154 THE ER=ITIStt HOM(EO~ATt~IC J O U R N A L

LEAI%NING A N D TEACHING HOM(EOPATHY

By FRANK BODMAN, M.D.

IV[R. PRESIDENT, LADIES Al~D GENTLEMEN

I t seems preposterous that I should be giving this lecture. Quite obviously the proper person to speak on this subject is yourself, Sir, who have been teach- ing Homceopathy for over a quarter of a century. You, Sir, and our President- elect with his long experience must know all the snags, must have encountered all the difficulties.

For my part, I have no experience in teaching homceopathy. My con- tribution must be based on my experience in teaching other subjects, and my own clinical experience as a homceopathic physician.

As for my teaching experience, if it is not very extensive, it has covered a fairly wide range. During the war, I have been a university lecturer t o medical students ; I have also acted as a tutor to qualified men taking a course of post-graduate study ; and took part in a pilot scheme of adult education, which foreshadowed the present Bureau of Current Affairs)

Now, Sir, the first question we must ask ourselves is : Can homoeopathy be taught at all in our present civilization ? Is it any good trying to teach it ?

That may seem rather a ridiculous question to ask this Faculty. But I would ask you to t ry and envisage the general conditions through which hom0eopathy first emerged.

Perhaps we can best do this by imagining ourselves as suddenly transported to some region like the Belgian Congo--our equipment, medical supplies and instruments have been lost in transit, and there we are, faced with a village population, illiterate, superstitious, and prone to a variety of infectious and deficiency diseases with which we were previously unacquainted. We have no laboratory facilities, no X,rays, no thermometers, stethoscopes, sphygmomano- meters ; nothing but a notebook and pencil and our eyes, ears, noses, hands. In fact, just the sort of situation our missionary students look forward to facing. In 1946, we should have to go far afield to find such conditions, but in Hahne- mann's time, the era of the Napoleonic wars, such conditions were common throughout Europe. 2

Before the Industrial t~evolution, there were no great cities ; there were, of course, the great trading centres, the mercantile towns ; but, on the whole, towns if crowded (? populations) were small, and the population was pre- dominantly rural. Transport was slow and difficult ; the doctor's work was done on foot or from the saddle. Sanitation hardly existed; food supplies fluctuated wildly from year to year ; infantile mortality was very high; epidemics were common and severe--typhoid, typhus, cholera, smallpox, scarlet fever, relapsing fever, were a large part of the doctor's da i ly work. Infestations, pediculosis, scabies, and their concomitant diseases were common ; deficiency diseases, such as scurvy and pellagra were probably frequent. People did not live long enough to get cancer often, and the " wear and tear diseases "--gastr ic ulcer and high blood pressure--were not recognized, if they existed ; road accidents were news. There was no social insurance, so doctors were expensive and called in for emergencies only, except by the wealthy.

Supposing our petrol supplies' were suddenly cut off, how many patients a day could we visit on foot ? Ten ? And in walking from house to house, might we not have time to think over our patients' problems, instead of, as now, concentrating on how to beat the traffic lights ?

In those days, the average doctor's knowledge of medicine was limited, precise instruments of diagnosis were lacking, but these shortcomings were

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concealed under a windy theorizing about the nature of disease, which was no more than a rationalization of magical thinking and superstitions about evil spirits which had to be expelled, let out, purged and exorcized. The doctors' prescriptions were baroque, even rococo in their size and extravagance.

The modern practitioner, if asked to take over a case from these eighteenth century physicians could hardly have been more shocked than if he found him- self inside the camp at Belsen. He would immediately put up a blood transfusion to restore the exsanguinated patient, and prescribe continuous sedation to counteract the various painful t raumata to which the patient had been exposed, the wet-cupping, the blistering, the cauteries. He would probably repor t this eighteenth century colleague to the G.M.C. for aggravated malpraxis.

But it was Hahnemann who was the pioneer in indignation against these sadistic practices, against this redundant pharmacology. His simplification of both theory and practice was urgently needed, and won acceptance throughout the world in spite of the pressure of powerful vested interests.

