12 DIALOGUE ON POTENTISATION
12.6 Analysis of professional experiential data on the potentisation theme
experience of participating in a community of practice (Wenger, 1998). We reflect on how the homeopath embodies homeopathic values and the lack of reflexivity in homeopathy discourse (12.6.1), and the homeopath’s perceptive powers to transform the patient’s state (12.6.2). 12.6.1 ‘Being more homeopathic’
Participant observation fields notes: SoH continuing professional development workshop ‘Life- long learning from Practice’ London June 2005
Selected quotes from the workshop’s promotional leaflet:
The seminar gives you the tools needed for life-long learning in being more homeopathic.
Being homeopathic is itself life-long learning…. Homeopathy more integral to your life…. Learning to be homeopathic in our lives…..
An inquiry for the whole homeopathic community…. A homeopathic approach to clinical supervision……… Specifically a homeopathic way of teaching…..
Pre-text: The workshop’s focus on taking a homeopathic approach to practice based learning presented an excellent opportunity to examine what practice based research in homeopathy looks like. My participation was shaped by Wenger’s concept of “communities of practice” (Wenger, 1998), perceiving that the interactions with other homeopaths function to reproduce a collective identity. With the idea that practitioners are always in the process of becoming (Johns, 2000) I critically examine how shared identities are being constructed through the day’s activities.
Analysis of key concepts used during the day:
‘Being homeopathic’ ‘Homeopathic’ extends beyond clinical practice, to a way of seeing,
embodying and living homeopathic values. ‘Being’ emphasises a meditative role, with focus on the homeopath as an agent of change. ‘Homeopathic’ carries implications for taking
responsibility for one’s own health, taking a holistic view and acknowledging the wisdom of the whole person.
‘A specifically homeopathic way’ Homeopaths’ case taking skills are applied to practice
based learning. Analogous to the role of the observer in triads, we were encouraged to place ourselves in the role of the observer on our own clinical practice and to aspire to a “supervisory way of looking” (Ryan, 2004). This resonates with the practitioner researcher role, but is compromised by relying on the problematic notion of the ‘unprejudiced observer’. Observation is unavoidably value and theory laden, so the idea of suspending one’s values and assumptions is untenable. Clinical practice is subject to inquiry but reflexivity is notably absent.
The homeopath as an embodiment of homeopathic values This highly personalised
language unites how you approach practice with how you live. There is a danger of encouraging a self-contained, inward looking and complacent profession.
How is ‘being more homeopathic’ enacted through this event? Co-operation, in the form of
developing networks and peer support is presented to counter the image of an isolated independent practitioner. The orb web spider is used as a metaphor to show how by casting out a single thread, it is possible to spin a web of a learning community. Whilst the day set out to provide the ‘tools’ for practice based learning, I felt the ‘tools’ were notably absent. There was a conspicuous absence of encouraging participants to use reflective practice skills to learn more from their practice experience. The didactic charismatic teacher slipped into the discussion when the facilitators talked about their own significant learning experiences taking place at international seminars. This had the effect of diminishing the resourcefulness of each homeopath to bring about their own changes. I was disappointed that the workshop did not provide the opportunity to explore practice based research in the way that I had hoped for. Possibly setting such high expectations prevented me from making the most of what was enacted. In feeling constrained within the workshop discourse, I break out, only to become the subject of an academic discourse that takes a critical approach as if I am assessing another teacher. What I learnt from this workshop is that whilst congruence with the therapeutic framework is a priority for practitioner based inquiry, simply employing homeopathic concepts does not create homeopathy based learning. Reflexivity is a crucial element in enabling you to reflect on their position as a knower in discourse.
12.6.2 ‘Crack the case’
Extract from STAR group discussion transcript:
because I feel that the patient is not complying, there’s no learning situation for the students, you know, it’s frustrating for everybody; another supervisor might see it completely differently and might find it challenging to have the patient. They might want to crack the case or see it as symptoms, so that’s why it needs discussion of the whole. (STAR May 2004 lines 825-829)
In this dialogue a clinic tutor describes the ‘difficulties’ encountered in providing treatment for a patient in the University Polyclinic. The totality of the case is perceived to what the homeopath is experiencing in delivering treatment. The patient’s behaviour becomes pathologised and used as indications for choice of similimum. ‘Crack the case’ captures the assumption that a well
chosen remedy has the potential to transform the patient’s state. ‘Crack’ evokes the homeopath’s power to perceive what is needed to transform the patient’s state. This patient is placed in a passive role.
12.6.3 One remedy wonders
Extract from reflective writing May 2006:
The myth of a ‘one remedy wonder’ suggests that the patient’s health can be transformed by a single well chosen prescription. Like most myths, it is based to some extent on life experience. I recognise that ‘miracles sustain practice’. By this I mean that the sense of myself as a ‘successful homeopath’ is maintained by those handful of exceptional instances where the individual appears to enjoy a sudden and lasting transformational experience following taking a remedy. This may be a marked improvement in symptoms or in sense of well-being. These accounts appear to be miraculous as they appear to defy explanation. These are memorable events not only for the patient concerned but also for the homeopath.
Case presentations at conferences tend to be these ‘best’ cases. False expectations can be set up for the inexperienced homeopath or student as these cases are not representative of daily practice. These cases are often presented in a way that invests power in the homeopath in solving the patient’s problems, health or even life circumstances. This rhetoric is used to promote the exceptional claims of the particular prescribing methods. Well established teachers such as Sheilagh Creasy, pay more attention to the role of the homeopathic prognosis, which helps to set realistic expectations for potential change in the case and keeping the patient as well as possible.
Use of the terms ‘wonder’ and ‘miracle’ carry connotations of the supernatural and lack of rational explanation. This account highlights both what attracts people to homeopathy, and what attracts the label of unscientific practices. The popular press carry stories of celebrities’ positive experiences of homeopathic treatment (Sawalha, 2010). These stories have an important place in homeopathy culture. In my experience of interviewing applicants to study homeopathy, positive personal experience of treatment is often cited as a key motivating factor. This is mirrored in the importance of ‘word of mouth’ referrals from existing patients in financially sustaining practice. Amongst patients and homeopaths (Shohet, 2005) there is an emotional commitment that is based on personal experience of treatment effects. This emotional commitment is anathema to scientific discourse, but an integral feature of homeopathy discourse, indicative of how the practitioner is also a recipient of homeopathic treatment.
Significantly in the text the transformative experience is attributed to the remedy, other factors such as the patient’s self-care or life events, consultation process and therapeutic relationship are absent. This suggests the influence of the pharmacological interpretation of homeopathy where the prescription is de-contextualised from the treatment process. Biomedical discourse shapes the way we talk about our practices, and can create a lack of congruence with the therapeutic framework.
How the practitioner negotiates scepticism and belief is illuminating. Tensions are managed by recognising that occasionally a patient’s response is extraordinary and apparently inexplicable,
whilst at the same time advocating a practical strategy to set informed expectations for change. Out of context, these anecdotal accounts can be interpreted as making extravagant claims for the efficacy of homeopathic treatment. However the National Cancer Institute (USA) Best Case Series suggests that when fully documented, these anecdotal accounts have the potential to lead to research into new treatment strategies (NCI, 2010).