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Hahnemann in his Organon [1] makes little to no reference to the therapeutic relationship. The few indications for the patient-practitioner encounter that he does make, in particularly when treating mentally impaired persons, were revolutionary in his time.

The first mention of details pertaining to the patient-practitioner relation is made by Hahnemann in Aphorism 83, where he not only stresses the individualized analysis of a patient case, but also emphasizes the need of the practitioner to be unprejudiced toward his patient. In Aphorism 84 he notes, that a practitioner should register with all his senses what is altered or peculiar in a patients case.

Hahnemann recommends aspects a practitioner should be attentive to and be sensitized for in the patient in Aphorism 90, and stresses in Aphorism 96 to be aware of the fact that all patients have differing dispositions. He goes on to mention in Aphorism 98 that the treatment of disease requires care, precariousness, knowledge of the human nature, caution, and much patience.

Sharp and persevering observation, and diligence of the same, Hahnemann repeatedly stresses throughout the Organon (Aph. 211, 216, 217). He emphasizes in cases of mental illness, to be understanding (Aph. 224) and trusting (Aph. 226). He continues that the practitioner needs to be without reproach towards his disabled patients, must show confidingness, and must abstain from all corporal punishment and torture (Aph.226). Hahnemann further mentions, with these patients, the need to avoid allegation (Aph.228), contradiction, reprehension and taunt (Aph.229).

Interestingly Hahnemann recommends, in the treatment of mentally impaired patients, the employment of concealed deceit to induce an emotional sense of comfort, which in turn may evoke physical well-being in the patient (Aph.226). This is an approach that is considered ethically disputable. He further suggests another form of deceit, where he recommends that in avoidance of the need of force, a patient may be given a homeopathic remedy without his knowledge, in a beverage, for example (Aph. 228). This too may be considered ethically questionable.

In Hahnemanns’ time there was little emphasis on a ‘relationship’ of patient to practitioner. It was largely the practitioner who was considered the expert and a patient case was frequently only subtly taken. Hahnemann strongly opposed this practitioner-focused approach that was common in conventional medical therapy, and openly criticized his contemporaries for not taking more rigid case histories of their patients, and for generally not focusing more on the patient. He mentions this in the footnote to Aphorism 104 (p.200).

Leaving aside the considerations of ethicality of deceit in the treatment of mentally impaired persons (Aph. 226 & 228), which until today is considered ethically disputable, and in spite of the little information given in the Organon on the therapeutic relationship, the few aspects mentioned by Hahnemann accentuate first elements of a patient-centred therapeutic relationship.

 
Reference:
[1] Hahnemann, S. (1974). Organon der Heilkunst (2.Auflage) 6B Heidelberg:Karl F. Haug Verlag.

 

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