Version: 26/11/2010
A new hypothesis on the mode of action of
homeopathic treatment.
Homeopathy works through a
non-material effect.
Keywords: homeopathy, mode of action, systemic therapy, family
constellations, Hellinger, Sheldrake.
Summary:
Homeopathic treatment follows largely the paradigm of classical medicine
in which the treatment of an illness is mediated by a substance. Careful
consideration leads to the conclusion that the assumption that the material is
crucial to bring about the healing effect of homeopathic treatment is unlikely
and very difficult to defend against criticism. Therefore a new hypothesis is
formulated which is based on an energetic, non-material mode of action.
Analysis:
The question whether or not homeopathic treatment is effective has been
the issue of a long- standing debate. The debate is characterised by strong
emotions and is often drawn into a broader context: the question whether
therapeutic methods, which are designated as ‘alternative’ methods, can have
any effect at all. The debate can be seen as the fundamental discussion between
‘classical’ and complementary medicine.
Classical medicine bases itself on the context and the laws of science,
obeying the principles of repeatability and coherence with material and
molecular models (reductionism). This is expressed in the statement: based on
sound scientific principles. Results of experimentation and theories are
subject to a debate, which is in principle open and transparent. Findings are
considered to be true only if they can be reproduced by other experimenters and
fit into the framework of scientific theory. Unfortunately in practice this
debate is not perceived as open because participation requires extensive
specialist knowledge. This means that in fact the layman is unable to enter
this debate.
Complementary medicine bases itself on less strict laws of
reproducibility: often the argument is used that each finding refers to a
unique situation, which in essence cannot be repeated. The context is said to
be holistic, taking the client/patient as a unique case, not comparable to
other cases. As a consequence findings cannot be generalised. This means that
falsification (Popper) as a mechanism to prove or disprove is not applied. The
complementary techniques appear to have no strict ‘rules of the game’.
Argumentation does not follow stringent logical principles but allows for
intuitive reasoning and phenomenological approach. This means that there is
room for emotional arguments and for the layman’s views. Basically everybody
can participate in the discussion and there are no mechanisms of judgement
(peer review) to guarantee ‘quality of the information’. Also
consequentionalistic argumentation is rejected because the basis is phenomenological.
The two systems are essentially so different that they cannot be
confronted with each other in such a way that a productive and fruitful
discussion could take place. There is no common basis of argumentation from
which to start.
Nevertheless, complementary medicine asks for recognition: by society,
but even more, by classical scientific medicine. For this reason especially
homeopaths argue that their treatment deserves a place next to classical
medicine. They argue that there is a theoretical basis underlying their
therapeutic interventions. This basis is described as the similia principle. The therapeutic intervention is to give a
medicine, which would evoke in an undiluted form specifically the complex of
symptoms, which are present in the client. The medicine is diluted in a special
way so that it is made harmless and at the same time has the effect to
stimulate the body of the client to heal. It is said that the medicine evokes a
self-healing response in the body of the client.
The key of the homeopathic treatment is the choice of the right
medicine, which corresponds with the symptoms of the client; symptoms in this
context is interpreted in a broader sense then only symptoms as indicators of
disease: it implies the whole image the client shows to the therapist. This
whole image has to be recognised by the therapist and is the basis for his
choice of medicine that would correspond to this image. Let us call this the
‘specific image of the client’.
This hypothesis is criticised on three major points:
- the similia
principle: is there a proof that this principle is true? There is no sound
scientific argumentation that this principle is valid and there are no
experiments that have adequately addressed this issue. Homeopaths point to the
widely used practice of vaccination, where the material causing the disease
(the bacteria or virus) is subjected to physical treatment and upon
administration to an individual lead to increased resistance to that particular
disease. The application of vaccines however is clearly dependent on the
physical presence of specific molecules in the medicine. Also vaccination is
well understood in terms of immune response of the body.
- The principle of dilution (potentiation): homeopathic treatment uses medicines that have
undergone sequential dilutions: the theory says that the more diluted the more
effective the preparation is. Critics point at the fact that the multiple
dilutions lead to a situation in which it is highly improbable that there are
still molecules from the original medicine present. Homeopaths argue that the
healing principle has been transferred during the dilution to the water.
