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Limits of Self-Prescribing

by Paul Houghton(more info)

listed in clinical practice, originally published in issue 61 - February 2001

The customer should get what the customer wants, but what is that exactly? Some come in expecting to talk to an expert. Others want the client-servant treatment. Quite a few would like a friend. And a lot have no idea what it is they really want. Whether they go away happy or otherwise depends a lot on grasping quickly where they are coming from.

Over the Counter-Top

"What's good for cancer?"

Tricky one, this. Oddly enough, the people who ask it are often on the prosperous and well-educated end of the spectrum. They look at you with the most earnest expression, demanding a straightforward, practical answer. Trouble is, the straightforward answer is that it's a ridiculous question. But give them that, and The Boss will likely soon be gravely showing you a letter from 'distressed and outraged at this utterly inappropriate response'. It has happened more than once.

Pointing out the complexity and individuality of treatments cuts surprisingly little ice. It is like they had previously braced themselves to meet this kind of evasion and negative thinking. One approach that is often effective is to start asking serious questions, in very business-like tones. Who is the patient? Diagnosis confirmed? Prognosis? Proposed therapies? Family history? Obvious aetiology? Maintaining causes? Psychosomatic factors? Pretty soon they will be asking if there are professionals or organizations they can consult, without one even having to hint that the matter is beyond what can be done for them over the counter. And they will go away feeling a bit happier.

The boss would quite like them to go away with 'something to try, at least'. That is why destiny has ensured that he is the boss, kept in his office at a safe distance from delicate human beings.

"So who is the best practitioner?"

This one can really test your patience. The most expensive? The one who wrote the most books? The one with the biggest following of reverent students? The upholders of the traditional way? The cutting-edgers? The one that's always on the radio? The one the Royals go to? Sometimes I excuse myself momentarily and try to make a meaningful connection with the filing cabinet: "Oh repository of knowledge, how long, exactly, is a piece of string?" This thought does not have to be audible, it somehow works a subtle change in the atmosphere anyway.

If they are still looking determined, one might ask what they do for a living. "And how would you suggest that someone find the best private investigator/ foreign exchange dealer/search-engine rankings-optimizer, according to their particular needs?" This usually conveys that one is not just too slow, ignorant, or uncaring to give a simple answer to their simple question.

But that doesn't mean they are happy yet. One hears a little voice gathering force at the back of the mind: "Well, if you would like to have something to try in the meantime at least, we've had lots of good reports from the top practitioners about…."

The difference between what we believe, what motivates us, our conceptions of dis-ease and how to fix it, between what it says in the prospectuses of our colleges and on our certificates, the difference between all this and what actually happens at the point where the public meets the providers of natural therapies, is an area of some interest, after all. And it does not obey the protocols of any research programme – there's the rub.

"One of my grandchildren…"

Stay calm. There is a special place in the annals of human folly for grandparents bearing theories about their grandchildren's health. But jumping to generalizations won't solve anything. Keep listening, one might be able to help.

"…has a rash, that won't go away. The doctor says its fungal and he's given some steroid cream. But I think it could be stress-related. I prefer natural things. What would be the best thing to start with?"

What would be the best agenda to start with?

Making symptoms go away is not what we do. Symptoms are there for a reason, they are sacred in a sense, like facts in a sea of opinion. In principle, we want to understand the cause of the symptoms, and address that.

Dermatological diagnosis. Richard Feynman says the most important lesson he ever learnt was the difference between knowing what something is, and knowing what it is called. One good practitioner says the only thing about the pathology in a case that does not matter is its name. Acute abdomens, chest pains, yes, one has to establish which of the tissues are affected and how. But with skin conditions there seems little advantage in finding a term for it in Latin. We swap all the uniqueness and variety our senses can give us, for one dead classification. Certainly, micro-organisms are present. Antibiotics and steroids are the only conventional options anyway.

To say something is stress-related is to say that it is related to the forces at work in the universe. Yes, it is stress-related, but that is not a very meaningful statement.

Natural. Natural like manure, or natural like bottled, transported, packaged, marketed 'spring' water?

But that kind of response helps no one. The customer knows it all anyway. And if we don't respond constructively soon, the situation could deteriorate.


"Of course, my daughter-in-law…"

Yellow alert. Concentrate. You cannot afford to be thinking of how impatient the people behind are getting, your own favourite granny, the overdue tea-break; anything, if you are going to keep this conversation sane. They suspect they are interfering, and it would be easy to suggest gently that they are and have them go away quietly. Or one could collude, sell them some high potency something, and watch the resolute determination with which they leave, while resolutely stuffing the cash in the till.

But what is really going on? Everything's changed so much. The parents are ignoring the rules the grandparents learnt, and constantly alluding to others they never heard of. Everyone is tense, no one is happy, but it seems they never talk about it. The grandparents love the kids; they can't do anything, they can't do nothing. Is there something natural we could try?

Ma'am, I would like to help. Believe me, I would dearly love to help. Everyone in the natural health business has some wound they are vicariously trying to heal. That's why they are there. Much of the time it's like being a grandparent, you can't do anything but let the forces at work in the universe run their course. You can't do anything. Except be there. Which is something.

Sometimes they see what you are offering them. Then strangers meet in a moment of that giving that is also receiving and receiving that is giving. Often they don't. So they get some high potency combinations and salves, and the till rings out. That too has its place.

Sometimes the expert is going to need hours of time to explain what the individual needs to know, but sometimes a friendly person in a shop can convey what a professional role will always obscure. Then there is serious/minor; chronic/ acute; simple/complex; independent/needy.

One might think that the serious/minor classification would yield fairly definite guidelines.

"I'm run-down. What can I try? No, nothing obvious. My life is always stressful. I just thought there might be something simple I could try."

If you see a good professional, open up, and really follow the suggested regime for a few months, you might, just might, see a significant change. That is the truth of it. I realize that you did not really want to hear that. No, I don't think echinacea will do much for you. You will like me more if I keep this to myself and sell you something that would be basically placebo. I hate doing this. But that is my problem and you are the customer. But in a few months time you won't feel any different and may have been put off natural therapies for good.

A big question is how much time do we have and how much inclination to talk to each other? Sorry I can't be of more help. Next?

"The doctor says I have colitis. I thought it might be the liver because the pain is usually on that side. Actually, I am pretty sure it got worse since the reorganization at work, I preferred the old ways. Yes, I love sweets but they make it much worse. The wind can be pretty embarrassing. For some reason it seems to get worse late afternoon."

One can only hope the previous enquirer has left. We can help the next one. We could change his life. Any first-year homeopathy student will have spotted lycopodium by now. The only question is the strength and the follow-ups. And ten different professionals will give ten different answers to that one. Should we hold back from helping?

A formula for defining the limits of self-prescribing remains illusive. And, far more, the limits of assisting in self-prescribing in non-clinical situations. It is as complex as the human condition, of which it is a microcosm. One can study and experience and learn and assimilate, and then meet people here and now as another vulnerable human being. After ten years divided between the counter and the clinic, nothing more definite than that is in sight.


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About Paul Houghton

Paul Houghton took a degree in philosophy at the London School of Economics and followed a career in journalism before training in homeopathy at the London College of Classical Homeopathy (now part of the University of Westminster). He now practises as a homeopath alongside GPs and also works part-time at Ainsworths Homeopathic Pharmacy in London. He can be reached on tel: 020 8743 0446 and

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