AS: We are very fortunate to have Dr. Bernardo Merizalde with us today. Dr. Merizalde is a homeopath, psychiatrist, researcher, writer and current president of the American Institute of Homeopathy. Greetings Dr. Merizalde and let me welcome you to Hpathy. We all look forward to you sharing thoughts and wisdom with us. How and when did you first become involved with homeopathy?
BM: I was in my fourth year of medical school when I became disenchanted with the limitations of conventional medicine. In Colombia, where I grew up and went to medical school, the medical students do the work of the residents under the supervision of attendings, so we had to attend clinics, examine patients, and prescribe, starting in the third year of medical school.
Looking for an answer to what to offer patients with chronic conditions I started exploring alternative modalities of treatment. I found a clinic in a pastoral region of the country, where doctors used only alternative medicines and decided to pay them a visit.
This was a place out of a postcard, a “hacienda”, where four doctors and one dentist treated the patients holistically. They used various modalities, including “neural therapy”, herbal medicine, chiropractic manipulations, holistic dentistry and homeopathy- through the electro-acupucture according the Voll (EAV). That was December, 1978.
When I looked at those vials and dropper bottles of highly diluted substances I thought it was all bogus and gave it no credence. However, I saw impressive results from those “water solutions” as the patients returned for consultations; so I decided to give them a chance.
I opened a homeopathic materia medica and started reading substances I was familiar with. I had been very good in pharmacology, so I was able to compare what I was reading to what I learned from the textobook of pharmacology of Goodman and Gillman, the “official” textbook in medical schools around the world. Upon reading Belladona, Digitalis, Strophantus, Curare, and many of the salts, I realized that there a strong correlation between the two fields and perhaps I should give it a chance.
It took me a year before I felt comfortable enough prescribing remedies. I was studying Eisayaga, Vannier, and Marzetti, who use mostly low potencies and use a lot of keynotes; so, following a prescriber’s guide by diseases and condition I started prescribing remedies.
AS: That “hacienda” of holistic healing seems ideal for a student or a patient. Do you have any thoughts on why homeopathy and natural healing is more accepted outside the U.S.?
BM: Yes, the bucolic environment was very conducive for patients to get away from the pressures of regular life. I found that environment ideal for studying the new medicine I had found. I had never studied as hard in my life. The place had a vast library of books on all subjects related to alternative medicine, and I just couldn’t get enough!
A probable reason why homeopathy and natural healing is more accepted outside the US has to do with particular psychological, cultural, and nationalistic characteristics and differences.
Dr. Clare Graves described the development of conceptual frameworks, and belief systems, in human groups and cultures across the evolution of human kind, societies, and individuals. The particular history a group, or individual, goes through determines those belief systems.
In many of the third world countries traditional healing systems are more accepted, which have a significant representation of magical thinking, including shamanism. I am not using the word magical in a pejorative way, but as a perspective that views certain aspects of life as seemingly supernatural and not explainable through our current knowledge of the world. Homeopathy has this magical quality, a significant component that has yet to be explained, how the power of diluted, and succussed, substances increases as the dilution increases. This is hard to accept by a purely rational mind.
In those cultures, the magical perspective gives answers to certain questions about life; healing and health, life and death, are conceptualized within a broader context, not just factual constructs. In those cultures we find a rich amount of tales, myths and legends.
People in those cultures find it easier to accept concepts that may not appear totally rational; they may accept things at face value; they don’t care about the scientific rationale. The shortcoming of that perspective is that at times it may difficult to discern what is a truly valuable treatment approach, and why; it may also lead to the acceptance of practices that have no therapeutic merit in themselves, and are just placebo effects attributable to factors other than the particular intervention.
In Europe, perhaps because the experience of WWII was so close, it created a closer community, where the care of concern for each other became more prevalent. The prevalence of regime with socialist parties and programs permits ideas that address the common good instead of pure profit, and tolerance. Homeopathy, therefore, and also because it has a longer history and diffusion across the continent, is more accepted. The situation in the US, regarding homeopathy, is complex. There are scientific, economic, political, and sociological issues that limit the acceptance of homeopathy in the US.
