Dr. Mangialavori applied complexity theory to the field of homeopathic medicine to provide an epistemological ground for his clinical research into substances, remedies and patients as complex, dynamic systems.
Massimo’s Method of Complexity in homeopathic medicine is an original approach developed collaboratively with a number of colleagues over a twenty-year period. This model emphasizes coherent themes, homeopathic families, and clinical evidence through cured cases. Seminars and publications found on this website are all based on this approach.
The word ‘complex’ comes from the Latin complexare and complectĕre: to encompass, embrace, but also to pleat or to twine together. A second meaning, related to intertwining or weaving, is about being intricate and elaborate. Together this yields ‘an elaborate, interwoven encompassed whole’. In modern times, this evolves to ‘an intricate unified system or network made up of manifold constituent parts’.
Alternatively, ‘complex’ can imply ‘too intricate to the point of being problematic as in knotted and tangled’. This meaning is most fully borne by its partial synonym, ‘complicated’, which has a similar Latin root, complicare, to twine together or to fold multiple times. By contrast, the word ‘simple’ derives from the Latin simplex, composed of the Proto Indo-European root sem (one) and the Latin verb plicare (to pleat or fold), meaning literally to fold once.
There is no substitute for the word ‘complexity’, whether in the scientific theory or this method. It is the only English term that sufficiently, succinctly describes an ‘intricate, interconnected system’. Unfortunately, another meaning binds it closely to the word ‘complication’, which can mistakenly lead people to the assumption that this method is inordinately difficult.
In actuality, the Method of Complexity, though rigorous, is relatively easy to use. The whole point of this model is to apprehend the essential features and dimensions of a system such as a remedy so that it can be more readily grasped in its essential qualities and therefore more easily compared to other remedies of a similar nature.
Complex systems are not so many pieces of a clock that by their decomposition will reveal the inner workings of a mechanical device. This logical positive stance of the Enlightenment has been replaced by a systems emphasis where the total is more than the sum of its parts. Most important is how the parts relate to each other within a dynamic field. In fact, in quantum mechanics the difference between matter and energy cannot always be differentiated.
The Method of Complexity seeks to simplify and capture the essence, the flow, the vibration of a system without turning it into flat rubrics or mere code. Neither patients nor remedies should become two-dimensional, and analysis should not become an algorithm. To see the full dimensionality of a person or remedy requires a mindset that is scientific and artistic, logical and analogical, as both are required to accurately render the contours of organic life. This ‘both-and’ approach is necessary to anthropological medicine, narrative medicine, and homeopathic medicine.
The Method of Complexity seeks to retain the rich, complex reality of life as an interwoven set of systems that is more circle than square, that obeys rules but is also spontaneous, that has structure but is also fluid, that is predictable but also surprises. This approach is phenomenological and embraces life as it is lived, in all its myriad facets, rather than imposing a reductive frame that limits it to fixed parameters.
The Principle of Similitude
The first postulate of homeopathic medicine is similitude, a concept that is not exclusive to this discipline, but was identified long before. Many anthropological medicines employed this principle in their own unique ways, noting a resonant dynamic between the patient and the substance used to treat this individual. I am not speaking of an oversimplified doctrine of signatures whereby a red leaf, because of its color, is considered good for the blood. Rather, the point is to observe the substance, whatever it is, within a natural environment in order to understand its dynamic in life.
It is as if every living substance has a strategy that is adaptive to its design and a design that is adaptive to its strategy. Even minerals have qualities in their structure that affect how they appear and react in the world. These same qualities or strategies are captured and amplified within the homeopathic remedy and are the basis for their healing power when applied to a resonant patient.
The level of similitude varies between acute and constitutional use. As an acute, Arnica is a similar for the situation of traumatic mechanical injury. When the remedy is given in this circumstance, it has a good likelihood of assisting the patient to recover from his or her injury. In some of these cases, however, the remedy does much more than cure a hematoma; it may help stop the tendency to repeatedly injure oneself in the first place. When Arnica or any remedy acts effectively on a constitutional level, it demonstrates that the dynamic of the remedy is extremely similar to that of the patient.
Provings and Cured Cases
The proving, one of Hahnemann’s most important innovations, was used to determine the healing potential and profile of a remedy, beyond whatever information was already available about the substance in its environment and its use in traditional medicine. Even today, without a good proving, it is difficult to gain a precise idea about the remedy’s potential use as a healing agent.
Though such an approach is considered merely empirical today, implying that it does not meet the highest standards of research, it was an important part of early homeopathic methodology. At the very least, it represented a tremendous leap past the doctrine of signatures which was being applied, at that time, in the most trivial way.
