Never Well Since.... (NWS)

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CHAT BEGAN AT 21:00 EDT, AUGUST 12, 2009
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Moderator: Welcome, Ann Jerome, Director of the Academy of Classical Homeopathy, with classes in Florida and Philadelphia. Watch for online classes in the future!
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Ann Jerome: Thanks, glad to be here.
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Kristy: Do we know which homeopath first coined the term "Never Been Well Since..."?
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Ann Jerome: That's a really good question, Kristy - I don't know. The concept certainly has been with us since the beginning of homeopathy.
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Kristy: I guess we should say "Never Well Since.... PSORA...
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Ann Jerome: Hmmm, well actually psora is always with us, according to Hahnemann. It's transmitted by touch, so even if we could get rid of it, we'd gain it right back again.
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Kristy: OK, Never Well Since PSORA was suppressed
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Ann Jerome: That's the way! Or since another miasm was suppressed or activated, or since a particular "insult" of some kind... "Never well since" is a very broadly applicable concept.
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Just to explain the groundwork, for anyone who's new to this: sometimes in looking at a whole homeopathic case, we see that there was a moment when that person's health changed, a moment when many symptoms began and became chronic. Often we can find an origin for this change in an illness, a treatment, an event, an experience &ndash; something happened that created the new lower state of health. That would be the "never well since." It helps us understand the person and their individual sensitivities, as different people are affected in this way by different things.
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skyheights: What do you think about the standard recommendation of Thuja for NWS (Never Well Since) a vaccine? Or would you simply repertorize the case as normal?
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sarahjay: I have a similar question. If you have a NWS a particular vaccine, would you recommend starting with the vaccine nosode before a constitutional remedy?
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Ann Jerome: Skyheights, it's a good question because Thuja is so often used routinely this way. There are lots of other remedies that can be indicated, however - the rubric is GENERALITIES; Vaccination, after. Thuja is there in bold, but so is Silica, and there are many other remedies there too. We need to choose the remedy, as always, in light of the case as a whole.
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The problem with using Thuja (or Silica, or a vaccine nosode) routinely in this way is that it's not homeopathy. In homeopathy, we work according to the Law of Similars. Thuja would be the indicated remedy, really, only if the person's picture matched the proving symptoms of Thuja. Otherwise it's a "give this for that" process.
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Sarajay, I've certainly seen the nosode of a vaccine help when the vaccine was suspected as an issue. I've also seen it not help, which either means the vaccine was not the issue, or that the person needs a personalized constitutional remedy instead. What I've seen more commonly is that the vaccine nosode helps but a constitutional remedy is required to finish the case.
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skyheights: So, you would start with Generalities; Vaccination, after, and go with the closest that matches, initially? If that didn't work, then go with a nosode, and then go constitutionally? What do you do?
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Ann Jerome: That&rsquo;s a good summary of the approach I would favor, except that I'd start with that rubric only if (a) it's crystal clear that the vaccine was the culprit and (b) a constitutional remedy is not clear.
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skyheights: Thanks!
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sarahjay: In the case I'm telling about, it was crystal clear. The vaccine nosode helped at first but then seemed to fizzle. A series of constitutionals led to improvement but not complete resolution. A number of issues remain. But it definitely all began with a vaccine.
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Ann Jerome: Vaccine damage can take a long time and many remedies - don't despair, Sarajay. It may be that there are miasmatic issues that need to be addressed, and that's what's blocking the progress.
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Battilocchi: I have a patient whose menses became very late in coming (50 days), and continued this way, after she developed agoraphobia.&nbsp; After counseling, she overcame the agoraphobia, but the periods never went back to normal.&nbsp; How would this be repertorized?&nbsp;&nbsp; Never well since a fright?
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Ann Jerome: Battilocchi, that's an interesting sequence of events! I'm not sure about using "never well since a fright" (in case anyone wants to look it up, the rubric is MIND; Ailments from Fright, or MIND, Fright, Ailments from, depending on your repertory). From what you say I get the impression that she didn't have a particular fright, but that the agoraphobia and the disrupted menses may have been part of the same picture in her. In that case, they are concomitants of each other, two parts of the same remedy picture. In other words, agoraphobia itself is not a fright, but a susceptibility to it &ndash; so we&rsquo;d need to discover what created the susceptibility, and whatever that was could be a &ldquo;Never Well Since.&rdquo;
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skyheights: I guess my question is, how well can we separate an event from a constitution? I have another patient who is NWS his mother committed suicide when he was a teen. In the interim he got married, became a binge-drinker, then divorced. Would you just toss the NWS and go with present, mostly emotional, symptomology?