Different theories have been formulated to explain this transfer: one of them
is the ‘memory of water’ theory, in which it is argued that the water molecules
surrounding the molecules of the medicine orient themselves so that they retain
an ‘imprint’ of the medicine. Several experimental studies have been published
that claim to investigate this ‘memory of water’ theory. Wide attention has
been paid to the work of Benveniste: one experiment in his lab has been
critically followed by a team from the scientific journal Nature to assure the
scientific quality of the procedures. The conclusion of the team was that the experiment could not meet
the qualitative standards of scientific procedures.
- The third point of criticism is the reproducibility.
Classical medicine accepts the medical (pharmacological) efficacy of a medicine
after clinical trials, which have to be done in at least ‘blind’ (single or
double blind set up) conditions, to prevent any interference by the bias of the
experimenter and the patient. Homeopathic interventions rely so heavily on the
unique evaluation of the individual client by the homeopath that the (double)
blind set up cannot be used. Classical homeopathy does not orient itself to
treat a specific disease or syndrome. Although different clients may present
themselves with the same symptom, the homeopath may prescribe different
medicines to each of them. For the homeopath places the symptom in the whole of
the picture of the client. Based on that whole picture a medicine is chosen for
that particular patient in this particular situation. That is why pragmatic
trial studies have been undertaken, to investigate the potential effect of the
whole of the patient-homeopath interaction including the medicine. These
studies took as starting point a specific syndrome (like common cold) and
evaluated the efficacy of the homeopathic intervention. The results of
these studies have been inconclusive in general. It is for sure that these
studies are confronted with serious methodological drawbacks since there are so
many variables involved that cannot be well defined and/or controlled.
In addition it can be noted that apparently the laws and principles of
natural sciences (chemistry, physics and pharmacology) do not apply to
homeopathic medicines and the methods of preparation. This can be illustrated
by the following arguments:
The dilution to a degree even above the number of Avogadro, so that the
chance that molecules from the original substance are present in the medicine
Quality control of the medicinal products is only performed essentially
by a process control: standardisation of the method of preparation. No chemical
or physical tests are in use or even available to control or check the steps
taken in the preparation.
In the same way there is the question of shelf life and stability of the
homeopathic medicines: in principle the
medicines retain their healing properties for indefinite time, without being
stored in cold or even deep frozen. Any
material substance would loose its capacities after some time, due to the
influence of temperature, resulting in molecular movements and therefore compromising
any chemical or physical properties. The loss of structure or orientation in a
molecular system, the increase of chaos, entropy, follows from the laws of
thermodynamics. This means that limited shelf life is inevitable in any physical
preparation.
Evaluation:
Looking at the situation presented above it is clear that the debate
between classical medicine and homeopathy will not be easy to settle. The
difference in approach is so great and so fundamental that a constructive
dialogue will very difficult to establish.
In my view a major reason for this is that the debate takes place too
much within the paradigm of classical medicine.
The classical medicine and also many traditional (herbal medicine)
‘doctors’ are working in a process, characterised by the following steps: the
patient calls to the doctor, explains the symptoms from which he is suffering,
the doctor comes to a diagnosis and prescribes a medicine. The patient takes
the medicine.
In this process the patient gives the authority for his healing to the
external person: the ‘doctor’.
The healing action is mediated through a substance: the medicine. The
medicine is a physical substance, which plays a vital role in this
doctor-patient interaction.
Fundamentally this process is also applicable to the interaction between
the homeopath and his client.
Because this process of interaction is so familiar, it is dominating the
thinking about proving the efficacy of homeopathy. In fact, attempts to
experimentally prove the validity of homeopathy rest on material: the material
is the medicine itself, or, to overcome the paradox of dilution above the
Avogadro number, the imprint of the medicine in the diluting water.
Sticking to this ‘material’ makes the homeopathy vulnerable to criticism
from classical science. When the homeopathic effect is mediated through a
material, a substance, which is based on physical molecules, immediately
questions have to be answered about the high dilutions and the transfer of
effect to the diluting water.
In fact, when we carefully consider the results of experimentation so
far, this is a lost battle. It is a waste of energy to keep on trying to prove
that the material involved has an effect.
In my view the zest of the homeopaths to prove that the homeopathic method
is valid rests too much on the adherence to this pattern, to this model. Much
of the investment of homeopathic therapists to demonstrate the validity of the
technique they apply is in fact concentrated on demonstrating that the
homeopathic medicines work.
