The author is concerned with the division that the miasms theory caused in the homeopathic community. In this article he challenges the premises of Hahnemann’s concepts of the nature of miasms on logical grounds and in a constructive fashion. He asks the reader not to look for the true nature of chronic disease in its appearance, but in the development of human life instead. The author proposes a shift of focus on case taking, from the disease point of view to the point of view of individual development.
Going through the curriculum I felt very excited at the beginning of my second year study of homeopathy back in September 1995. Eagerly I looked forward to the lectures and reading material that would reveal Samuel Hahnemann’s and, as I understood at that time, the homeopathic approach to chronic disease. But even the introduction to the information offered, made me feel puzzled. One of the very first lines of the introduction to miasm theory was something like this: “Nothing caused more division among Hahnemann’s followers than the introduction of the Miasm theory.” At once this statement changed my attitude towards the study of chronic disease. I realised then and I am still of the opinion that a sound theory which is supposed to be the foundation of the homeopathic materia medica could not lead to divergence in the practise of so many homeopathic practitioners at present. Yes, there is a broad consensus, or call it a status quo, which makes a lot of sense for many practitioners I meet. : “The applicability of a homeopathic theory, principle and/or method depends on the individual case”. Over the years I too have practised with that convention in mind. I wonder how it is possible that some prescribers are convinced and subscribe with conviction to the idea that anti-miasmatic prescribing is essential success and the only way forward. Clearly, if that is to be true it would be needless to defend it, just like it is needless in the homeopathic community to defend the validity of the law of similarity or Pythagoras’ theorem.
We have Hahnemann’s inheritance of a still disputed theory of chronic disease, which doesn’t seem to work for every practitioner in every case. Seeing this, I feel that the prevailing ad hoc convention will undermine homeopathy as a system of medicine in the longer term. To me the only way forward is to scrutinise the Miasm theory again and determine beyond any doubt what aspects of it are really useful and adhere to the true nature of human life. Through this article I would like to contribute a little to that on-going debate, and will start by briefly re-addressing Hahnemann’s concept of the origin of miasms.
Hahnemann’s concept of miasms
The establishment of the law of similarities was reinforced by Hahnemann’s relentless effort to release and experiment with the potential healing powers of the used and abused substances of the medical profession of that time. Through trial and error, he discovered that there were remedies effective in acute manifestations of disease, which although well chosen, could not stop disease from recurring. He concluded that many acute diseases recurred because they were actually acute manifestations of underlying chronic conditions. He studied this phenomenon the same as he studied epidemics. From his detailed records he deduced that groups of patients with the same recurring acute diseases, required a limited group of remedies to stop them from recurring. Through this study the nature and cause of chronic disease became clear to him. He discovered that the foundation of all manifestations of chronic disease is essentially threefold, and he called these elementary causes Psora, Sycosis and Syphilis. He regarded acute conditions, which lead to death, subsided of their own accord or did not reoccur after a well chosen remedy, as manifestations of the acute miasm. With regards to the aetiology of miasms, Hahnemann stated the following:
The infection with miasmas, as well of the acute as of the above-mentioned chronic diseases, takes place, without doubt, in one single moment, and that moment, the one most favorable for infection.
When the smallpox or the cowpox catches, this happens in the moment when in vaccination the morbid fluid in the bloody scratch of the skin comes in with the exposed nerve, which then, irrevocably, dynamically communicates the disease to the vital force (to the whole nervous system) in the same moment.i
A page further he adds one other important aspect:
From the progress of all these miasmatic diseases we may plainly see that, after the contagion from without, the malady connected with it in the interiors of the whole man must first be developed; i.e., the whole interior man must first have become thoroughly sick of smallpox, measles or scarlet fever, before these various eruptions can appear on the skin.ii
So he indicated 3 important aspects of the cause and development of chronic disease:
The contagion takes place from without and involves a pathogenic agent with a physical (smallpox, cowpox, etcetera.) and a non-physical, spiritual component.
Then follows an interval during which the whole organism (mentally, emotionally and physically) becomes penetrated.
The manifestation of the external acute miasmatic disturbance is a sign that internally, it unfolded completely.
