Omeophatic medicine

Shared pathos: Epistemological reflections on the concept of similitude

Alberto Panza

In one of the fundamental works of 20^th century thought, Martin Heidegger wrote that the merits of a discipline can be assessed by its capacity to tolerate, without dissolving, periodical revision of its fundamental concepts. This flexibility is necessary of course given that the epistemological frame upon which it rests is itself constantly changing.

Under the pressure of inescapable epistemological change, such a discipline (or for that matter, an individual) can reach a state of crisis manifesting typically along two lines:

• • Loss of heuristic potential and collapsing of the discipline’s frame

• • Resistance to change and retreat into a rigid and uncritical defense of fundamental concepts which thereby they lose their character as paradigms and become dogmas

This chapter focuses upon the central paradigm of homeopathic medical thought, the concept of similitude, not from the perspective of clinical efficacy—this is discussed elsewhere in the present volume—but in response to current epistemology, particularly complexity theory.

Every therapeutic act, according to Francois Laplantine, depends upon a search for correspondence. Both in traditional medicine and scientific medicine, there is a constant effort to establish a connection between what scientists call a ‘pathological complex’ (which can mean the ill person or a functional limit) and a ‘therapeutic complex’ (the combination of certain acts and instruments which characterize adequate treatment).

The well-known Hahnemannian formula similia similibus curentur designates a type of natural correspondence, a profound solidarity between the cure and the cured. A synthetic formula, it is elegant and suggestive while also enigmatic. From which perspective should we consider similitude? Similar to what? As Massimo Mangialavori states “The principle of similitude can be applied at various levels.”

The most superficial (or mere phenomenological) level is seeking analogy through an isomorphism of emergent symptoms. Correlation is sought, for example, between a patient’s symptoms and those produced by a healthy person during a proving. Configuring this as a ‘homeotherapeutic’ model, the fundamental idea is to induce a controlled therapeutic crisis which acts in the same direction as the disease. The term ‘homeotherapy’—to which homeopathic medicine is not limited—evokes a sense of shared pathos, a resonance based on the principle of sympathy between two organized systems defined respectively as ‘remedy’ and ‘patient’.

A similar theme of secret correspondence between man and ‘other’, that is, an ‘ultra-specific entity’ present in the biome is a well-known anthropological concept. By ‘ultra-specific’ is meant a one-to-one correspondence that is highly individualized: for each person there is a signified other and the two manifest a powerful resonance. This correspondence, referred to as ‘participation’ by the ethnologist Lucien Lévy-Bruhl, is fundamental to most rites and magical practices. The complex of beliefs known as totemism provides one obvious example among countless others. Totemism is founded on the idea of an intimate connection between an individual (or clan) and an animal, plant, or object from the natural world. It is precisely through such highly individualized correspondence that a protective and therapeutic effect is achieved. (For the contemporary observer, a vision quest can facilitate discovery of one’s own totem.)

In traditional societies the principle of similitude is not limited to ritual but operates in various ways as a principle of true knowledge. Giorgio Raimondo Cardona, one of the better-known sages of ethnoscience, emphasizes how the principle of similitude inspires amazingly accurate and specific knowledge of the natural world. This occurs both in larger cultural complexes and smaller tribes. Such material, if amassed into one collection, would be considerable. It would afford a quite refined articulation of taxonomy organized through “systems of coherent thoughts characterized by correspondences between elements at various levels.”

Unfortunately this rich inheritance from traditional cultures is too often denatured and deprived of its heuristic potential in two (opposite) ways: confined to a mere intellectual curiosity or employed as a means to demonstrate and validate a concept or principle. To illustrate the latter, one could make analogy to the rich repository of an individual’s personal mythologies. Taken as a psychosocial data, it does not by itself demonstrate anything. However, with the application of critical intelligence to this data, a number of suggestive possibilities present themselves. Upon further elaboration they serve as excellent representations of key (enigmatic) elements of human existence.

The information offered by traditional cultures is often too isolated, reduced and schematized (if not also trivialized) to give rise to suggestive possibilities. Consider the case of the BaMbuti and the Bantu. The representative horizon of the pygmy BaMbuti of the Ituri forest (central Africa) is the forest from which they gain protection and support. The forest, however, is also the source of myriad evil phenomena such as disease, suffering and death. This occurs not from a malicious intent but because of a momentary lack: when the forest goes to sleep at night, men lose the forest’s support and protection and are therefore exposed to evil attack. To avoid this, the forest must be woken up at sunset with a sweet droning song so as to reestablish beneficial contact. Meanwhile, for the neighboring population of Bantu, evil originates from a malevolent deity which is called “the one who makes siege.” This divinity stands on the shoulder of every man like the Greek daimon, invisible to the subject but inseparable from his destiny. This example underlines how seemingly arbitrary, far afield, and therefore unique two traditional cultural beliefs can be. Because these two cultures are in longstanding communication, one might assume some level of influence on one another regarding the fundamental concern: the origin of sickness and suffering. Yet their concepts are nearly opposite. In other words, their two views are not only dissimilar but hard to reconcile within a simple comprehensive scheme despite their having lived adjacent to one another over a quite extended period of time. This suggests that intelligent inquiry should follow open horizons of association rather than delimited frames of conformation, i.e., the assumption that neighboring tribes automatically demonstrate confluence in significant areas of their respective cultures.

In models of therapeutic action, just as in the anthropology of disease, we encounter more opposites: adorcism and exorcism; addition and subtraction; excitation and sedation; homeopathy and allopathy. (It is interesting to note that exorcism, a common element in many magical ritual therapeutic techniques which involves an invasion of evil or attack by an enemy combatant, bears some resemblance to biomedicine’s attempts to eradicate certain ills through hypertechnological means.) As with the example from Central Africa, such opposite views tend to defy easy generalization or schematization.

