Hahnemann uses the concept of Gestalt at key points in his writings, interestingly like a premonition in a direction that was developed over 100 years later by Ehrenfels, Wertheimer and Kafka, which is why a theoretical-conceptual reappraisal from this perspective seems helpful.
Recognition of disease (Org. §§ 5-18)
§ 6 - "The unprejudiced observer, - knowing the futility of supersensible inquiries which cannot be proved by experience, - perceives, even if he is the most acute, nothing in every single disease but changes in the condition of the body and soul which are externally recognisable by the senses, signs of disease, coincidences, symptoms, that is, deviations from the healthy, former state of the now sick person, which he himself feels, which those around him perceive in him, and which the physician observes in him. All these perceptible signs represent the disease in its entirety, i.e., together they form the true and only conceivable form of the disease [author's mark]." (Hahnemann, 2017, after the 6th edition by R. Haehl 1921; author's translation with linguistic smoothing]
Case recording (Org. §§ 82-104)
§91 - "The accidents and the condition of the patient, during any previous use of medicines, do not give the pure picture of the disease; those symptoms and complaints, however, which he suffered before the use of the medicines or after their exposure for several days, give the true basic concept of the original form of the disease [author's mark], and the physician must record these in particular.
He may also, if the disease is protracted, leave the patient for a few days without any medicine at all, if he has hitherto taken medicine, or give him something unmedicated, and till then postpone the more exact examination of the signs of the disease, in order to comprehend the permanent, unmixed symptoms of the old malady in their purity, and afterwards to be able to form an unmistakable picture of the disease."
§ 92 - "If, however, it is a rapidly progressing disease, and its urgent state suffers no delay, the physician must be content with the state of the disease as modified even by the medicines, if he cannot learn the symptoms noticed before the use of the medicine, - in order at least to discover the present form [author's mark] of the malady, that is, the medicinal disease united with the original disease, which is usually more considerable and more dangerous than the original due to the often inappropriate remedies, and therefore often urgently requires an expedient remedy, into an overall picture and, so that the patient does not die from the harmful remedy taken, can be defeated with a suitable homoeopathic remedy."
(Hahnemann, 2017, after the 6th edition by R. Haehl 1921; author's translation with linguistic smoothing]
Drug research (Org. §§ 105-145)
§119 - "As certainly as every plant species is different from every other plant species and genus in its external form, in its own way of life and growth [author's mark], in its flavour and smell, as certainly as every mineral and every salt is different from the other in its external as well as internal physical and chemical properties (which alone should have prevented all confusion), so certainly they are all different and divergent from one another in their pathogenic - and thus also curative - effects (§ 145).
Each of these substances acts in its own, different, but definite way, which forbids all confusion, and produces changes in the state of health and well-being of people (§ 146)."
(Hahnemann, 2017, after the 6th edition by R. Haehl 1921; author's translation with linguistic smoothing]
The ideas behind these statements are far-reaching and entirely compatible with the basic theorems of Gestalt theory. This essentially includes the following hypotheses:
- Emergence property , the unmistakable individual peculiarity of a form, homeopathically by recognising the characteristic reaction pattern always as a coherent whole
- Summation theorem, the incompatibility of the perception of form through the simple addition of partial properties - the form is more and something other than the sum of its parts - which is worked out homeopathically via the individualisation of the disorder/disease
- Parallelism, a meaningful correlation between forms is systematically worked out - the condition is concrete parallelism according to the principle of structural relationship - homeopathically illustrated by the similarity between disease symptoms and drug reactions
- Transportability means the testable transferability of the Gestalt properties, homeopathically via the monitoring of the drug reaction in the specific case of treatment
Summary of Hahnemann's concept of Gestalt
The epistemological analysis of the Organon excerpts thus results from a Gestalt-theoretical perspective:
- Hahnemann describes the basic understanding of disease as follows: symptom patterns of disorders and diseases, all perceptible and observable phenomena, "...recognisable changes in the state of the body and soul, signs of illness, coincidences, symptoms..." are deviations from the previous "healthy" state. These changes in themselves form a Gestalt that must be recognised in its entirety.
