‘A Chat with Roger van Zandvoort’
A 2006 interview with Roger van Zandvoort by John Harvey for Similia, journal of the Australian Homœopathic Association. Published in Similia 19(1);2007:35-38. The interview followed Roger's keynote address to the AHA's 5th Australian Homoeopathic Medicine Conference in 2006.
Similia: Your conference presentation was well-received. What were you fundamentally trying to convey?
van Zandvoort: I wanted to convey two messages:
- that there are better ways to repertorise than Kent's;
- to let go of the idea that every patient should be repertorised in the same way.
It's the patient who makes you decide which kind of repertorising to do; at times the information is detailed; at other times that information is not there, and you need to be able to use a more general type.
Suppose someone comes and tells you that she has heart complaints related to the endocardium. Swelling, or circulatory. You come to understand that the endocardium itself is important in this person. This isn't in the Kent repertory; for that reason, you need another type of repertory sometimes. They exist.
Snader's repertory of heart symptoms too probably has a rubric with a strong affiliation to the endocardium.
Similia: Where does the information for a rubric such as Endocardium come from?
van Zandvoort: Throughout the repertory and MM, you look for rubrics or symptoms that have something to do with the endocardium, such as "Inflammation of endocardium". In early homeopathy, without too many internal investigations and autopsies, you wouldn't find too many. Later on, there's more information from autopsies, and things come up related to more-internal tissues.
Similia: Not provings, then?
van Zandvoort: No, clinical material. To throw in another piece of food for thought: I think provings are quite overrated in a certain sense, because those we normally use are homeopathy students; in the clinical situation, we're usually dealing with patients. Proving information that comes out of people who (a) are homeopathy students and (b) know that their job is to produce symptoms usually produces symptoms not necessarily connected with the remedy: as true for the placebo group as for the the test one. Unless clinically confirmed later, I don't give too high value to proving information as such. On the other hand, a patient who produces symptoms ultimately doesn't want them; so whatever they produce is really a product of the way they feel at that point. If you find a remedy that can cure a symptom, then…
Similia: I have a different view from you on the value of clinical symptoms. For starters, I've formed the view that a remedy can cure more than it can cause.
van Zandvoort: That seems very true. But what comes from our literature is never the total of what can be proven. With 15 provers, those 15 can never produce the complete range. So actually the gist of our info should come from clinical information. I'm the only person doing this work full-time, so there's an awful lot of info I know is there but I don't have time to go through.
Seventy per cent of proving symptoms are unverified clinically. If they're not verified by now, they maybe never will be. That's a lot of uncertainty.
Similia: Do you think that to some extent this is because the symptoms that a homœopath bothers to verify will tend to be the sexier ones? Such as worse on waking but better after moving around…
van Zandvoort: Yes, it is of course certain symptoms that the homœopath takes notice of, and this partly depends on the environment. In Western society, with so much pressure on money and time, we notice mental symptoms. In many other places, it's the physical symptoms that the patient cares about.
Similia: To come back to the value of proving information: Vithoulkas too makes the point that many modern provings are fallacious, as demonstrated in the same symptoms' appearing from placebo as from the substance under test. His solution is not to ignore provings but to conduct provings of greater reliability. Given that recognition of "cure" is even more subject to error than recognition of pathogenesis, if we began focusing as a profession on producing reliable provings, how useful and how necessary would "cured" symptoms be, do you think?
van Zandvoort: Very useful. In the past, Hahnemann did provings and didn't have the luxury to use placebo inside the provings; nevertheless, Hahnemann and others produced very reliable provings, if you look at the way it's done and if you look at the validity of the proving material through the last two centuries.
Nevertheless, if you look at the repertory data… let's talk about Sulphur. Big remedy, but no more than 30% of the info collected (mostly from the original proving by Hahnemann) gets clinically confirmed. You might extrapolate that and say that no more than 30% will be clinically confirmed on average. It was the same proportion in Kent's Repertory. Placebo, I don't know. What I would say is very important and not done as often as it should be to make things clear is to count the number of provers. More provers is better. In preparing an overview of the proving, grouping symptoms by how many provers elicit them, so that you know how many symptoms came only from one prover and how many came from two or more provers. There's room at least in my repertory, and in the past too in the Bönninghausen repertories, Guiding Symptoms, and Allen's Encyclopaedia (2nd degree in each case), to show how many provers.
