Dr. Ajit Kulkarni M.D.(Hom.)
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The human being -The complex structure
Homoeopathic interrogation is a complex process. To live with the truth that life is difficult, is difficult for many people. Homoeopathic interrogation is not a simple ordeal based on mere clinical orientation. It is multi-dimensional and multifaceted because it encompasses human orientation. As homoeopathy is a life medicine, Homoeopathic interrogation is difficult. It deals with the cross and transverse section of a man who is a complex being – at times difficult to understand. Man is the best of creations as he is gifted with intellectual powers and thinking abilities and owing to these qualities he has conquered everything coming in his way. This has eventually led to increasing demand of conquering new heights and this unending desire has translated itself into a deadly trap of greed. Man uses every resource and reserve to satisfy his greed. This has made him the most destructive force on this planet. It is not incorrect to say that he has become a first class predator to grab his goals in his lifetime. A human has become a problem of survival for the each other.
A dreadful question that very often haunts our mind is that – are we really humans? Have we attained ‘the quality of being human’ in the process of evolution? Or we have devolved? Is it true that we have failed to ‘kill’ the animal within us? Is this the animal within us which is responsible for all the sufferings, conflicts and illnesses amongst us? To achieve the Godliness is what we are here for. This is our final journey. Indeed we have to return to the point of our origin! Destination is Godliness. How many people want to become Yatris- the spiritual path seekers? All these considerations are important for a homoeopath. Because health is of three types – physical, mental and spiritual. What is to be cured in a patient depends on physician’s knowledge which renders a specific approach to the physician.
The silent communication
“The Doctor of the future will not give medicines, but will be someone who is able to listen.” — Thomas A. Edison
I often wonder what made Thomas to write this statement. Besides the tremendous benefits of listening, today’s doctor doesn’t have time to listen to the grievances of the patient is also a reality. Doctor of today’s time is usually carried away by the materialistic concepts of the modern medicine which degrades the humans into machines and believes in the dictum ‘fit everything into the machine and enjoy whatever comes out of it’. For a classical homoeopath, there is nothing like the doctor of the future. He has to do the essential job of listening, as he has to stand up on the terra firma of adequate and accurate data which cannot be acquired unless we seal off our tongues and sensitize our tympanic membranes to understand uninterruptedly what patient has to say.
I give pivotal importance to listening. The first hospitality is nothing more than listening. Through listening, a homoeopath shows his politeness, gentleness and his compassion. The process of ‘getting acquainted’ with the patient becomes a smooth one if a homoeopath symbolizes himself as a listener. A homoeopathic physician who sits on a chair with holistic philosophy in the mind, who has to deal with the patient from totalistic viewpoint, who has to focus keenly on the emotions, on each and every body movement, gestures, postures, speech modulations etc., has to be a good listener. We should never forget that the words of wisdom say – the first step to acquire knowledge is to keep silence. The next step is to listen properly, understand properly and lastly to promulgate the knowledge to others. One who follows these steps truly gives justice to the knowledge. The process of case taking is a knowledge-seeking process. Ultimately it is the patient who gives knowledge to a homoeopathic physician.
Listening doesn’t happen automatically. It is there, always. But a physician has to enter into it, wisely, with discipline, with pros and cons, with perspective and prospective vision. It is not an easy task as it is the quality which develops after years of grooming.
‘Hearing’ and ‘Listening’ are altogether two different processes. They are no way alike. Hearing alone is not listening. Hearing means merely picking up sound vibrations through the ears while the process of listening has a wider domain. It means making sense out of what we hear. Hearing is related with functioning of ‘ear’ while listening encompasses all the three things – ears, brain and mind.
“Active listening is an important way to bring about changes in people. Despite the popular notion that listening is a passive approach, clinical and research evidence clearly shows that sensitive listening is a most effective agent for individual personality change and group development”- Rogers and Farson.
The relation between silence and listening must also to be understood. One can be silent without listening to anybody. But for listening one has to be silent. One may be in silence while listening to the inner voice of self. But listening to someone who is talking is difficult, ambiguous and impossible too. ‘A man is a slave of spoken words but he is a master of unspoken ones’.
Silence-The ultimate musical melody
Silence is relative or total lack of sound. But this definition of silence is very inadequate and superficial. Silence is a state being fully aware of. But this awareness is not only physical. It is with understanding. It is with knowledge. It is with sharp intellectual faculties in which we can take an appropriate decision. Silence per se has no purpose or expression. When it is actualized as a sound in speech, it is called by the name silence. Silence is not an archetype; it cannot be designated and it is unknown. When it is expressed in a word, it is no longer silent. ‘Real silence begins when a reasonable being withdraws from the noise in order to find peace and order in his inner sanctuary’- Peter Minard.
Silence can run from very active consciousness to the torpidity and this dimension must be known to a physician. It can be a positive or negative force in the communication process. It can act as a bridge between messages or severe relations. Silence has the capacity to evoke many responses in a patient like threatening, panic, curiosity, anger and even suspicion. A patient can be comfortable or uncomfortable with a physician’s silence but when used wisely in interacting with a patient, it can be a powerful communication tool. Silence is one of the more dramatic tools we can use with patients. It can intensify the expression of excitement, shock, anger, disappointment, and can motivate, persuade and educate just to name a few. All these emotions can be conveyed when sound and voice are omitted with appropriate timing. On the other hand, silence at the wrong time may evoke a negative response in a patient. There is a saying, “Music is made beautiful by pauses between the notes.” But these pauses must be well-timed. A long pause with physician’s closed eyes may give an impression to the patient that a physician is sleeping! Silence must aid for a fruitful conversation, it should facilitate the interview. There is one more saying ‘Silence is more musical than any song’.