The BaMbuti culture’s image of waking the forest at night is compelling, suggestive and poetic. It expresses the idea of a link between the survival of evil and the lack of cohesion and contact between few parts and the totality, as when a disharmonic condition arises between the individual and the grand breath of physis. Meanwhile the Bantu culture’s concept reminds us that entropy is nestled into the very heart of our (provisionally) aggregate corporality. The physis/forest is the great cradle of all that is living; and man exists through continuous recombination or, better yet, through cycles of organization, disorganization and reorganization. In the long-term no forest is able to protect one from the destiny already written inside the corpus (“he who hovers near”), the destiny to which even the forest must eventually submit.

Is it necessary to choose one of these battle lines? Instead of seeking evidence in the anthropological record for this or that thesis, it seems preferable to seek open horizons regarding what is proposed rather than succumbing to the prejudicial binary code of true/false—the origin of all reductionism.

The mere fact that the concept of similitude is so broadly diffused throughout the anthropological record should by itself provide some confirmation of its reliability. The argument against this assertion cannot be proven merely on the grounds that these cultures are traditional.

One could argue that this concept, despite its pervasiveness, is nevertheless nothing but a fascinating and persuasive confabulation, a persistent animist fantasy which ill fits the coordinates of our current episteme. From this vantage point, it is a ‘super-stition’ in the etymological sense: that which is ‘super’ (over) and ‘stition’ from ‘stare’ (stay, stands), hence ‘overstays’ or survives like an empty shell, having lost its referent context.

Even here, however, one may ask how such survival occurs. What lends it support? Many answers can be considered, from the most trite and banal to the most poetic. Perhaps the difficulty is rather our own narrow context. As a refined theoretical psychoanalyst once commented, our tendency to confine the experience of the self to the psychosomatic perimeter of the individual is a fairly recent development. The more extended precedent was to experiment with self-identity via the other (whether human or non-human).

Should the principle of similitude be seen as merely a simple metaphor (where the subject is represented through other in contradistinction to self)? First of all, we may wish to challenge the supposed simplicity of metaphor given the current perspective that metaphors are not mere ornaments, but rather essential instruments, of thought. In this way, elements of the ‘real’, i.e., the literality of life, which are innately difficult to understand gain expository representation.

Secondly, we can observe that, according to homeopathic medical thought, the remedy is not just a metaphor by which a person is represented; rather, the therapeutic effect depends upon a series of correspondences which are structural and dynamic. These close correspondences between the patient-system and the remedy-system allow the former to be receptive to the therapeutic action of the latter. The homeopathic symptoms not only describe those pathological processes from which one can derive and define a semiotic; most importantly, they describe the function of the living system. In other words, they point not only to the disease but to the well state; not only to the defensive mechanism but to the compensatory and reparative; not only to the vulnerable core but to one’s dominant emotional tones.

All this material allows us to configure (without pretending to an exhaustive synthesis) some fundamental trends in the way one inhabits one’s body and the space-environment. As such, the homeopathic remedy serves as a prefigured ‘anthropological model’ which can be recognized as it occurs in the concrete lived experience of the patient-system.

Even so, one might ask whether it is possible for disenchanted post-modern man, living in a technological world, in a universe devoid of the sacred, to continue thinking in terms of correspondences and attunements with ultra-specific entities from the natural world.

Is not the disappearance—or deep metamorphosis—of the landscape in 20^th century figurative art an indication of an irreversible distance from the world of nature and its replacement by a technosphere, the new kind of habitat? In the context of a resolute anti-naturalism, the principle of similitude becomes nothing more than a naïve anthropomorphism whereby human traits are projected onto a non-human fabulation in the manner of a Disney cartoon.

We cannot afford to indulge in such simplistic generalizations and narrow-minded approaches. This is the orientation dictated by technology—the attendant risks of which are to become self-referential and self-celebratory. This is not the only direction of current epistemological thought. We should ask ourselves whether, according to contemporary science and its neo-positivist paradigm, many illegitimate criteria (or those considered non-scientific) can still be considered viable.

It is important in this regard to remember how in the second half of the 20^th century there was a radical and profound change in paradigms—a true epistemological break—in the natural sciences. The inception of this break was general systems theory, followed by dynamic systems theory and chaos, arriving at the science of complexity. Within our current discourse, there is not sufficient space to describe this epic shift; it will suffice to say that the new paradigms of the biological and physical sciences allow us, as described by Ilya Prirogine, “to be able to speak of a new dialogue between man and nature.”  This dialogue avails itself of what the scientists define as “a new scientific vocabulary: the vocabulary of complexity.”  The expressive potential of this new lexicon permits us to overcome the classical distinction between systems which are simple and complex; open and closed; random and organized.

This dichotomous opposition is replaced by a pluralistic vision of the physical world where entropy and negentropy, determinism and stochastics, closely coexist in all types of systems. This opens up enormous possibilities in the confrontation and connection between different entities and states in the physical world. Obviously, this does not ignore the potentially big differences between systems, but such differences do not constitute antithesis. The common problem here is the tendency to dichotomize, to transform what is different into dualistic opposites: anthroposphere/biosphere; organic/inorganic; thought/instinct; mind/body. Dichotomizing seems to come less from a deficiency in thought than from a suffering in thought. It represents the difficulty to ‘com-prehend’ in the etymological sense: ‘com’ (together) and ‘prehend’ from ‘prendere’ (to take). From this perspective, dualism represents a difficulty of relating to the real world without nullifying it. In the end, dualism does not represent the assumption of difference but its negation; it is an attempt to eliminate and exorcize the disturbing idea that opposites belong to each other.