Reading through the 1845 volume of the British Journal of Homoeopathy, I find reports of p~ogress in Brazil, Vienna, Lemberg, Berlin, Russia, Hungary, Paris, Palermo, New York, Geneva, Madrid. ~

In 1946, the modern doctors' work is in a quite different setting. Many of them work in the enormous cities that are characteristic of our present-day civilization. Modern sanitary science h a s el iminated the majori ty of the infectious diseases that constituted the main battle .of the day-to-day work of the eighteenth-century practitioner. Modern rationing has eliminated most of the malnutrition and deficiency diseases that were common in the inter-war period among the working classes. The expectation of life is longer, and people live to die of cancer, arteriosclerosis. Transport is cheap and easy : a panel practitioner may make forty to fifty visits a day, besides seeing another for ty to fifty patients at his surgery. With the advent of social insurance, he deals not only with acute disease, but minor ailments ; while the setting of his work has altered beyond recognition; so also has his equipment. The modern practitioner has a lengthy training, and has many precise instruments of diagnosis. Behind him also are laboratory facilities. At his command are a variety of powerful agents which, appropriately prescribed, give rapid and effective results in the majori ty of cases.

With this acceleration in the tempo of living, he sees gonorrhcea cured in thirty-six hours with penicillin, pneumonia afebrile i n similar t ime with sulphamethazine, malaria quickly controlled with mepacrine, sufferers from Addison's anmmia restored to efficiency with liver extracts, diabetics under- taking the most onerous tasks with the aid of insulin, Graves' disease p~tients resuming housekeeping after three weeks of thiouracil, prolonged depressions back in harness after a short course of electroconvutsive therapy.

In fact, living in a machine age., mass production methods have been adopted ; standardization of t rea tment is the type of rationalization that medicine has adopted ; and the results have been impressive, particularly to the man brought up in the " teaching hospital ". That, Sir, is why I asked my first question : Is there any scope for homceopathy in modern medicine ? Is there any point in trying to teach it ? Are homceopathic physicians merely survivals of a fo rmer civilization--craftsmen doomed to die out, specimens in the anthropological museum like the Chiltern Chairmakers ?

My answer is, No - - and this answer is not based on blind faith, but given for the following reasons. I n the first place, we know from our own experience the wide range in individual reactions, both to diseases and to drugs. And while modern standardized methods of t reatment can claim anything up to 80-90 per cent. successes, even with these methods, there are at each end of the average range, a fringe of individuals who are either unresponsive to the accepted treatment, or else hypersensitivet The approach to this 10-20 per cent. has to be on different lines, if they are to be relieved.

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Secondly, although the advances in modern medicine in certain directions have been brilliant and successful, the penetration has been in certain salients, and the gains have been local. In certain areas, disease is well dug in, and little progress has been made in treatment, even if the enemy territory has been mapped out by the pathologists.

The medical t reatment of children's disorders, particularly the exanthemata, such as measles, pertussis, mumps, lack any satisfactory specifics. At the other end of the scale, the medical t reatment of old persons is limited to a very few drugs. And in between there are the psychosomatic disorders of middle life, including the allergic group of illnesses--the asthmas, hay- fevers, migraines, eczemas, and other psychosomatic disorders--the effort syndromes, the pseudoanginas, the nervous dyspepsias, the oolites, the dysmenorrhceas, the recurrent pyelites, the cardiospasms ; orthodox t rea tment for most of these diseases is still symptomgtic.

And these psychosomatic disorders, when established, "lead us into the field of chronic disease : the rheumatic hearts, the coronary thromboses, the essential hypertensions, the rheumatoid arthrites, the vast field of crippling disorders. The morbidity of these diseases is as serious to the nation as their mortal i ty is to the individual. 4

Thirdly, man himself changes with his environment, and his diseases, which are a reaction to harmful influences in tha t environment, alter as tha t environment alters.

The diseases characteristic of a nomadic tribe of hunters will be different from those of communities living a pastoral life in villages. The maladies of the dweller in the crowded medimval town are different to those of the inhabitant of the modern industrial slum.

I look back forty years, and I realize tha t the conditions under and against which m y father worked are very different from those tha t obtain now. And 1 am fairly safe in guessing that in twenty years' t ime they will have altered radically again. So that, as conditions of living change, the impact of environ- ment will modify the way human beings react, and the taint of ill-health will manifest itself in a different way/

Coccal infections will have been practically eliminated by the sulphona- mides and penicillin, but it will be useless to swamp the sufferers from virus infections with sulphonamides, just as it was ridiculous to bleed the bver- worked, underfed town labourer in the eighteenth century, because venesection was so successful in his overfed, overweight, gouty employer. So that the successful methods of t0-day may be the failures of to-morrow, if they are only directed to dealing with the current failure of equilibrium.

:But homeeopathy is based on knowledge more fundamental. So with I~Iahnemann, the essential question proved to be, not : What is this pat+cut suffering from ? but, In what kind of way does he react ? And diagnosis did not mean the labelling of the patient with the name of a disease, and then treating tha t nominal entity, but diagnosing the patient in the terms of the drug-reaction, which would restore his equilibrium.