Robert Rabbins writes beautifully, “When there is no noise around, we open to life and life opens to us, life reaches towards us in the center of our heart”. The core identity, the essential nature of every patient is felt in silence when a physician concentrates fully on the patient. In silence the physician opens himself to receive the innermost core of patient’s being and it is in the deep silence of thought and perusal that the real meaning of sickness is unfolded to the physician. The otherwise difficult case, not getting resolved, finds its answer in the deep embodiment of silence.
Dr. N. L. Tiwari lists three circumstances for the use of silence – a) when the patient himself needs it after he has ventilated and wishes time to recover. b) when the patient has come to an end of his narration and appears to be searching for fresh material and c) when the physician expects the patient to cooperate along the lines indicated and there is resistance from the patient.
Types of silence
Silence fall into three distinct sections.
First is the Psychological, second Interactive, and third is Socio-cultural. All of these are distinctly defined through time, context, and perception.
The Psychological form of silence can be identified through momentary silence in communicative interaction like hesitation, stutters, self-correction, deliberate slowing of speech for the purpose of clarification or mental processing of ideas to elaborate on topics of discussion. This type is short and combines internal or psychological factors into a physical form of external expression. Interactive silence can be found within interpersonal context – that is interpersonal relationships along with the management and maintenance that relationships require. This category of silence is evident through interactive roles, reactive tokens, or turn-taking. Lastly, there is the Socio-cultural framework of silence in which the communication is formed through cultural norms and it follows the culturally defined patterns of social interaction.
One more distinct way to honor the sacrifices of martyrs or to venerate those who have died tragic death is commemorative silence. This usually consists of silence for a minute or two by the mass of people in which they remember and give condolences.
Each patient radiates his silent thoughts, feelings, expectations and beliefs to the physician. At the same time a physician also radiates his responses to the patient’s silent communication. So each patient is simultaneously reflecting and responding to the physician’s expressions on his face, eyes and the tone of his voice and various other shades of expression etc. – all completely, silently and ‘unconsciously’. This is the actual crux of the communication. It is generally believed that verbal communication is the most direct form of expression and body language is a supplement to this. A ‘spiritual’ way of looking at human beings portrays the picture in a different way which is totally reverse. It is actually the silent communication that is the most direct because it reveals the ‘deepest truths’ of an individual, while speech is ‘indirect’ in that it represents ‘we should be like what we think’. This is the difference between importance of silence and listening in interrogation and the speech. In silence, the radiant energy of both the patient and the physician resonate with each other in a better way. Silence enhances observation and observation is actually an interaction. Observation changes what is observed and the physician can take advantage of this to perceive the patient’s inner being.
Let us take an example. If a man has a problem with anger and regards it as a bad thing and the physician also regards anger as a bad thing, then the resonance will be manifested in a common bridge between a patient and a physician and actually he will be reinforcing the patient’s problem in a subtle way. But if a physician believes internally that the expression of anger is completely natural and healthy, then this feeling reflects to the patient and results in the formation of ‘composite’ bridge between them which alters the patient’s feeling from within. Feelings are like ‘electrons’ in the shared bond. The peaceful and accepting attitude of the physician to anger will inhibit the original reaction of the patient as he will accept the understanding of the physician more readily. Eventually the patient will land up in a receptive mode to receive what a physician has to offer.
This process of resonance is actually the application of the Law of Similars. In order to know where the shoe pinches, a physician should wear the shoes of a patient and should try to experience, through the image transference, the actual feeling states, the patient has gone through.
A silent mind, free from the onslaught of thoughts and thought patterns, is both a goal and an important step in dealing with a patient. Inner silence should be understood to bring one in contact with the divine or the ultimate reality of this moment. The ultimate truth of ‘self-realization’ is experienced by the great people in the silent phase of tranquility. This is because knowing silence is knowing our ‘self’. The ‘self’ has existence in silence, just enter yourself and you will find this silence.
Let us take an example of crying. During the consultation, when a patient becomes very emotional and starts crying, it is always better to respect the crying, through the silence. Don’t blame a patient or ask a delicate question at once during this period, the answer of which is difficult for the patient to give. Don’t lash him with any big advice. Just concentrate on how the patient cries and this requires a silent mind. There are more than 50 types of crying and each one is different in its emotional energy and overtone. Perceive what changes the crying induces in you. Watch out for the discomfort in a patient when it is better on your part to turn away slightly rather than facing or staring the patient directly. Try to focus your attention on the book like a repertory or materia medica to avert any discomfort to the patient. Once the spell of crying is over and a patient is reverting to emotional balance, ask a question relevant to the issue and wait for the reaction. This gives the patient a feeling of space, of being given the time and freedom to think about and form the response without being compelled. The counterpart of this is physician’s own mental state and reaction. I recall one of student’s reactions to patient’s genuine crying. She also started crying and the whole scenario became too emotional. The professionalism and the emotionality should have a balance.
- Silence is powerful in the arsenal of the physician’s communication toolbox. It demands a refined consciousness and when used correctly, it greatly impacts patient learning, motivation and emotion, ultimately causing referral, retention and patient adherence!
- Silence is our deepest nature. The ownership belongs to us only. It is within our breath. It is between inspiration and expiration. It is in our polarities, as a connecting medium. It is there like music between our thoughts.
- Silence illuminates. Silence reveals. Silence unfolds the truth. Silence arouses the healer within.
- Silence heals.
- Disappear into silence, to become an unprejudiced healer.
- Be silent for efficiency.
- Be silent for rejoicing yourself in the noble path of healing, with the highly salubrious therapy of homoeopathy!