With the enlightenment, which was very influential in the founding of the country, rationalism and skepticism became important in the assessment of claims. The magical dimensions were relegated to childhood; although superstitious practices are often found in adults.
Practices which have questionable credibility according to the rational stance are not worth considering, especially if they contradict strongly held convictions. Since accepting the probability of homeopathy would put into question certain deeply held beliefs about how the body’s organs function, and the nature of disease and healing, it is discarded without giving it a thorough evaluation. It is not about being truly scientific but the avoidance of cognitive dissonance.
There is enough scientific data in favor of homeopathy; there is as much in its favor as with many conventional approaches. Yet, it is still unacceptable to most medical authorities.
They would have to change their conceptual frameworks, which is hard to do for most people unless there is a great, incontrovertible, amount of data to support such a change. This information needs to come from an entity with authority, for it to be considered reliable by individuals at that conceptual, “belief-construct”, state; that includes the great majority of the medical community and most politicians.
I believe homeopaths became too comfortable, and complacent, about their knowledge and about homeopathy, their truth and lagged behind in gathering data in the manner the conventional establishment was developing. Therefore, the ones with the greatest amount of work and data, according to the parameters set by what became the orthodoxy, took the upper hand.
That is the state we are in, from a scientific standpoint; we could be about 60 years behind in the amount of research needed. To gather the evidence we need research that is definitive, yet not many people in the homeopathic community have been interested in developing the skills to conduct high quality research and develop protocols that are tight and conclusive. This can be because they are functioning at a different belief construct state.
Besides the advent of the scientific revolution there was the industrial revolution, and the increase of wealth in the country particularly in the late nineteenth century; the distribution of power became more divergent and concentrated in a smaller group; the interests of the few became more influential.
A broad acceptance of homeopathy would probably destabilize the pharmaceutical industry. That became obviously a threat, starting at the time of Hahnemann, who was chased out of towns by the local pharmacists and physicians; his concepts affected their trade. It didn’t help that he was so caustic in his criticisms of the establishment. I wonder what would have happened if he had been more tactful and had woven the new concepts into the prevailing ethos without being overtly confrontational.
Going back to the Graves’ model, people develop conceptual frameworks about life and the world along two main directions, the satisfaction of personal needs, or the denial/sacrifice of personal needs for a reward, either future or now. These two directions are: towards self, with less concern for the other or the community, or with a greater concern for the other, or the community. Along these two main directions there are three or four distinct stages or phases. I will not get into this, particularly as it relates to homeopathy at this time. That is the subject of a presentation I will be giving at the next Joint American Homeopathic Conference in April, 2008.
If accepting homeopathy threatens personal interests, because a broader acceptance would threaten livelihood, or induce shame (“what will my friends think about me, that I’m weird!?”) then the idea will be rejected. On the other hand, I know people who are able to accept homeopathy while working for a pharmaceutical company, but they do it quietly, they are able to tolerate the state of cognitive dissonance within, but they would never promote homeopathy to the public. It would be personally too risky to do so.
In the other direction, some people will reject the idea of homeopathy because it is not the accepted way, not the “acceptable” way, not the conventional position. Accepting it would be “wrong”; no acceptable authority, to them, has validated the idea. They wait for other people, particularly authority figures, to endorse the idea before they can accept it.
People who have no limitations in their ability to contemplate new conceptual frameworks are able to accept homeopathy by its own merits, not because an authority endorses it or because the majority of peers are using it. Other people will accept it because the framework they use stops offering them satisfaction or their needs and homeopathy has helped them significantly, so they accept it without concern for the other’s opinions. Other people are willing to sacrifice themselves, their honor, and even their reputation, for the sake of homeopathy because they believe it is the right thing to do for the community.
