The most you can learn from your patients. Interview with Massimo Mangialavori.
How did you get to homeopathy? I know something about your journey to South America but not so many people know it so could you please tell me more? What did you do there and how happened everything?
So briefly because it is a long story and also because it is a pretty private stuff ... I had a big interest in anthropology and systemic approach to medicine including psychology and this kind of things. Because I was offered to make a study I was invited to join the group mostly of anthropologist to study magical medicines in South America. I joined the group. It was in the end of university, so I was twenty four, then I had an opportunity to remain longer because the trip long lasted only a couple of weeks. By chance I met some very interesting and real shaman. I was invited to see few of these villages, mainly one in Colombia where they train those shamans from the very beginning. They took them out of their family in the age of five six and until the age of twenty one twenty two they train them in this way. It was a very significant experience mainly because we approach to a knowledge of these people which is actually not the opposite but very complementary to the western medicine. Nothing is there in their knowledge which can be transmitted into books since ages. They even have a kind of myth that the culture was destroyed because of a bad use of technology. And in the mythology it is as if certain wise people after a destruction of this culture decided to continue without making the same mistakes. It was forbidden to use the wheel, it was forbidden to write and (it was forbidden to use the metal. So try to imagine if you cut off from the very beginning in some culture the use of wheel, metal and writings, so it is something outrageously different. So what is interesting is that in our culture we pile up together one information after another and in a certain moment we have to use what we assembled to try if it works, if it is true. I those cultures the approach is completely different. They mainly train you HOW to get by yourself your security, the proof of something which means improving in a very serious and precise way your sensitiveness, your capability of recognizing something. So it is almost up side down. Practically it means that they know very few plants, very few metals, very few animals as remedies but they know how to recognize clearly what is characteristic, what is the substance and what is the person and what is similar. And it was really striking because you can see these people to treat really with a great success, many problems and many diseases, mental as well as physical ones. And it is interesting that we consider this culture a magical medicine while in that opinion it is one of the most positivistic approach to nature. It is not because of the idea that they would feel something ... When they say I feel what is the use of some substance it is something which is shareable for all the people which know that in realistic, practical, direct way. In the same way it could seem magic that a car can walk without horses, that there is an airplane which can fly...Generally speaking the concept of what is magical in modern medicine and some modern anthropological studies is something pretty distant from what reality is and what these kind of people do. It is interesting to think in a more humble way that our medicine comes from this approach to nature. We discovered later why digitalis, why the bark of salix alba and this kind of stuff works, we use aspirin since decades and the use of prostaglandin is pretty recent in our medicine. We should ask ourselves how it is possible that with analogical approach in many parts of the world people were able to recognize it. This was very striking for me. Coming back from this trip I met a guy in Colombia who was a homeopath, very famous homeopath working in Bogota, it was shocking experience for me.He had a big clinic with many people coming to see him, there was an earthquake when the clinic was destroyed. He suddenly decided to change the way of his living, he went to live close to a forest and to treat these pure people for nothing. He was a very fascinating person. We had a very long speech and he invited me to stay in his house for few days. We spoke what I was studying in those magical culture. In some way what he told me about homeopathy was something very close because in some way they use remedies coming from different kingdoms, they use different potencies of remedies in the sense that they can work using directly the plant, it can be cooked, boiled, triturated, whatever you want or they can even pray to the spirit of the plant and the patient...And the concept of something similar which is not chemical concept was already well known in our consciousness in our cultures for centuries even before Hahnemann of course. It was really striking and such a strong experience... I had to go home to finish my last exam on university. I was trained to become a cardiology surgeon even with a kind of successful life in front of me because. My uncle was a chief of a hospital and he trained me in a very strict way to become a very good doctor. He was very disappointed, he did not speak to me for more than twenty years because of this decision. When I came home I said: OK, I want to study something else. That was the beginning.
And then you went back again?