Complexity theory is a relatively recent discovery whose ideas have not yet fully permeated our established way of thinking and the reflex ways by which we relate to various manifestations of nature. Even so, it’s not especially difficult, according to Prigogine, to conceive of our financial system, our language, the mammal’s brain, or even the most humble of bacteria as complex systems. He goes on to suggest an interesting example: a cubic centimeter of gas or liquid, which with slight variation of scale, is quickly apprehended as an astounding aggregation of complexity. We know that at the pressure of 760 mm of mercury and at the temperature of 0 celsius, a mole of any kind of gas contains an equal number of molecules according to Avogadro’s number, (6.02 x10²³), which are moving in every possible direction and constantly colliding against each other. “Is it enough to say that this is a complex system?” asks Prigogine. One could say that such a microsystem (or macrosystem, depending on the point of view) manifests a disorganized and irregular behavior, random and mechanical. Physicists, referring to the absence of any coordinated activity, call it molecular chaos. But it’s enough to produce a thermal dishomogeneity and assist the emergence of an organized complexity: the appearance of a harmonic arboreal structure (a snow flake). The scientist concludes that the difference between simple and complex, between randomized and organized, is less clear than one would think.

The theory of autopoietic systems, coming from the fields of biology and neurobiology, constituted the next important paradigmatic shift. This theory revealed that living systems are based on the net relationships of which they are composed: “the relationship is the tissue of a system,” so wrote Humberto Maturana and Francisco Varela in their best-known work, Autopoeisis and Cognition. There they state that the traditional approach of biological sciences, which is based on increasingly finer degrees of discrimination (and division), ends up ignoring the most fundamental characteristic of living systems: that they are interactive.

All such living systems depend upon the maintenance of an organized functional structure in order to survive. This depends in turn on an ability to self-observe so as to contend against eventual disturbances which threaten to disorganize the system. If disorganization passes a certain threshold, however, the system can no longer maintain its usual structure and function. At this point it ‘de-structures,’ and component parts enter into a cycle of reorganization whereby they are “at play” and aggregate in newly complex ways. To summarize, self-organization operates within a plastic, dynamic, cohesive structure until certain limits are passed; then the system evolves/devolves a new structure and organization. In essence, such a process demonstrates the two fundamental aspects of living beings: continuity and discontinuity.

This discussion recalls the work of Gregory Bateson in the field of psycho-anthropology, namely his expanding the semantic conception of mind. Relying on various complex perspectives offered by anthropological theory, Bateson emphatically affirmed how the term ‘mind’ could be extended to define the ability for organization, and especially self-organization, within every living system. From this perspective, limiting the concept of mind to Cartesian cogitation seemed not only restrictive but implausible. In other words, mind, within this broader definition, can and should be attributed to plants and animals as occurs in the great majority of traditional cultures. This view exposes our tendency toward anthropocentric colonialism, a tendency which leads to self-attribution—as if by divine right or absolute monarchy—and a belief in the exclusivity of mind as a means to justify the predatory supremacy of our species.

The so-called ontological solitude of man—which could be considered as either a privilege or a curse (or both)—and his radical incomparability with other living beings have recently been reconsidered from the perspective of a new scientific discipline called anthropozoology. This field first appeared in Europe and the United States at the end of the 1980s. After developing a more precise approach in the first years of the new millennium, it became redefined as post-humanism. The post-humanist perspective proposes a radical critique of anthropocentric dominion and isolationist principles; meanwhile, it promotes overcoming our essentialist purity and the autarchy of the anthroposphere (seen as separate and in opposition to other realms of the biome).

Ontological autarchy corresponds to epistemological anthropocentrism which strove to consider illegal or senseless any attempt to presuppose a relationship—which was not just an instrumental partnership—between man and other ultra-specific entities.  Post-humanism, by contrast, underlines the concepts of hybridization (not used in the usual negative sense of the term) and ‘other-reference’. As Roberto Marchesini wrote: “Understanding hybridization means going all the way in evaluating the debts humanity has contracted toward what is not human; acknowledging that, far from being an autonomous fruit, man constructed his history through trade with non-human references, importing and writing the genetics of this ‘other’ inside his own genetic code.”

It is important here to underline that post-humanism is not anti-humanism. Naturally the critique of anthropocentrism should not be read as a disputation of human beings’ extraordinary complexity or a proposed return to simplistic biological reductionism. Rather, it represents an opening to a conjugated and pluralistic logic, capable of assuming the presence of ‘other’ as a constitutive element of identity. According to the post-humanist perspective, man is defined as “a transitional ‘other-referring’ being.”

This transformation is not of little consequence. All those aforementioned areas of thought, to which we can now add the astounding conclusions derived from genome mapping, have significantly contributed to reducing the split which separated human from non-human, removing man from an autoreferential ontology, a real autarchic cage which disallowed dialogue with the ‘other’. This radical change of paradigms afforded a batting down of fences between disciplines, helping to realize the hope of Adolf Portmann to: “overcome the barriers which separate the natural from the human sciences.”

Great turning points in art and science are not simply epistemological breaks, wiping the slate clean of what came before; rather, something already known is conjoined to something just now being told. The old is seen in a different light based on the apical change in perspective; it is made afresh through its recombination with the new. The work of the poet Giovanni Pascoli is a particularly appropriate example here. Therefore, the principle of similitude need not be dismissed as unscientific, nor embraced, following the homeopathic adepts, as a religious article of faith. Rather, it can be viewed within its rich anthropological and historical contexts, and through the new epistemological lens of complexity theory.

A particular danger regarding the principle of similitude, and another reason why it has sometimes been dismissed by science, is its superficial application on the level of morphology and behavior. Such can lead to rather simplistic conclusions and caricatures as when a patient might be given Limulus (butterfly) for ‘walking on tiptoe’ (i.e., ‘fluttering’) or Helix (ivy) for ‘grasping’ at things. The principle is effective when it operates at the level of system organization following the definition offered by autopoiesis: the identity of a system coincides precisely with its modes of organization. This concept was clearly expressed by Maturana and Varela in a foundational passage which is worth quoting in its entirety:

The organization of a system…specifies the identity of a system class, and must remain unchanged so that the identity of the system class remains unchanged. If the organization of a system changes, then its identity changes and becomes a unity of another type. Nevertheless, given that a particular organization can be realized by systems with various structures, the identity of a system can remain unchanged while its structure changes within certain limits determined by its organization. If those limits are exceeded, that is to say, if the structure of a system changes in such a way that its organization can no longer be realized, the system loses its identity, and the entity becomes something else, a unity defined by another organization.

