Pastoral Medicine

LECTURE 2

Dear friends,

If we are going to consider the mutual concerns of priest and physician, we should look first at certain phenomena in human life that easily slide over into the pathological field. These phenomena require a physician's understanding, since they reach into profound depths, even into the esoteric realm of religious life. We have to realize that all branches of human knowledge must be liberated from a certain coarse attitude that has come into them in this materialistic epoch. We need only recall how certain phenomena that had been grouped together for some time under the heading “genius and insanity” have recently been given a crass interpretation by Lombroso [Note 1] and his school and also by others. I am not pointing to the research itself — that has its uses — but rather to their way of looking at things, to what they brought out as “criminal anthropology,” from studying the skulls of criminals. The opinions they voiced were not only coarse but extraordinarily commonplace. Obviously the philistines all got together and decided what the normal type of human being is. And it was as near as could possibly be to a philistine! And whatever deviated from this type was pathological, genius on one side, insanity on the other; each in its own way was pathological. Since it is quite obvious to anyone with insight that every pathological characteristic also expresses itself bodily, it is also obvious that symptoms can be found in bodily characteristics pointing in one or the other direction. It is a matter of regarding the symptoms in the proper way. Even an earlobe can under certain conditions clearly reveal some psychological peculiarity, because such psychological peculiarities are connected with the karma that works over from earlier incarnations.

The forces that build the physical organism in the first seven years of human life are the same forces by which we think later. So it is important to consider certain phenomena, not in the customary manner but in a really appropriate way. We will not be regarding them as pathological (although they will lead us into aspects of pathology) but rather will be using them to obtain a view of human life itself.

Let us for a moment review the picture of a human being that Anthroposophy gives us. The human being stands before us in a physical body, which has a long evolution behind it, three preparatory stages before it became an earthly body — as is described in my book An Outline of Esoteric Science. [Note 2] This earthly body needs to be understood much more than it is by today's anatomy and physiology. For the human physical body as it is today is a true image of the etheric body, which is in its third stage of development, and of the astral body, which is in its second stage, and even to a certain degree of the ego organization that humans first received on earth, which therefore is in its first stage of development. All of this is stamped like the stamp of a seal upon the physical body — which makes the physical body extraordinarily complicated. Only its purely mineral and physical nature can be understood with the methods of knowledge that are brought to it today. What the etheric body impresses upon it is not to be reached at all by those methods. It has to be observed with the eye of a sculptor so that one obtains pictorial images of cosmic forces, images that can then be recognized again in the form of the entire human being and in the forms of the single organs.

The physical human being is also an image of the breathing and blood circulation. But the entire dynamic activity that works and weaves through the blood circulation and breathing system can only be understood if one thinks of it in musical forms. For instance, there is a musical character to the formative forces that were poured into the skeletal system and then became active in a finer capacity in the breathing and circulation. We can perceive in eurythmy how the octave goes out from the shoulder blade and proceeds along the bones of the arm. This bone formation of the arm cannot be understood from a mechanical view of dynamics, but only from musical insight. We find the interval of the prime extending from the shoulder blade to the bone of the upper arm, the humerus, the interval of the second in the humerus, the third from the elbow to the wrist. We find two bones there because there are two thirds in music, a larger and a smaller. And so on. In short, if we want to find the impression of the astral body upon the physical body, upon the breathing and blood circulation, we are obliged to bring a musical understanding to it.

Still more difficult to understand is the ego organization. For this one needs to grasp the meaning of the first verse of the Gospel of St. John: “In the beginning was the Word.” “The Word” is meant there to be understood in a concrete sense, not abstractly, as commentators of the Gospels usually present it. If this is applied concretely to the real human being, it provides an explanation of how the ego organization penetrates the human physical body. You can see that we ought to add much more to our studies if they are to lead to a true understanding of the human being. However, I am convinced that a tremendous amount of material could be eliminated not only from medical courses but from theological courses too. If one would only assemble the really essential material, the number of years medical students, for instance, must spend in their course would not be lengthened but shortened. Naturally it is thought in materialistic fashion today that if there's something new to be included, you must tack another half-year onto the course!