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Ann Jerome: Really good question. To answer it, we need to look at a bit of homeopathic philosophy - the idea that what we're prescribing for is the person's reaction to the event rather than the event itself. Two people can have the same event in their lives, and their reactions (hence their remedies) can be different. So, using your case as an example, what you'd prescribe on would be how he reacted to his mother's suicide. Was binge drinking a kind of response? That tells you something about him - versus, for instance, others who might react to the same event by withdrawing and becoming loners.
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One of the dangers I see with using the "never well since" concept is that it can lead to mistaken prescribing - specifically, to prescribing based on the precipitating event rather than on the person's response. We have to remind ourselves constantly, because it&rsquo;s so easy to forget: in homeopathy, the remedy is indicated by how the person responds, not by what happened to them. The same thing can happen to several people and each will have their own individual response. It&rsquo;s the individuality that leads us to discover the remedy that can help each person.
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Kristy: If you have a "NWS" patient who does NOT respond to his constitutional remedy after the event, would you look for the next miasmatic layer that might be coming through?
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Ann Jerome: Wow, Kristy - big question. In that case, we might wonder whether the event has caused a kind of layer over the constitutional remedy, such that the layer has to be treated separately before the constitutional will work. Homeopaths in NYC saw this a lot after the 9/11 attacks - they used a lot of Stramonium for the "layer" that many people developed after witnessing the attack, if they went into the Stramonium state. At the same time, there were others who responded in other ways and hence needed other remedies, and there were many who needed their constitutional remedy repeated instead.
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Krishnaonkar: How would you repertorize Never Well Since teething?
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Ann Jerome: I don&rsquo;t know of any rubrics specifically for Never well since teething. You'd have to use the teething rubrics themselves (DENTITION, difficult; or DENTITION, delayed, if that applied) along with rubrics covering whatever the problems have been since teething.
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Kristy: Is there any kind of time frame for choosing to look at a case as Never Well Since?&nbsp; For example, if someone has a bad case of flu, and 4 weeks later, they're still running on 3-1/2 cylinders, is that 'normal' for post flu or is that NWS?
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Ann Jerome: This question helps us understand some of the principles at work when we use this category. Simple answer: no, there's no time frame. More detailed reflection on this: the Never Well Since concept shows us some of the ambiguity between our definitions of "acute" and "chronic." An "acute" (time-limited) ailment can become a "chronic" (lifelong) one if the person is sensitive to it.
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This brings up another important consideration. If this is a really bad flu and most people are still fatigued 4 weeks later, then the fatigue is normal (or common) and you wouldn't use it to prescribe on. Always, always, we prescribe on what is individualizing and characteristic of the person.
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I know of an Arnica case where the injury was over 40 years old. What that means, in a way, is that the person was in an injury-induced Arnica state for all that time. After the Arnica, then her constitutional remedy could work.
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battilocchi: Was the Arnica patient in pain for 40 years?
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Ann Jerome: Yes, he had some pain, but the acute stage of the pain had passed in a normal amount of time and he had adapted to the mild chronic pain so that it was not a big problem for him. What remained was the rest of the Arnica picture: aversion to touch (emotional as well as physical), denial that there was a problem (&ldquo;I&rsquo;m fine, really, I don&rsquo;t need a remedy, except that my wife brought me here&rdquo;) etc.
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Kristy: If one can be stuck in an injury-state for such a long time, doesn&rsquo;t it mean that this ability to be stuck is part of one's constitutional symptom-picture?
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Ann Jerome: Actually, what it means is that constitutionally, the person is especially sensitive to that kind of injury. So they might be constitutionally Arnica, or some other remedy that has an affinity for the soft tissues, as Arnica does.
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skyheights: From an earlier comment, I gather you believe that these NWS events can insert a kind of layer between the pre-NWS-event constitution and the present state? And then successfully prescribing for the NWS event can re-reveal the constitution?
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Ann Jerome: In a way yes, Skyheights - the NWS layer, though, would actually be the present state. In the example of Arnica, for example, what showed was an Arnica picture; it obscured the constitutional picture, so that the latter couldn't be seen until after the Arnica layer had cleared.
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Interestingly, though, the susceptibility to the particular kind of NWS event may be due to the constitution anyway. So for example, someone whose constitution is particularly sensitive to soft tissue problems might have a BIG reaction to a soft tissue injury, bigger than most people's - and hence might develop an Arnica layer as a result of the injury. Or their constitutional state might help to determine how they react to the event, and hence which of the many possible new layers they might acquire.