Superficial isomorphism is not very helpful in studying the principle of similitude, whereas deeper structural analogies and system processes are essential. From this perspective, it is important to underline the characteristic autopoietic processes of a system, distinguishing chance variables from those which must not be excluded. This is true for both the patient-system and the remedy-system.

In terms of organization, every living system presents:

• • a particular morphology, with some changeable elements (to a certain limit)

• • a particular structural arrangement which takes form (‘emerges’) amidst the vicissitudes of life

• • a certain degree of cohesion

• • a differential degree of plasticity or rigidity

• • specific modes of accrescence and decline (aspects of entropy and negentropy)

Every living system develops its shape in a context. It grows within a habitat that is more or less favorable. It shows particular strategies to use its internal resources (and to access external resources) for nutrition, reproduction, and defense against antagonists. Every system, from the perspective of autopoiesis, is distinguished not only by its structural qualities but also by a series of ethological characteristics which describe:

• • a way to live in the space-environment and to enter into relations with environmental resources

• • a way to relate (or to avoid relating) with other beings of the same species and with antagonistic species

• • a way to manage peculiar areas of vulnerability

• • a way to modify his own structural characteristics so as to effectively utilize resources, to curb entropic tendencies, and to confront threats from the environment

Discussing similitude based on structural organization and processes is easier with living systems such as plants and animals than minerals or other inanimate substances. Even so, such substances do evidence differential modes of aggregation or disaggregation, qualities of compatibility or incompatibility (in relation to other substances), and characteristic points of vulnerability or fragility. We should not forget that few substances are in a pure state unless they are created or isolated in a laboratory. Nearly all substances are hybrids, that is, a combination of constituent parts brought together and formed into a unity. This process of formation occurs within a specific context. To identify potential analogies for a substance, one needs to ask oneself two questions: 1) in which larger system does it appear?; and 2) what function does it serve within the aggregation of which it is a component part? According to the theory of autopoiesis, the identity of a system consists in its organization. To understand a remedy-system, therefore, one must do more than simply index a list of symptoms: a complex inferential procedure is required.

A decisive step in this direction is the suggestion, presented in this book by Mangialavori and Marotta, to substitute the old term ‘homeopathic symptom’ with ‘homeopathic theme’, along with a reorganization of material which more easily affords thematic inquiry and analysis. Fashioning themes confers visibility and concreteness to the holistic orientation (shared by homeopathic medicine with other therapies) but which often remains a mere petition of principle rather than a principle believed and adhered to. Articulating an analogical relationship through comparison of organizational systems permits one to make explicit the corner stones and nodal points by which the interwoven web of a holistic approach can be concretely configured.

One of the problems with the homeopathic hermeneutic is the innate ambiguity of the term ‘symptom’. Different meanings refer to different phenomenological areas, leading to many misunderstandings. The proclivity for listing mental symptoms, for example, can inadvertently lead the practitioner down the path of rigid determinism, whereby the entire psychical life of a person (hopes, fears, projects, disappointments, anxieties, desires, dreams and fantasies) is reduced to mere epiphenomena (of the remedy)—strange approach for a discipline which claims to be respectful of the whole person. If one is not careful, the approach can further devolve from symptomatic to hyper-symptomatic, whereby all possible expressive modalities or experiences of the psychophysical self are reduced to mere symptoms.

This shadow-like effect is made worse by the severe approximation in some rubrics. A typical example is the conflation within the rubric ‘delusions’ of real hallucinations (with clear evidence of altered perception by the subject) and false hallucinations (where the subject knows that the experience does not reflect objective reality—as in reveries, fantasies, and open-eyed dreams). Obviously, these experiences are quite different and point to two very separate patterns of organizations, namely, the presence or lack of awareness that an experience is hallucinatory.

This brings us back to the fertile suggestion to reorganize registers and research around themes. Currently, despite impressive progress in recent years, computerized repertories are still unable to satisfactorily render the palpable experience of the clinical consultation into intelligible therapeutic terms. Attempting to do so recalls the anguish of a student translating a difficult, enigmatic text from another language, clinging to the dictionary in the hope of finding, among the examples listed, a phrase from the text that one is trying to translate. This hope is most often disappointed since the dictionary, like the repertory, is more suited to creating text than matching it. This higher-level function would depend upon a much more sophisticated elaboration as well as a multi-nodal reorganization of the material.

The WEB has made us familiar with the challenges presented by vast amounts of dyshomogeneous data. Hypertrophic information without hypertextual organization, as communication theorists are well aware, leads to disinformation. This type of organization is accomplished by building networks of connections woven together with nodal points. In this way usable navigation paths can be made inside the sea of available information.

In terms of homeopathic medicine, an organization of material through various thematic registries is quite different from the mere categorical classification of various themes (as in current repertories). A hypertextual approach would employ particular nodal points (characteristic themes, fundamental themes and motifs) which, when taken together, do not simply inform but meta-inform; that is to say, the very way in which the material is organized implicitly illustrates the criteria.

A text is more than a mere list of words. The etymology of the term points to the essential feature: ‘text’ is related to the word ‘textile’ (weaving). A text therefore is a woven network of associative meanings which, when considered together, i.e., in ‘con-text’, are multi-layered. In other words, a text is a net of instituted and reinstituted, hence ‘woven’, connections.

