Book review: "Praxis" by Massimo Mangialavori

Perhaps the phrase "it is a pleasure to read this book" needs further clarification. Can it be a pleasure to re-examine every step of our work and every justification for our thinking? Or is it fun to have the shortcomings of our earlier training and the bad habits we didn't even know we had rubbed in our faces? Fortunately it is the kind of medicine we all need, because it teaches us what we already know and to whose truth we are committed. We just cannot yet imagine how to reach our goal, or we are simply too lazy or too self-satisfied to make the effort.

Even what is particularly innovative or controversial is firmly rooted in the homeopathic philosophy we all share, in the firm conviction that this tradition is the best that science and holistic thinking have to offer. So, having decided to take this medicine, I assure you it tastes good and will not upset your stomach.

Massimo is, of course, well known everywhere and is highly regarded by many homeopaths for his excellent courses in Italy. They are the practical basis of his seminars on the materia medica and his growing number of publications. The present work contains the full presentation of his theory. It begins with methodology, then follows an overview of the "remedy" family and its main themes. The book concludes with vivid case presentations related to six remedies, most of which are still little known.

The subtitle of the book "The deeper connection of the symptoms" already points to the aim of his discussions: to detect a deeper, meaningful connection, a more significant and expressive similarity between remedy and patient than can be found in a repertory, where symptoms can only be listed without direct relation to the patient. Thus all the various symptom elements fit together like puzzle pieces and can be derived from an integrative whole, similar to the "essence" sought by Kent, Vithoulkas, Scholten and Sankaran. Massimo's personal way of discovering, describing and understanding this unity is undoubtedly unique.

For reasons of limited time and space I will simply highlight a few points that I found particularly interesting and stimulating while reading. I love the way he begins with the doctrine of signatures and even seems to agree with the fundamentalists, for example, that a trivial similarity such as the yellow colour of Chelidonium and that of bile does not constitute a real match. This, however, is solely linked to his interest in the deepest levels of meaning, precisely the topic the old school tends to avoid clarifying. Massimo understands each remedy from its core as a unique system of adaptation to its natural environment, incorporating both the physico-chemical level and the realm of myths, as is appropriate according to the venerable traditions of folklore and medicine.

Sometimes these multi-layered connections and resonances can seem almost eerie. Since my first homeopathy course I have, for example, often thought about the fact that our greatest snake remedy is named after Lachesis, one of the three Greek goddesses who spin the thread of life, and about the almost incredible coincidence that Hering, who first identified the venom in 1828, died on the fifty-second anniversary of that event, almost to the day. Signatures of this kind are very meaningful to me because they delve deep into the history of our culture, and things that at first glance appear to be independent details weave together into an inescapable and convincing pattern of destiny.

Massimo's "complex method" is so called because it spans and connects such different fields as anthropology, folk medicine, physiology, biochemistry, toxicology, classical homeopathy and the art of clinical medicine, showing us that more can be learned from the knowledge of human nature than from books.

It is especially this multicausal approach that distinguishes him from other teachers. He searches for resonance and confirmation on many different levels and insists that no method of case-taking or remedy-testing must always work. Homeopathy is an art to be re-experienced with each case and is never complete.

Contrary to the sacrosanct truths we have all learned, his first major heretical claim is that provings are not the best source for studying the materia medica, because they provide long lists of detailed symptoms, whereas the homeopathy student above all needs to know how important each symptom is for prescribing a remedy. Reliable information appropriate for prescribing therefore requires a system that organises the data and sets priorities. More than any other leading teacher today, Massimo prefers for this purpose cured cases, because they alone offer sufficient variety to network the connections between the totality of the remedy and the totality of the patient; to link the threads that led to prescription and to recognise analogous situations in other patients who need the same remedy. He calls such connections "themes", and from them he builds his materia medica.

My clinical experience has shown me – as it surely has many other homeopaths – something that is rarely said aloud. This little iconoclasm reminds me of the time when I was often called to home births. How often I shook my head at Cimicifuga and its incorporeal rubric "fear of madness", it always seemed not to fit my cases.