He found that all miasmatic conditions developed the same way, with the only difference that the chronic miasms persisted for a lifetime.iii He was of the opinion that the spiritual miasmatic forces act in conjunction with the life force, corrupting it and debilitating the defences of the physical organism against material pathogenic agents. Hahnemann defined Psora as the mother of all chronic disease, for she has been around as long as humanity is has dwelled the Earth. iv
He tells us that leprosy and scabies are the most original acute manifestations of Psora. Leprosy has never been suppressed, but instead its victims were isolated from the community. This measure was, although inhuman, adequate enough to curtail leprosy and avoid further contamination.v
At the end of the fifteenth century, due to the introduction of certain hygiene measures and a more refined life style, Psora was reduced to the very contagious and itchy scabies. The first registered case of syphilis occurred around the same time. In Hahnemann’s opinion, suppression of scabies’ external manifestations pushed Psora to the more vital organs, where it remains latent until the organism is weakened enough so that it can manifest itself as a chronic and more severe disease.vi
The transmission of scabies only requires the slightest skin to skin , while Syphilis and Sycosis are only transmitted through sexual intercourse.
The most obvious of all Hahnemann’s contradictions is that the one and only law that unites homeopathic practitioners, the law of similarity, is allowed to be breached when it comes to the application of the miasm theory. The miasm theory demands that in a range of cases, one should put the individualising symptoms aside and act as if one has to deal with an epidemic in order to get at the roots of disease. It furthermore insists the prescription be based on latent and invisible expressions of disease. To me the so-called opening of cases with an anti-psoric remedy like Sulphur, is in grave contradiction with the law of similarity and can be called not-homeopathic. The anti-miasmatic treatment contradicts his own words of §12 of the Organon, which states:
It is the morbidly affected vital energy alone that produces disease1, so that the morbid phenomena perceptible to our senses express at the same time all the internal change, that is to say, the whole morbid derangement of the internal dynamis; in a word, they reveal the whole disease; consequently, also, the disappearance under treatment of all the morbid phenomena and of all the morbid alterations that differ from the healthy vital operations, certainly affects and necessarily implies the restoration of the integrity of the vital force and, therefore, the recovered health of the whole organism.
And in the footnote to this aphorism Hahnemann really undermines his own concept of miasms:
1 How the vital force causes the organism to display morbid phenomena, that is, how it produces disease, it would be of no practical utility to the physician to know, and will forever remain concealed from him; only what it is necessary for him to know of the disease and what is fully sufficient for enabling him to cure it, has the Lord of life revealed to his senses.vii
To me this very basic contradiction of the miasm theory with the law of similarity validates another question. How is it possible that on the one hand disease as a manifestation of a perverted dynamis is not separate from the living whole, while its causes, the hostile half material and half spiritual miasms that are lurking in the dark, are indeed separated from life?
The paradigm shift in homeopathy
During my struggle to get to grips with the homeopathic theoretical heritage of chronic disease, I made a discovery that put it all in a non-dualistic light for me. A human error of the first kind blocked Hahnemann from perceiving the reality of disease for what it actually is. In his tireless efforts to reveal the true face of disease he looked for its cause in disease and not in life itself. Through his intense twelve year study of the phenomenon of chronic disease, he isolated it and his object of study became an entity separate from health and, worse even, disconnected from the individual experience.
Life has a purpose and every homeopathic practitioner who follows in the footsteps of Hahnemann, as Kent, Hering, etcetera, knows that people are more or less in a continuous effort to fulfil that purpose. Life has a purpose and so health and disease must have a purpose too. Health and disease are the two sides of the one coin, namely development. How health and disease relate to one another can be compared with learning how to walk. We cannot learn how to walk without falling. Falling is the downside to learning how to walk and likewise disease in its broadest sense is the downside to our mental, emotional and physical development. If a disease process is stopped from following its course, a developmental process is hindered. Disease is that aspect of our development that we simply don’t like. The tragedy of it all is that when it comes to so-called anti-miasmatic prescribing, we fail to see that development is impossible without disease. Disease, when dealt with properly, with or without the help of homeopathy, makes us stronger. A deeper understanding of the true nature of chronic disease can never be obtained by a study of disease alone, but should be sought in human life instead.
In the allopathic school the study of disease has been taken to the extreme. Disease has been drastically isolated, alienated from human life and only understood and acknowledged in terms of physiological, structural and/or behavioural changes that exceed well defined formalised boundaries. Beside the materialistic approach, the most significant difference between homeopathy and allopathy is the point of view from which disease essentially is observed. To the homeopathic practitioner, the symptoms that are mentioned spontaneously and appear to be rare and peculiar, are the most valuable in the case analysis. One might avail of less individualising symptoms, like “Sadness in the afternoon”, but when it comes to working with single remedies we rather base our prescription on the most individualising symptoms. The most individual expressions of disease, which is but the shadow side of a certain personal development, tells the homeopath in what way the organism intends to get over the disease of its own accord. The homeopath who prescribes a single remedy at a time, essentially aims to address disease as it is perceived by the patient. The allopathic practitioner aims to address disease essentially from the point of view of formalised definitions, the framework of pathology.