For people who are interested in a model to help to spread the use of homeopathy, you can read Malcolm Gladwell’s “The Tipping Point” which describes the process of diffusion of novel ideas. You will find there a description of personalities that corresponds well with Graves’ model. I am currently designing a study that can include the whole homeopathic community to determine the prevalence of each belief construct state, or level of existence according to Grave’s terminology. This could provide some answers as to how we can harness our energies, as a community, and develop a model to integrate more effectively and work towards a wider spread of homeopathy.
AS: That’s a fascinating perspective on the psychology/sociology of accepting new ideas. As a psychiatrist and homeopath, do you often get patients who have been on psychoactive drugs? How do you approach such cases? What practical lessons have you learned?
BM: Even though I practice integrative general medicine, I am board certified in psychiatry and neurology, so I get a good number of patients who are on psychoactive drugs. Many of them have been on medicine for years and want to come off of them. I discourage patients from stopping their medications without working in concert with me, to prevent relapses. Often, when the brain is used to using conventional drugs it takes a while for it to get going. I do not take on patients who have had more than a couple of hospitalizations and/or more than two or three medications, especially with a history of psychosis, because those are patients who are difficult to treat, usually have poor insight and often tend to be impulsive, and come off their medications without contemplating the consequences. Otherwise, I do a complete intake, which can take between 1 ½ to 2 hours; I assess their ego functioning (ego strengths, coping mechanisms, impulse control, insight, etc) and based on that I can determine whether someone has the potential to come off of medications, eventually. I will always prescribe a homeopathic remedy and depending on the concomitant clinical history I select the potency of the remedy. I have not found the, often referred to idea, that high potencies are used for mental/emotional cases. It all depends on the person’s sensitivity and susceptibility. I have had many patient gets unacceptable aggravations from high potency remedies and even from 6C potencies. I will often try the 12C, unless there is a history of sensitivity in which case I start them on LM potencies. Many times I find that patients will need lower dosages on conventional medications and little by little are able to come off of them. I find that homeopathic remedies often will start addressing symptoms that the conventional medications are not addressing. Sometimes I have had to prescribe conventional medications to patients with emotional disorders. They are suffering so much and such a difficulty functioning that it is imperative to use them. However, I often have been able to use very low dosages with very good response. In fact, some of the medications could be considered prescribed homeopathically, like Prozac at a low dosage, for patients with depression and suicidal ideation, like 1 mg every fourth day, when the usual dosage is 40 mg per day. Some patients respond to sub-therapeutic dosages, from a conventional dosage perspective. I will always continue treating them homeopathically.
AS: You’ve said that you believe in integrating physical, mental and spiritual dimensions. How do you affect a patient’s spiritual dimension? Are there spiritual beliefs that guide your work?
BM: That is a very complex, yet important question. I come from the premise that we are wired for spirituality and trascendental experiences, as many researchers have found through research in the last thirty years, particularly using MRI technologies. I define the spiritual as those experiences beyond the concrete, material world, yet not necessarily with its exclusion. Such experiences may be: observing a sunset, or a sunrise, or a beautiful landscape, a painting, listening to a concert; or it can be absorbtion in deep meditation, experiencing samadhi, or ecstasy, or any so defined mystical experience; with everything in between.
I have studied comparative religions and can converse about particular faiths with my patients. I have found that my being able to address those cultural aspects, with the existential issues they include, is reassuring to patients.
It is those experiences, and how people interpret them, either rationally, or irrationally, which I will explore with patients. I often find there are a few rubrics I can identify during those conversations. I you look up rubrics that include religion, salvation, ghosts, evil etc, you will find that spiritual and religious themes are well represented in the homeopathic repertory.
For people interested in exploring more about integral spirituality, I recommend the book “Integral Spirituality” by Ken Wilber, or his audio production, “The 1-2-3 of God”.
AS: Is it true you worked with children who had been abused?
BM: Yes, I did work with children and adolescents who were adjudicated dependent, by the Department of Children and Youth Services of Philadelphia. Many of them had histories of breaking the law, but were there mostly because of physical abuse or neglect. I had the opportunity to treat many of them with homeopathic remedies. However, the treatment was more sporadic and not as intensive as I would have liked it to be.