It would be more productive to change the basic hypothesis of the mode
of action to a different model. This would give more freedom to thinking about
the mode of action of homeopathy. It would mean to stay clear from a
battlefield, which proved so far to be a drain of energy. Therefore I propose
to look at the interaction of the client with the homeopath on a more general
level.
New hypothesis:
The relation between the client and the homeopath can be seen from the
level of energetic interaction. It is difficult to define ‘energetic’ in a
positive way, because it is not measurable by physical techniques. Energetic
interaction I define in this context therefore in a negative way: an
interaction not mediated by a material, physical substance. With this definition
we can start to think in a free context: spiritual and intuitive. There are
many manifestations of energetic effects and interactions. They pertain to
intuition, gut feeling, impressions. Often it is considered belonging to the
realm of spirituality. In the context of this article I suggest to link the
concept ‘energetic’ to being in contact with deeper levels, closer to the real
self, which is often hidden under masks. It touches to the concepts that are
underlying psychotherapy of a more spiritual and holistic nature as they have
been developed and elaborated in the body-oriented therapies. Examples are the
bioenergetics as developed by Lowen (1975) and the postural integration as
developed by Painter (1986). Sheldrake developed the concept of energetic
fields in a broader context, not only connected to persons, but linking it to
natural structures: organisms like trees, plants and also communities of trees
and plants together. Bert Hellinger
developed the concept of systemic work, more specifically family
constellations. This concept assumes that any person carries with him elements
from his family that influence his life and actions. In fact any system: an
organisation, a business, has an energetic structure, that influences the
members of the system (Varga von Kibed). Conclusive evidence for the validity
of the energetic concepts cannot be obtained by physical methods. Nevertheless
astonishing results have been obtained in practical work. The binding element
of these techniques is the reliance on ‘energy’, there are no material or
physical intermediates involved.
This leads to the hypothesis that in homeopathy a similar mechanism is
operative.
In systemic work, as developed by Hellinger, the energetic constellation
of a family or organisation plays a central role. The beneficial, even
therapeutic, effect is mediated through words, through invisible effects from
the position of persons or objects in relation to each other. It is as if
during the development of a constellation changes are brought about in
invisible structures, which lead then to more balance, more peace, and in this
way bring about a beneficial effect. These invisible structures are like
images. The effect of systemic work lies on the deeper levels of the
individual: in my belief at the level of the soul. The systemic therapy
addresses the client’s soul.
This means that systemic therapy addresses rather specific effects. It
is more than just consolation for the worried soul, more than softening the
pain through meaningful words. Systemic therapy addresses the basic structures
of a family or organisational constellation and the disturbances that may exist
in the specific case presented.
Often critics of homeopathy argue that, in view of the fact there can be
no meaningful material effect in the treatment with homeopathic, very diluted
preparations, the reported effects must be a placebo effect. It is beyond doubt
that the placebo effect is an important healing effect.
But such placebo effect would be an unspecific effect. Essentially a
placebo mediates the care and positive thinking of the healing doctor. The
placebo is therefore a symbolic preparation, which is as close as possible
mimicking the ritual of administration of an effective medicine. The patient is
to believe that the preparation is an active substance.
In a way it can be seen as an energetic effect: it is a substance
administered to the patient, but the substance is believed to be biologically
inactive.
Nevertheless there is a fundamental difference with the homeopathic
method.
The consultation of a homeopath is characterised by a long and extensive
intake, anamnesis. During this the homeopath enquires about a broad number of
items to get a picture of how the client feels, about his specific complaints
and characteristics. Even aspects of past diseases, ailments and the childhood
are taken into consideration. On the basis of this vast amount of information
the homeopath chooses the medicine that corresponds to this specific client,
with his specific symptoms and in this phase of time: the ‘specific image’. The
choice is made on the basis of the knowledge compiled in books: in the Materia
Medica, and other works. In these works
data have been collected for specific substances describing the symptoms that
have been encountered after the administration of these substances. This has
resulted in a vast amount of ‘specific images’, corresponding with specific
medicines. This data collection in fact started with the founder of the
homeopathic method: Hahnemann. It is said that this data collection still
continues up till today. Substances for which such data have been compiled
include a wide variety of plants, metal elements and preparations of animal
origin. The material of origin is not considered just a source of material. In
fact even characteristics of the plant or animal are taken into account in the
choice for the medicine: ‘grows in a secluded place’. The healing art of the
homeopath is considered to be his skill to identify the ‘specific image’ in the
client that corresponds to a specific medicine. With a correct correspondence
the healing effect will be optimal. Sometimes there is some trial and error to
find the right treatment. To find the correct correspondence the homeopath
needs to tune in on the client, as a whole, not on the level of some specific
symptoms only. This focus on the identification of the ‘specific image’ is a
crucial process and it is logical that this tuning in will have a profound
effect on energetic level.