Out of the knowledge that Anthroposophy gives us, we can say that the human being stands before us in physical, etheric and astral bodies, and an ego organization. In waking life these four members of the human organization are in close connection. In sleep the physical body and etheric body are together on one side, and the ego organization and astral body on the other side. With knowledge of this fact we are then able to say that the greatest variety of irregularities can appear in the connection of ego organization and astral body with etheric body and physical body. For instance, we can have: physical body, etheric body, astral body, ego organization. (Plate I, 1) Then, in the waking state, the so-called normal relation prevails among these four members of the human organization.

Plate I Click image for large view

But it can also happen that the physical body and etheric body are in some kind of normal connection and that the astral body sits within them comparatively normally, but that the ego organization is somehow not properly sitting within the astral body. (Plate I, 2) Then we have an irregularity that in the first place confronts us in the waking condition. Such people are unable to come with their ego organization properly into their astral body; therefore their feeling life is very much disturbed. They can even form quite lively thoughts. For thoughts depend, in the main, upon a normal connection of the astral body with the other bodies. But whether the sense impressions will be grasped appropriately by the thoughts depends upon whether the ego organization is united with the other parts in a normal fashion. If not, the sense impressions become dim. And in the same measure that the sense impressions fade, the thoughts become livelier. Sense impressions can appear almost ghostly, not clear as we normally have them. The soul-life of such people is flowing away; their sense impressions have something misty about them, they seem to be continually vanishing. At the same time their thoughts have a lively quality and tend to become more intense, more colored, almost as if they were sense impressions themselves.

When such people sleep, their ego organization is not properly within the astral body, so that now they have extraordinarily strong experiences, in fine detail, of the external world around them. They have experiences, with their ego and astral body both outside their physical and etheric bodies, of that part of the world in which they live — for instance, the finer details of the plants or an orchard around their house. Not what they see during the day, but the delicate flavor of the apples, and so forth. That is really what they experience. And in addition, pale thoughts that are after-effects in the astral body from their waking life.

You see, it is difficult if you have such a person before you. And you may encounter such people in all variations in the most manifold circumstances of life. You may meet them in your vocation as physician or as priest — or the whole congregation may encounter them. You can find them in endless variety, for instance, in a town. Today the physician who finds such a person in an early stage of life makes the diagnosis: psychopathological impairment. To modern physicians that person is a psychopathological impairment case who is at the borderline between health and illness; whose nervous system, for instance, can be considered to be on a pathological level. Priests, if they are well-schooled (let us say a Benedictine or Jesuit or Barnabite or the like; ordinary parish priests are sometimes not so well-schooled), will know from their esoteric background that the things such a person tells them can, if properly interpreted, give genuine revelations from the spiritual world, just as one can have from a really insane person. But the insane person is not able to interpret them; only someone who comprehends the whole situation can do so. Thus you can encounter such a person if you are a physician, and we will see how to regard this person medically from an anthroposophical point of view. Thus you can also encounter such a person if you are a priest — and even the entire congregation can have such an encounter.

But now perhaps the person develops further; then something quite special appears. The physical and etheric bodies still have their normal connection. But now there begins to be a stronger pull of the ego organization, drawing the astral body to itself, so that the ego organization and astral body are now more closely bound together. And neither of them enters properly into the physical and etheric bodies. (Plate I, 3) Then the following can take place: the person becomes unable to control the physical and etheric bodies properly from the astral body and ego. The person is unable to push the astral body and ego organization properly into the external senses, and therefore, every now and then, becomes “senseless.” Sense impressions in general fade away and the person falls into a kind of dizzy dream state. But then in the most varied way moral impulses can appear with special strength. The person can be confused and also extremely argumentative if the rest of the organism is as just described.

Now physicians find in such a case that physical and biochemical changes have taken place in the sense organs and the nerve substance. They will find, although they may take slight notice of them, great abnormalities in the ductless glands and their hormone secretion, in the adrenal glands, and the glands that are hidden in the neck as small glands within the thyroid gland. In such a case there are changes particularly in the pituitary gland and the pineal gland. These are more generally recognized than are the changes in the nervous system and in the general area of the senses.

And now the priest comes in contact with such a person. The person confesses to experiencing an especially strong feeling of sin, stronger than people normally have. The priest can learn very much from such individuals, and Catholic priests do. They learn what an extreme consciousness of sin can be like, something that is so weakly developed in most human beings. Also in such a person the love of one's neighbor can become tremendously intense, so much so that the person can get into great trouble because of it, which will then be confessed to the priest.

