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.
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.
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.
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.
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.
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.
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.