- If significant changes in the symptom pattern have occurred as a result of taking medication, and if the phenomenological appearance is distorted or blurred, the aim is to achieve an approximation of the actual condition by discontinuing (or reducing) the medication in order to reproduce the actual symptom pattern in its composition and weighting, the original Gestalt, as accurately as possible.
- However, Hahnemann mentions an ethical restriction: In acute or threatening cases, where this approach is not possible, the current condition that has arisen as a result of the initial treatment should be analysed as the mixture of symptoms of the disease and the effect of the remedy, as an introduction to the case.
- Similarly, the specific remedy reactions of plant-based and mineral substances from which medicines are derived are also understood and described - through their manifestations and compositions, and thus in their unmistakable individual effects - as a remedy-specific Gestalt.
Change of Gestalt and Disease
From this derivation it is easy to understand that, from a homeopathic perspective, illness is understood as a complex regulatory disorder.
Changes and shifts in the patient's symptom picture, e.g. a headache symptom disappears and a chronic intestinal inflammation develops, are therefore analysed as belonging together in the sense of such an understanding of the process and are not regarded as separate entities that are passed on from specialist to specialist and should be diagnosed and treated independently of each other.
The restriction to a reductionist model of health and disease, which breaks down the patient into reparable units, appears against this background to be an unnecessary and scientifically unnecessary restriction.
This is also reflected in the research approaches of psychosomatics and psycho-neuro-immuno-endocrinology as well as in the fundamental work on the bio-psychosocial model, which scientifically work out the comprehensive interactions of the organism with the environment as a whole and the importance of a regulative understanding of disease processes, thus paradigmatically emphasising the transition to a complex understanding of health and disease (see above).
Significance for Practice
Such a comprehensive and in-depth understanding of illness requires comprehensive medical and psychological knowledge, basic knowledge of phenomenological concepts and detailed skills in using the homeopathic analysis tools[1] as well as a broad view of the patient's circumstances and living conditions. Together, they form the basis of holistic, individualised treatment.
Special training in interviewing and professional case documentation is also required (see above).
Change of Gestalt and Vicariation
The change of Gestalt (metaschematism[2] ) and the concept of vicariation (replacment symptom) are anchored in Hahnemann's thinking as an empirically derived concept and described in the Organon of Medicine in paragraphs §201 - §203[3]. (Hahnemann, 2017 based on the 6th edition by R. Haehl from 1921 [4]; author’s translation)
§ 201
"Obviously the human vital force, when it is burdened with a chronic disease which it cannot overcome by its own forces, decides (instinctively) to form a local symptomatology on some external part, merely for the purpose of, by making and keeping ill this external part, which is not indispensable to the life of man, to allay that internal disease which also threatens to destroy the vital organs and to rob life, and, so to speak, to transfer it to a representative local symptomatology, to divert it there, as it were. In this way, the presence of the local symptomatology silences the inner illness before the hand, without, however, being able to either cure it or substantially reduce it*. However, the local symptomatology always remains nothing more than a part of the whole disease, but a part of it, unilaterally enlarged by the organic vital force, transferred to a safer (external) part of the body in order to appease the inner suffering. But, as I have said, by this local symptomatology, which silences the inner disease, so little is gained on the part of the vital force for the reduction or cure of the entire inner disease that, on the contrary, the inner suffering gradually increases and nature is compelled to increase and aggravate the local symptomatology more and more, so that it may still suffice as a substitute for the inner, intensified inner disease and for its palliation. The old thigh ulcers worsen when the internal psora[5] is not cured, the chancre increases when the internal syphilis is not yet cured, and the genital warts multiply and grow as long as the sycosis is not cured, making the latter more and more difficult and harder to cure, just as the overall internal disease grows by itself over time."
