Pastoral Medicine

LECTURE 1

My dear friends,

For this “Pastoral Medicine” course we are bringing together for the first time the members of two distinct circles of spiritual work. This is of quite special importance. We must inquire, therefore, first of all into the reason for the combination, from the intended content of the course itself. In the first place I would like to point out that perhaps this course will be an example of how ancient traditions must be renewed through a particular form of spiritual activity in our time. For what has so far developed under the name “pastoral medicine” has lost its original content. We will see that this is so in the course of our study. Yet out of the very foundation of this present age there arises a most significant task that as it takes shape may be allowed to bear the name of pastoral medicine. We have made the strict requirement that this course be mainly for real theologians and real physicians, including those who are training to be real physicians, in the sense in which that title can be given them from the standpoint of the Medical Section of the Goetheanum. How this standpoint is to be understood will become clear during the course. We have admitted a few individuals who are exceptions to the general requirement, and these for reasons based on the opinion of the Medical Section of the Goetheanum.

First and foremost, dear friends, there must be an absolutely clear understanding in the part of the theologians and on the part of the physicians what is now going to be made possible by their working together: namely, a new pastoral medicine. Their working together has indeed often been discussed; it has even been pointed out that the anthroposophical movement should try to bring it about. But things have come to light that must be corrected during this course. A proper working together must certainly not be understood to mean any dilettantish interference by one side into the work of the other side. It certainly does not mean that the theologians are to become physicians, or that the physicians are to become in the slightest way theologians. It is purely a matter of the two professions working together hand-in-hand. The course will stress very strongly the importance of preventing any kind of confusion by, for instance, the theologians trying to get their hands into various medical measures that cannot possibly lie in their sphere of work. On the other hand, physicians must be clearly aware of the position they must always hold — in the sense just described — toward theologians. It is tremendously important that this should be thoroughly understood by both sides. A great deal will depend upon it.

Apparently the thought has even been entertained that theologians should actually acquire medical knowledge. Well, of course, it is always good to acquire knowledge. But the important thing here is to realize absolutely clearly that physicians, in addition to the cultivation of their thinking, feeling, and willing, have had specific medical training. People should not play with the idea that they can push their way into the world with bits and pieces of medical knowledge without this specific medical training — even if they are theologians! On the other hand, physicians must develop a special conception of their profession; they must learn through pastoral medicine that something essential is expressed when it is said: The flame of offering belongs to the priest, the Mercury staff to the physician. And only through the working together of the flame of offering and the Mercury staff is a healthful cooperation possible. One must not want to heal with the flame of offering, or to celebrate ritual with the Mercury staff. But one must realize that both are divine service. The more fully this is realized, the better their cooperation will be, with physician remaining physician and priest remaining priest, and the more healing will be their work in the world. Our anthroposophical movement must not be allowed to become an area where everything is thrown together in chaotic fashion: the seriousness that we should be cultivating so strongly within our movement would suffer thereby. One can have knowledge of the general procedure for a foot operation, but one should certainly not think that therefore one can perform the operation. And this holds true for all medical matters. Above all, Anthroposophy must not become propaganda for quackery. Theologians must not be allowed to become quacks.

The Medical Section at the Goetheanum will handle with extreme seriousness whatever is going to give an individual a position out in the world as an anthroposophical physician. But the following must also become an established procedure: that physicians who want to work with the same impulses as the Medical Section at the Goetheanum will have their status and their relation to the Section properly defined by the Section. There will be no progress unless this procedure becomes a complete reality — so complete, in fact, that in the future someone will be acknowledged as a physician if the requirements of the Medical Section at the Goetheanum are filled. From this point of view also, we are justified in not having admitted to this course healers who are not physicians. Those who are here today (with a very few exceptions) can lay full claim in the outside world to membership in the medical profession. Perhaps we have made ourselves clear. I have been speaking more from the administrative angle. But the matter will be the concern of pastoral medicine itself. When the theologians recently raised the question of whether something of a medical nature could be given them, I could not do otherwise than say that I would give a course on pastoral medicine in which theologians could participate. And so the course has been organized by the Medical Section of the Goetheanum, and the theologians are taking part in it. It must be quite clear why we have structured it in this way.

Up to now, pastoral medicine has not been a subject in the medical faculties, but in the theological faculties. And the pastoral medicine that has been taught in the theological faculties has really not contained anything specifically medical. Or perhaps I should ask, have any physicians here who have gone through the academic training had any pastoral medicine in their medical courses? It is not offered in any catalogue of a medical faculty. It hardly appears any more in Protestant theological faculties, but it does have a role in Catholic theological faculties — and for a good reason. Only it contains nothing of a medical nature. In the main it contains, first, the knowledge priests need in order to work as pastors, not only with healthy people who are given into their care, but also with those who are sick. There is a difference in whether one has the care of the soul of a sick person, particularly one who is seriously sick, or of a healthy person. With the sick, perhaps severely sick individuals, the question is how one shapes the soul care, how one relates to it. But I have never yet found a book on pastoral medicine that did not stress repeatedly that the first task of the pastor is to make certain by word and deed that a real doctor is found, and that the pastor should refrain from all medical measures.