Though valuable, perhaps even indispensable, provings have nevertheless become a kind of untouchable sacred cow within various homeopathic circles, particularly those with a more orthodox mindset. Even so, provings also present several challenges.
That they are subjectively based is both a strength and a weakness. Certainly, this subjective focus helps us to better understand the corpus, that is, the interface between mind and body. In other words, subjective experience can highlight how the mind interprets, amplifies or diminishes, or in some other way distorts the body’s pain signal. Provings can also identify modalities that govern the exacerbation and amelioration of symptoms.
On the other hand, objective clinical symptoms and disease processes are also important. If a patient has gastritis, it may be beneficial to know what this feels like, what it means for his life, how it affects his dreams, etc., but also whether he might have an ulcer or a neoplasm. Fortunately provings cannot grow a neoplasm. And the subjective symptoms produced by a proving do not provide any indication of whether a neoplasm might be likely for a patient needing this remedy. Even if one could get blood tests or biopsies during a proving, it is unlikely that this would provide useful clinical information. Provings tend to emulate disease processes in terms of sensation rather than inciting an actual disease process.
Another challenge is to know which symptoms pertain to the remedy specifically or the group to which the remedy belongs. The proving of Lachesis, for example, was extensive and produced many symptoms. How many of these were characteristic of Lachesis specifically, the crotalidae, a hemotoxic as opposed to a neurotoxic venom, poisonous snakes, snakes, reptiles, etc? How many of these symptoms can be superimposed on a related remedy that has fewer listed symptoms, like Toxicophis pugnax in order to fill out the picture.
Whatever is recorded is then assigned a value, based on a particular perspective, reference model, or homeopathic school. How do the different symptoms become hierarchically organized? Based on how many provers experience symptoms in that part of the body? Based on the intensity of their symptoms? Or as with the Method of Complexity, based on how they form coherent themes that point to an overall strategy? Provings may not provide enough reliable information to make these decisions, and yet proving authors assign degrees nevertheless.
The Method of Complexity posits that the proving provides a good map of the territory, but the patient, i.e., a cured case, is the territory. In other words, the patient reveals not only subjective but objective experience, demonstrating attitude, behavior, symptoms and strategy. The patient is the bona fide example of the remedy and helps to reorient the various proving symptoms into their proper order, dispensing with symptoms that are occasional and unrelated to the remedy’s core issues.
Provers, even sensitive provers, are like actors assuming a role under the sway of the remedy. Cured patients are the remedy. They are not acting and they have much more to say. Compared to an Arsenicum prover, an Arsenicum patient can better articulate what it feels like to deeply mistrust others, to have a terrible fear of death, and to experience the cold burning in her body.
Every age has its own tools. The proving was an essential tool for Hahnemann to launch homeopathic medicine. But by now we have a plethora of cured cases that provide a better tool for drawing an accurate, detailed portrait of the remedy. The portrait is not drawn from a pastiche of various symptoms tied together with our imagination; the portrait is drawn from the person—the many patients, in fact—sitting right in front of us.
Provings help us find our way to a remedy prescription, before too many cases have been cured. In turn, cured cases help us structure the vast information of a proving. Though the cured case is the more reliable of the two, both are helpful to creating a full and balanced picture.
To verify that a case is truly cured, it must be followed for several years during which the patient does not require taking other remedies for acute conditions. It is not that I preclude the use of other remedies if they are needed, only that a patient on a good constitutional always does better taking that same remedy rather than a different remedy for his acute condition. If this remedy does not work well during an acute, it leads me to reconsider the prescription.
With so many more remedies available now than in the past, it was inevitable that different systems would arise to help categorize remedies into different groups. As with provings, authors and schools vary in how to approach categorization. To create schemas and show associations, one must identify what is significant. For example, linking various remedies to Belladonna requires that I first identify what is significant in Belladonna. This is a subjective and relative assignation that then serves as the basis for the association. Mother Nature does not need to be classified.
Botanists have their methods, which have changed and evolved over time, to group plants together. They may focus on appearance, habitat, active principles, DNA as well as other factors. Even if they succeed in showing a cogent close relationship between the members of a taxonomic group, it does not mean that their classification system has much bearing on homeopathy.
The problem is that remedies belonging to the same taxonomic group may show quite different features homeopathically, while remedies from different taxonomic groups may show quite similar features homeopathically. In other words, homeopathic criteria are different specific to this discipline.
The classification suggested by the Method of Complexity is primarily based on determining the most important themes of each remedy, themes that should be shared within a close grouping, termed a homeopathic family. Most important is the dynamic of how this substance and how this patient adapt in the environment; what is their strategy to survive? How do they cope with their core suffering? Close similarities in these areas are important for determining the degree of relatedness between two remedies and whether they belong to the same group.
