Cases – a puzzle or a mystery?

I was recently reading about the distinction between a puzzle and a mystery in a piece written by Malcolm Gladwell about Enron. He states that “a puzzle is a situation where you don’t have enough information.  If things go wrong with a puzzle, identifying the culprit is easy: it’s the person who withheld information. Mysteries, though, are a lot murkier: sometimes the information we’ve been given is inadequate, and sometimes we aren’t very smart about making sense of what we’ve been given, and sometimes the question itself cannot be answered. Puzzles come to satisfying conclusions. Mysteries often don’t.”

So let’s take all that and think about case taking and prescribing.  The parallel isn’t precise but I think it can be useful.  So puzzle or mystery?  I think it’s important to understand the distinction in each case before us.  If a case is a puzzle, if we think hard, we often realize that we’re missing a vital piece of information.  Either the patient didn’t volunteer it, or we didn’t ask it.  Whether it’s modalities or particulars – is it better to lie on the painful side or on the painless side, where exactly is the sweating on the body, which comes first – the chill or the perspiration – when these pieces of information are missing, we are faced with a puzzle.  And when we sense that something is missing from our case-taking, we’re faced with an even more complex puzzle, because we need to go over all our case-notes and find what we neglected to ask the patient, what information is missing.

But if the case is a mystery – we’re in a whole other ball park.  We know we asked all the questions.  We know we have all the information.  But the patient isn’t responding to the remedies we’re giving.  Often in such cases we retake the case, over and over again, but no new, dazzling piece of information comes up.  Here it is not the information, it’s how we’re connecting the dots.  What patterns we’re forming in how we view the information we’ve been given.  Maybe we’re putting more stress on recent developments when we’re really facing an old symptom that has morphed into different versions of itself over the years.  Maybe we’re putting more emphasis on physicals and we will only be able to resolve the case using mentals – or vice versa.  Maybe we’re getting bogged down in ancient history, when we should be looking much more closely at current presenting symptoms.

The reason I found this distinction so interesting in its possible application to case-taking and analysis is this: there is a tendency among homeopaths to take down much more information than needed during a case.  I remember during my training that you could always tell students who were finishing first year – they were suffering from constant chronic hand pain from writing down every word in live cases.  (yes, in the olden days not everyone brought a laptop to class, our caves didn’t have electricity sockets… ).  And then our case-taking and analysis is flooded with a tsunami of information – which is just too much.  From looking for a missing piece of information to solve a puzzle, we essentially create a mystery of finding a path through the deluge that is now our case, and trying to keep our heads above water in a sea of case-taking disorder.

I believe that when we begin working with each patient, the case should be viewed as a puzzle.  We want to make sure we have all the information we need to fill the boxes – if a patient perspires we need to know where, when, hot, cold, mental state etc.; we need to know actual facts, where, how much, hard or soft, internal or external, colours, textures.  We need to know presenting symptoms and background.  Prescribing is a function of viewing the relevant facts, examining the provings and literature on a small group of remedies, coming to conclusions.

But if we’re sure of a remedy and it’s not helping, we’re now faced with a mystery.  And as any avid watcher of thrillers knows, often the criminal is found when someone looks at the event board and arranges the facts in a different pattern.