Praxis: Method of Complexity - The Search of Coherence in Clinical Phenomena (2 Volume Set)

Review

This book review is reprinted from Volume 2, 2010 Edition of Spectrum of Homeopathy with permission from Narayana Publishers .

Reviewed by Richard Moskowitz

Building on Hahnemannian principles, Massimo Mangialavori presents a complete methodology for homeopathic medicine, in which he offers a new approach to epistemology, literature, research, case-taking and analysis. The method incorporates concepts from various humanities and from the natural and social sciences. Volume one explains Mangialavori's methodolgy in detail; Volume two serves as a materia medica of the homeopathic Drug family, while demonstrating the application of the method.

Massimo Mangialavori's latest work is valuable medicine for all homeopaths. Simply reviewing it has already enriched and sharpened my practice. It is written perceptively, with careful attention to detail, yet never loses sight of the "big picture", and it requires a comparable intelligence on the part of the reader. Most of all, it is a philosophy, beginning with the basics, and reshaping them according to the needs of our own time, in a way that makes logical and practical sense.

Its subtitle, "The Search for Coherence in Clinical Phenomena", is its guiding purpose: to find a deeper, more meaningful similitude between remedy and patient than any list of unrelated symptoms in a Repertory can provide, such that its various symptom-elements fit into and indeed are derived from a coherent whole; indeed, the "essence" that Kent and Vithoulkas sought, and that Scholten and Sankaran are now seeking. It is Massimo's way of discovering that unity and of describing and understanding it once found, that is uniquely his own.

His "Method of Complexity" is so named because it includes anthropology and folk medicine, physiology, biochemistry, toxicology, classical homeopathy, and the art of clinical medicine, which ties them all together and arises from acquaintance with human nature more than book learning. Massimo differs from other teachers chiefly in this multi-systems approach, his quest for resonance and corroboration on so many levels, and his insistence that no one method of case-taking or remedy study will cover every case, that homeopathy is an art to be experienced anew with every case, and is never complete.

His first great heresy is that provings are not the best source for materia medica study, because they yield vast amounts of information, in long lists of detailed symptoms, whereas what the student needs to know is how important these symptoms are for prescribing the remedy. Reliable remedy information adequate for prescribing thus requires some system for organizing and prioritizing data. Massimo prefers cured cases, because they alone provide the richness and context that allow us to see the whole of the remedy in the whole of the patient, to connect the threads that led him to prescribe it, and to grasp the analogy with other patients needing the same remedy. These connections he calls "themes", and from them, rather than disembodied symptoms, he builds his materia medica.

Themes emerging from cured cases also provide the ideal framework for organizing the symptom-data that provings generate, which then in turn can be used to confirm, refute, or modify the themes. Materia medica study is thus an ongoing process of integration, not a rote memory exercise. The result is a rewriting and re-organizing of the Repertory itself on thematic grounds, a monumental task that will require the collaborative efforts of a whole generation of dedicated homeopaths.

"Characteristic" themes, while distinctive of the remedy and often present, are not always so because they are limited to certain stages in its evolution, like acute inflammation for Belladonna, which occurs mainly in childhood, or to opposite polarities, depending on whether the patient is in a compensated or decompensated state. "Fundamental" themes are "essential, structural components of the remedy", "nearly always present", and provide the ultimate basis of its similitude. Thus the theme of "Isolation" in Camphora turns out to be fundamental to all the "Drug" remedies, while "Sensitivity to cold", its famous keynote, is characteristic of only its most decompensated cases: a typical compensated patient might actually defy the cold. This kind of nitty-gritty scholarship is everywhere in the book, and is a thing of beauty. His elucidation of themes is masterful and easy to grasp, although it makes their actual discovery look easier than it is.

His concept of the Homeopathic Family is uniquely his own. Scholten and Sankaran identify remedy "families" taxonomically, whereas Massimo's approach, based on shared fundamental themes, begins with a polycrest as the best-known remedy of a biological or chemical group, like Lachesis for the snakes, and identifies common themes in others taxonomically related to it. He then adds other remedies with the same themes but different taxonomy, often "small" and unfamiliar, i. e., underrepresented in the literature.

In Volume II, I marvel at how he induces his patients to confide in him as they do. The Method of Complexity aims to identify the patient's basic adaptive strategies, often exhibited in physical symptoms no less than mental, so that the distinction between them evaporates. The emphasis is on facilitating a free-flowing narrative, tolerating the silences, trusting the essence to reveal itself spontaneously, without trying to force it in a certain direction; and recognizing the theme there, without having to amass as much data as possible.

The cases are beautifully presented and are gems of materia medica writing. Each remedy is introduced with a brief scholarly essay on natural history, folk medicine, pharmacology, toxicology, and homeopathic characteristics, so the narratives emerge from this background. Many conclude with commentary by Dr. Giovanni Marotta, Massimo's long-time mentor, collaborator, and friend, almost an alter ego, whose more reflective style is nevertheless so perfectly attuned to the method which they created and developed together that it adds further richness and in no way detracts or distracts from the whole.