I returned back several times. I had a good relationship with those people. I wanted to try to enter that and to know something more about this culture. I can tell you I have never had any experience with drugs, I have never had any experiences which are written in many books of people going there. It was just an interest with the way of living where the man is not considered as a centre of universe but as a part of universe and how you can recognize in substances around you where is the soul, the meaning of the substance and how a person can resemble this kind of things. So the concept of similarities is very clearly here. It was not experience, it was a research ... people become to be what they are when they are because of their fifteen twenty years training so what can we do in some weeks? You can watch. You can get something but not more than this.
But anyway it can change your perspective, your way of thinking...
Yes. It was like that but anyway I think in the life of many person this kind of an important trip can allow you to discover that something else is already inside of you (smile). Traveling means something but in the end there is something what was there even before you need to travel. It is the way you can recognize something like this...
In the field of homeopathy you had to start just from the beginning. How was it for you?
In the beginning it was a severe frustration. More than twenty years ago in Italy there were few schools. Very superficial, not very well organized. So because of my character and because I am a kind of greedy person I attended three schools in the meantime, I went to several seminars abroad, I studied a lot. On one hand I found this world of homeopathy extremely interesting and on the other hand I noticed in my understanding significant discrepancies between what is claimed and what is a reality and what you see around. Because claiming of seeing individuality in the person and treating people with twenty or thirty substances is a gigantic contradiction. And to adjust your theories, to support your unsuccessful ideas in order to make it easier instead of an issue that treating people is a complex stuff and it is difficult it seems to me very superficial, sometimes dishonest not to use other bad words (smile). And so I started to investigate a lot and try to find out the system which could allow me to think in the terms of relationships between substances, to think in terms of arranging and organizing what we can recognize and to try to understand why we do have such a large farmacopoea, such a beautiful and big materia medica and why for human reasons we have to restrict this gigantic amount of information to a few remedies. I think the theoretical part is very interesting but I think it is fundamental as in every science to distinguish which are the roots and which can be the compulsory evolution that has to exist in every science which means to do a classical work because we started from there and what is a kind of orthodoxy which is based on a fundamentalistic way of thinking which is not scientific but religious approach. I have nothing against religion but here it is different. So I think to talk about Hahnemann, to recognize Hahnemann, to know how ingenious was his work and how gigantic was his step in the growing of medicine that he did is something which I of course completely do respect and I do consider that he did something beautiful, some really ingenious step forward but I think that to honor what he did we have to keep going on and add our little brick to building this temple not considering that what we think he said is the only possible true because this is not to continue what he did in a good way. And it is true in every science.
And even him he changed his concept many times during his life ...
Of course, he was a scientist. How could you do it in a different way? I can understand now there is a big movement of something connected to this orthodoxy because in my opinion there is a big split in this moment. There was a kind of revolution in the way of thinking which was based on a great enthusiasm and which was based on the idea that is much more easy to study since we have computers and much more books available and it is easier to work with more remedies because we are not so restricted anymore as years ago to e few stuff we have in our office. As for me it was a kind of explosion and now we have to face a kind of implosion.
What I really do not like so much is that what is claimed to a good possible interesting idea very often is not presented as a theory or as an idea but as a fact. In serious science we use articles, journals, congresses to present ideas and theories and usually you write a book if you have something substantial. Not the contrary. And this is something what we should discuss in our homeopathic community. All those interesting new fantastic and sparkling ideas which have to be studied, underlined, understood, defined and so on ... the reaction of many of our colleagues could be a bit scared and saying we would like to have something a bit more substantial. It is absolutely logical and it is true. But being serious and substantial does not mean to go back to our origin. It means to do a better science than we are doing now. And it means also not to remain closed in a little gold cage but around there is a world of other scientist investigating other fields complementary to homeopathy which we can discuss and showing what we are doing. I think that one of the reasons of implosion of homeopathy nowadays starting in western countries is because our entire international community was not able to come out with homeopathy in those years as something fascinating and beautiful and interesting as it is. Honestly I can tell you I went to some congresses not only in Italy and you can be easily disappointed if not even disgusted for what you find there. Is not only completely not scientific but also completely faraway from a basic knowledge of psychology in which we have more than one hundred years of studies and investigation, it is faraway from modern biology ... so it is very strange to see in our community people which do not have more than basic idea about science, more than basic idea about biology, more than basic idea about mind symptoms and so on and then they claim something which is completely untrustable, illogical, unrealistic and so on. So we do give a space to ideas which do not deserve.