It's sometimes useful to have that information of the symptom that came from that one prover, but I don't know whether that's true in most cases; may be a lot of personal symptomatology, mixed with disease ailments concurrent with the provings.
I'm not going to pretend that all the information in the repertory is homeopathic information; it's not.
Take Phosphorus as an example. The symptom that the water is vomited once it becomes warm in the stomach never appeared in the proving.
Similia: What about remedies that have had more than a hundred provers? Some, like Sulphur and Thuja…
van Zandvoort: I'm not aware of any that have had a hundred provers. Though I suppose there are polychrests whose provings have been repeated, and if you collect those provers together...
Similia: Perhaps you need a hundred provers from modern times.
van Zandvoort: Perhaps.
Similia: I wonder whether the best symptoms are those of incidental provings.
van Zandvoort: They are; they're very good. But it's a matter of logistics. That is very good information indeed, but incomplete. But it would take a great deal of coordination to build it all together (with other incidental provings)
Similia: I remember a notice from a German group that wanted to coordinate incidental provings and cures. Homœopaths would send them in…
van Zandvoort: They had a name that was an old name or a god.
Similia: A German name, I think.
van Zandvoort: Yes. I think they are still doing a little.
Similia: It would be easier to coordinate now, with content-management systems and wikis and blogging software that may suit.
van Zandvoort: Homœopaths swim upstream, are individualistic, and are hard to organise; maybe even more so in Australia. In the old magazines, time after time people suggested these things; and the character of homœopaths hasn't changed.
And you want the information from the homœopaths with busy practices, but they're too busy. You're asking them to take an extra hour out of their sleep.
Similia: We need a basis for better cooperation.
van Zandvoort: Yes, that's it.
Similia: It could be done through the software, though.
van Zandvoort: If each symptom had above it a place ——
Similia: Like a tickbox ——
van Zandvoort: Yes, and if the remedy had an effect on that symptom, regardless of whether it was better or worse, that could be done. But you're looking for a common standard between the manufacturers, and they don't want that.
Similia: The IT industry has many open standards.
van Zandvoort: Like Unix, Linux Red Hat, and so on.
Similia: Well, let's think about software developers for Macintosh. Apple Computer makes available a kit for software developers, and I'm sure it's free to small developers at least, and all the developers use that standard.
van Zandvoort: Yes; I see what you mean.
Similia: Besides the Synthesis database and yours, there could be a third database. The program manufacturers (MacRepertory, RADAR, and so on) who access your database or Synthesis can choose to implement in their software a feedback system that adds to the third database. Now, the first manufacturer who implements it gets access to the information in that database…
van Zandvoort: It's a reward-based system. It's something to think about. But they don't implement features unless there's already a demand.
Similia: What prompted you to begin the process of updating the repertory?
van Zandvoort: Something to do with my tendency to collect things. I saw at one point, working with Kent's Repertory, then invested in the Synthetic Repertory, then got additions by Bill Gray, and started to compare them and found differences and added one to the other -- during my study time, 27 or 28 years ago. It was a private project. By ’85 or ’86, I got MacRepertory, using it first on a Mac Plus, and updated it; and at one point I met David Warkentin, and we agreed that what I had was worth selling. I was using MacRepertory to add the remedies and symptoms, and then in 2000 had someone write me a particular application using Filemaker Pro. It can have multiple authors and sources, whether the remedy is from a proving and how many provers, whether it's clinically confirmed, and so on. The plan is later on for people using it in practice to be able to upload clinical information to the database as well. Automatic upoad is a matter of having good rules as to the kind of information uploaded to the database. A future project is to link repertory information to the original materia medica from which it comes.
Similia: You've created three repertories now?
van Zandvoort: The Complete Repertory, the older one, more maintains the Kentian format.
Later, I created Repertorium Universale. It has all the CR info, but the structure resembles more the ideas of the Bönninghausen methodology of repertorisation. For the future, I'll probably go back to the Kentian, Complete Repertory style, which people more easily recognise. I've let go of the structure of R.U. It's a clearer structure, but my feedback from the last 4 years is that people simply don't grasp it. I'm back on the drawing back in the design of the Complete Repertory. In the new version, "Mind: ailments from anger", which in R.U. would be "Anger aggravates", will be as it was a long time ago, "Anger: aggravates". Since the teachers don't teach students any other structure than the Kentian structure, they didn't grasp it.