* The fontanelles of the old school of physicians do something similar; as artificial ulcers on the external parts, they soothe several internal chronic diseases, but only for a very short time (as long as they still cause an unaccustomed painful stimulus to the sick organism) without being able to cure them, but on the other hand they weaken and spoil the whole state of health far more than the instinctive life force does through most of its organised metastases.
§ 202
"If the physician of the previous school, in the opinion that he thereby cures the whole disease, locally destroys the local symptom by external means, nature replaces it by awakening the inner suffering and the other symptoms that previously existed alongside the local evil and were still dormant, that is, by increasing the inner disease - in which case it is then incorrect to say that the local symptomatology has been driven back into the body or onto the nerves by the external means."
§ 203
"Every external treatment of such local symptoms, in order to remove them from the surface of the body without having cured the internal miasmatic[6] disease, i.e. to eradicate the scabies rash from the skin with all kinds of ointments, to "pickle away" the chancre externally and to destroy the condyloma solely by cutting it away, tying it off or applying red-hot iron to its site. This hitherto so common, external, pernicious treatment has become the most frequent source... of the innumerable, named and unnamed, chronic ailments about which mankind so generally sighs. It is one of the most criminal acts of which the medical profession could be guilty, and yet it has hitherto been the one generally adopted and taught as the only one by the catheters[7] .
*For whatever medicines were to be administered internally merely served to aggravate the symptoms, since these remedies had no specific healing power for the totality of the disease, but attacked the organism, weakened it and added other chronic medicinal diseases to it."
Organon Analysis: Change of Gestalt & Vicariation
Hahnemann draws up a sketch that defines the following principles:
- Hierarchisation principle: in chronic diseases, the peripheral symptom stabilises the flow balance and reduces the risk of progression of internal diseases.
- Holistic thinking: The localised partial treatment of peripheral symptoms as separate entities generally promotes the progression of a chronic disease as a whole, even if it does not become apparent immediately but only over time.
- Concept of suppression: If peripheral symptoms are locally inhibited or made to disappear by strong therapeutic measures, the condition as a whole worsens over time and the internal disease becomes more pronounced with more and different symptoms. However, a directly recognisable causal relationship does not necessarily exist over time, as the internal disease (in the sense of a systemic disorder) is already present when local symptoms develop.
- The harmful effects of the therapy (adverse drug reactions - ADRs) can also occur and complicate the treatment.
- Change of Gestalt Change: The newly occurring symptoms show a changed symptom pattern and can be varied in their localisation and expression.
Summary
The Change of Gestalt follows the constant interaction of all regulations of the organism involved in the disorder or disease and describes the continuous reorganisation of the flow equilibrium under the given autoregulatory conditions, to the optimum achievable at the respective point in time, summarised as homeodynamics.
From this perspective, the development of a disorder or illness can lead to a change or shift in symptoms at the transitions between different stages or phases of a disorder or illness. Detecting these phase transitions is therefore of particular diagnostic relevance.
A special feature here is the concept of vicariation (lat. vicarius vicarious). It states that partial treatment of complex disorders or simply the localised alleviation of symptoms of a disease through a specific medication leads or can lead to an autoregulatory transformation or shift of the symptom pattern to a different focus, with intensification of existing symptoms or the appearance of new ones. These changes can be accompanied by a worsening of the overall condition.
Hahnemann describes these observations as empirical deductions from the analysis of a large number of case histories in the first volume of chronic diseases (Hahnemann, 1979, p. 20 ff.) , in which numerous such courses are illustrated.
Analogous to the findings of the local treatment of syphilis, as a chronic disease of his time, and the experiences from the homeopathic treatment of acute epidemics and chronic conditions, Hahnemann formulated the significance of inadequate partial treatments as factors that generally aggravate the disease.