As you wrote in your book we should be able to endure some critics from other scientists and support our knowledge by another sciences ...
Of course, this is what happens in every science. It is just a different perspective of observing the same phenomenon. You can take a look to life from chemical, biochemical, physical, electrical, magnetic, medical, psychological point of view. Not each one of these is even something different. It is another perspective. And this perspective can only support and enrich the others not closing and thinking that you are the only one who is right. I think that gigantic failure of homeopathy, of our homeopathic community in the last years was that we were mostly unable to communicate this to other scientists. The main focus until now was a kind of minority complex which is still affecting the most of our homeopathic culture which means to demonstrate that our remedies are not plain water. I keep asking myself how much certain colleagues are so focused on this topic. On one hand I am very happy because for me this kind of investigation is absolutely boring, I prefer a clinical work, each one of us has his own pleasure, on the other hand I am asking myself: Do they really believe that homeopathy works? It is really interesting. And there is also the other thing that the homeopathic remedy is not the only part of the process. It is much more intriguing for me to consider our way of thinking, our system of working, our way of taking case, our way of evaluating and so on ... the homeopathic remedy is only a part of this process. It is not the only thing. So it is fascinating and beautiful and I do respect a lot our colleges studying this but I want to say that focusing only in this point in my perspective is a gigantic mistake because our therapy is something much more than just using something what is not a plain water ... and at the right point we have to demonstrate that the only missing point from the scientific point of view is this black box because still we do not know HOW it works though we know that it is not placebo. There are so many things that we use in homeopathic medicine and we do not know WHY. So why cannot we show our good results, why cannot we claim what we are doing not only because we are using something natural, something which is not toxic, something which is inexpensive. This is a part but what is a beauty of our work is the way of thinking, the way of treating people, the way of watching, of understanding, the way of thinking of what is a model of disease, the process of symptoms which have a meaning one after another, of thinking in a complex way which is extremely modern in our science in the beginning of the third millennium. An for me to see these fantasies is really a pity because still the majority of doctors, scientist and people believe that homeopathy is something using small doses and nothing more ...
Your understanding mostly comes from your clinical experience...
Mostly I study a lot. I study our sources, our literature, provings, together if it is possible with what I consider larger study of substances that can be used. This is the first part. I used to study in terms of relations. I ask myself: this is an interesting remedy... in which other remedy and why and for what sense this substance can be related to others. So nothing in the sense of unit single little boxes but what is connected. It is a systemic approach.
What you say about the clinical experience for me is fundamental because as for me there are two levels of understanding remedies. One level which is sharable, so it is important to understand what other colleagues think, what they recognize and to understand what you can share and tell to other colleges about what you think. It is a level of consensus. There another level of understanding in studying has nothing to do with what is sharable, is much more analogical and belongs to your own way of understanding. Not because there is anything magical but because each of us has his own way of understanding, his own sympathy, his own way of thinking, his own way of making mistakes. So surely for every homeopath there are remedies easily to be understood because of a structure of our personality and other remedies that are faraway from our way of thinking The same like if you are a psychotherapist you can stay much easily with certain person than with other. This is not a sharable level because it is something extremely personal. It is important to learn from your mistakes. To understand why you prescribe so often a certain remedy, why you often make this mistake. What do you not understand about this substance and so on. I use a lot of information out of this. This is the reason why I designed a program in1991 which can allow me to do this work and to evaluate my success, my mistakes, my misunderstanding and so on and I regularly check and check an check to find results of my experience...
Do you mean Consulta?