The sad thing is that the teacher these days doesn't come with the skills to teach Bonninghausen-style repertorisation, or repertorisation based on a more general approach. They all go for specific symptoms, or there is too much emphasis on mental and emotional symptoms.
Why would it be necessary that you do a whole psychological profile on them? This isn't homeopathy, it's practical psychology. It's also partly to make the practitioner feel good; "I opened [him or her] up", etc. And maybe the patient feels better for that. But we're talking here about homeopathy. I'm not saying we shouldn't do it; but keep the clear picture, keep the overview.
So many people go to a seminar and hear wonderful things. They try them; they don't work. They're disappointed, keep trying new things, they say "It's me", and they quit homeopathy.
It's a matter of hard study.
With the pressures of our society, a lot of competition, a lot of emphasis on making money, that creates a lot of emotional pressure; you come home, and instead of having a patient to listen to, you have a partner to listen to. It creates symptomatology, initially emotional. But a lot of people are okay emotionally and just have a physical complaint. So you need a remedy that works on the complaints they come with.
In most situations, you can get to a better potential remedy when you know how to work with the repertory in a different way than just the way Kent used. I'd like people to be able to try different methodologies of repertorising and see the results.
At the beginning of next year [2007 — ed.], I'll bring out a Complete Repertory, Kentian style, which will have all the information. I had hoped that by issuing the Repertorium Universale format, I'd get people to think rather than press buttons.
I want to present a tool that is flexible, because your patients deserve that and need that.
Similia: Is there a weakness in the Kentian repertory in the usefulness of its more general symptoms?
van Zandvoort: The general symptoms are very incomplete except in the Generalities section.
But you know that most of the time you do not find that specific symptom that the patient told you about; so, if you want to deal with the details, you'll need a much larger repertory than Kent's. There's a way around it, by creating synthetic symptoms: crossing more generalised rubrics brings you that detail anyhow.
It would be easy enough to be able to click to show those subrubrics automatically.
Each complete symptom has modality, phenomena, & location. Modality is the dynamic part, the part that tells under what circumstances the whole disease moves.
In Kentian repertorisation, we're taught to look for the complete symptom – phenomenon, location, modality – as in his repertory. In Bönninghausen's method, we look for a rubric that represents any of those parts. Head pain, or head pain stitching. Let's say we have head pain, stitching, < walking (to use an example from the conference). We look for the modality, and if it's not there, we can get it in generals (< walking). Cross all three to get the highest common denominator. This is the part where homœopaths need to take action, go to some trouble, to create those parts. That group of remedies is usually a little larger than you find in Kent's as a preset text [a complete symptom].
It's a different way of thinking: in parts, not just in the end result, because then you have more possibilities for your patient, beause the suggestions from an analytical program are usually more than in a Kentian repertory.
Similia: I've seen many references to the need, in using Kent's system of repertorisation, to have the most detailed symptoms in order to find the potential remedies. But Kent himself says otherwise.
van Zandvoort: Yes, he did that; the trick with Kent… Every homœopath repertorises in such a way that it complements his kind of case-taking, which is influenced by whatever the patients tell him or her. So partly it's all the same, partly an individual thing, depending on what the patient says. In Kent's case, there's also some history mixed in, and there are also some non-homeopathic doctrines mixed in. Initially, he worked much as Bonninghausen did, which is what everybody did. But working with generalised symptoms, you don't get anywhere; you need the juice of the symptoms, of course.
Then what happened was that he structured it according to Swedenborg, deeper and deeper into the symptoms, which is fine. But then he did something non-homeopathic: dismissing Bönninghausen was not just for homeopathic reasons but partly for commercial reasons.
Kent published the "Mind" section and asked who would buy the completed repertory. He didn't want to publish too many copies. And he did a good job of suppressing Bönninghausen's work. He agreed to lecture at universities on condition that they used only his repertories.
Kent's wife was strong in the Swedenborg religion, which presented a specific structure and formatting of life, so Kent implemented that structure (of how the universe was built up) in his repertory. Everybody had been using Bönninghausen-style repertories. Initially Kent published the mind section looseleafed, to save costs, since he didn't know whether it would sell. Boger never used Kentian-style repertories; they stuck to Bönninghausen, improved on it, and his, along with Phatak, is the other line of repertories available. It's a soap opera.
But he couldn't let go of Bönninghausen completely, so he included the generalities section info that comes completely from Bönninghausen. And it's useful.