A homeopathic family can often be organized around a well-known remedy, perhaps a polycrest, like Arnica, Belladonna or Tarentula. Such a remedy is not necessarily more effective than remedies for which less information is available; their picture is simply more defined at this point in time. Mandragora, for example, is similar to Belladonna, but outside of homeopathy and within traditional medicine, it has a stronger reputation. There are countless other examples that have more importance within the traditional rather than homeopathic pharmacopeia: Garlic, Rosemary, Sage, Buckthorn, Cinnabar, Realgar, Cod Liver Oil.
Even if these remedies are not well-described, if there is enough information to link them to a well-known remedy to support a prescription, and some cases become cured, eventually the affiliation between the remedies can be confirmed. Mandragora is such a remedy that does bear close relationship to Belladonna, as does Stramonium, Hyoscyamus and Solanum nigrum. But as mentioned before, this homeopathic family does not include other Solanaceae that have a very different quality, such as
Tabacum, Dulcamara and Capsicum, despite belonging to the same taxonomic group.
The Therapeutic Field
The relationship between patient and homeopath is critical to the success of treatment. In our field, good case-taking is what generally separates excellence from mediocrity. The study of substances and remedies all comes to naught if one cannot take a good case.
I prefer to call case-taking an art rather than a science because the so-called scientific approach dominates so much of academic medicine and tends to have a detrimental effect, I believe, on the doctor-patient relationship. Similar ill effects can occur when homeopaths follow this model. Often they simply do so because they have not developed their own well-conceived, personally articulated approach. Perhaps they never even felt the desire to create such an approach.
Case-taking is in art in that it combines creativity and technique, improvisation and precision, logical and analogical skills. This close encounter with the patient cannot help but engage one’s own emotions, personality and history of experience. For this reason, it is important to develop oneself as a human being as well as a doctor. This way, personal issues are less likely to interfere in the therapeutic relationship.
With any art there is always a plurality of styles. In fact, there are likely as many styles of case-taking as there are homeopaths—even more, because sensitive homeopaths often make further adjustments according to the specific needs of each patient. As patients change over time, the homeopath may need to make further subtle adjustments along the way.
This fluidity does not mean that one becomes an actor or a chameleon. The point is to be genuinely oneself while attempting to match the patient in certain ways that provide a sense of safety, comfort and connection. Unlike some arts, there can be no false pretenses here. A patient will likely sense this and it will weaken rather than strengthen trust and rapport.
I am reminded of the metaphor provided by Milton Erickson, the famous psychiatrist and hypnotist. A psychotherapist—we could substitute ‘homeopath’—is compared to a man returning home on horseback. The animal instinctively knows the right way but every now and then stops along the path when distracted by a clump of grass or deviates when frightened by a sudden noise. For a variety of reasons, not the least of which is the impressive size of the animal, it makes more sense for the rider to work with the horse, calming and reassuring it, than to be forceful and oppositional.
Homeopath and patient are on a journey together that develops across shared time and space. Borrowing from psychology, this mutual context can be called the ‘therapeutic field’. If this journey goes well or, following our analogy, if the horse relies on the rider to be gently guided through territories both beautiful and treacherous, the patient develops a deepening trust in the homeopath. With the establishment of trust, the patient naturally becomes more open and capable of providing access to the main features of the case. Over time these themes can be gently explored and further developed to make them more explicit for later analysis.
The goal, from the perspective of the Method of Complexity, is to recognize the patient’s adaptive strategies at work: her relation to herself and to the world around her. This helps the homeopath to form a hypothesis about the underlying structure of her system. In many cases the structure is apprehended through the soma. To quote Alberto Panza:
Historically speaking, a notable aspect of homeopathic medicine was its reliance, for an understanding of the physical, upon the Greek notion of physis, which itself includes the concept of the great breath of life. This renders the body less alien, and avoids the mistake made by academic medicine of relegating it to the lexicon of a cold laboratory. More attention is also given (albeit in the reductive format of the repertory) to what we might call the ‘corpus’ (soma), that is, to the tissue that links together all the sensory zones of the body, and which therefore facilitates the communication of sensations regarding wellbeing or unease.
A primary function of the therapeutic field is to constitute within the therapist’s mental space a network which links (in a manner similar to movies) a great quantity of elements: verbal and nonverbal, organized and disorganized; which the patient brings into the field. These are technically distinct from, though often emanating from and associated with, the patient’s experience of suffering—whether psychic, somatic, or as is most common, a combination of the two.