But when one of my patients reached 42 weeks without early labour, the impending hospital admission led her to tell me about her earlier miscarriages and the subsequent dilation and curettage, the worst experience of her life. Terrible images tormented her and she believed that the more intense the labour, the greater the danger that the pain would drive her mad or that she would "snap", i.e. fall into a state of psychological disintegration from which she would never recover.

A few days later she returned to my practice and labour had already begun. Her gaze was wild and she seemed completely out of control, just as she had feared: she spoke only incoherently, her movements were abrupt and uncontrollable and she was overall in a pitiable, distressing state.

In that moment I not only understood the rubric and her lack of trust in me, but also the relationship of many of her physical symptoms to the remedy, so that I too began to fear for her mental health. Although she showed psychotic behaviour throughout the birth, she improved quickly after two or three doses of Cimicifuga C 200, delivered normally and made a full recovery. From this impressive case I learned to prescribe Cimicifuga to many of my patients, and I achieved brilliant results.

Massimo's criteria for recognising a case as "cured" are so strict that many of the successes we like to report at conferences would by far not meet his expectations.

For chronic conditions he accepts a remedy as the simillimum only after a follow-up period of at least two years (or more). During this time the remedy should have continued to contribute to recovery and proved useful in overcoming acute conditions that developed in the meantime independent of the chronic disease, even for injuries and other everyday complaints instead of the usual first-aid remedies.

Themes and motifs that emerge from cured cases provide an ideal framework for reviewing patient data, which can then be used to confirm, refute or modify hypotheses. Thus the study of the materia medica (and its completion) becomes a continuous process of integration and is no longer routine memorisation. The long-term consequence is a reworking and re-organisation of the repertory on a thematic basis, a monumental task that will at least require the joint effort of a whole generation of committed homeopaths.

Credit: Holger Ellgard / Wikipedia

Thus, in connection with this patient's hobby, rubrics in "symptom language" such as "passion for model making" or "plays with toy trains before dinner" at first glance appear to be possible candidates, since they disappeared after the remedy was given along with other disease symptoms. These are exactly the quasi-objective, "value-neutral" observations with which our repertories are stuffed. Ultimately he found them misleading because they went too much into detail and obscured the deeper meaning that could have provided meaningful analogies for similar cases. This led him to assign the remedy to the rubric "childish", thereby elevating it to a theme. This made it possible to recognise and treat other patients with similarly elaborate hobbies.

Another fascinating highlight for me is how he defines and distinguishes themes. What he calls "characteristic" themes are distinguishing features of the remedy. They often occur, but not always; either because they are limited to certain life phases or disease stages, such as the acute inflammation in Belladonna that typically occurs in childhood; or they are opposites that may appear depending on whether the patient is in a compensated or decompensated state. "Fundamental" themes, on the other hand, are decisive structural components that must be present even if they are not always easy to recognise. They form the core or ultimate basis of similarity. Thus the theme "isolation" in Camphora proves fundamental for all "drug" remedies, whereas "sensitivity to cold", the best-known keynote, is only characteristic of the most extreme or severely decompensated cases; a typically compensated patient would rather tend to brave the cold.

This kind of indispensable practical knowledge can be found in every chapter, and that is the charm of the book. His explanation of themes is masterful and comparatively easy to understand. Nevertheless, the discovery of themes seems much easier when reading than it does for someone attempting to apply these ideas for the first time. In any case it is obvious that the extensive repertory work on which Massimo's approach is based would only be possible with MacRepertory and Reference Works, the computer software he uses and to which he regularly pays due tribute.

Massimo's method culminates in his concept of the homeopathic family. This is precisely the point where his method comes closest to those of Sankaran and Scholten and where it also differs most clearly from them. While Sankaran and Scholten classify homeopathic "remedy families" taxonomically according to their place in nature, Massimo insists on a classification system that is based solely on the homeopathic characteristics of the remedies.

Often he begins taxonomically; he has a suspicion that arises, for example, from the failure of therapy with one of the best-known representatives of a biological or chemical group, usually a polycrest - such as Lachesis as a snake remedy. But the next step, which extends the analysis to a few other taxonomically related remedies such as Crotalus, Naja, and Bothrops, demands an exact homeopathic determination based on the fundamental themes that all these remedies share. By recognising these fundamental themes it becomes possible to add other remedies that are taxonomically independent of the group - often "small" or at least unusual and underrepresented remedies in the literature - to the family.