I think that Hahnemann’s successful introduction of homeopathy was a definite contribution to a paradigm shift. It was a paradigm shift in which social, political, spiritual and also professional conventions increasingly made way for individual values and norms. Now that I am writing this I feel an enormous gratitude for Hahnemann’s lifework, and admire the way he coped with the enormous resistance he met. He was successful in establishing the law of similarity in medicine and his teachings were sufficient in helping his followers to set up flourishing practises. However, he didn’t complete the paradigm shift.
To me the miasm theory is a testimonial of Hahnemnn personally giving in to the medical conventions of his time. With regards to the miasm theory, he obtained a position somewhere between pathology and the individual point of view. Currently students and also very experienced practitioners shift between the two points of view, without even being aware of it. This clearly does not help to develop the full potential of homeopathy as a system of medicine. Choosing to wholeheartedly embrace the law of similarity and to acknowledge its efficacy in all cases, is the final step to complete the emancipation of homeopathy from her big brother.
The focus on development
In cases of chronic disease it is my foremost aim to increase the possibility to unveil some of the current core development of the patient. Keeping the focus on the patient’s development requires a balanced discernment between personally expressed negative, positive and neutral characteristics. First I address the chief complaints and history of disease. After that I put aside all the books and everything I have learned. I let myself be guided by the patient as much as possible through open questions. I try to not to let the question suggest what is wrong, but about who he/she is, how he/she lives and most importantly, what the patient really wants. Naturally the patient cannot avoid talking about the obstructions to his/her happiness, and these will be addressed appropriately. Every question that is not triggered by the patient’s expressions but by my reference books, can be more or less an obstruction to the natural flow. When taking the case I differentiate three different expressions of development:
Expressions of fulfilment or acceptance indicate successful development. They are expressions of realism and represent the building blocks for the future. (neutral)
Expressions of cheerfulness could possibly indicate a dwelling on successfully completed developments. Moments of cheerfulness are on-going celebrations as it were of the obtained achievements which possibly obstruct a realistic outlook in the present and might cause stagnation of development. (positive)
Striking and peculiar alarming expressions, provide reliable indications about stagnations in the current development. (negative)
Developmental processes appear chronologically in layers and I peel off one at a time starting with the current state.
The threefold materia medica
I have no doubt whatsoever that the materia medica is essentially threefold and that sub-groups of remedies can be derived from it. A thorough study of the appearance of disease in its entirety, reveals indeed three fundamental groups of remedies, and that is the main reason why the miasm theory is still regarded as a valid concept. But why is the materia medica essentially threefold? Hahnemann and some of his followers, like Allen, ascribed this threefold appearance solely to the three spiritual enemies of life that pre-exist to any earthly manifestation of disease, namely Psora, Sycosis and Syphilis. Some contemporary authors, like Luc de Schepperviiiand Prafull Vyayakarix believe that the answer to this question is to be found in the physiological defence mechanisms.
The materia medica is derived from the instant experience of our development that we don’t like and call disease. So, wouldn’t it be more appropriate to look for the origin of the threefold materia medica in human life itself? Why should we look in areas that are out of reach of the direct individual perception and/or cognitive faculties? The law of similarity is based on the direct perception of phenomena. A phenomenological approach of life reveals the presence of our threesome existence on many levels and in many sciences and in communities. Just a few examples: The three spatial dimensions; Birth, life and death; The triangle and her properties form an intrinsic part of Euclidean geometry; A chair with three legs guaranties a most stable seat irrespective of the type of surface it is standing on; The triad patient-therapy-healer; The Christian trinity; The Hindu triad Brahma, Vishnu and Shiva; The Tridosha in Ayurveda medicine; Many policy strategies are based on threefold concepts; And let’s not forget the three defence mechanisms of the cell.
I am convinced that the materia medica presents itself in threefold for the same reason that other concepts of life appear threefold; because the process in each of us that leads to the awareness of phenomena progresses in three clear steps. With regards to the materia medica the first step is the direct mental, emotional or physical experience via all senses and receptors freely expressed in consultations or provings. Homeopathic practitioners take the case and intend to record the expressions as objectively as possible. Secondly, we take a distance from the impressions and relate them functionally to one another. We collect the individualising symptoms and classify them. So, first we depend on our sensitivity in order to open ourselves to the impressions, and after that we need to withdraw and close our selves off to process the data. Two clearly distinguishable activities of the mind that can NOT take place at the same time, but can alternate very quickly. During the third step we try to determine a bit of the real identity, the core, of the developmental process that the patient here and now expresses.
