This article was originally written for publication in the Homeopath, the Journal of the Society of Homeopaths. Although it was accepted for publication by the Editor he was subsequently ordered not to publish it by the board.
Professionalism by Peter Fraser
Professionalism is environmental. Amateurism is anti-environmental. Professionalism merges the individual into patterns of total environment. Amateurism seeks the development of the total awareness of the individual and the critical awareness of the groundrules of society. The amateur can afford to lose. The professional tends to classify and to specialize, to accept uncritically the groundrules of the environment. The groundrules provided by the mass response of his colleagues serve as a pervasive environment of which he is contentedly unaware. The "expert" is the man who stays put.
Marshall McLuhan in The Medium is the Massage
In recent years there has been a substantial movement towards developing and establishing standards of professionalism for lay homopaths who would now like to be referred to as "professional homopaths". This movement has been spearheaded by the Society of Homeopaths, but it has been an objective of almost all the organizations, schools and individuals involved in homopathy. It pervades all aspects of modern homopathy, including registration, supervision, education and research. However, the idea that professionalism only enhances homopathy seems to have been accepted by organizations and individuals without any sort of critical examination.
There are three aspects to be looked at in evaluating an activity such as the pursuit of professional recognition. The first is what is to be gained; the second is the chance of success and the third is what has to be sacrificed.
The first of these aspects is the pretty obvious advantages of professional status and the financial rewards that professional status gives to those that have it. If homopaths are regarded as medical professionals they will have the respect given to doctors and will be able to earn substantial fees from the NHS and from private health insurers. Even though many health professionals are not as well paid nor respected as they should be and the NHS might be close to complete collapse, there is still much to be said for this. A decent income and acknowledgment of our skills and dedication are not to be sneezed at.
The second aspect is more variable and depends on the other two. Small sacrifices are often worthwhile and if the rewards are great or the chance of success is high then even large sacrifices need to be considered. The reversibility of these sacrifices is also an important consideration. In our situation the chance of reversing things, of moving back from the strictures of state regulation to the freedoms of common law rights, is virtually non-existent: the sacrifices we make are permanent and even if we gain nothing from them we still pay the cost.
The chances of success in achieving status and financial advantages are not great. Homopathy is based on a completely different paradigm from conventional science. We are not going to be able to change the structures of knowledge and thinking that underpin the worlds of science, commerce and government. Yet without such change it is not possible for homopathy to be truly accepted, let alone respected. The overwhelming view of homopaths held by those with power is, at best, one of well meaning new age kooks peddling expensive placebo. There are individuals who have been convinced and many more that are happy to be polite when it costs nothing, but this does not alter the distrust and disbelief that is the norm. Financially homopathy appears to have little to offer the medical industrial complex, there are no great profits for anyone, no patents to be had, and no showy statistics to offer an electorate. Both our way of working and our results are energetic and subtle.
The most important factor to be considered however, is undoubtedly the third, the sacrifices that homopathy will have to make in order to achieve professional status. These sacrifices have not been carefully examined, yet they are already being made.
Just as homopathy is subtle and employs the minimum dose, so many of these changes are subtle and of minimum apparent importance yet the effect can be enormous and felt throughout the practice of homopathy.
An example of this is the diphthong. Homopathy is a discipline built on its own history and an understanding of its past. The language we use, like the common language we observe in our patients, has meaning and significance. We are an archaic science, we build on our past without the need to destroy it. This is our strength and connections to our history are valuable. The need to be modern, to appear not to be archaic, means not only that organizations have accepted the incorrect spelling but they have forced it upon others. The use of the diphthong will have been removed from this article and in the last Homeopath even the spelling of the title of Julian Winston's book was changed in his letter on the subject. In a profession diversity is unacceptable and uniformity is forced on all its members. The diphthong is a small sign of the way pressures to be modern and scientific are forced on us at the expense of our philosophy and effectiveness.
A more obviously important example is vaccination. The Society currently espouses a very noncommittal stance that in no way reflects the opinion of the overwhelming majority of its members. The argument goes that only if we accept vaccination, and probably only if we support it, will homopathy be accepted into the fold of professional medicine. I am sure that I am not the only person who finds this tactic hypocritical and distasteful. It also brings into question what other views will need to be suppressed. The whole philosophy of homopathy is directly opposed to many aspects of conventional medicine. What is the future for principles such as suppression, holism and Hering's Laws which do not fit the current medical model?
