Dr. Bhavisha and Sachindra Joshi practice in Vile Parle, Mumbai, India, where they have had an independent practice as Homoeopathic consultants for the last 13 years. The Joshi’s have a satellite practice set up in England & America and their work is recognized around the world. They have served as honorary doctors at the Mother Teresa’s Home for the Dying and Destitute (at Santacruz), and they have served as educators at the Juvenile Diabetes Foundation, Maharashtra Chapter, for the past 15 years.
V: The homeopathy world is split into two groups. There are some who practice good old classical homeopathy using repertories for picking out remedies. They stay true to the roots, so to speak. They oppose any change, research and development. For them, if it is not Hahnemannian style, it is not classical homeopathy. But the fact cannot be denied that the Sensation method has taken the homeopathy world first by surprise and then by storm. In your daily practice where do you stand?
S: Hahnemann wrote six editions of the Organon. Five were published while he was alive and the sixth came out after his death. If he had not changed his style and method, he would have remained content with the first edition. For any science to grow, it has to move and integrate newer approaches, and methods. That does not mean that we take each and every new technique that comes out of the blue. But we can take on methods that are based on the fundamental philosophy of homeopathy as given in the Organon, materia medica, proving symptoms, and the repertory. All of these, taken together, make the fundamental basis of homeopathy. Any approach that helps us use these in a better way for our patients, we should look at with an open mind.
In our day to day practice, Bhavisha and I try to implement this principle very strongly. We see what approach would work best for our patient. We aim to find out the symptoms that help us understand him as an individual and we do this by way of a very systematic and detailed case receiving process. We take our own observation of the patient into consideration. We put these two together. Then we use rubrics, materia medica, key notes, sensation method, or kingdom classification. By using any of these methods alone or in combination, we come up with the best remedy needed by our patient in any given time.
V: So, it is your patient and his needs driving the case taking, instead of you deciding, ‘this is what I am going to do’?
S: Yes, very much so. It is all about what the patient needs and not what we want to do.
V: What is your take on synergy in homeopathy?
S: It is very good. It is a way of bringing people of different schools of thoughts together. The sensation method seems to be out of context and groundless to many practitioners. It is not actually so. Synergy is a system of taking the sensation approach, and connecting it with the Boger/ Boeninghausen approach. By this, everything comes together in a systematic way and that is very important. By bringing genius, symptom and system, synergy approach creates a very solid platform where everyone can find something to connect with.
V: Students in the US are in a particularly tight spot. Their schools teach them the classical homeopathy. And when they observe the latest research in homeopathy, it is all about sensation method. What is your advice for the newcomers and students?
S: Learning classical homeopathy is very, very important. The fundamentals that I spoke about – the Organon, materia medica, provings, repertory, pharmacology of remedies, these have to be understood and mastered by all students of homeopathy. Once they have these basics clear, then they can learn and absorb any new method that comes their way and they will understand where this new method is coming from. They will be able to choose and apply what their patients need. Fundamentals of homeopathy have to be very clear for them and they have to realize that the castles cannot be built in the air. Homeopathy requires rigorous study for years. Deep study makes strong foundation.
V: How is the sensation method different from intuitively arriving at remedies? Besides using sensation method, do you arrive at remedies by way of intuition, dream, gut-feeling, or picking up some odd cues and remarks from the patient, even though these do not fit into the frame of the sensation method?
S: Some people are blessed with an insight. They can feel remedies and understand people’s state when they talk to them or see them. They arrive at a remedy intuitively. It can work in some cases. In some cases it does not work. The disadvantage of this approach is that no one else can repeat the result. Intuitiveness is someone’s personal quality. My gut feeling can differ from someone else’s. With intuitive prescribing, everyone will come up with a different remedy for a person. However, case receiving in a systematic manner that includes taking symptoms, general modalities, mental / emotional states, these create a simple and solid basis that cannot be disputed or argued upon, and by using these details, we can come to a remedy. In our practice, we would systematically arrive at a remedy and prescribe. There have been cases when I have given a remedy based on gut feeling. But I have done that with the awareness that my gut feeling could have led me to the right or the wrong remedy.
V: So the idea with intuitive prescribing is to be open for the possibility that it may or may not be the correct remedy. Another thing I hear from your answer is that intuitiveness and gut feeling is something you cannot teach someone.
S: The standard approach in homeopathy that takes into account all the basics is a system by itself, and that can be taught. The simplified and systematic approach can be learned by more people and used for helping a lot of patients. But gut feeling cannot be taught. We will be mocked for our science. Suppose we go to a medical conference and present a case of a patient who has really done well and has improved on a remedy. We will be asked about our approach. If we say that we gave a remedy just because we felt like it, this answer will not be acceptable, even though the patient has improved and the intuitive way of picking a remedy is not wrong at all.