The patient was to be diagnosed in terms of t reatment. Therefore faced with a hitherto unknown disease, the homceopathic

physician is still equipped to undertake t reatment from his basic understanding of how the normal human individual responds to drugs.

On these grounds, therefore, I maintain there is a large field of work for the hom~eopathic physician. We must teach--but whom are we going to teach ? I t will be agreed, that in this country, homceopathic medicine must be a post- graduate study. Even if we had the. resources, finance, buildings, staff, a hom0eopathic school of medicine, training men from the undergraduate stage would be impossible. I t has been tried in America, but on the whole, the result has not been successful.

The learners, therefore, will be graduates. The Goodenough Report

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estimates that there will be 1850 students graduating a year in the next few years. 5 Are we being too optimistic in expecting 1 per cent: of these graduates to specialize in homceopathic medicine ?--an intake of eighteen students a year.

At present the membership of the Faculty is about ~- per cent. of the 45,400 practising doctors. But I do not consider we can expect the majority of recruits to be amongst those recently qualified. We must first ask ourselves what are the motivations behind the wish to study homceopathy.

Firstly, there will be a group of men who have been in practice some time, and who have discovered that they are not satisfied with their results. They find that the bulk of their work is concerned with diseases of unknown cause which they do not know how to treat. You may call them idealists--romantics --perfectionists--but they cannot bow the knee to the god of Things as They a r e .

Secondly, there will be a group of men who are natural rebels, always agin the Government, who automatically sheer away from the orthodox, and are in revolt against the established order--the born nonconformists. These shade off into a third group who become almost pathological in their cult of individuality, and who are projecting their personal problems, feelings of dissatisfaction with themselves, into the field of medicine, and attempting to find solutions for personal problems outside themselves. When this tendency becomes exaggerated, we are up against the cranks and faddists, l~ourthly, there are those men who by personal experience, or through personal example, have enjoyed a demonstration of the effectiveness of homceopathie medicine.

Finally, there will be a fifth group of individuals whose natural curiosity is so highly developed that they cannot help investigating any new phenomenon.

Not all these groups are equally valuable as recruits. The first group of mature but dissatisfied doctors is probably the soundest material, and the fourth group who have personal practical proof a s s basis for their enquiries are also likely to be good, but the natural rebel of the second group may quite likely rebel against his new teachers, while the extreme individualist of the third group will be a liability, as he will tend to twist his knowledge to suit his own distorted ends. The interest of the fifth group is unlikely to be long sustained, as they are easily distracted and go off sniffing after the next new CHIt.

So much for the motives for studying homceopathy. What are the deterrents ? The psychologists tell us that in all learning processes, feelings as well

as intelligence are mobilized. 6 We may be aware of the intellectual process, but are less likely to be aware of all our emotional reaetions. Consciously we may desire the new experience, but unconsciously there may be a resistance to the effort involved, and to the pain of giving up or sacrificing concepts already learnt.

This ambivalent attitude to new experience must be taken into account. In approaching new knowledge there will always be an underlying anxiety : What will it do to me ? What will it require of me ? Will it give me what I want ? How much will it change me ?

I f the student of homceopathy assumes he will have only to learn some theories and memorize some formulse for good practice, he is soon undeceived by the vital dynamic quality of what he learns. It is life itself that he encounters. Learning is a part of life---it is life itself. Jus t as living involves the whole person, so does learning. 7 But as l~aven has shown by his controlled projection technique, how we organize the ideas, or the systems of thoughts that we acquire in learning any subject, is determined by the individual nature of the person, and his past experience. S The way I think about homoeopathy will not be identical with your scheme of homceopathy. As people who value individual differences, we should be able to appreciate the significance of this.

158 THE BRITISH HOM(EOPATHIC JOURNAL

Even my drug picture of Bryonia will be different in some degree from each of yours.

So much for the learning process in general. When we come to post- graduate studies, we encounter another very important factor. We are told by the Government Actuary that the average age at qualification is 26. 9 We must add to this the compulsory year in hospital as a resident. H o w many young men and women will be prepared to undertake further postgraduate studies at 27 ?

I t is no use blinking the fact that in the second and third decades of life, literally nothing is so significant as finding a mate and founding a family/ We cannot, therefore, expect a majority of young graduates to seek a further postgraduate period.

But we must narrow the field still more ; for we must remember that a m o n g the Specialities, homceopathic medicine is unlikely to be popular. I f the young graduate is to specialize, why not select a fashionable speciality, such as child health, psychiatry, gynsecology, where prestige is high and rewards are certain ?