Similarly the practitioner, when applying the principle of similitude, must weave together the various elements conveyed by the patient. This requires a step beyond mere reorganization of material from the repertory. Participation within a therapeutic field immerses the practitioner inside the material. Here he is exposed to apparently disorganized and fragmentary elements which, when apprehended through an open, associative posture of mind, allow a weaving together of the most relevant themes in the life of the patient.

The problem of what to include as themes and how to coordinate them is relatively less emphasized in evidence-based medicine. In this context, themes tend to be linear and singular: identification or exclusion of pathological processes. The approach may be called ‘symptomatic emergency’ whereby one naturally relies upon a broad (if not exhaustive), detailed nosography. In essence, biomechanical medicine ‘sections’ the field, organizing what the patient said according to this singular theme, while all other aspects (functional or dysfunctional as they may be) are declared outside this scope and therefore irrelevant. To resolve a symptom with sure efficiency, it is perfectly legitimate to ‘cut’ the hermeneutic in this way. Homeopathic medicine, by comparison, endeavors to encompass the whole which includes, of necessity, more diverse, heterogeneous aspects. This creates a different set of possibilities and problems.

To adequately identify similitude requires comprehension of two preliminary operations: the autopoietic characteristics of the remedy-system and the fundamental manner of living in the patient-system. Then these two areas are compared. This is the moment when the principle of similitude takes shape and identifies a potential therapeutic nexus.  It is a complex process which puts into play the therapist’s capacity to conjecture, infer, but above all, empathize—empathy here means entering, through participatory listening, the world of the patient. The process is creative, not mechanical, and rarely works if approached as a grid or flowchart.

The heuristic potential of the similitude concept is drastically reduced if applied through simple and reductive transposition of A (remedy-system) to B (patient-system) or vice versa. The principle of similitude is not a datum but a hermeneutic operation; a path to travel, not a shortcut. The map is not the territory, and the anthropological model is not the living anthropos. This obvious but often disregarded point can help one to avoid the trap of reductionism. Too often the practitioner pours too many assumptions into the space between description and prescription, believing that one can deduce from repertory symptoms (for a particular remedy) all the virtual aspects of the patient-system.

Analogy is not identity, and patients do not appear in the prepackaged form that schemes typically guide one to look for. Though the remedy-system is prefigured, the patient is not; and so each time, the analogy must in a certain sense be reinvented. The most one can do is to orient oneself, through thematic organization of the repertory material, toward what the patient conveys. Such contributions, realized within the therapeutic field (and therefore not delegable), are what most guide our understanding of the ‘anthropological model’ of the remedy.

The principle of similitude takes its form through a constant interplay between ‘stored or inherited knowledge’ and ‘knowledge through experience’ which occurs only as a result of the therapeutic encounter. From this perspective, we could speak of an anthropological groundwork in homeopathic medicine. Whereas biomechanic medicine’s place for inspiration and verification is the laboratory; for homeopathic medicine, as with psychoanalysis, it is in the field. This work is similar to that of the anthropologist who, with only a guiding hypothesis in his field bag, ventures forth, putting his theory to the test. Invariably, he must continually modify both his hypothesis and his tools as a result of his ongoing encounter with ‘other’.

The principle of similitude permits one to gather together under one banner many scattered fragments (thoughts and mere sketches of thoughts) presented by the patient. It allows one to orient the therapeutic field under the guidance of a hypothesis so that it can be coordinated with fundamental themes derived from the unique organization of the selected remedy-system. On the other hand, clinical experience helps one put into the correct order the enormous amount of reportorial symptoms, whereby privilege can be given to some promising possibilities which can later be confirmed on follow-up.

Encouraging such relations, though not in an oversimplified way, is the heart of the hermeneutic adventure: searching for the similitude. This project entails, newly in every instance, the weaving together of two elements, the warp and weft of remedy-system and patient-system, but also repertory and clinic. In this way, the conjectural form becomes reified through evidentiary experience. In so doing, each element within each polarity is reciprocally illuminated by the other simultaneously. This circular rather than linear process is a recursive operation whereby the element to be defined is itself, at one moment of the elliptical orbit, the operator of the definition. Here similitude appears like the Virgin Mother in Dante’s Paradiso, who is welcomed by the poet as the daughter of her son.

I think it is impossible by definition to reduce the concept of “complexity” to the few lines that characterize a brief discussion on a site page. Therefore I refer those interested to the vast and most authoritative literature.

I limit myself to expose some basic concepts of the theory of complexity and, especially, to try to elicit the highlights of my original approach: the of model of study and clinical practice that I have called the “Method of Complexity in Homeopathic Medicine”.

In my opinion Homeopathic Medicine is always a medicine of complexity. Unfortunately, and especially today, too many business interests have polluted, as the persistence of a reductionist approach even by many homeopathic schools. My little theoretical and practical contribution reconsiders and reworks different assumptions, historically transformed by the homeopathic theories which defines more orthodox postulates.

First of all complex does not mean complicated.

Simple, complicated and complex all derive from the same root: Plek, ie part, bend, interlacing …

Plicare, plectere means bending, weaving.

Complicated, from cum Plicare, is something bent with folds: it can be unfolded, explicated. As a sheet placed a cloth, the petals of a flower.

Overall, cum plexus, is something with weavings that cannot be unfolded, explicated. As a network, a mesh, a nest.

Simple, sem plectere or sin plectere something not bent has no folds or with just one pleat. A single part: neither complicated nor complex.

For complicated problems there is a known linear procedure. The problems can be separated into simple problems, for which the solution is known.

For complex problems there is not a linear procedure: the problems cannot be broken down into simple problems, for which the solution is known. They are issues requiring more resources than what is commonlyavailable.

In Nature linear interactions are exceptional!

 A complicated system is fragile, rigid, non-adaptive.

A complex system – as a living being – is resilient, flexible, adaptive.

In a complicated system there is normally a complete explanation, a prediction and control.