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skyheights: Are NWS, then in a sense, the same as miasms?
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Ann Jerome: That&rsquo;s really interesting - in a way yes and in a way no. Both a NWS layer and a miasm can get in the way of our success if we don't take them into account - in other words, both can be an "obstacle to cure" that has to be addressed before the case can move forward. But a NWS is usually a single event, where miasms are more complicated - most people have several miasms and they need to be addressed throughout the person's care. A NWS can often be addressed by a single remedy, one time.
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Krishnaonkar: how should one repertorize NWS an amputation in a patient who is still diabetic? What do we focus on, the post-surgery problem or the diabetes?
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Ann Jerome: In my understanding, in the case of an amputee who was diabetic, we might want to consider that we are using homeopathy palliatively for the effects of the amputation. That would mean using the symptoms since the amputation independently of the whole person - in a way, prescribing for just one part of them, which is often what palliative care entails.
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battilocchi: It seems to me that NWS has a big emotional component to it, more so than any physical response, or that the physical response is there purely because of the emotions.&nbsp; Would it be safe to rely on the mental exclusively for this?
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Ann Jerome: It all depends on the center of gravity in the case. NWS can be purely physical - say, in the case of someone who suffers from fatigue for a long time after the flu or mono. But in other cases, NWS can be an emotional or behavioral reaction to an event, as with the 9/11 example.
Something else to remember in applying this concept: there are babies who are NWS birth!
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skyheights: I must agree. I see a lot of patients who are emotionally NWS unfortunate childhood experiences. And they are coming in for treatment for their emotional well-being as opposed to physical ...
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Ann Jerome: Yes, absolutely - the NWS can certainly transcend physical and emotional.
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skyheights: But there are very few rubrics for "Loss of parent" etc ... "Mother was an alcoholic" ... Or from a past life ... an inherited miasm ...
you get the picture ...
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Ann Jerome: Skyheights, you're right - which is part of the challenge of applying the NWS concept. The thing to remember is that we're looking for the person's response rather than for the thing that happened to them, mainly. So we can use rubrics like "Ailments from disappointed love" instead of "Mother was an alcoholic," IF disappointed love is what the person felt as a child. Or maybe instead it would be "Ailments from anger," if anger is what they felt.
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vlinnell: How would you ascertain that it was NWS birth as opposed to having carried through from the pregnancy or that it is actually the baby's constitutional...
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Ann Jerome: Great question - this illustrates both the usefulness and the limits of the NWS concept. Bottom line, we want to find the remedy that fits the person as a whole. The NWS concept is merely a tool for us to understand better their sensitivities and reactions (e.g. are they sensitive to vaccination? to humiliation? to anger? etc - and how do they react to whatever they are sensitive to?) So, to answer your question, we'd look for information, if it were available, about what happened in pregnancy and birth, just as we look for information about the turning points in any case history. What we&rsquo;re looking for is the point where the troubles began.
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Kristy: The media just announced that there is a high percentage of multiple myeloma in the 9/11 first responders. Should a homeopath treat the emotional trauma first, rather than the myeloma? The constitutional might clear up everything, or at least prepare the patient to be more successful with other treatment.
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Ann Jerome: In treating first responders, we'd apply the old principle of "what's most important?" In other words, assess what was most threatening or limiting to the person, and look for that to resolve first, according to Hering's Law. We want to see whatever is most threatening to their wellbeing respond first. Chances are, we'd find a remedy for the first responder that addressed the person's whole being - physically and emotionally - and hence covered their WHOLE reaction to the 9/11 events.
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vlinnell: In the case of the multiple myelomas- since the life expectancy is usually less than 4 years, would you try treating them constitutionally or try using a method such as Dr. Ramakrishnan's Cancer protocol?
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Ann Jerome: Vlinnel, it's hard to answer that question broadly - each individual case would have to be considered on its own.
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skyheights: Thanks, Ann. From now on I'm replacing NWS with NWS Whatever Their Reaction to the Event!
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Ann Jerome: LOL! That's a great idea!!
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Kristy: If a patient is NWS being put on prescription meds for, say hypertension, what's the best we can expect? palliation?
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Ann Jerome: If the meds are medically necessary and the person must continue them, then perhaps yes. If the person is no longer taking the meds, then often the effects can be overcome with either the constitutional remedy or something that addresses the "layer" that the meds may have induced.
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Moderator: Thank you, Ann, for sharing so much good information with us this evening. And thank you, participants!
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Ann Jerome: Thanks, everyone!
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CHAT ENDED AT 22:10 EDT
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