Homceopathic medicine is not a speciality that deans and professors are likely to approve. I t is never easy for the young person to join a minority group. The recently qualified, very conscious of their experience, however proudly they may disguise it, are in great need of the approval of their col- leagues, and very sensitive to the disapprovM of their peers. They are the least prepared to sacrifice the attitudes, concepts and framework of knowledge so recently and painfully acquired.

These obstacles to the postgTaduate study of homceopathy are serious. But furthermore we must take care that under the proposed National Health Service Bill room is left for the would-be specialist to transfer from one branch of the Service to another. Doubts have been expressed about this in the Committee stage of the Bill3 ~

The recruits, then, are drawn from a body of graduates who have through long years of study and clinical practice acquired the techniques and skills and attitudes of their profession. The recruits will include not only those who already approach their studies with a faith engendered by some personal experience, but also those discouraged by their clinical experience, those who are rebels, those who are personally out of adjustment with society , those who are merely inquisitive.

Shall we be wise in imitating Speransky who told an International Congress, "C'est le systeme qui a veille. Et la physiologic tout eomme la pathologic nerveuse, ne trouveront pas d'issue de 1'impasse ainsi cr6e, taut que les bases m6thodologiques de la pens6e et de la conduite des savants qui s 'y adonnent n 'auront pas 6t6 changdes. ' ' n In other words, you won't get out of the mess in which you find yourselves, until your experts give up their worn- out preconceptions about disease and change their habits of thinking and work- ing.

This was exactly the mistake Hahnemann's followers made, as Dr. Dudgeon pointed out in his lectures given at this hospital many years ago32 I t is too discouraging to be told that all these years you have been thinking and working along the wrong lines. You must start all over again. Such advice is bound to arouse resentment and antagonism. We can only avoid this fundamental mistake, and others equally serious, by taking note of what is happening to the learner during the learning process. J~ere I am following Bertha l%eynolds in her very lucid description of the stages of learning any art or profession/

The first stage of acute self-consciousness. I t feels to the student as if he had no intelligence, to say nothing of using it. I t seems impossible to grasp what the new subject is about. This is particularly the case in homceopathic medicine, as the materia medica is so immense, and the textbooks are written in such an out-of-date language that the beginner feels as much at a loss as if he were beginning his studies in a foreign language.

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The r61e of the teacher at this stage is to give a sense of security. To help the student to find the solid ground of: his own achievements up-to-date in whatever field they may have been. With his feet planted on this solid ground he can struggle with the new experience.

The next stage is the ,sink or swim adaptation. At this stage, the learner, bewildered though he may be, catches hold of something to which he can respond. He gets an inkling of what it is all about. The second stage of barely keeping up with what the situation demands lasts a long time. A common type of reaction is that the student realizes that Bryonia is good for pneumonia, Rhus tox for rheumatism, Baptisia for typhoid, in the same way that he knows Colchieum is the remedy for gout, Sulphamethazine for pneu- monia, Salicylates for rheumatic fever. I t is the stage in which our grand- mothers remained with their little boxes of phials--a sore throat, and they produced Mercurius biniod,, an earache, and you were given Chamomilla.

This second stage is deceptive because the student has often mastered the jargon, and his glibness gives t h e impression that he has grasped the whole science and art of homceopathy. But we must remember that at thi~ stage the learner cannot understand the meaning of what he is doing as he will later.

At this stage, we must increase his security by mobilizing his previous knowledge and skills, and relating them to the matter in hand. He still needs a specific for each disease. He is not ready to give up this concept, and criticism must be withheld until he has found himself, and begun to trust the authority of the teacher who will later help him to be self-critical.

The third stage is that of understanding the situation without power to control one's own activity in it. We perhaps can remember learning to swim or ride a bicycle. After laborious struggles and ridiculous failures, we suddenly find we have " got " it. The learner says, too, of homoeopathic medicine, " All at once it came to me. I thought I knew before what it was all about, but now I know I have been in a fog M1 the Lime " - -o r " I t was all words to me, and now it has come Mive "

But we are soon up against a difficulty. The s tudent thinks he has mastered the art, but he finds that in practice he cannot carry out what he understanc[s so yr Perhaps an analogy here will help. I t is like driving a car. One has learnt to drive it on the level fairly well, but suddenly con- fronted with a road-block round a blind corner, one has to consciously think the situation out. One has not built up a sufficient number of responses for reactions to be automatic. One has to think out, Do I change down before I brake, or brake before I change down ? instead of going through the motions automaticMly.