In a complex system, the explanations are partial, unpredictable and uncontrollable.

A large part of medical science would have us believe that human beings, their hardships and their illnesses, are complicated problems. It would be very reassuring!

The reality of clinical experience teaches us the opposite: living beings are complex systems with complex problems.

The etymology of the term complexity helps to understand the ultimate meaning of  a “complex attitude”, which warns about the failure of the only analytical approach and appeal for the integration of this with a systemic approach.

A complex system can not be understood by mere examination of its components. By analogy the “root causes” of a complex problem are not the trivial ones its essential parts, because it can not be solved by a simple decomposition but requires an iteration between this and an overview.

This is the starting point of epistemology of the complexity developed by Edgar Morin since the early 70s of the twentieth century.

I tried to lay the foundations of  the “Method of Complexity in Homeopathic Medicine” in my book Praxis, translated into English and German.

The subtitle of the book is: The search for coherence between the organization of a substance, of a remedy and a patient.

The principle of similitude

The first postulate of Homeopathic Medicine is exactly the concept of similarity. The application of my method starts right from the study of the substances that we use to make an homeopathic remedy.

Similitude is not a principle that not only belongs to homeopathy, but existed long before. If anything, Hahnemann has masterfully clarified and defined it within its own paradigm. In some way we could say that all of the “anthropological medicines” have employed this principle: this is based on the observation that they used a system/substance as a remedy. There is no question that a simple analogy between a characteristic of a substance and its possible therapeutic effect can be trivial: “eg. the read leaf is good for the blood”. Instead an observation of the “behavior” of the substance: what caracterizes the existence of a mineral, a plant, an animal, a fungus, a bacteria … to be exactly what it is and not something else.

As if every substance uses particular “strategies” to be what it is. These same strategies are reflected in the adptive resources of an homeopathic remedy, and the patient who benefits from that remedy: the substance-remedy-patient similarity.

The principle of similitude is always a relative concept, that can be applied to various levels of observation of the complexity of a  system.

For example the use of Arnica as a remedy for trauma is widespread. In a large percentage of traumatized systems Arnica works if the simile is: a system that undergoes a mechanical injury – remedy that stimulates the resilience of the system.

The homeopathic theories have begun to differentiate precisely on that perspective. Some were satisfied with a good response to mechanical trauma in an equally significant amount of patients. Others considered the issue of why a system could so easily face with repeated trauma; why some patients would respond so well in acute and other would improve even more inconveniences  than  some simple hematoma.

What kind of trauma do we observe in a constitutional Arnica patient? What was traumatized? Which kind of vulnerability existed before the trauma to make that experience so deeply disturbing, and for so long?

In the case of a constitutional Arnica patient the principle of similarity is not the same: the level of complexity goes far beyond the obsevation of a mechanical accident, for when it may seem important in acute.

The proving

The meaning of the proving is another homeopathic postulate.

Without a good proving we have no evidence of a precise idea about the remedy, beyond other information on that substance. Very true.

Hahnemann to his time had a great intuition, which defined a methodology for the study of the substances according to a paradigm, that now, we call empirical. But at that time, in the middle of Enlightenment, it was a first attempt to a “scientific” methodology of studying the substances. Who knows what they will say in 200 years of our paradigms of science!

That intuition was also a way to wipe out the degeneration that had reached the signature theory, reduced – in fact – to the elementary relationship: the plant red  is good for the blood. No more a complex observation of the system/substance strategies, but a trivialization of a puerile characteristic of a whole system. Like reducing the story of a film to a single frame.

Experience shows, however, that very often the information gleaned from a proving – what we call homeopathic symptoms – are not so specific of a single substance. Together with many symptoms, relatively useless for a good differential diagnosis, there are some others very useful, but that we can also found in similar substances.

Take the case of a snake venom.

The proving of Lachesis emerge many  not so significant symptoms to understand that we are dealing with the strangest and biggest rattlesnake venom. At the same time they emerge other which are, however, characteristic of all the rattlesnakes. Other characteristic of all snakes. Still others characteristic of many reptiles. Other specific of Lachesis and only of Lachesis.

If this is true the Surucucu proving can tell us much more, but not limited to this specific remedy.

At least as a working hypothesis it can be logical to apply the principle of the transitive property. Ergo if we have in our literature a meager proving of another snake as Toxicophis pugnax, we can probably remember that the general symptoms of the latter are similar to those of Lachesis. Maybe a few symptoms of Toxicophis, if they are that different from those of Lachesis, could be specific. But always within the framework of the reptiles, the snakes and the rattlesnakes. Whose venom is primarily haemotoxic and not neurotoxic as for elapides.

The study hypothesis does exist in all the sciences. It’s logical to make assumptions that often indicate a good associative capacity. If anything abnormal is taking a study hypothesis to established fact, without serious clinical verification.

The analysis of a proving is never objective, it cannot be by definition. The proving is a wonderful example of how the homoeopathic medicine rely upon the observation of the patient’s subjective corporeality. Our definition of homeopathic symptom does not take into account the fact that in medicine we distinguish the symptoms (subjective) from the signs (objective).

I dare say that – fortunately – to Hahnemann’s time the medical semiotics was essentially clinical, not primarily instrumental as today.

Consequently  in a proving we do not observe many signs: at that time they could not collect blood tests, biopsies and more.

For us homeopaths the remedy diagnosis is elaborated on the collection of what is “curious” in the patient. Not on what is typical of any homo sapiens disease. Certainly it is important to know if the patient in question has a simple gastritis, whether it is an ulcer or of a neoplasy. But the homeopathic diagnosis, the remedy one, needs to know what ails the patient’s subjective body, not his objective physical. We should look for what we call the modalities of the suffering of our patient: how is his own suffering, when it eventually it appears, what can eventually improve or worsen.