Published cases by Kent in the beginning of his career are Bönninghausen methodology, which he says is the best.
It's valuable to know what kinds of rubrics you might have – besides those in Kent's. To know what kinds you have.
The basic trick is that you shouldn't try to modify the information from the patient. You need to be a keen listener and abstract the information and be able to read between the lines. Avoid much interpretation.
Drawing the line: abstracting, generalising. For example, if the patient is < in the morning, or > by occupation, then you need to be able to pick that out, red-line symptoms. Or, if these are mostly head symptoms, then use head, morning <.
In the old magazines, they don't interpret a lot, they take the information mostly as is and look it up, very direct and only taking the most recent symptoms into consideration. Difficult cases. Of course it's valuable to do in-depth study of past cases, homeopathic Heritage, and so on.
Similia: But they don't say what rubrics they used?
van Zandvoort: Only sometimes. But I see that there's a certain remedy that they came up with, and try to reverse-engineer it; what kind of logic, what kind of methodology they were following. I do it to make sure I can come up with repertorisation that can follow that methodology, so that it's not just Kent on the left and Bönninghausen on the right.
Some people, eg. Adolf Lippe and Edward Berridge, presented their cases so that you could follow how they came up with the remedy.
Similia: Considering the results that Hahnemann obtained using so few remedies, sometimes with a little zigzagging, I wonder whether the magic – the meditative provings, spirit guides, the swing of a pendulum – that practitioners are using to desperately reach out for more remedies without the aid of proving symptoms is necessary.
van Zandvoort: Finke actually did something like dream provings and meditative provings, and some of the results of the dream provings found their way into his materia medica, because he found that some of the symptoms were verified clinically. But it's true that homœopaths are not taking full advantage of the tools at their disposal. Eighty-five per cent of cures can be obtained via these tools, and yet it's the other 15 per cent that practitioners are looking for. They buy the repertories and the programs, which lie around unused, or aren't used as they could be. Our education is failing homœopaths, because they're not learning to use repertories according to the circumstance. You can't expect to cut everything with the same knife, or with a blunt knife.
There was a case presented at the conference of a prostate cancer, and the presenter was guided to mango, Mangifera, not by her repertory, which wouldn't have done the job. Okay; but then I looked up some of the symptoms in my database, and they were there. She couldn't find them if she had tried, because her repertory was incomplete, but they were there. So we're not doing all we could for patients, for all kinds of reasons.
Similia: I have the impression that some practitioners don't bother with materia medica, jumping straight from repertorisation scores to prescription. These seem to be the same set of practitioners who end up concluding that homeopathy is too hard and fall for each wonderful new system that's far easier and doesn't depend on analysing the patient's symptoms at all. Do you foresee a time when practitioners can dispense with a materia medica separate from the repertory, relying on some integrated kind of repertorisation to recognise the simillimum to their patient?
van Zandvoort: That's very tricky.
Oh yes, and continuously trying to avoid studying. You need to go every once in a while into materia medica; the remedy needs to fit the profile of the patient. Most don't find the simillimum anyhow.
That's why that will be such a beautiful tool. You could even make a separation between proving materia medica and clinically confirmed stuff. A lot of other things should be improved, with the analytical functions of a program that works with repertory and materia medica, and to apply the information from practitioners onto a central database.
One way of thinking not represented in repertories is how often you see something. Hering's Condensed Materia Medica gives that, numbering how many anatomical sections a modality arises in. There's no room for that degree of info in Kent or Synthesis.
Hopefully, next year the first analytical program will come out that uses frequency. If a symptom comes up in more anatomical sections, you have a broader potential use.
A group of four or five homœopaths in Germany who produce analytical software may be the first to do it.
The big materia medicas use Bönninghausen's degree system. And if you have two degrees from provings, you already have an aid to analysis. And symptoms produced by more than one person might be a little more remedy-related.
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Good advice for any homeopath.: if you hear something in practice but it doesn't fit with the way you work, forget it, because it won't work. But keep experiencing with the way you work.
Always practise homeopathically, of course. Then ten different practitioners can come to the same remedy ten different ways. In filming a documentary, it would be good to film the practitioner instead of the patient. You seldom see that. You can't just copy what some higher soul is telling you in a seminar. You need to deal with your basic homeopathic information. In 90% of these cases, these masters are prescribing on the materia medica information in their head already, and it's for the last 10% that the extras may find something.