A second important subject of pastoral medicine has to do with the hygienic aspects of certain ritual measures. For instance, the healthfulness or unhealthfulness of fasting required for ceremonial reasons is explained for the lay person; also what medical science has to say, for instance, about circumcision and similar matters. For priests themselves — this, of course, has just to do with Catholic faculties — it sets forth clearly what is to be said from a hygienic standpoint about asceticism. This is spoken about very fully.

A further subject has to do with what measures should be taken, for instance, in a parish where there is a doctor, what connection there should be between the medical care and the sacraments. When a religious community bases its activity on the reality of the sacraments, the priest must be prepared to meet the medical treatment that is being given. There is, for instance, the anointing that the priest must perform at the sickbed by the side of the doctor. We have also to consider what significance the earlier pastoral medicine attributed to a person's receiving communion while recovering from a severe illness. Looking at the spiritual aspect, one has to ponder on the working of the sacrament in relation to the processes of healing in a human being.

A further subject examines how the pastor has to relate to the physician in psychopathic cases, cases of mentally handicapped or psychically abnormal individuals. The pastoral work is varied for such cases. This was the principal task confronting pastoral medicine in its earlier days, and it was taken care of through the centuries rather extensively by calling on the authority of the Church Fathers' writings.

That is a field of work that cannot appear in the same light to us who are involved in a renewal of spiritual life. Indeed, from fundamental anthroposophical views we are aware of very important tasks in that field for a new pastoral medicine. And we can discover the extent of such tasks if we consider the subject from two sides.

First, let us consider it from the medical point of view. What are we doing when we apply a therapy? When we give a medicine or apply some healing measure to a sick person, there is always the fact that in the healing process we want to set in motion, whether physical or spiritual or pertaining to the soul, we are going beyond the so-called normal relation of that person to the surrounding world. No matter what therapy we use, in every instance we are going beyond what the person has normally in everyday life, whether it is taking of nourishment, or exposure to light and air, or exposure to soul influences. In every circumstance we are going beyond all of that in our therapy. Even if we simply prescribe a small change of diet, we have gone a small step beyond what the person had permitted in his or her own everyday relation to the surrounding world.

Say we prescribe a medicine. If it's a physical substance, its effect will be that a different process takes place than would take place if the patient were merely eating food. And it is the same with other therapeutic measures. In using any therapeutic measure we are intervening in the life of the patient in a way that is different from the way life usually works upon that person. For what is the normal intervention in human life? How does a person take hold of his or her own life? We can distinguish three kinds of processes that intervene, or can intervene, in human life. First, the process that is active in the person in the same way that physical-chemical forces are active in outer nature. Second, the process that is active in the realm of a person's life forces, in life itself. Third, the process that takes immediate hold of the person in the sphere of consciousness:

1. Physical-chemical
2. Life
3. Consciousness

Here we must grasp an important concept. In ordinary life there are three states of consciousness: waking, dreaming, and sleeping. The moment we apply an active therapeutic measure, we are intervening in the sphere of consciousness to a greater or lesser degree depending on what the measure is. Such intervention never occurs in such a direct way in the so-called normal course of life. A person who is eating, for instance, is surrendering to the usual process of taking nourishment; then, if this has proceeded normally, waking, dreaming, and sleeping follow in normal fashion. At the most, we might vary a diet for the purpose of bringing about better sleep, but there the boundary is already shifted. Therapy has already begun.

It is quite another matter if you intervene with some therapy when, for instance, a patient has a fever. If you were to apply the same therapy to a healthy person you would alter the person's condition of consciousness. Thus a physician has to work fundamentally with the various states of consciousness. A human being's ordinary relation to the outer world has to do with life forces, but in medical work one is intervening in the states of consciousness. You will find this is so in every single therapeutic measure. And it is the specific characteristic of a therapeutic measure that it does enter into what has to do in some way or other with the variability of consciousness. In fact the only effective therapy is one that takes such deep hold of our human constitution that it penetrates to the source from which our various states of consciousness come. But thereby you are intervening as physician, as therapist, directly in the ordering of the spiritual world. Your alteration of someone's condition of consciousness means that you are intervening directly in the ordering of the spiritual world. And when you have a really active cure, through this penetration into the state of consciousness, even though it may be into subconsciousness, you are always drawing the soul of the person into the therapeutic process. You do not remain in the physical sphere. Ordinary consumption of food, ordinary breathing, and other ordinary processes remain in the physical sphere, and the higher members work indirectly through the physical sphere. Higher forces are active through the physical organism. In contrast, when you are working as a physician or therapist you draw the patient's soul directly into his or her physical body. Indeed we can say if physicians understand their profession properly, they realize that they enter directly into the realm of the spiritual. It only seems that therapy is merely a physical or biological process. True therapeutic measures always involve the patient's soul, even though at first this may remain unknown to the ordinary consciousness. You should observe what actually takes place in a patient when, let us say, a fever is suddenly lowered by some therapeutic means. In this event processes are introduced into the innermost depth of the patient's being — just as the illness itself had worked into this depth — beyond the merely physical and biological realm. So we have looked at the picture from the medical point of view. We have seen how doctoring, healing, by its very nature leads from the physical realm into the spiritual.