The situation can develop still further. The physical body can remain comparatively isolated because the etheric body — from time to time or even permanently — does not entirely penetrate it, so that now the astral and etheric bodies and the ego organization are closely united with one another and the physical organism is separate from them. (Plate II) To use the current materialistic terms (which we are going to outgrow as the present course of study progresses), such people are in most cases said to be severely mentally retarded individuals. They are unable from their soul-spiritual individuality to control their physical limbs in any direction, not even in the direction of their own will. Such people pull their physical organism along, as it were, after themselves. A person who is in this condition in early childhood, from birth, is also diagnosed as mentally retarded. In the present stage of earth evolution, when all three members — ego organization, astral organization, and etheric body — are separated from the physical, and the lone physical body is dragged along after them, the person cannot perceive, cannot be active, cannot be illumined by the ego organization, astral body, and etheric body. So experiences are dim and the person goes about in a physical body as if it were anesthetized. This is extreme mental retardation, and one has to think how at this stage one can bring the other bodies down into the physical organism. Here it can be a matter of educational measures, but also to a great extent of external therapeutic measures.

Plate II Click image for large view

But now the priest can be quite amazed at what such a person will confess. Priests may consider themselves very clever, but even thoroughly educated priests — there really are such men in Catholicism; one must not underestimate it — they pay attention if a so-called sick person comes to them and says, “The things you pronounce from the pulpit aren't worth much. They don't add up to anything, they don't reach up to the dwelling place of God, they don't have any worth except external worth. One must really rest in God with one's whole being.” That's the kind of thing such people say. In every other area of their life they behave in such a way that one must consider them to be extremely retarded, but in conversation with their priest they come out with such speeches. They claim to know inner religious life more intimately than someone who speaks of it professionally; they feel contempt for the professional. They call their experience “rest in God.” And you can see that the priest must find ways and means to relate to what such a person — one can say patient, or one can use other terms — to what such a human being is experiencing within.

One has to have a sensitive understanding for the fact that pathological conditions can be found in all spheres of life, for the fact that some people may be quite unable at the present time to find their way in the physical-sense world, quite unable to be the sort of human being that external life now requires all of us to be. We are all necessarily to a certain degree philistines as regards external life. But such people as I am describing are not in condition to travel along our philistine paths; they have to travel other ways. Priests must be able to feel what they can give such a person, how to connect what they can give out of themselves with what that other human being is experiencing. Very often such a person is simply called “one of the queer ones.” This demands an understanding of the subtle transition from illness to spirituality.

Our study can go further. Think what happens when a person goes through this entire sequence in the course of life. At some period the person is in a condition (Plate I, 2) where only the ego organization has loosened itself from the other members of the organism. In a later period the person advances to a condition where neither ego nor astral enter the physical or etheric bodies. Still later, (Plate I, 3) the person enters a condition where the physical body separates from the other bodies. (Plate II) The person only goes through this sequence if the first condition, perhaps in childhood, which is still normal, already shows a tendency to lose the balance of the four members of the organism. If the physician comes upon such a person destined to go through all these four stages — the first very slightly abnormal, the others as I have pictured them — the physician will find there is tremendous instability and something must be done about it. Usually nothing can be done. Sometimes the physician prescribes intensive treatment; it accomplishes nothing. Perhaps later the physician is again in contact with this person and finds that the first unstable condition has advanced to the next, as I described it with the sense impressions becoming vague and the thoughts highly colored. Eventually the physician finds the excessively strong consciousness of sin; naturally a physician does not want to take any notice of that, for now the symptoms are beginning to play over into the soul realm. Usually it is at this time that the person finally gets in touch with a priest, particularly when the fourth stage becomes apparent.

Individuals who go through these stages — it is connected with their karma, their repeated earth lives — have purely out of their deep intuition developed a wonderful terminology for all this. Especially if they have gone through the stages in sequence, with the first stage almost normal, they are able to speak in a wonderful way about what they experience. They say, for instance, when they are still quite young, if the labile condition starts between seventeen and nineteen years: human beings must know themselves. And they demand complete knowledge of themselves. Now with their ego organization separated, they come of their own initiative to an active meditative life. Very often they call this “active prayer,” “active meditation,” and they are grateful when some well-schooled priest gives them instruction about prayer. Then they are entirely absorbed in prayer, and they are experiencing in it what they now begin to describe by a wonderful terminology. They look back at their first stage and call what they perceive “the first dwelling place of God,” because their ego has not entirely penetrated the other members of their organism, so to a certain extent they are seeing themselves from within, not merely from without. This perception from within increases; it becomes, as it were, a larger space: “the first dwelling place of God.”