I have no doubt that this work will change how homeopathy is taught and practiced, both now and in future.

This book review is reprinted from Volume 23, Autumn 2010 edition, with permission from Homeopathic Links.

Reviewed by Bill Gray, USA

Every serious practitioner, whether novice or experienced, should read and deeply ponder Massimo Mangialavori's longawaited "Praxis". If Samuel Hahnemann was the Renaissance medical thinker of his age when he brought out the foundationcreating "Organon", Massimo (as he is commonly known) is the counterpart of this age.

Homeopathy is a science grounded in solid principles that progressed beyond even those of modern sciences like chemistry or physics or pathophysiology. Nevertheless, science itself has evolved into new realms - consider modern psychology or anthropology or even quantum mechanics and cosmology. Inspired by the spirit of Hahnemannian inquiry, modern homeopathy embraces all these fields as we deepen our understanding of remedies, families, and patients.

Massimo has always had a deep appreciation for philosophy and medical anthropologyand has been further expanded byepistemology, modern psychology, and computer tools, as well as creative and practical use of analogical thinking. In Praxis, he systematically and thoughtfully examines the foundations of homeopathic methodology, praising its strengths and challenging its flaws. Finally he presents principles and criteria for creating the methodology of the future. Each paragraph and each sentence are laden with profound thinking and deserve the same meditative approach for readers that we applied to the Organon.

In early chapters, Massimo considers in detail the bases of our science in provings, repertories, and the use of rubrics. He values the genius of Hahnemann's contribution in his time but points to the value of computers in helping us analyze cases much more effectively if we simultaneously appreciate the limitations of rubrics over the lively and dynamic descriptions offered by patients.

In discussing remedies, the starting perception is that every substance has a "strategy" of being in the world that is unique to it, has identifiable themes discoverable through cured cases, and even has some aspects shared by others in the same family. He develops this concept in a profound way. Moreover, Massimo elucidates how we can use this perspective to discover the "strategy" of remedies not yet known or fully fleshed out. We can use information from medical anthropology, historical uses, toxicology, etc., in the same way Hahnemann did but with broader focus.

Massimo then launches into the value of Families, how some polychrest images are archetypes of themes that can be seen in more detail in many other remedies. He defines different types of themes that I believe will become common distinctions we will make in our case analyses as our profession gains in sophistication.

An emphasis I personally value are the sections on case-taking. Massimo makes an important point of creating a "therapeutic field" in which the deepest experiences of the patient can be expressed. It is clear he is not merely cataloguing keynotes or rubrics but rather discerning the deeper inner story or "strategy".

Massimo makes a very important point when he sets criteria for what we as a profession need as a standard for the threshold of believing we have a true image of a remedy. Length of time of cure is significant, of course, but he very soundly insists that we
 

Book Reviews - HomCEopathic Links Autumn 2010, Vol. 23: 185 - 186 <i) Thieme Medical and Scientific Publishers Privote Ltd.

should also have cured cases of both genders, adults as well as children, and even animals in order to be complete. These criteria escape the trap we often find ourselves in by carrying a stereotype that views a remedy as "male" or "female", or not including its evolution from childhood.

Chapter Seven in Volume I is a truly ground-breaking chapter that renders modern psychology relevant to homeopathy. We all use these principles in practice at least casually. Massimo goes further by illustrating how these basic truths can be defined concisely and then applied to our understanding of the dynamic in each patient, as well as how this relates to remedy types. By being more precise and careful in our evaluations of patients, we gain better insights and make deeper prescriptions.

The entire presentation Massimo calls the "Method of Complexity". His perspective on this is very useful to us. Homeopathy is not a matter of matching data points or even keynotes - or even mere patterns. It is a matter of grasping dynamic processes that are completely true to life. This complexity is not so difficult or abstract as to be unreachable with reliability. There are principles that can be understood and followed, and Massimo does a brilliant job of making this clear.

If we had only Volume I, we could easily end up saying, "This is all well and good intellectually, but I need something practicaL" Volume II is the answer to that. It is purely clinical and illustrates principles described in Volume I. Moreover, it illustrates part of the fascinating family of drug remedies. The cured cases illustrate in depth the full subtlety of Anhalonium lewinii, Psilocybe caerulescens, Agaricus muscarius, Bovista lycoperdon, Convolvulus duartinus, and Nabalus serpenteria. In doing so, he shows how Family themes can be differentiated from individual themes. They also illustrate tellingly the value of modern psychological thinking in understanding remedies.

In summary, these books deserve full and contemplative attention. As practitioners, we need a solid foundation of thinking to keep us grounded in consistent and reliable results. Praxis provides that foundation.