Now let us examine the priest's profession just as carefully. Priests whose calling is not one of teaching, if they are truly active priests, then they are connected with the ritual, and the ritual includes the sacraments. But the sacraments are not symbols. What are they? They consist of the fact that external events take place, which are not exhausted, in chemical or biological processes. They contain orientations which are embodied in the physical-biological sphere, but which have their origin in the spiritual world. Sense-perceptible actions are performed, and spirit streams into the actions. Spiritual reality is present in the ritual on the level of sense perception. And what takes place there in front of the congregation takes place first of all before their conscious observation. Nothing is permitted to take place except what does take place in that way. Otherwise it would not be ritual, not sacrament, but suggestion. The sacraments — if they are done right — are never allowed to contain any element of suggestion. All the more, therefore, they are able to contain what is spiritual. They take place before the waking consciousness of the participants, but they work into the sphere of the life forces.

In communion a person is not just eating the material substance; in that case it would not be a sacrament. Nor is it a matter of symbols. Rather it has to do with reaching into a person's life, because a sacrament is enacted, is celebrated, through an orientation toward the spiritual world. Therefore one can say therapy leads from life to consciousness; the ritual with its sacraments leads from consciousness to life.

Therapy: life to consciousness
Ritual (sacraments): consciousness to life

There you have the two activities in polarity: therapeutic activity and the celebration of the sacraments. In therapeutic measures, the course leads from life to consciousness, and consciousness becomes a helper, at least (in ordinary consciousness) an unconscious helper, in the healing process. In the celebration of the sacraments life is made a helper for what is enacted before the consciousness. Both of these activities have to be grasped spiritually in deep inwardness — not merely diagrammatically as it is now being presented to you. They require the involvement of the total human being if that individual wants to make one or the other a vocation. In our present civilization therapy has left behind the spiritual element, and theology has left behind the concrete world. In our present civilization therapy has taken a false path into materialism and theology a false path into abstraction. For these reasons their true relationship has become completely veiled. This true relationship must be reestablished. It must become active again.

Again it must become clear that for diagnosis physicians need a trained observation that enables them to see a biological or physical process in the human organism as a spiritual process. For all processes in the human organism are spiritual. For diagnosing, and still more for treatment, physicians need an observation that is trained to see the lighting up of the spirit within the physical. Priests need an observation that is trained to see the lighting up of the physical reflection of a spiritual event. There is a polarity again. But there must always be polarities working together in this world, and these are no exception.

To see how they are to work together will be a task within the sphere of Anthroposophy and based on Anthroposophy, a task also to be fulfilled within anthroposophical spheres of activity. So one can think that out of this gathering for a pastoral medicine course there may actually be created future anthroposophical physicians — physicians who will hold the right relation to priests because of their own relation to the spiritual world. The priests themselves will have come out of the Movement for Religious Renewal. Something quite special will develop out of this course for the physician and the priest so that they will work together in a true way.

For what in this case can it mean that they work together? Surely not that the priest does dilettantish doctoring and that the doctor is a dilettante priest! If their working together were to consist of priests knowing a few medical facts and physicians vesting themselves as priests, then I'd like to know why they should work together. Why should an experienced physician be interested in half priest-half doctor dilettantism? It makes no sense. And why should a priest want to interfere in medical matters except when the physician asks for a pastor? On the other hand, if the physician is a good physician standing squarely within the medical profession, and if the priest is a real priest, they can work together. It means that one offers help to the other out of professional abilities, not that one pushes into the other's professional domain.

Such an association will bring about a profoundly important result for our culture. The physician will truly understand the priest, and the priest the physician. The priest will know as much about being a doctor as is needed to know and the physician as much about the vocation of the priest as is needed to know. And then in time we will see to what extent physician and priest can work with the teacher to accomplish something beneficial to humanity.

In that area, too, people will have to work together — and in the most manifold ways, because education is also something that must be looked at from a fresh point of view. The priest cannot be a physician, nor the physician a priest, but they can both in a certain sense be teachers. But all the details of these new associations will have to be thought out quite concretely. Therefore I would like to ask you from the very beginning to count this earnest request as part of all that this pastoral medicine course is going to present: that everything be worked out on a professional and expert basis. Priests will truly help actual physicians if they reject all thought of medical dilettantism. That will be one of their responsibilities. And physicians will be able to do very much at the sickbed to bring the mission of the priests to proper fulfillment — precisely at the sickbed, where often a priest has to intervene in life in a really essential way.

We will continue tomorrow.