V: Besides looking for core sensation and what the patient wants to express, what other factors do you take into account when you see patients? Do you note their dress, skin and eye color, facial features, hair line, handwriting, color preference, on a color chart, their dearly held beliefs and philosophies?
S: Everything is considered. All of these points tell you about the patient. Case taking starts at the time when the patient makes an appointment. We sometimes get feedback from our receptionist… she says this patient was very tricky, wanted to speak to you directly, fooled around me and had me pass her chart directly to you. We notice this special element in the patient. Our assistant tells us ‘This person is so sweet to you, but is very rude with the junior doctor and the receptionist. He does not want to talk to us at all’. Now, that tells a lot about the patient. Basically anything that can give information about the individual is helpful. But all of these are taken into account at the end. Case taking has to be done systematically and with clear logic so that we can arrive at a remedy and then all these points that you mentioned are taken into consideration for confirming the remedy and adding up new observations in materia medica.
For example, if all patients needing Naja wear spectacles with very sharp ridges, that is a very strong observation. Another strong observation could be that people with very rigid mentality who like to keep things hidden deep down in themselves, wear glasses with very thick and dark frames. This observation could be included in the repertory. This can confirm the prescription.
V: So, you have all those notes and you watch with very keen attention and find all the details.
S: I might not make a note on paper. I watch them as they enter the office. A particular way of walking, sitting, fiddling with something, fidgeting with napkin — all these are important observations. Hahnemann taught us to observe the patients.
V: A lot of patients are quite put off by the relentless questioning and ‘tell me more’ style followed in the sensation method. They feel that other than describing their presenting complaint they do not have anything more to say. They like to give answers in yes and no, sometimes not even saying these but just nodding their head for yay and nay. What is your approach with these patients?
S: The technique that Bhavisha and I use in our practice is to take the patient along with us in the journey of case taking. The moment we make it like an interview, when we are asking and the patient is answering, this can at times create a wall. Often, the questions we ask are something the patient has heard for the first time. He is making much effort because he has come asking for help. But he does not understand what we are looking for? When I say that we take the patient along, it means that we explain to the patient beforehand what to expect. We tell him what we are looking for, and how his answers will help us in understanding him and figure out how to help him. Sometimes the patient may feel that he has said enough. We tell them, we have understood this much about you. These are your sensitivities, and now, I need to understand a bit more so I can make a prescription and then it rings a bell. He understands we have arrived at some logical basis from all the answers and information he has given us. If we do not explain our process to the patient, he will feel that we are lost and in turn he will feel lost too. By making the patient aware of the process and what to expect, we make him a willing and cooperative participant and he does not feel like a laboratory specimen.
V: You take the patient along by educating them about the process. When you educate them about the process, they open up.
S: Yes. We have patients with very different intellectual capacities. Some are highly educated and vocal CEOs, and some have no education and are hardly able to get two meals a day. We are able to help patients from every possible background. If we take the case in our style, educate and help the patient to come along, he is very content. Not only the educated ones but also the poor patients with no education are able to give a beautiful description of their suffering, because they have been told about the process and what to expect. They become sensitized and they open up. Even if they are not very vocal, they will participate enough to describe the condition. The process of case taking also shows our empathy for the patients. If they see that you are appreciative of their participation, they open up and participate eagerly.
V: Many patients stay at the story level. Every question we ask them leads to yet another story which gets repeated in one form or the other, without going into any depth. What do you do in these situations?