In order to compose a picture of how it expresses the suffering of a remedy means to elaborate its more subjective components: those of the provers, as well the observers of the proving ones. Each school assigns different values to twhat arise from the proving, according to its specific reference model.

Leading epistemologists as Varela taught us clearly that the observer and the observed are just one entity.

The proving it can be processed according to different perspectives. Probably all sensible, although some may be more sensible than others. More accurate in describing the characteristic elements: like a fractal.

According to the Method of Complexity the homeopathic symptoms can be joined together into “themes”, which describe different levels of complexity of the strategies of a system and its most structuring suffering nuclei. This method does not consider all the symtoms having the same importance, only separated by repertory degrees and located in different sections of the repertory.

Another postulate of so-called homeopathic ortodoxy holds that only what emerges from the proving is meaningful for the remedy.

A well know concept that other scientist of anthopos which, using a very suggestive metapohor, distinguish the map froms the territory. The proving can be read like a map, more or less precise depending on how it was conducted and analyzed. The territory is the patient!

Definitely a good map of an unknown territory can drive better in our exploration. Just as surely we fix and define our maps when we visit that area, when we take advantage of better tools to describe it accurately.

When more patients successfully treated, observed over a long period in which that remedy has been shown to be effective, refer symptoms and themes these information enrich our map. They define, they specify, they correct it.

Otherwise it would be like saying that the observer of an abstract model – the proving – knows better than the patient what is happening to him. As saying that an homeopath who studied Arsenicum knows better than the Arsenicum patient his own suffering.

Does not makes more sense to think that the “proving map” can let us ask to the patient what he feels more precisely? How does he imagine its death anguishes? What kind of burning does he feels when he experience a pain. How does he feels satisfied about his hyperactivity …

Surely the proving can inform us that much.

Surely it is not forbidden to think. Even better it’s just so nice to do it!

Surely mankind described its relationship with the world in which they live using different tools: the more congenial to their nature and those available in their historical period.

Hahnemann laid the foundation of his method of investigation. Thanks to him, to his ongoing research, we could use a lot of information to help so many people. But this does not mean that the information of provings can not be enriched, guided, defined by other knowledge.

Still respecting the paradigm of complexity one thing is the integration of multiple knowledge, respecting our precise interpretative framework: that of Homeopathic Medicine. Something else is to use simplistic data and elevate it to an homeopathic paradigm: producing theories supported only by intriguing visions.

Homeopatich families

The concept of homeopathic family probably was a need, created by the increasing availability of remedies, the need to clarify the differential diagnosis, the need to classify and aggregate the repertory analysis results that – fortunately – widened the horizons of a few tens of remedies to a few hundred.

In my opinion, once again, there is a significant risk of confusing relative concepts and absolute ones.

In many cases the attempt to simplify the access to our information and to the consequent differential diagnoses become a complication. How often do we see colleagues disoriented in front of the different authors’ classification of our remedies! I think that the problem lies in the definition of each model.

Grouping remedies is always a subjective process, which can only be meaningful if it is clearly explicit what we consider really important of certain remedies.

For example if I suggesting that a certain remedy resembles Belladonna this has no meaning unless I make explicit what I consider significant for Belladonna. Belladonna is never an absolute concept, but always a relative one.

Mother Nature does not need to be classified, it is our problem to define the basis of our classification!

A typical example is the botanical classifications: the plants can be classified according to their appearance, where they live, to so-called active principles, their DNA, and lots more.

It’s hard to prove that a classification drawn up according to well-understood botanical principles can be used to group and / or distinguish our homeopathic remedies. Even more, if we should consider all the existing botanical families, even those belonging to just one classification, we had to face the complication of thinking in terms of  a few hundred families.

The claffication suggested by the method of complexity is primarily based on a definition of the most important themes of each remedy and their dynamic interaction. Substantially on the observation of how the adaptive strategies of each remedy are organized, starting with what I consider the greatest suffering nuclei. These elements, these interactions, these organizations define the remedies that look alike.

According to a purely “homeopathic” perspective, according to the homeopathically significant elements of each remedy, according to the paradigms of my model.

Often we start from the reference to a kind of ancestor. A better known remedy, simply because in was most studied in our literature . For example, the family of remedies similar to Belladonna, or Arnica or Tarentula. What in our lexicon we define a polychrest: an important remedy in the history of Homeopathy, but by no means more effective than other so-called small remedies. Remedies that, in fact, have only been studied less. Not at all less important substances in traditional medicine or, pharmacologically speaking, less known. Just think of Mandragora, a very similar remedy Belladonna, but traditionally speaking much more important. Just think of Garlic, Rosemary, Sage, Buckthorn, Cinnabar, Realgar, sugar, cod liver oil. Historical medicines, folk remedies or very well known substances present in the official pharmacopoeia, but of little importance in the homeopathic tradition.

A homeopathic family, according to the Method of Complexity, it is not necessarily formed by substances classified as similar.

In my first methodological book, Praxis, I purposely presented the homeopathic family of drugs. A set of remedies that do not even come from the same kingdom, as Anhalonium cactus, the Psilocybe mushroom, Bufo toad, Opium.

In my experience the Belladonna botanical family and the homeopathic one are two very different things: some remedies belongs to the same botanical family (Stramonium, Hyosciamus, Solanum nigrum). Many others do not (Tabacum, Dulcamara, Capsicum). According to the evidence of my clinical experience.

The clinical verification

Last but not least I consider extremely important the essential verification of a serious clinical observation. Again even on this issue different homeopathic theoried have obviously different points of views. I have already expressed how important I consider the need to proceed in our investigations following reasonable working hypothesis. All this is completely meaningless if these assumptions are not validated by a serious clinical confirmation.

Hahnemann wrote that the purpose of a good therapy is to help our patients to achieve the highest purpose of their existence. A beautiful sentence that may sound obvious or omnipotent, but that – in my opinion – retain a profound truth. Surely it is important to help reduce the suffering that entails any illness. Equally important is worryng to accompany our patients in their path, helping them make sense of their existence. The best it can.