This book review is reprinted with the permission of the National Center for Homeopathy

Reviewed by Sybil Ihrig, Lac, HMA, CCH (Cand)

Just two years ago, the LIGA Congress invited as its main speakers the three homeopaths whom it considered to be among the greatest modern innovators internationally: Rajan Sankaran of India, Jan Scholten of Holland, and Massimo Mangialavori of Italy. All three of these celebrated practitioners have contributed new systems of remedy classification that have enriched our understanding of "small" little-known remedies, and Dr. Sankaran has also pioneered an intuitive method of casetaking. But because Dr. Mangialavori has not published as extensively as his contemporaries (except for several monographs that, with a few exceptions, are largely student transcriptions of selected seminars), knowledge of his contributions has not been as well disseminated as those of his colleagues. That is about to change, however, thanks to the publication in English of his long-awaited Praxis.

Praxis: A New Approach to Homeopathic Medicine is more than a "system": it elucidates a comprehensive methodological approach to homeopathic practice. I've been attending occasional seminars by Massimo (as he is known by his student colleagues) since 2006 but have been frustrated by the piecemeal nature of the knowledge thus gained; the experience is akin to shining a light on a single facet of an intricately carved crystal prism. Praxis finally brings us the complete prism with all its facets polished and brilliantly exposed to sunlight. Volume I of this two volume set elucidates the conceptual basis of Massimo's theory and practice, while Volume II is comprised of case studies of what he refers to as the homeopathic Drug family of remedies.

As a clinician, Massimo is best known for his pioneering use of "small" and relatively unknown remedies and for his system of classifying remedies, which is broader and more conceptually based than the strictly "taxonomical" classifications used by Sankaran and Scholten. He is also known for following patients according to exacting standards, considering no case as "cured" unless follow-ups have spanned a minimum of two years (sometimes much, much longer). Cured cases constitute one of the cornerstones of his methodology; as sources of information about materia medica, he accords to them greater weight than he does to repertorization. Traditional repertories, he maintains, are frequently unreliable aids to finding the simillimum: the grading of rubrics is historically haphazard, symptoms have been taken out of context, and far too many remedies are simply underrepresented.

What, then, to use as a coherent basis for remedy characterization? The living patient is our best source. But to characterize the remedy states of patients adequately, it is necessary to apply a deep conceptual framework. Themes, rather than rubrics, are Massimo's preferred method of organizing information and recognizing remedy states. He carefully delineates the differences between symptoms, themes, coherent symptom groups, characteristic themes (which often express polarity depending on whether a patient presents in a compensated or decompensated state), and fundamental themes (which express the "structure" of a remedy or entire homeopathic family as well as the adaptive strategy of a patient). Also important is the remedy phase; every remedy state evidences a continuum, and the portion of the continuum of information about a given remedy that is manifest to the practitioner depends on the phase at which a patient presents.

Massimo's understanding of homeopathic remedy families is quite different from that of Sankaran or Scholten. He describes this difference by referring to "horizontal" and "vertical" modes of classification. Horizontal classification relies on taxonomy (in the case of plants and animals) and periodic table organization (in the case of the mineral kingdom), whereas vertical classification schemes rely on coherent symptom groups, themes (characteristic and fundamental), and structural symptoms of a patient, all of which may (and do) span across kingdoms and taxonomic classifications.

The second volume of Praxis offers an extended example of his vertical classifications: the homeopathic Drug family includes such disparate remedies as Anhalonium, Psilocybe, Agaricus, Bovista, Convolvulus, and Nabalus serpentaria. (A future, third volume of Praxis will include Drug family remedies from other kingdoms, including Bufo.) For each remedy described, Massimo includes information drawn from natural history, medical anthropology, mythology and legend, traditional herbal uses, and provings.

In fact, one of the significant features of this two-volume set is the extent to which it draws upon other sciences relevant to homeopathic knowledge and practice (systems theory, complexity theory, medical anthropology...). One rather puzzling feature of Volume I is a chapter devoted entirely to psychological concepts as they relate to homeopathy; it takes up more than 80 pages and was written with Massimo's supervision and approval-by John Sobraske, a psychologist and fellow homeopath based in Rochester, NY. Isn't this discussion out of place in a treatise on homeopathic methodology and practice? Doesn't it give too much weight to a discipline that is quite distinct from homeopathy?

I interviewed Massimo briefly about this concern at a recent conference outside of Boston. "Not at all," he maintained. "Contemporary homeopaths spend so much energy discussing so-called Mind symptoms, yet as a group we show great ignorance about this subject. Therefore, we need a more serious background in it. An important part of homeopathic practice is to keep our minds open to other disciplines, and we need to engage with scientists in other fields." Massimo also feels that our concept of "Mind" should be broadened to include the corpus, which describes the expression of a remedy state through body systems. A rubric that appears under "Abdomen" or "Extremities," for example, can incorporate clues about the core mental and emotional state of a patient and should be considered just as important and deep-reaching for some remedies as rubrics appearing in the Mind chapter of the repertory.

Heavy stuff, indeed. There's a lot of deep material in Praxis that should keep practitioners engaged and enlightened for years to come.