They would be in the residential program for several months and the great majority of them had behavioral problems. I, and the staff, felt the remedies were helpful in the management of the kids’ behavior. I wish I would have had the time and the support staff to tabulate the results.
AS: Your work with adjudicated children suggests a whole new dimension for homeopathy. Can you envision how homeopathy might be being incorporated into the social service and criminal justice systems?
BM: Absolutely, Alan, the use of homeopathy in a public health context could change the lives of many families in so many different ways; with better ability to focus and concentrate in their studies, due to better mental and physical health, we can develop youth with better education, a more involved citizenry, less interpersonal conflicts, higher productivity, less sick days, etc. The implications are enormous, on political, economical, social, personal, psychological, and spiritual dimensions.
To incorporate homeopathy as a modality within conventional medicine we need to validate our data according to the standards of current science, which in my opinion, can be done, provided that protocols are properly designed. There is no way around that; the current belief system of the majority of the population, their representatives, and legislators, is at that level. That is the only way that is going to get done. Grassroots movements, seeking to spread homeopathy, and populist strategies can work, but will take longer.
AS: With periodic table, Jan Sholten has attempted to make remedy selection more objective. Rajan Sankaran, seems to be moving toward more subjectivity. In your own case taking, how do you find the balance between analytical and intuitive? Is one more important than the other?
BM: This is a critical question, not just for a practitioner, but for homeopathy as a whole. If we become too analytical, and try to follow principles rigidly, we stifle innovation and miss what a patient may need, that is different from what our analysis is determining. We also may delay the growth of homeopathy and its application. On the other hand, if we try to be only intuitive, we run the risk of acting in way that can be irrational, we will make more mistakes and present a way of practice that has no methodology but mostly subjective interpretations of the material. That’s a mode almost impossible to teach. This kind of practice will not be credible to a large majority of people, and will turn off many potentially good homeopaths.
There has been a lot of research on intuition, what it is, how to develop it. Some of the works are in the lines of spirit invocations, incantations, and tea leaf readings; other works are serious and substantiated, with a great deal of analysis. A popular book, presenting how intuition works, is the book “Blink”, also by Malcolm Gladwell. The most “intuitive” people are the ones who have the greatest knowledge and experience in a particular field, who have learned the concrete data and the analytical processes, and when they have mastered that material, they move into “intuitive” work. The information is so deep inside the person, that the choices come up effortlessly. Likewise, to be a good homeopath, we need to learn materia medica and repertorization, and do it for several years. After that, we will be able to practice intuitively.
AS: Homeopathy could really advance in the U.S. if it were covered by insurance. Managed care organizations in the U.S. have everything to gain from covering homeopathy. They would save money on drugs; they wouldn’t have to pay out huge sums for patients injured by side effects; preventive and curative treatment with homeopathy would save much money. Having worked for a managed care organization, do you have a sense of what’s holding them back?
BM: If an insurance company agrees to pay for homeopathic services it would set a precedent; it would be inferred that they endorse the treatment approach they are reimbursing. They would be taking a risk, as far as they are concerned, in paying for something that, according to mainstream medicine is at best, not scientific, at worst quackery. Homeopathic medicine, according to the scientific establishment, is not just unproven, it is unscientific and non-sense; it is implausible, according to the established scientific framework.
It doesn’t matter whether it could potentially save them money, or lives. For them it is about weighing the probabilities, and as far they are concerned, according to the prevalent framework, chances are that homeopathy is just placebo and they would be throwing money down a dark hole.
The weight of the evidence is on our side, like it or not. We have to prove that homeopathy works; we have to work on developing a credible mechanism of action, and prove it. I know a lot of people will disagree with me, but unfortunately, we are a minority; we are challenging the establishment. Fortunately, we are not at risk of being burned at the stake, but maybe quite close to that (which I say tongue in cheek)!
