Georg Ivanovas From Autism to Humanism - systems theory in medicine
Towards 1835 Hahnemann described two kinds of diseases. The first, the acute disease, is a simple disturbance of regulation. It is self-limiting, leads to death, to a residual state or to complete recovery. The second kind of disease, the chronic disease, has never the tendency to become better spontaneously, even if it vanishes for a while. On the occasion another disease or a mental stress it ‘awakens’ again and continues its development (Hahnemann 1835: 62). The disease is not bound to certain characteristic symptoms. It is more a continuing decline of vitality in different forms. In such a disease the first interventions might be helpful, but therapies become less effective each time (Hahnemann 1835: 4). Hahnemann called these chronic states miasms meaning something like "taint" or "contamination".
His concept of chronic disease says in short that
- all chronic disease is contagious,
- starts with a representation on the skin,
- spreads if the first signs are suppressed,
- acquired chronic diseases can be inherited
The first point, the infectious origin of chronic diseases, became a central topic lately under the header of 'germ theory' (chap. 4.3). Also the fourth point, the importance of epigenetics for health and diseases is slowly acknowledged (chap. 4.3). The importance of the third point, the concept of suppression will later be discussed in detail (chap. 6.8). Only Hahnemann’s second point, the skin representation, is not supported by current knowledge. In any case, it would be misleading to try to translate Hahnemann’s concept 1:1 into modern terms. In order to understand whether and/or in how far older observations are reasonable for a better medical epistemology, the whole context has to be analysed appropriately.
The homeopathic paradigm for a chronic disease is syphilis. As already mentioned (chap. 2.2), Hahnemann maintained that during his more than 50 years of practice he never saw syphilis stadium II or III if the initial lesion, the chancre remains untouched. On the other side the chancre has no tendency to go away spontaneously and might even last for years (Hahnemann 1835: 110). He saw the main cause for the progression of the disease in the local ‘treatments’ of the chancre. Disturbing the local equilibrium, as we would say today, was in his opinion disastrous. Even cutting the chancre off, sometimes performed in his time, never prevented the further progression of syphilis (Hahnemann 1835: 120). It might be theorized that the chancre represents a local mechanism, a first line of defence of the immune system against the invading Treponaemae, such that its disturbance of this first line of defence leads to the spread of the germs. Although this is a decidable question, it is of no further relevance in times of an effective antibiotic therapy.
The more general question as important as to Hahnemann’s times is, in how far a local treatment of a disease might lead to its chronification. There are a lot of examples supporting this view. The interference with inner rhythms (chap. 5.3.b) has been cited earlier, also the example of the identified patient maintaining the balance of the family (chap. 5.2). Others will be discussed later (chap. 6.8). Again, systemic psychotherapy provided a related meta - theory demonstrating how the interference with local symptoms might lead to the decline of the stability of the whole system (family). These principles are, to a certain extend, applicable to the human regulation in general.