S: People, especially who feel things or see the world at a very emotional level, are very sensitive. They are touched by every small thing, and they tend to give a lot of stories. They narrate a lot of situations / circumstances and that can go on endlessly and that does not always give a lot of detail. In these stories, we look for the pattern that appears repeatedly. We see if the stories have a constant theme, or a phrase is used repeatedly, or there is something very peculiar about his sensitivity in every story? For example I had a patient, a 53 years old lady, who emotes a lot, talks a lot and every time her visit goes on for at least half an hour, even though generally we keep very little time for a follow up. She always tells me a long story about her family, her arguments with her husband, her discord with her children, and that nobody listens to her. In all these stories, the common factor is that nobody is listening to her. I ask her what is the feeling that no one listening to you? She says ‘I feel that no one values me. I am insignificant. No one listens to me. My servants have to be told ten times. Nobody listens to me’. I told her, ‘Nobody is listening – just describe that, how does it feel when no one listens to you?’ She said, ‘Nobody values me. I feel so indignant and humiliated with the fact that people are not valuing me. How can they behave in such a way with me?’ I saw a strong sensitivity in her toward the fact that people are not valuing her and she feels humiliated. For me humiliation is very big word – all her stories point to humiliation. I asked her to describe it. She said, ‘When I feel humiliated, I simply keep quiet. I feel like blowing out but I just hold back and just start weeping.’ Now, I understood that this person before me feels intensely humiliated, wants to emote, wants to but cannot blow out, and she starts weeping. Strong build-up, strong sense of humiliation, tendency for weeping. When I ask her to describe humiliation, she says, ‘The moment I go to talk to someone, I avoid them. I start trembling. My mouth, hands, feet are trembling. I just do not get the right words. I walk out.’ So, this person is not able to express her humiliation. This behavior is found in Staphysagria, family ranunculaceae, Ranunculus bulbosa, and Pulsatilla. So, now I have the family. Her response is ‘Stand back and starting weeping’. The remedy in ranunculaceae family which cannot express indignation, holds it back and starts weeping, is Pulsatilla. You know pulsatilla has the keynote of weeping at the slightest cause, weeping when insulted. So, I come to this remedy by my approach of case taking and also come to the same remedy by way of rubrics and also materia medica. I can do this because I have learned the symptoms and read the materia medica.
V: At the same time, you also heard the patient’s story without dismissing it and undervaluing her.
S: That is it. How do I know what to value and what to undervalue until and unless I listen. Only then I can make a decision. Listening to what the person is saying is very important. That is what forms the basis of a good prescription.
V: When a patient comes, it is about them, they have come to seek help in their desperation. As a practitioner, it becomes the homeopaths prime duty to listen as an unprejudiced observer. This is something Hahnemann has said in the Organon. We have to be clear like an open slate and let the patient draw.
B and S: Yes, very much so.
V: Some patients participate in the long-drawn process of case taking by the sensation method quite willingly, but in the end they leave the office feeling rather silly. They do not understand what all those questions have to do with their presenting complaint or how a remedy arrived at by this route will help them in any way. They become confused by the process and become unsure of the skill level of their homeopath. Some of these patients may not come back, they get so offended. What are we to do in these situations?
B: In fact, what we have done from the beginning, which is unlike other sensation homeopaths, is that we have been on the milder side. Some sensation homeopaths are relentless in asking more and more and more questions till the patient has no other option but to feel totally cornered and reveal the core sensation. Our approach is always to engage the patient in a way where it is a dialog and they do not feel ungrounded. They do not feel they are in a situation where they do not know anything and we know where we are taking them. I think that is very important. So, our patients never have felt like that. I say, with the sensation methods, we have had patients who have not gone to their core sensation, but we have not had cases who have felt stupid or they do not want to come back. The reason is what we did and what everyone can do, which is to start explaining the process to begin with. When we do that we tell them clearly that all problems can be treated by balancing the personality. We do not tell them that the personality is the cause of the problem. We tell them that we are trying to choose the remedy that helps balance personality. We thoroughly look at all their medical records, blood work, and pathology reports. So the patients know that we are medically rooted to the ground. Once they know that we know our work, and we are not quacks, they begin to relax. We then explain to them that in the process of understanding their personality, we might ask them some questions repeatedly. It does not indicate inefficiency. Every time we repeat the same question and they give an answer, we might be able to get a bit deeper in our understanding of their personality. We also tell them that we have the ability to filter out the information they give and take only what is necessary for understanding their personality. So, if they feel that they are repeating themselves, it is not a problem. Once all these are said out aloud, the patients know that the process will be good for them and they begin to happily participate. They develop confidence in our work. They do not back off and they know where we are going with all the information they provide. We also explain to them about their personality, and special features, like their unique sensitivity, and tell them what is their core personality and what is happening to them because of their sensitivity. We give them tangible points that they understand. It is two- way traffic. It was not so in the beginning. Over time, as we got more confident of our own system, we became more and more comfortable with this two way approach. Our face has to always show that they are making sense even when they are repeating themselves.
At the end of the case, we explain to the patient what we have understood. This is something no one else does. After listening to their presentation, when we put our pen down, we tell the patient, ‘This is the person you are. These are your sensitivities. These are the areas where you need help and you are sensitive to these things right from childhood and my remedy is going to help you with these, these and these levels, right from the complaint and all the way to the sensitivity.’ We say that the treatment will go on till we see a change at the deepest level. The general consensus is that homeopathic treatment goes on endlessly. But we chalk out the road, and we explain that a chronic complaint of 20 -25 years standing will not go away in a day. When we see a point when a patient‘s deepest sensitivity does not react as violently, and we observe that he not falling sick as often, and when the trigger points appears and he is still feeling better, and when he is beginning to feel good at all levels, then we tell them, ‘This is enough treatment, this is the best the remedy can do for you at this point in time.’ When you chalk out the plan and give it to the patient, he understands that you know him, and he has many details to take home with him, a lot of food for thought and also the patient feels confident when you make a prescription. He knows you can help him long term.