Carl Sagan, the famous popularizer of astonomy, used to say that “extraordinary claims require extraordinary proof”. As far as conventional science is concerned, homeopathic medicine is highly diluted preparations and their clinical efficacy are an extraordinary, and improbable, claim. We will need to come up with the extraordinary proof.
I believe that the current evidence we have is good; but we need to be able to replicate all of the studies that have been published, with greater numbers of patients. Only the studies on allergies done by Dr. Riley; the studies on childhood diarrhea, by Dr. Jacobs; the degranulation of basophiles with histamine; and treatment of ADHD by Dr. Frie, have been replicated, as far as I know.
If the homeopaths at the end of the 19th century and beginning of the 20th century, would have followed the developments of scientific methodology and updated their information accordingly, we would have been able to maintain our advantage. We would have enough data to prove that homeopathy was the way to go. However, we only have three or four reports, good reports nevertheless, of homeopathy being effective in epidemics, but they were not publicized or replicated.
Serious researchers have proven that we can use the prevailing scientific methodologies for research to confirm homeopathy’s efficacy. If we take on the task of learning statistics, research design and development of protocols of homeopathic treatment that fit current evidence based methodologies, we will prove, once and for all, that homeopathic medicine is the best medical paradigm for treating disease and the best solution to the healthcare crisis that looms.
AS: Are there some of your cases that stand out because of dramatic or unexpected cures?
BM: I always have had trouble with that question! I always end up thinking of various people who call me in awe about the wonderful responses they get with remedies; or the patients who ends up calling three or more years after their last appointment saying how well they had felt from their chronic migraines, back pains, depression, etc.
I am always thankful to all of my patients, who have had the courage to come on this journey through homeopathic treatment and have me be their fellow traveler. I have been in practice long enough to see infants born in my practice grow up and go to college, after going through their childhood and adolescent challenges. I am always overjoyed to see how they are in a great state of integral health, and feel privileged to have participated in that process.
I see my patients moving through layers of issues, physical, emotional, intellectual and/or spiritual, and reaching states of greater freedom and independence. Of course, I am not saying anything original here. I just don’t see myself as a masterful homeopath who uses the arcane remedies or that single dose that has cleared up a chronic condition with one dose of a remedy; I still have much to learn.
AS: On your website you mention the Bach Flower Remedies. What has been your experience with them?
BM: As you probably know, Edward Bach, the developer of the Bach flower remedies, was a homeopathic physician. I did try those remedies for a while in my practice but found that the well selected remedy worked better than the essences. However, I still use the “Rescue Remedy” compound, for patients who are very anxious and need to take something frequently or in times of crisis and I don’t want to use more than one remedy. I find this the case in very sensitive patients. I have not found that they interfere with the homeopathic remedy.
AS: Do you want to say a few words about the role AIH has played in American homeopathy?
BM: The American Institute of homeopathy is the oldest, extant, medical organization in the United States, not just homeopathic, but medical! It was founded three years prior to the AMA. The AIH was founded to assure that homeopathic teaching was carried at a high standard and according to the principles presented by Hahnemann in the Organon; it has carried that standard through its existence. The mission of the the AIH is to advance healthcare through homeotherapeutics, and the vision is to have homeopathy available to the majority of the population. Being a trade organization, we focus on the education and training of licensed healthcare providers.
Thank you for sharing your thoughts with us today.
Bernardo A Merizalde, M.D., has been in the practice of General Medicine since 1980 and is Board Certified in Psychiatry and Neurology. A writer and researcher, he has lectured to undergraduate, graduate, and medical students at the University of Pennsylvania, Jefferson University, the Medical College of Pennsylvania and consumer groups. He is the current President of the American Institute of Homeopathy. Dr. Merizalde believes in integrating the physical, mental and spiritual dimensions to reach a maximum of health and well being. To reach this goal he incorporates various therapeutic modalities such as homeopathy, counseling, relaxation and visualization techniques, traditional natural remedies, herbs, exercise, physical treatments, flower essences, counseling and conventional medicine. Visit his website at : www.pahomeopathy.com /[email protected]
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