“When the pupil is ready the teacher appears”
It was one consultant in particular who would change the way I saw medicine and myself, forever. Dr. Eric Ledermann had qualified as a doctor in 1932. The very next year, after an unpleasant encounter with the Nazis, he fled Germany for Scotland and managed to drag the rest of his family out in 1939. After re-qualifying as a doctor in Edinburgh, he studied naturopathy and homeopathy intensively. Later he became a psychiatrist and when I met him in 1982 he was a fellow of both the Royal Society of Psychiatrists and the Faculty of Homeopathy. As if all this was not enough, his main area of personal interest in medicine was philosophy of science and medical ethics.
He made me trawl through books on philosophy, psychology as well as many of his own publications. (See www.wholepersonmedicine.co.uk for details of these) This was hard work indeed, but the significance of doing it, was always clear to me. I thought back to second year of medical school where we dissected a dead body six times a week and had to commit long lists of branches of arteries, veins and nerves to memory. At the time, I knew that the punishing detail would neither serve me nor be remembered. Studying philosophy of science with all its jargon (e.g. epistemology, teleology and phenomenology) was tough as writers like Kant and Husserl are not exactly easy reading! Still, I was privileged to be guided through the works of these philosophers, so I didn’t have to read long portions of unintelligible text.
Dr Ledermann was my first mentor as a medical doctor and was as often stern with me as he was totally generous with his time. The main point was that I’d found a teacher whom I could totally respect. It had been a long journey, but there is that old saying: ‘When the pupil is ready, the teacher appears.’
At last I was pushed to ask myself what the doctor-patient relationship was all about. He supervised my cases and by example showed me what stuff a doctor should be made of. Doctors need to have a philosophy when they enter the clinic to see patients. Many doctors would disagree, stating simply that they are guided by ‘common sense’. Ledermann made me laugh by calling this the philosophy of ‘Naïve Realism’!
In the end I found myself most comfortable in the works of the existential philosopher, particularly Karl Jaspers, who was a medical doctor, philosopher and major influence on Ledermann and helped him formulate his own existential approach in psychotherapy.
Dr. Ledermann’s simple existential ethic, which underpins his psychotherapeutic approach, has never left me. Stated simply: All patients have a conscience. Deep within themselves they can distinguish between right and wrong and know what they need to do with their lives. This is axiomatic and the only exceptions are psychopaths. Psychotic patients have a conscience but are obviously limited in their ability to make contact with it. The conscience of the patient is always at least partly unconscious. If it were totally conscious, the patient would know what to do and not consult a psychotherapist! The challenge for a psychotherapist is to help make the unconscious conscience of the patient, conscious. Understanding this was a revelation. The answer to a patient’s problems is already within the patient. What a relief!
This period had profound ramifications on my career as a doctor and homeopath. I began to realise that consultations with patients were not simply a matter of me choosing the correct homeopathic remedy. Sometimes, in consultation, I had felt as if the patient’s job was to empty on to my desk, a whole lot of symptoms in the form of an unformed jigsaw puzzle. It would then become my job to put all the pieces together, see the ‘big picture’ and then prescribe the homeopathic remedy that fitted it. An awesome responsibility for the homeopath and a chance to off-load for the patient. There is nothing inherently wrong with that except that the patient doesn’t have to do much for himself or herself in order to get better. After sitting in on Dr. Ledermann’s clinic for a year, I began to see the whole homeopath-patient relationship in a completely new light. I still felt some pressure to come up with the right remedy, but now I always asked myself two questions during each consultation. ‘What can I do for this person and what can they do for themselves?’ The second question is crucial and empowering for the patient. There is always something a patient can do to help himself or herself. Improve their diet, exercise, relax, meditate, work on relationships etc. etc. Of course, if you have appendicitis or meningitis, surgery and anti-biotics are respectively the usual treatments of choice, but for most people consulting a doctor, there is a something, however small, that they can do for themselves.
A decade or so later, I would find a potent way to motivate patients to do what they needed to do, but I jump ahead of myself…