In my view the energetic tuning in may be the key to the healing
process, not as a first step necessary to the analysis of which medicine is
required, but as an energetic focus in itself. The therapist will bring with
his questions the client into a state in which deeper levels of the personality
will be activated and addressed. In the mean time the energetic concentration
of the therapist will tune in and make contact at those levels. This process
may not be principally different from what is supposed to occur during
psychotherapeutic counselling and also during the preparation for a family
constellation or systemic therapy. The homeopathic therapist will concentrate
this phase on finding a suitable medicine, he will collate the information into
a picture that corresponds to a medicine and he will then prescribe this
medicine to the client. The process will essentially be an interpretation of
the complex of symptoms and characteristics presented by the client. It cannot
be carried out by an expert system (computerised), it requires the intuition of
the human therapist. Considering the intensity of this process there is much
energetic focussing, in which the healing properties attributed to the medicine
serve as a template, as a useful construct to focus the energy. In my view this
is the healing effect itself. The medicine as material is essentially not
required for this; when the medicine is handed over to the client, this is
implementing a ritual. Still the healing picture of the medicine itself is
important. In defining the medicine to be applied in this specific client, the
homeopathic therapist concentrates and structures the energy field of the
client in this specific situation. It is certainly a highly subtile process.
The healing effect depends to a large extent on the skills of the therapist and
essentially cannot be made objective.
Discussion
As shown above studies to evaluate the efficacy of homeopathic treatment
yield ambiguous results. Also there are strong arguments that no physical
substance can be in the homeopathic preparation that explains its healing
effect. The homeopathic treatment depends on the subjectivity in the
interaction between the client and the therapist. The homeopathic medicine
administered to the client serves as part of the ritual, the essence of which
is energetic concentration.
In my view homeopaths should not let themselves be drawn into a
discussion on proving the material substance as a mediator of the healing
effect. Then they step into the trap of working according to the classical
medical doctors’ paradigm. It is beyond any doubt that it is very attractive to
use the classical medicine paradigm: the patient is used to that and easily
fits into this way of functioning. On top of that it relieves the client from
the responsibility for the healing effect: the doctor and the substance
prescribed by him take over the healing effect. This has the attraction of
being a tangible and concrete action. It is comprehensible for the client.
Also for the homeopathic therapist it is attractive to assimilate with
the image of the medical doctor. It gives him the stature and position of the
medical doctor. The price for this is that he has to engage in the fight about
the efficacy of his treatment. This fight is, as stated above, improductive and
a waste of energy. It would be better to accept the results of scientific
experimentation and argumentation that there is no material basis for the
homeopathic treatment. Having accepted this point of view there will be room
for new concepts of thinking.
In fact this would have secondary advantages as well: homeopathy
sometimes uses medicines with an origin that is questionable on ethical
grounds. Prominent in this respect are the medicines prepared from wild animals
like the bear, the lion, the rhinoceros. Leaving the material out and
concentrating on the energy from such animals would save the animals
themselves.
Conclusion
Many arguments lead to the conclusion that the homeopathic treatment
cannot adequately be explained by an effect mediated through a physical
substance. Homeopaths would better accept that they are not providing a healing
substance, a medicine to their clients, but they should realise that the
healing occurs through an energetic process. Concentration of energy takes
place with the help of the ‘image’ of the homeopathic medicine, which has to
correspond to the ‘image’ exhibited by the client. This process of energetic
concentration is not a-specific, like in placebo treatment. The ‘image’, the composition
of symptoms and effects attributed to a specific homeopathic treatment is
itself a way to concentrate the energy. This means that the body of data, which
has been collected in homeopathy, Materia Medica, plays an essential role in
the healing art of homeopathy.