The Unprejudiced Observer: Translating The Concept In Practice
NATIONAL JOURNAL OF HOMOEOPATHY 1999 Nov / Dec VOL VIII NO 6.
Dr N L Tiwari
Introduction:
Hahnemann at the very outset of Organon has introduced the term "Unprejudiced observer", (Aph 6) and entrusted the Homoeopathic physician with the task of erecting "the portrait of the disease". Is the unprejudiced state a natural state of the mind? Or is it something that needs to be developed? Is there something to be learnt? Or a lot to be unlearnt? And why should only the unprejudiced observer be capable of erecting a 'true & only' portrait of disease? What are the consequences of prejudice in general and in the working of a homoeopath? And if we do discover that this state is important, what should we do to impart it to our students? Can it be taught to us? Or is it possible for us to find it in ourselves? Is it a position to reach and then to rest in? Or is it a point that we need to continually strive to maintain? These are a host of questions that arise in one's mind when one seriously ponders over the penetrating words of the 6th Aphorism. The late Dr M L Dhawale was also faced with these puzzles and what follows are what his students taught him and he incorporated in his Methodology of training at the ICR. The 1978 conference on Hahnemannian Totality introduced this theme to the Homoeopathic world for the first time.
Prejudice and Unprejudice : Definitions
Prejudice originates from Latin PRE = before & JUDICUM = Judgement i.e. judgement that is formed before the facts are known. The word is synonymous with bias, partiality and unfairness.
Naturally unprejudiced would mean without prejudice. Can man exist without prejudices? It would be impossible to find anyone who has no strong unfounded likes or dislikes. A little reflection would convince us that these opinions assist us in our day to day decision making eg I hold the opinion that beggars are work-shirkers and thrive on exploiting the sentiments of unsuspecting fools. This allows me to effectively deal with beggars whom I encounter on the street and I do not feel that I need to give a second look at them. If I were not to have such a strong opinion about beggars, I would be hard put to deal with the pain every beggar would inflict upon me.
There are innumerable such opinions that I hold and which I may not be aware of. I act almost habitually and lead a tolerable existence, free from any serious conflicts. The difficulty occurs when someone else catches me with a wrong opinion. Then according to my temperament, I might quietly accept & change, noisily reject and fight or continue to remain blissfully unaware about the whole thing.
Under these circumstances, unprejudiced should carry an altered meaning in order to become meaningful, I should be sufficiently aware of my prejudices in a certain situation so as to prevent them from influencing my judgement. Let us consider an example.
Example - 1
An obese, round-faced, pockmarked lady of about 35-40y, entered the clinic in a poor Muslim locality. She had bold make-up, wore a silk sari and was chewing pan. She had come for her obesity, joint pains and constipation.
Looking at this picture, I instinctively felt the utter incongruity of it all and felt strongly that she was a prostitute.
After asking her name, I asked her husband's name. She answered shortly and almost venomously, "He is dead!" I was shaken by the answer and my worst fears appeared to have been confirmed. I did not know how to react. I changed my line of inquiry and inquired about her occupation. I learnt that she was a full time maid working at the house of an old parsi couple. After the case was over, I was still in a quandary about the husband. Finally the patient informed me that he was in fact alive. But at the time of her delivery when she was serious, he did not turn up at the hospital in spite of having been informed by her mother. So he was practically dead for her and she had no worth while relationship with him.
I realized how my initial prejudice had prevented me from giving value to her tone and manner of initial response. The patient from her side had tried to tell me the truth in her way. I was not able to receive her.
Would I like to change my pattern of connecting external appearance with certain social behaviour?
Prejudiced State: Diagnosis
We thus identify that our major problem is becoming aware of our prejudices in our role of a physician. We have seen above how a physician was brought face to face with his biases by the patient herself. But a great deal of sensitivity & honesty is needed on part of the physician to accept the confrontation. Not all of us are blessed with this quality. So what is the way out?
During the period of training, a trained observer can be provided. His task is what our master has defined in his celebrated essay "The Medical Observer". He has to make careful notes of the verbal and non-verbal interactions between the patient and the physician without interfering in the least. Let us look at the result of one such interaction recorded.
Example-2
A 25 year old GP with Asthma consulted a Homoeopath.
| Physician: | How are you suffering from Asthma? |
| Patient: | since about 2 years |
| Physician: | Did you have any disappointment in love? |
| Patient: | No (rather surprised). |
| Physician: | (Insistent) Tell me truth. |
| Patient: | No. An arranged marriage. |
| Physician: | There has to be some disappointment in love. People who suffer from Asthma are deprived of love and when they cry for love, they feel suffocated. |
| Patient: | (Uncomfortable, disturbed) I did not have any disappointment in love. |
The observer realized that the area of love and marriage was a sensitive area for the physician, he knew that there was an unhappy past, which he did not want to face. He wrote a report of the interview on the standard format (Appendix-1) and handed it over to the physician. A discussion ensued and the physician gradually came to realize the connection between his behaviour during the interview and his personal history; he understood that he was refusing to face the real problem.
It is rare for a physician to be so open to his observer or vice-versa. More often he remains unaware and one-to-me interaction fails to drive the point home. How is one to tackle the situation?
Prejudiced State: Treatment
Example - 3
A 49 years old highly qualified male from a business house consulted for Manic-Depressive Psychosis. He was suffering from business stress for quite some time. He was married to a beautiful physician and was deeply attached to her. She, on the other hand, found it difficult to adjust to his set up and was often away at her parent's. There used to be frequent interviews between the physician and the patient. Once, patient suffering from sleeplessness and restlessness after wife's departure, called on the physician in a disturbed state.
After some time, the observer has recorded the following interactions:
| Physician: | Have you found herself? |
| Patient: | (Excited) Have you found yourself? (Turning to the observer, he asked) Has he found himself? (and pointed out to the physician) |
| Physician: | I do not know about that. But I can sleep in peace. So I am not troubled. |
| Patient: | Yes. That is more than I can say. |
The observer who was noting this interaction was pleased that at long last, someone had confronted this physician. He wrote down his feelings frankly and expressed a desire to present the case in a group of colleagues. He wished to share this experience with the group.
The group participated actively. They could see the significance of the physician's query and also meaning of his reply. They were unable to vibrate with the observer who was found to be harbouring an antagonism to the physician and a sneaking sympathy for the patient and set him thinking hard of the genesis this phenomenon.
Such a learning and consequent change could not have come about without the help of the group.
Conclusion:
We will see from the above that a system of training has evolved from the cue that Hahnemann left us in the Organon.
This system of training is capable of catering to the needs of several learners at once and can truly be considered on a mass scale.