The examples of cases that I use in my books, in my seminars, in my articles, in my additions to the repertory, are always the result of a long term follow-up. A period of a few years, during which the patient did not have to take other remedies outside of the recommended one. Obviously not for a stance, but because it was not necessary.

According to my best observations a remedy that works well is capable of widly stimulating the resilience of a patient. So I do not distinguish between acute remedies and constitutional remedies. It is not at all a criticism of those who work differently. It is simply the result of my best observations.

When I think that a certain remedy, which I consider constitutional, does not work in the acute I reconsider my hypotesis.

Obviously in a fair percentage of cases I have to use different remedies to help the best I can my patients. But I experienced that, to get a precise framework, the best information is from those cases that respond to the same remedy for a long period.

I do not use talking about remedies that I have never prescribed with good results, how could I say to know them?

 

The therapeutic field and the case: the doctor-patient-remedy system (refer to Praxis: chapter 4 )

 

Much has been written about the doctor-patient relationship. While I do not have much to say that is new here, I would nevertheless like to address this topic since it is critical to the art of homeopathic medicine. 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 occur when homeopaths follow this model. Often they do so simply because they have not developed a well-conceived, personally articulated approach (or perhaps ever felt the desire to create one).

Case-taking, when done correctly, truly is an art. It combines creativity and technique, improvisation and precision, logical and analogical skills. It is inescapably subjective and cannot help but engages one’s own emotional and experiential background. And one’s emotions and personality can affect both the interview and the relationship profoundly. 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 are always pluralities of practice. In fact, there are as many styles of case-taking as there are homeopaths—even more, because sensitive homeopaths 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 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 pretences here.

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 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 least of which is the 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 complexity method, 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 A. 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.

 

In essence, the homeopath arranges and organizes the observed symptoms so as to clarify the dynamic process which is at the root of such phenomena.

Even so, it is important that the homeopath also has the ability to understand symptoms in terms of their cause and effect, that is, from what might be described as a homeopathic physiology or pathology. Unfortunately these areas are yet to be well developed, though every serious clinician of whatever persuasion depends upon such knowledge. Thus there is as yet no underlying homeopathic explanation which links the appearance of a symptom to a precise hypothetical cause or a homeopathic classification of diseases as free-standing nosological entities. In fact, for many if not most homeopaths, such endeavors would be considered antithetical to the homeopathic model.

Just because homeopathic medicine has had a symptom and phenomenological focus does not mean that it can simply dispense with these domains. Nor can one argue that these areas are irrelevant to natural medicines. Chinese medicine, for example, is well renowned for having, in addition to an extensive corpus and epistemology, its own functional anatomy, physiology and pathology.

Let us consider an example to underscore this need. If we read in the repertory ‘swelling of a lymph node’, we would consider a particular remedy known for this phenomenon. We may be able to successfully cure this symptom (and perhaps other symptoms at the same time) thanks to the action of this remedy. But this is not enough. Without doubt, it is also our duty as doctors to ascertain whether this lymph node is cancerous or simply inflamed. From the strictest homeopathic viewpoint, however, it makes little difference to the diagnosis or the remedy prescription (which in many respects are one and the same).

Part of the dilemma here is that provings, upon which most of our literature is based, do not continue until severe pathology develops. I am not suggesting that we should inflict pathology on provers! I am merely pointing out that provings are not as reliable as clinical results, particularly because they have severe limitations with regard to true pathology.

To be fair, some pathological dimensions have made their way into homeopathic medicine via the study of remedies. This is quite evident when making differentials. If we recognize Conium or Phytolacca in a case, since both remedies easily develop destructive pathologies, we will regard those swollen lymph nodes as potentially serious. If the diagnosis leads toward Calcarea carbonica or Arum triphyllum, we would be less preoccupied, thinking that the patient is probably not so seriously ill.

This is similar to the situation after bereavement when the symptom complex of a patient makes us think of Ignatia or Aurum metallicum. These two patients will not have the same prognosis in spite of having the same causative trauma. We will be more concerned about the possible development of severe depression in the case of Aurum whereas we might anticipate hysterical lamenting and a need for support in Ignatia.

Returning to the question of causation, the challenge is twofold: first, as already mentioned, to develop a subfield of homeopathic pathology; and second, to integrate this with an understanding of the individual’s unique structure and strategy. Put another way, a general causative pathological process such as a cold or cancer is expressed in a particular way in the context of the individual; in other words, it is individualized. The point, when looking at swollen lymph nodes, for example, is neither to dismiss the pathology as irrelevant nor to become focused on the pathology (as occurs routinely in academic medicine) to the exclusion of the patient. Consideration must be given to both.

As A. Panza states: “We are always dealing with a relationship (difficult or absent) between a container and its contents where the contents are not the events, but the tangible resonance of those events registered at the physical, corporal level.” If a traumatic event, for example, were identified as a likely partial precipitant of pathology, the focus should shift from that event to how it reverberated within, and was metabolized by, the individual system. Meanwhile special attention is given to the body as the field where such effects most palpably manifest.

Finally, this discussion of diagnosis and causation is not meant to suggest that the patient should not also receive a clinical diagnosis according to an interpretive, allopathic model. Such diagnoses have real value and tend to be based on a careful, rigorous understanding of the physical body.

They are not the totality of symptoms and even their supposed objectivity that allow a good homeopathic diagnosis. Already the concept of “totality”, so frequently ab-used in Homeopathy, speaks volumes about the delirium of omnipotence that afflicts doctors in general and, even worse, the homeopaths, especially those who believe in the beau geste of the unic prescription that fundamentally will change the patient’s life.

Once again, perhaps, instead of “all” the term “complexity” is fitting more to those who hardly reach enlightenment sitting in the shelter of the head of a king cobra.