Yes, yes. But it does not matter. What is important is that I check from my experience what I am doing. I think that first of all what is important in every case if you are a doctor independently in which kind of medicine you practice. Unfortunately our books are seldom based on an experience. You know that our literature is mainly done by people who copied what was written by others without any experience. So very seldom you can really trust in what is written. Not because I would be a suspicious person. It is not the point. Considering that what we are doing is a medicine I think probably it is the only medicine in the world where people are allowed to write books of materia medica without never prescribed successfully one remedy written about. This is just ridiculous. It is a shame because you should not even allow to person in a seminar to talk about a remedy which he does not know. Something is to say to people: You know I studied that so I can give you a favor and I can present you something which is a result of my study. Honest, clear, good. As Clarke did: He wrote a dictionary of materia medica and said: I collected these information. And in the right moment when you write a materia medica in the situation when you never ever prescribed it well it is just crazy. It is complete nonsense. And in homeopathy we have tons of information like these. And what is even more ridiculous is that what we teach in our courses our students is to use a repertory and then to see for confirmation into our materia medica. Confirmation of what? So who ever in the world could know better the remedy than a patient which was really healed by it? This is a real source of information. And I think that from this point of view was very often misunderstood. I do not want to say that provings are useless. Never. They are extremely important but I think that a proving is a proving. It is not a remedy. The proving is a map, the territory is the patient. So the proving can tell you some information about what you can do, what you perceive, what you can recognize and the patient is telling you if what you have thought is true or not. If your hypothesis makes sense or not because he knows is and not you. And this is the reason why I think that a clinical experience is the main source of our information. As well as we absolutely need good provings in order to design the map of what this remedy could be but I repeat that important are the territories of a patient. More than one patient can give you more information and this information is not coming out just from a single doctor. That is what I mean.
Yesterday we spoke with Gianni Marotta about what is happening in Italy how do you do your schools. I have noticed you are just changing a bit your concept now, not giving so much seminars, not teaching so much, concerning more about studying, materia medica and so on. Can you tell me more what are your projects now?
I have decided to make a choice in this direction because I was happy and in the same time disappointed by my work for some years. Happy because I can tell you in a great majority of cases my work was recognized and appreciated. Disappointed because I saw that many colleagues were interested and after one or two days of seminar they got few information. So in the end I thought that I would have liked to allow to the colleagues who were interested in this approach to understand better what I meant. You have experienced it. You came once to Prague for seminar and then you attended the course of three years. So what?(smile) The difference is extreme of course(smile). You can sell more books, you can look more popular, you can travel much more, you can do something what can look much more successful, you can make more money whatever you want. But I must tell you that I was pretty unsatisfied because in the end the impression that I could give out about five ten percentage of what is my way of thinking. It is honestly is not so easy. One of the reason why I think that my work is beloved by someone, somebody considers it crazy and not so successful in terms of followers is because I decided to do it in this way. I prefer to work with less people and to show them as much as I can.
You know, your way is difficult, deep and people sometimes like if things are not too complicated ...
I know perfectly. I know that we are adult, we can work with families and many things like this. I did not choose this way because I would prefer it to another. This is the only one that I can do. It was not a choice, it is an obligation (smile). I cannot do it in a different way. I think it is human that everybody seeks a shortcut but in my opinion to treat seriously people is not something what you could do in a shortcut. This is my experience. This is not a choice. First of all to be a doctor it is a never ending process. To study human beings is a never ending process. I think that to work as a homeopath and to be a homeopath is not the same. In the moment when you start even beyond homeopathy to think in this way, when you start even beyond the homeopathy to investigate the meaning of an inner world of human beings you open a door that you will never close again. And bellow this reason is that it is a passion. It is not only because it is just a homeopathy, it is the way how to enjoy life, how to understand of what is around you. It is a permanent process. And there is a moment where you use books and information to get in but your learn from your experience, from your patients, this is your materia medica. And your daily work. So seminars and congresses can be useful to give you some hints but it is your daily work with your patients which makes you to become a good doctor. So in the end when you are correctly understanding this is not the choice it is not that I prefer this to do like that. And I have the impression talking with some colleagues coming to my seminars and courses that we are sometimes a bit disappointed because they would like to see more people coming, because they would like to see me to write more articles. I do not want to look presumptuous. In these more than twenty years I put together almost six hundred remedies, exactly five