The first two steps to confirmation of the essence of the case will progress with more ease for the experienced prescriber and are more or less a matter of skills. The third step is about self-actualisation of the patient and the emphasis is definitely on the art of homeopathy, which relies more or less on the mindfulness of the practitioner. With the increase of experience the art usually becomes more prominent. Students, first time practitioners, or experienced practitioners who are avoiding mindfulness are heavily depending on the skills and knowledge that is passed on by their teachers and the old masters. The practitioner who endeavours after mindfulness knows about the beautiful difference it makes to his/her practice and the existentialistic struggle it requires. The effect of increased mindfulness in homeopathic practise is that it enables one to prescribe more quickly and with more certainty irrespective of the number of remedies that one knows by heart. I feel it is worth our while to have a closer look at the act of self realization.
To a certain extent, most people have the experience of a little self realization after a crisis. The experience of truly meeting oneself after a crisis strengthens us. But we do not have to wait for a crisis to become more self-aware. Daily life offers us plenty of opportunities to find out who we really are, if we were only alert enough to take them. Life presents itself as a flow of impressions to the mind. This flow is like an ever-changing river and all impressions from in and outside our body are like tiny mirror fragments which, if we are looking for them, are presenting aspects of our true self. It only takes a split second for those tiny mirror fragments or opportunities to pass by and continue their way with the river. To be, is not passively sitting on a chair. The activity of being urges us repeatedly to actively leave the impressions for what they are and to perceive them – re-addressed, in the unique light of the new moment. The activity of being here and now requires our concepts of the patient to change accordingly with the flow of impressions.
During the consultation an environment can be created which increases the possibility of the homeopathic practitioner and patient coming to a little more self-realization, through one another. The possibility might arise that the practitioner and the patient truly meet in a flash beyond the dualistic patient-practitioner concept. It is a dualism that originates from the pathology point of view that I described above, in discussing the paradigm shift in homeopathy. The practitioner truly meets the patient through clear and objective understanding and an acknowledgement of the uniqueness of the patient. To genuinely meet is the direct awareness of what all of us would experience, if we were in a similar situation as the patient. A schizophrenic patient for example, told me with a smile of embarrassment how she is constantly aware of a cat with a human face in the house. As I queried her about this experience, I genuinely felt no urge in any way to reject or oppose her experience as untruthful. The patient was pleasantly surprised by my objective attitude and expressed indications of acceptance, the first signs of healing. On my own part, I felt a sense of fulfilment.
Throughout the years the properties that Hahnemann assigned to miasms have been stripped off to such an extent that there is virtually nothing left of the original concept. Most colleagues I meet and who say that they are miasmatic prescribers, perceive Hahnemann’s miasms as mere syndromes or just as a help to classify remedies. Whatever the fundamental cause of chronic disease in the distant past might have been, it is definitely not scabies, gonorrhoea or syphilis. The reasons for this are that:
Each acute manifestation of chronic disease on the surface has a more fundamental cause which is hidden from the view of the community in which a person lives, from the homeopathic practitioner and even from the individual himself. It is impossible to determine the origin of chronic disease from factual public journals. Looking for the first cause of chronic disease is a fruitless effort because each cause is preceded by another one. In this world the chain of cause and effect is never ending.
The appearance of disease is not the same as BEING sick. A person might for example have severe acne in her face, but it doesn’t trouble her at all and it never triggered her to look for help. It is the individual who asks for help when the severity of disease reached a personal limit. The homeopathic practitioner actually treats the WHOLE PERSON and not the appearance of disease alone.
Hahnemann was right in acknowledging the threefold appearance of the materia medica. But it is not threefold because of the nature of chronic disease. The materia medica is threefold because each of the three states of mind put the experience of our physical , emotional and mental development in a different light. To be able to accept the burden of disease, a disability or the effects of a crisis, with or without homeopathy, is the beginning of a healing process.
iii De chronische ziekten, page 44; a Dutch translation of Dr. Samuel Hahnemann’s Die Chronischen Krankheiten – first edition 1828 by O.E.A. Goetze. Published by Homeovisie bv, Alkmaar, The Netherlands, 1988.
iv De chronische ziekten, page 17; a Dutch translation of Dr. Samuel Hahnemann’s Die Chronischen Krankheiten – first edition 1828 by O.E.A. Goetze. Published by Homeovisie bv, Alkmaar, The Netherlands, 1988.
v De chronische ziekten, page 12; a Dutch translation of Dr. Samuel Hahnemann’s Die Chronischen Krankheiten – first edition 1828 by O.E.A. Goetze. Published by Homeovisie bv, Alkmaar, The Netherlands, 1988.
vi De chronische ziekten, page 13; a Dutch translation of Dr. Samuel Hahnemann’s Die Chronischen Krankheiten – first edition 1828 by O.E.A. Goetze. Published by Homeovisie bv, Alkmaar, The Netherlands, 1988.