B: They will not waver when you explain the whole program to them. They come for something to take back home, a remedy or a message or a diagnosis. When they have something to take back home, they will never feel stupid, exhausted, or used. By explaining the process to them and by summarizing their physical and emotional condition, you have shown your expertise and also your understanding and empathy, as well as your practical approach to their problem. Homeopaths in the US can always ask about the presenting complaint ahead of time and do internet research and familiarize themselves with the condition. Doing homework ahead of time is very valuable. The patient has to be convinced that you know your job very well. Medical diagnosis is something he will know from his medical doctor, but as a homeopath you can explain to him his personality, sensitivity and how homeopathy can help with overcoming the sensitivities and weakness of his temperament. You have to be confident of what you can do as a homeopath and what you can offer your patients.
In the western countries, it may not be possible to complete the understanding of the patient in one interview. Most of them have been to psycho-analysts, therapists, and counselors. To them a homeopathic interview will look very much like the sessions that they have had with these practitioners. You will have to explain to them that though the homeopathic interview looks similar, it is in fact unlike any that they have gone to before. You might have to split the initial case taking interview to two or even three sessions till they feel comfortable enough to share the core sensation with you, so that their personality unravels and you get a thorough understanding of the same. They will see that as a homeopath you present confidence and clarity. Patients like to see that in their homeopath.
V: Some patients show a range of emotion when subjected to a whole range of questions. Some feel angry, exposed, shy, bored and some others feel misunderstood, as if the answers are not from their mind. Some feel vulnerable. They have shared so much but the homeopath has not said much. Do you run into these situations and how do you deal with them? Some patients also feel that since they have shared so much with this homeopath who is such a great listener, he is now their friend. Where do you draw the line?
S: We do draw a line. The patient commits to you, and in total confidence, says everything to you. You must assure the patient that you will not be judgemental about him or his personality or circumstances. We are just a mirror. The patient comes very close, but we have to be the unprejudiced observer. If we cross the line beyond that and create a relationship with the patient, it with be difficult to give a prescription. Friendliness should not come in the way. Also, make sure to tell them that you do not offer quick fix, but a long term solution. If they want a quick fix, you can send them to another homeopath. Some patients ask for something for the moment – if it works, they assure you that they will come back. At our level, we find the remedy in the first 15 to 35 minutes. If you give them the responsibility and choice, they pick up their end of the bargain. They do not feel crunched for time.
B: Sometimes a patient will ask for advice – since they have shared so much information. That is when we say that we do not give this sort of advice. You must make it very clear that you are not their advisor or life-coach. Homeopaths are not priests or counselors. We can tell them that the remedy will help them find the right directions by balancing their personality and smoothing their weak points and sensitivities. It will help them find the capacity to be independent and find their own abilities and strengths. Then, from a point of strength and confidence, they can make their decisions and choices.
S: A small example. One of our patients is a matriarch of a very large business family. Six members and three generations of this family come to us. They are a very famous family running a public limited company. The eldest member, the mother, came to the clinic and told us that it was her time to make a will. There was so much wealth and she was not sure how to divide the property. She wanted our advice because we knew every person of that family. It was a very peculiar situation for us, because everyone of this family had confided in us. The mother already had her views so we let her speak. We did not participate much, but just listened, and helped her come to a decision by making her thoughts heard. As she spoke, we asked a few questions here and there. She was then quite clear about what she wanted to do with making her will. She went out quite happy.
V: It was like holding a mirror so she could see herself and understand.
B and S: Yes.
V: When a person comes with deep pathology and are taking several drugs, do you ask them to stop the drugs? If a homeopath in the U.S. said this, they would get into a legal bind. What can they do?
S: Ideally, a remedy prescribed by a particularly physician should be monitored by that physician. The dosage of homeopathic prescription should be managed by the homeopath. We do not interfere with medical prescriptions, but if a patient is on a long term treatment we will ask him to take the homeopathic remedy and continue to take his medications. As his symptoms and blood picture improve, we ask him to talk with his doctor and find out if his drugs can be reduced or discontinued. We don’t dismiss a drug. The U.S. homeopaths can do the same.
V : Do you advise about nutritional supplements?