The principles of homopathy have also been forced into retreat in the Society's register. Where once they had pride of place on the back cover they have been replaced by a commercial advertisement that uses the images of allopathic medicines and money. The principles are relegated to the inside, they are not enforced and are now threatened with removal. That this is happening now is not a coincidence but the direct result of the move towards professionalism. A profession needs to have a single well defined structure, it cannot accommodate a variety of different or opposing views. The result is that such a structure will be built around a level of mediocrity. It is not practical to demand standards that are not acceptable to virtually all practitioners. The problem is that a profession takes responsibility for all its members. At the moment it is possible to say that anybody can practise and some who do are not very good, each homopath is judged on his or her own merit. In a professionally registered situation the entire profession is judged as a whole and the reputation of that whole is gauged by the effectiveness of its weakest members. The problems in public confidence being experienced by the medical profession come not from the thousands of brilliant surgeons and physicians but from the handful of Ledwards and Shipmans.
The oft cited reason why homopaths need to be regulated and controlled is for public safety. Although homopathic remedies can do harm, it is not easy to do so and it is not something that conventional medicine admits anyway. We are not in the position of bodyworkers or acupuncturists who can cause physical damage, or of TCM practitioners and herbalists who use potentially toxic agents. The argument goes that incompetent practitioners will not identify diseases and will not send patients for conventional treatment until it is too late. Some homopaths want to act as primary carers for their patients and feel that they are in a position to decide when others should be consulted. One of the main arguments for professional registration is that it will show homopaths are competent to do this. This is totally unnecessary because in our culture we are not the sole primary carers. All my patients have at the very least a GP, most have a psychotherapist, several consultants and several other alternative practitioners as well. In a society with public healthcare, homopaths do not need to take on non-homopathic roles. It is also ridiculous to believe that the trivial amount of conventional medicine taught to homopaths is adequate for the role of primary carer. If a person would like the role of primary conventional practitioner as well as that of homopath they should do the proper seven odd years of training and get the qualification. If by moving down the path of professionalization we are saying that we claim this role, future authorities will be perfectly justified in demanding that homopaths gain full medical qualifications first.
As Marshall McLuhan points out there are substantial differences between amateur and professional approaches. The word amateur has connotations of inferiority and a lack of commitment but in this context it is being used as the antithesis to professional. It encompasses the concepts of unstructured as opposed to structured, individual as opposed to uniform, general as opposed to specialized and critical as opposed to conforming.
A professional structure has enormous constraints on it. "The amateur can afford to lose"; a profession cannot. The amateur can make mistakes but a profession, as a whole, cannot. As individuals will always make mistakes, a profession has to be structured so mistakes will be minimized. This involves specialization, so that the professional will know as much as possible, even if it is about a restricted field. It also involves tactics that have the least chance of failure, even if the chances of exceptional success are also limited.
This is not how classical homopathy works. Classical homopaths are generalists, they take a holistic view of their patients and need to be able to understand all aspects of disease, physical and emotional. Even the most experienced practitioner cannot guarantee that he or she can choose the right remedy. In conventional medicine there are protocols to follow in every situation and following them will on the whole bring the best chance of success. To do this with homopathy you cannot use a classical approach, protocols can only be used with a practical approach where specific remedies are indicated for specific diseases. This is why professional homopathy eventually becomes practical, or even allopathic, and this is why the principles have disappeared from the back of the register.
The way in which homopathy is moving away from the classical model has been noted by many people. The issues of materia medica and philosophy were both raised in the last issue of the Homeopath. In these areas syntheses that are professional, acceptable, interpreted and secondary are replacing an individual interpretation from first principles, primary sources and raw data. Many, though not all, recognize that this is ultimately bad for homopathy; few however, recognize that this is an unavoidable consequence of a move towards professionalization.
Research, education and supervision are similarly affected. Professional research has to be absolutely certain. Double blind and placebo controlled techniques have to be used to achieve this certainty. These techniques provide that certainty but they lose the information that is not distinct enough to prove with certainty. A professional approach to proving remedies will produce all those symptoms that are definitely part of the proving picture but they will fail to produce a far greater number which might be. These possible symptoms can be used in a holistic approach where anomalies will stand out, they cannot be used in a protocol based system. A professional approach that will only accept information from conventionally designed trials is already permeating homopathy and truly useful information, which may come from diverse sources and disciplines with varying degrees of reliability, is deemed unacceptable. In education, professional homopaths must learn from a structured and restrictive plan and they must all learn all of the things that are taught. It is no longer acceptable to teach things that some students might never fully comprehend and it is not acceptable for students to push themselves and sometimes to fail. In supervision a simplistic model based on that used in psychotherapy has been adopted because it is safe and straightforward. The homopathic model would be far more complicated and might sometimes go wrong. In all these areas certainty and mediocrity have replaced risk and the possibility of genius.
The strengths of homopathy lie in those things that are the antithesis to professionalism: individuality, archaism, holism, risk-taking, generalism, understanding and awareness. To professionalize it is to treat it allopathically and so to cause serious damage. To treat it homopathically is to amateurize it. This may not sound very nice, but we should remember that the remedies we give are precisely those things that are poisonous in the hands of others.