what will happen?

P: I am scared.

D: Of what are you scared of?

P: Car comes, and my father shouts and says see and cross the road; so I am scared.

D: If you don’t look and cross the road then what will happen?

P: Will get injure and hurt.

D: You were burnt on your stomach. What had happened tell me about it?

P: Mummy was making the tea and I was sleeping and as I turned the tea fell on my stomach.

D: You said you are scared of insects, what do you mean what insects do?

P: If they come near me also then I am scared.

D: About what?

P: The touch of their body I am sacred.

D: Why?

P: If they will bite then.

D: How will they bite?

P: They bite with their teeth.

D: You said you get weird thoughts; what are they?

P: When I sleep, what time I will get up tomorrow, how will be tomorrow’s day.

D: What are the weirdest thoughts you get?

P: If I will do mischief then teacher will hit.

D: What mischief you do?

P: If we talk then teacher hit us.

D: What else teacher do?

P: If we write wrong then teacher hits.

D: More?

P: If we don’t study and don’t do our home work then teacher hit us.

D: If teacher hits then what do you do?

P: Nothing, I tolerate it.

D: How much is your thirst for water?

P: Less.

D: How much angry do you get?

P: Medium.

From her Mother: She gets angry a lot.

D: What does she do in anger?

Father: If we give something to eat she gets irritated and doesn’t eat.

D: Do you feel chill?

P: Yes.

D: Where you get chill the most?

P: Legs.

D: Where in legs?

P: Soles.

D: Which food causes you trouble? Which type of food?

P: Fat, chapattis difficult to swallow.

D: And if you eat fatty food then?

P: There is gas in the stomach.

D: Is there any pain in the abdomen?

P: No. 

 

Physicians’ observations:

This patient was very dull and very slow; she would hardly answer the questions. She seemed as if she lacked energy and there were many pauses before she could answer.

 

Physical examination: Liver enlarged 2 fingers

 

Ultrasonography of abdomen on 18th May 2012:

 

chauhan-dec13-img02

 

UNDERSTANDING OF THE CASE:

Out of place / out of order words during PASSIVE CASE WITNESSING PROCESS:

  • Many weird thoughts come to my mind and I don’t like it.
  • I am scared to cross the tracts, if someone hits me it hurts on hands.

 

ACTIVE WITNESSING PROCESS TO FIND THE FOCUS:

  • I am scared of ghosts and aliens.
  • I am scared of insects also.
  • I got burnt in my childhood at abdomen area.
  • I was scared to cross the roads.
  • I can’t go out in night, scared to go alone at night.
  • I get dreams of ghosts, sometimes I get good dreams, once there came a ghost at our place we were scared and we went and hide and the ghosts finds us and eat us up. Once I saw that I went to my uncle’s place and some bad people came and started hitting everyone with a knife.
  • Once there came a ghost at our place and we were scared and were hiding, and ghost was shaking his legs and we were getting hurt by it.

 

About the author

Dinesh Chauhan

Dinesh Chauhan

Dr. Dinesh Chauhan practices Classical homoeopathy in Mumbai, India. Case Witnessing Process is a scientific and human-centric case taking approach developed by him over a decade of research and seeing patient after patient at Swasthya Homeopathic Healing. Distinguished as a lecturer in many countries, he has the ability to captivate listener’s attention as he masterfully makes homoeopathic theory come to life. He heads the non-profit ABJF foundation with his wife Dr. Urvi Chauhan where Indian Homoeopaths are taught free. He is the author of three books A Journey into the Human Core; A Wander with a Little Wonder - Child centric Case witnessing, and The Scientifically Intuitive Case Witnessing Process – A Journey of Three Steps. Website: www.homeohome.com, www.casewitnessing.com Email: [email protected], [email protected]

About the author

Devang Shah

Devang Shah

Dr. Devang Shah graduated from D.S. Homoeopathic Medical College and has been practicing homoeopathy for the last three years in Pune. He feels blessed to have studied under Dr. Sunil Anand, Dr. Dinesh Chauhan and other teachers of the Bombay School of Homoeopathy. His goal in each case is to reach deeply and find the root from where the branches of disease originate. "May we reach the depth so that the spirit arises. Silence is the opening of an infinite world within each of us."

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