This is the stage where the teacher's criticism can be helpful, provided the criticism is constructive and not destructive. The learner can now, with help, think out for himself why he has failed. The teacher can help the student to say without losing courage, I made a mess of that [ The third stage may last a long t ime--some people never get beyond it. The usual difficulties in homoeopathie medicine here, are the failure to differentiate sufficiently, and the tendency to over-vMue symptom indications which are already familiar. I t is the stage of favourite remedies.

The fourth stage is the stage of relative mastery. The new knowledge has really become part of the person. He has related his new skills to his old skills. So much of the activity as is routine is taken care of with the minimum expenditure of energy, leaving conscious attention to cope with new aspects of the problem. The person can criticize and change his approach as the situation demands.

We may ask, is a teacher necessary any longer. The risk at this stage is that when we reach this level of competence, we may feel we are" finished " I t is easy to forget that situations never repeat themselves; that there is always something new to be mastered. The danger is of becoming hidebound,

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worse still , of resent ing the g rowth of younger s tuden t s who, wi th fresh vision, see th ings dif ferent ly and challenge accus tomed methods .

The homceopathic phys ic ian mus t be an a r t i s t as well as a scientist , and, l ike al l ar t is ts , requires the s t imulus to go on learning. This s t imulus comes f rom his colleagues, f rom informal discussions, f rom research, and f rom contac ts wi th s tudies in o ther fields of medicine.

The last stage of learning is learning to t each wha t one has mastered . I t is a common idea t h a t because we know a subject , we can teach it. Bu t there is something more to t each ing t h a n proving to the learner tha~ one knows one 's subject . We have to a d a p t our knowledge to the person who mus t learn it . W e are no longer preoccupied w i t h the sub jec t ma t t e r , and our energies m u s t be devo ted to the unders tand ing of the difficulties of the person who is learning. A n d so the teacher h imself has to begin all over again, learning to t e a c h - - th rough the s tage of self-consciousness or s tage- f r ight ; (if you have lec tu red to a t hea t r e full of rowdy th i rd -yea r s tudents , you will realize wha t I mean) ; - - t h r o u g h s ink-or-swim stage in which you hope you are helping the s tuden ts , b u t are no t sure how you are doing i t - - t o the s tage of under s t and ing the teaching s i tuat ion, b u t not being able to control one 's own ac t iv i ty , so t h a t one does s t up id discouraging th ings and discourages and de ters the s t u d e n t s ; unt i l one reaches the stage of compara t ive m a s t e r y of t e a c h i n g - - I do no t claim to have reached t h a t level.

Tha t , Sir, is m y apprec ia t ion of the s i tuat ion. To recap i tu la te : There is st i l l a wide field of ac t ion for homceopathic medicine. The s t u d y of th is spec ia l i ty m u s t be a p o s t g r a d u a t e one. I have discussed

the incent ives and de te r ren ts to the s t u d y of a n y spec ia l i ty and homceopathic medicine in par t icu la r , and demons t r a t ed the heterogeneous na tu re os the group l ikely to presen t i tsel f to t h e teacher . And, finally, I have ana lysed the difficulties of a n y learning s i tuat ion, bo th f rom ghe s t a ndpo in t of the s tuden t a n d teacher .

I do no t wan t to say more a t th is stage, b u t I hope in the pape r and dis- cussion t h a t follows, some fo rmula t ion of p rac t i ca l measures will be a t t e m p t e d .

REFERENCES

1 C. Williams-Ellis: " Factory Discussions." Spectator, 1943, October 29th. 2 F. Bodman : " The Contribution to Medicine m~do by Samuel Hahnem~rm." Janus,

1933, p. 247-256. "~ British Journal of Homceopathy, 1845, vol. iii. r F. Dunbar: Psychosomatic Diagnoses. 1943. New York. 5 Report of Interdepartmental Committee on Medical Schools. 1944. London.

C. M. Fleming : The Social Psychology of Education. London. 1944. 7 Bertha Reynolds : Learning and Teaching in the Practice of Social Work. New York.

1942. s j . C. Raven: Controlled Projection. London. 1944. ' G. S. W; Epps : Appendix A of reference 5 .

10 D. Renton: B~rliamentary Debates. Standing Committee C. National Health Service Bill. 1946. May 16th, p. 128.

11 Speransky : " Contribution h l'dtude do la pathogdnie dn rhumatisme." IVmo Congros Internationale centre le rhumatisme. 1934. Moscow.

12 Dudgeon : Lectures on the Theory and Practice of Homvzopathy. M~nchester. 1854.

(Discussion on p. 186.)