The same idea bears fruit for "second prescription" when a remedy has helped over a period of several years but then stops working and must therefore be changed. In my earlier training based on Kent and his successors this was a clear signal to re-open the case and re-prescribe, but not necessarily to add a complementary remedy. Yet if the big themes continue to operate in the patient, as one would expect regarding the duration and strength of a healing reaction, Massimo's family concept strongly argues for choosing another remedy from the same family - a strategy he obviously employs with great success.

In Volume II I admire how Massimo gets his patients to confide in him as openly as they do, how they reveal their deepest inner truths to him. Because we do not always succeed in the same way, we often take refuge in critiquing the method as a way to buy time. It is the secret of case-taking that distinguishes the truly great homeopaths from those who are "merely" competent. This secret cannot be taught in a theoretical way because it involves the subjective experience of the homeopath as a person, not only as a physician, scientist or healer.

The method of complexity aims to find the patients' adaptation strategies and defence mechanisms. They are found as much among the physical as among the mental-emotional symptoms, so that the distinction between them increasingly blurs. The idea is to encourage the patient to speak freely, to tolerate moments of silence and to trust that the patient will say what he has to say without trying to steer him in a particular direction. Thus we uncover the themes and with them the whole history of suffering, wherever the patient leads us, and this is much more promising than simply accumulating as much data as possible with a standard attitude.

The cases in Volume II are very well presented. It is a pleasure to read them. Each remedy is introduced with a short scholarly treatise on its natural history, its use in folk medicine and its pharmacological, toxicological and above all homeopathic properties, so that the cases materialise against this background. These little "gems" are materia medica literature at its finest. The cases are recorded with great sensitivity and testify to the deep trust Massimo's patients place in their physician. In this way they give life to the method he has designed and developed. Many cases are accompanied by comments from Dr Giovanni Marotta, Massimo's long-time colleague, mentor and friend - one might almost say: his elder alter ego - whose rather reflective style nevertheless fits perfectly with the method they have both created and developed and in no way impairs the work or distracts from its mission, but enriches it in his own way.

I wish I could say the same about the contributions of some other authors. The final part of Volume I, Chapter 1, for example, is a learned treatise by Professor Alberto Panza, an academic colleague of Massimo. He attempted to identify the themes of modern European philosophy, science and culture that are compatible with homeopathic doctrine, an outstanding and honourable undertaking. I could not help feeling a little disappointed and let down because both the text and the translation, and even some of the quoted sources, are written in very technical terminology that is difficult to translate and also unfamiliar to most readers, and moreover too abstruse to really understand.

Another example is the last chapter of Volume I, the longest in the book, which presents a summary of the most important teachings of modern psychology for homeopaths. For the English edition this important task was undertaken by John Sobraske, the editor, and carried out thoroughly. Compared with Massimo's committed, concise and goal-oriented style, however, it reads like an overlong and tedious excursus that is irrelevant to the work as a whole. On the other hand, Sobraske's introduction to Volume II (a short summary of Volume I) is excellent, thorough, competent and easy to read. My only question is why a summary is presented here for people who think they can omit Volume I, although it contains some of the best expositions on homeopathy I have ever read and it would therefore be very regrettable and a great mistake to skip it.

Moreover, a considerable number of translators and editors contributed to the book, including such dedicated homeopaths as Betty Wood, Krista Heron, Bill Gray and Maria Kingdon in North America as well as various others in the UK and Europe, and their work deserves sincere recognition. Yet their task was on the one hand almost superfluous given Massimo's excellent English and on the other hand incredibly difficult in view of the urgent need presented by Professor Panza's rather unattractive subject matter.

All of this, of course, are insignificant quibbles. The main reason for recommending these books is my conviction that they will change and ultimately enormously improve the way homeopathy is taught and practised, both today and in the future.

Praxis, Volumes 1 and 2 by Massimo Mangialavori
Modena, Italy
284 and 298 pages respectively, Special price instead of € 110.- only € 78.-