hundred eighty with good information. To each of them I have at least four five cases with a long follow up which as for me is reliable material. I am known for working on animals which is not true because I did so much work in plants and so much work in others. I put together really a large amount of knowledge and information. I really do not have time to write articles, it is not really so easy to find time to write books. I think I am now in a moment in my life when I would like to put together all those information and try to translate this into some reliable material that I can try to share with my colleagues, to try to make a kind of synthesis. And this is another reason why I am giving up seminars because my work is not to be a teacher, I am a doctor and I have to take care of my patients as well. And it is hard to do this and in the meantime to give lectures, to do seminars and courses, to take care of the school in Italy and in Boston and so on. So this is what I would like to do for the future. And I am absolutely aware that this approach is not easy, takes time, takes energy. It needs a good background, it needs an interest in this kind of stuff. I have seen until now several colleges sometimes fascinated by those ideas clearly saying: “For me this is too much.” I can understand it. Believe me I have nothing bad to think and to say against other approaches. First of all anybody of us has his own reasons so we can only add our little brick to this temple and anyone of us can think and do what he likes. I know that this approach is not popular. But I cannot do anything else because I love it. It is what it is. Eventually I have to take care of not doing it even not more complicated, not too sophisticated. Otherwise only few people can follow it. I am trying to make it easier. If you come to some seminars you can see that the material on which I am working is something pretty deep and pretty heavy. It is not compulsory for being a good doctor to have an interest in these kind of things. I think that a magical aspect of homeopathy is that you can prescribe arnica for injuries without understanding nothing about materia medica, learning few symptoms and using it. And it works. Why not? For me would be impossible to work in this way. I need to understand, I need to find out the connection between remedies, I need this idea that I can go deeper with my cases. So it is an obligation for me, it is not a choice.
In your materia medica you write in the same way how did you do it in Praxis or is it different? There will be also cases?
My project is to write a materia medica. I do not want to tell you want I am doing. It is a little secret. Then I will publish a book with many cases. I had to wait with this materia medica. Something what I really dislike is that in this moment you can see many things written about remedies which in my opinion are poorly supported by clinical experience. And again according to which model of thinking you are using a good case can be something different from one homeopath to another. For me a good case means a significant improvement on many levels, helping really to person to develop, helping the person to grow using the remedy in acute and chronic conditions working for a long time which does not mean at all that I dislike somatic way of working because sometimes in some cases it is the only thing or it is the best that we can do. If you have to face an epidemic of cholera you cannot waste your time with the things like this. But something is to say that the only way of working is to do something symptomatic and superficial and something else is to say that this is the way of treating seriously and deeply people. This is something else. Every doctor should know what he is doing what is better to do what is necessary. If you have to stop a hemorrhage you have to stop a hemorrhage. Independently of which problems has this person with his mother or what he wants to do with his life. But this does not mean that then you could not have an interest to do more. Some of us are more than happy when the abscess is opening, some of us are more than happy because the hemorrhage has stopped but my desire is something else (smile).
My final question: Do you have some wish for the future? For you yourself, for homeopathy?
In general I think it would be very nice to have a possible integration with other medicine. I have never thought and I do not think that homeopathy is something else from conventional medicine. I think it is something enriching conventional medicine and something enriching a concept of healing. Of course there are many things that I totally dislike of the conventional approach but I think that is not anymore a time of years ago when you could avoid the consideration of a work of our allopathic colleagues, not even a work of scientists. I think that in medicine there is a large field where you can reach every patient from many perspectives. So I do believe in an integration. You can have similar models of thinking, you can discuss and reach a different perspectives of what you can do in terms of treating people. So I wish something like this. When I went to Scotland to work with Tom on the cases of supervision I thought I was in completely different world – to have a patient which was sent by another doctor, which was sent by a department in a hospital officially asking you for some help, a place where you can take a patient to be healed, to be hospitalized, to be studied, to be observed for one week, you can talk with nurses about what that guy is doing all day long and the reality of working with these people without risking that you loose your licence or that you are doing something what is not officially recognized it is such a freedom, a feeling that you can do what do you like, a sense of I can do the medicine what I like, I trust and so on. This is really something.
About my personal work I would like to be able to share this little treasure with people who are really interested in my work and again I repeat that this is not a large number and it is fine for me like this.
So good luck! Thank you a lot.
Author: Dr. Katerina Lucká. Interview performed in Capri, June 2007.