Such a way of thinking was immensely revolutionary for Hahnemann's time and the following generations and therefore met with considerable resistance, which from the beginning of the history of homeopathy initiated an ongoing paradigm dispute - in Kuhn's sense (insert link).
The basis for Hahnemann's postulates is the Gestalt understanding of the symptom pattern as a feature of complex autoregulation, which cancels or negates a monocausal relationship between isolable causes of disease and different groups of symptoms, as well as moral-ethical, religious or purely mechanistic-corpuscular ideas of the causes of disease.
This extremely far-sighted outlook was difficult to formulate linguistically in Hahnemann's time. The scientific basis for this has only gradually emerged since the late 20th century up to the present day and there are still numerous unanswered questions. A comprehensive scientific basis with a suitable vocabulary for this can currently be found in the approaches of systems theory. (Bertalanffy, 1969).
It is understandable why, over the course of two centuries of medical and homeopathic history, many alternative theoretical superstructures can be traced back to the present day, which have been implemented or appended by numerous authors on a trial basis in order to create a theoretical model for homeopathy. These can be understood as epochal attempts at explanation and assigned to their time.
From both an epistemological and a scientific-theoretical perspective, the paradigmatic polarisation and division on homeopathy, which continues to this day and is actively pursued, appears artificial and superfluous against this background.
[1] This includes comprehensive knowledge of repertories as well as practical instruction in the correct use of Materia Medica.
[2] Metaschematism, Greek since antiquity, the term means shape-shifting - remodelling of any kind, especially in medicine as an internal change in diseases (Ritter & Gründer, 1980, p. 1299).
[3] A detailed treatise on this topic can also be found in the work of A. Matner, which - being a philosophical dissertation -serves up some rather heavy fare for the reader (Matner & Hahnemann, 2022).
[4] Linguistic smoothing by the author, in particular the term "local malaise" (German: “Lokal-Übel”) was replaced with "local symptoms" and "internal malaise" (German: “innere Übel”) with "internal disease.
[5] The term “Psora” is an artificial definition which describes the process of increased systemic disease symptoms as a result of the topical treatment of skin symptoms, e.g. the symptom shift of neurodermatitis towards asthma or psoriatic arthritis after intensive local treatment of the skin symptoms. Hahnemann analogised this concept to the medical findings on syphilis of his time. The process of symptom shift is thus understood pathologically as a primarily infectious process and at the same time generalised from a phenomenological perspective to all symptoms of disease.
[6] From a pathological point of view, Hahnemann meant chronic infections and from a phenomenological-regulatory point of view, all disease manifestations of related symptom patterns. The distinction was not diagnostically possible at the time and was therefore treated linguistically synonymously as one
[7] This refers to the desks in the lecture theatres of medical universities
Sources and references
- Bertalanffy, L. von. (1969). General system theory: Foundations, development, applications. Braziller.
- Hahnemann, S. (1979). Die chronischen Krankheiten, ihre eigenthümliche Natur und homöpathische Heilung. (Unchanged 5th reprint of the last edition with introduction by Will Klunker, vol. 1). Haug.
- Hahnemann, S. (2017). Organon der Heilkunst (6. Aufl.). Hahnemann Institut für homöopathische Dokumentation. https://archive.org/details/organon-der-heilkunst
- Matner, A., & Hahnemann, S. (with Europa-Universität Viadrina Frankfurt (Oder)). (2022). Das Denken der Homöopathie: Samuel Hahnemanns Lehre vom lokalen Stellvertretersymptom: ihre Bedeutung für die Klassische Homöopathie und die Anthroposophische Medizin: eine ideengeschichtliche Studie zu den Grundlagen einer hermetisch-hermeneutischen Medizin. KVC Verlag.
- Ritter, J., & Gründer, K. (Hrsg.). (1980). Historisches Wörterbuch der Philosophie: vol. 5: L-Mn. Schwabe.
Authors: glt | Rev.: gbh, mnr, sfm, smi | Ed.: pz | last modified May 17, 2025