What next appears, what I have described from another point of view, is richer; it is more inwardly detailed. They see much more from within: “the second dwelling place of God.” When the third stage is reached, the inner vision is extraordinarily beautiful, and such a person says, “I see the third dwelling place of God; it is tremendously magnificent, with spiritual beings moving within it.” This is inner vision, a powerful, glorious vision of a world woven by spirit: “the third dwelling place of God,” or “the House of God.” There are variations in the words used. When they reach the fourth stage, they no longer want advice about active meditation, for usually they have reached the view that everything will be given them through grace and they must wait. They talk about passive prayer, passive meditation, that they must not pray out of their own initiative, for it will come to them if God wants to give it to them. Here the priest must have a fine instinct for recognizing when this stage passes over into the next. For now these people speak of “rest-prayer,” during which they do nothing at all; they let God hold sway in them. That is how they experience “the fourth dwelling place of God.”

Sometimes from the descriptions they give at this stage, from what — if we speak medically — such “patients” say, priests can really learn a tremendous amount of esoteric theology. If they are good interpreters, the theological detail becomes clear to them — if they listen very carefully to what such “patients” tell them, to what they know. Much of what is taught in theology, particularly Catholic pastoral theology, is founded on what various enlightened, trained confessors have heard from certain penitents who have undergone this sequence of development.

At this point ordinary conceptions of health and illness cease to have any meaning. If such a man is hidden away in an office, or if such a woman becomes an housewife who must spend her days in the kitchen or something similar in bourgeois everyday life, these people become really insane, and behave outwardly in such a way that they can only be regarded as insane. If a priest notices at the right moment how things are developing and arranges for them to live in appropriate surroundings, they can develop the four stages in proper order. Through such patients, the enlightened confessor is able to look into the spiritual world in a modern way but similarly to the Greek priests, who learned about the spiritual world from the Pythians, who imparted all kinds of revelations concerning the spiritual world through earthly smoke and vapor. [Note 3] What sense would there be today in writing a thesis on the pathological aspect of the Greek Pythians? It could certainly be done and it would even be correct, but it would have no meaning in a higher sense. For as a matter of fact, very much of what flowed in a magnificent way from Greek theology into the entire cultural life of Greece originated in the revelations of the Pythians. As a rule, the Pythians were individuals who had come either to this third stage or even to the fourth stage.

But we can think of a personality in a later epoch who went through these stages under the wise direction of her confessors, so that she could devote herself undisturbed to her inner visions. Something very wonderful developed for her, which indeed also remained to a certain degree pathological. Her life was not just a concern of the physician or of the priest but a concern of the entire Church. The Church pronounced her a saint after her death. This was St. Teresa. [Note 4] This was approximately her path.

You see, one must examine such things as this if one wants to discover what will give medicine and theology a real insight into human nature. One must be prepared to go far beyond the usual category of ideas, for they lose their value. Otherwise one can no longer differentiate between a saint and a fool, between a madman and a genius, and can no longer distinguish any of the others except a normal dyed-in-the-wool average citizen.

This is a view of the human being that must first be met with understanding; then it can really lead to fundamental esoteric knowledge. But it can also be tremendously enlightening in regard to psychological abnormalities as well as to physical abnormalities and physical illnesses. Certain conditions are necessary for these stages to appear. There has to be a certain consistency of the person's ego so that it does not completely penetrate the organism. Also there must be a certain consistency of the astral body: if it is not fine, as it was in St. Teresa, if it is coarse, the result will be different. With St. Teresa, because of the delicacy of her ego organization and astral body, certain physical organs in the lower body had been formed with the same fragile quality.

But it can happen that the ego organization and astral body are quite coarse and yet they have the same characteristic as above. Such an individual can be comparatively normal and show only the physical correlation: then it is only a physical illness. One could say, on the one hand there can be a St. Teresa constitution with its visions and poetic beauty, and on the other hand its physical counterimage in diseased abdominal organs, which in the course of this second person's life is not reflected in the ego and astral organization.

All these things must be spoken about and examined. For those who hold responsibility as physicians or priests are confronted by these things, and they must be equal to the challenge. Theological activity only begins to be effective if theologians are prepared to cope with such phenomena. And physicians only begin to be healers if they also are prepared to deal with such symptoms.