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Pastoral Medicine
GA 318

Lecture IX

16 September 1924, Dornach

Dear friends,

You have seen how necessary it is to relate a state of illness in a human being to his or her spiritual life and experience. The understanding that should be brought to illness by the two groups of people who have especially to do with pastoral medicine can really only come from such a point of view. Therefore I would like once more to consider the actual state of illness in connection with a person's spiritual life, this time from a standpoint that I think will throw greatest light upon the nature of illness.

As human beings we alternate between waking and sleeping. You all know in general what can be said from our perspective about these two conditions.

Today let us hold clearly in our minds what really happens in the human being during sleep. The physical body and etheric body are by themselves; the astral body and ego are also by themselves. Turning first to the physical and etheric bodies, we know that by virtue of what these bodies are, certain processes go on that during the person's sleep are independent of the activity of the astral body and ego. In the human organism we find processes going on that are not at all suited to it in the way they must play themselves out. The physical body has to do with physical processes. Physical processes take their course outside in the mineral kingdom; they are suited to the mineral kingdom. They are not at all suited to the constitution of the human physical body. And yet while it is asleep this human body is, so to speak, subject to these physical processes in the same way that the mineral kingdom is. We must be aware of this contradiction in the human being precisely during sleep. During sleep the human being ought to be a world of physically active forces and substances, but this is something that really cannot be. That is why processes that go on in the physical body during sleep—unless they are brought into balance—cause illness.

The general assertion that sleep is healthful is correct in a certain sense, but only under certain conditions. And it must not prevent us from examining the true situation without prejudice. Physical processes in the human physical body can only be healthful when the ego and astral organization are down in the physical body, as is the normal condition during waking life. It is constantly interrupted by the sleep condition. Normally, however, even during sleep the catabolic process is still always going on in the physical body; it must be there so that the soul-life and spiritual life as a whole can really unfold. For the spiritual life is not connected with anabolic processes, only with catabolic processes. During sleep, therefore, there must be just as much of the catabolic processes as a person needs for waking life to unfold the next morning. If too many catabolic processes are there because of some unhealthy sleep condition, a residue of these processes piles up in the human organism, and then we have the inner cause for an illness.

If we extend our investigation to the etheric body, we find that during sleep only the processes can take place in the etheric body that can otherwise take place in the plant kingdom. During daytime consciousness, when the astral body and ego are in the etheric body, these processes are always raised to a higher level. But from the moment of a person's going to sleep to the moment of waking, they take their course in the same way that they do in the plant kingdom. Thus they too are not suited to the human organism; they need to be balanced by the astral body and ego. If they create a residue, this too is cause for illness. So we can say that sleep can show us how causes of illness really originate in the human organism. For they are fundamentally the normal sleep processes; at the same time they are the basis for human soul-spiritual life. And that points to a secret of this world—that whenever one penetrates to reality, one finds it has two sides! On one side, in the sleep condition of the human physical and etheric bodies we find the basis for spiritual development; on the other side, in the very same processes we find the basis for illnesses. Thereby illness is brought into direct connection with human spiritual development. Thus if we study what is active during sleep in the human physical and etheric bodies, we find the fundamental causes of illness.

Now let us consider from this point of view those who during waking life do not go down deeply enough into their physical and etheric bodies—which is what we have found to be the case in the mentally retarded or the psychopath. With such people the soul and spirit enter into processes of illness and live with them. Special value should be laid on this knowledge, that psychopaths and the so-called mentally disturbed are always closely involved in their inner lives with the causes of illness. You see, one has to look at such things carefully.

But now let us go to the outer world. Let us start from the human physical body (Plate VI, left) and consider the outer mineral world that relates to it. During sleep we have processes in the human physical body from which the ego is missing. They go on without really any inner working “motor.” But there is ego out there in the world in all those mineral processes. In them is what we can call world-ego. So we have on the one hand within the processes of the human physical body a condition of non-ego, a sum of processes that are egoless, processes that lack ego. And we have on the other hand in our outer environment a sum of mineral processes and mineral substances that are permeated by ego—that means, by all the hierarchies who are to be identified with ego. Mineral substance has ego.

Therefore let us assume that we observe in some person's physical body a process that should not be there, a sick process. It lacks ego. What can we do if we want to cure this condition? We can search outside in the mineral kingdom for that part of the ego that the person lacks, to cure what is too much asleep, to cure what is still continuing to sleep during waking life. Then we have the right remedy. If you give the substance that has an affinity to the sick organ, the ego-force that the organ lacked is brought into the organ. This is the principle underlying our search in inorganic nature around us for medicinal remedies for the physical body of the sick person. We have to find the corresponding substance that has ego-force; then it has a healing effect. Thus the transition from pathology to therapy rests upon a correct insight into the relation between the processes of the human physical body and the outer mineral world on the one hand, and the relation of the human etheric body to the plant world on the other. If we observe too exuberant a growth in the etheric body, we realize that the etheric body is lacking proper penetration by the astral body. Then we must search in the plant kingdom for the proper corresponding remedy. This is the direction our work must take.

One must recognize the spirit in nature, the spirit that is in the mineral and plant kingdoms of the world. It is the spirit, not the substance, that one must know, because in reality one heals the human being through the spirit that is in the mineral and in the plant. In its nature substance is not truly governed by spirit, but even so it has spirit in it. And those who want to heal without recognizing the spirit in stones and plants can only grope their way through traditional theory. They can try one thing or another and see whether it helps, but they will never know why it helps—because they will never know just where the spirit is in possession of some mineral or how it is in possession of it. To be a healer requires first and foremost a spiritual outlook on the world. And indeed this is the greatest anomaly of our time: that it is medicine itself that has the frightful disease of materialism. Medicine is seriously ill with materialism. It has become blind and is falling asleep, and this is creating harmful soul substances in science. It really needs to be healed. One can indeed say, the sickest entity of our time is not Turkey,12The sickest entity ...” This refers to a European expression, “the sick man of Europe,” applied to the Ottoman Empire in the nineteenth century. as was the case in nineteenth-century Europe, but the medical profession. This is a fact that physicians should know—as well as the theologians, for then perhaps the secret will remain among those to whom it has been entrusted!

Let us look at these things more closely. There are certain persons who are not psychopathic or insane in the sense in which one is justified in using those terms, but who nevertheless illustrate what I have been talking about during the last few days. They descend into their physical and etheric bodies in such a way that they acquire a certain perceptible connection to their sick condition, to sick processes. These are sleepwalkers, whose peculiar state is not make-believe; it has often been described to the general public, and every initiate knows it well. While they are in their somnambulistic condition, they describe their illnesses. They go down into their physical and etheric body. Now the normal human being in waking life has the physical and etheric bodies completely saturated by the astral body and the ego. In the case of these sick individuals, the ego and astral body do not combine with the etheric and physical body in accordance (figuratively speaking) with their exact atomic weight. Some of the ego and astral body is left out; it has not entirely sunk down. But then it is this element that is able to perceive. Only that part of the ego and astral body perceives that has not sunk down into the etheric and physical body. When some of the astral body and ego is superfluous in such a person, then there is this inner perception, and the person can describe his or her own illness.

But now there is another condition—a condition of the opposite kind, in which the normal sleep condition is disturbed. In this case, when the ego and astral body are outside the physical and etheric body and things happen in the ego and astral body that do not belong in this soul-spiritual entity (as the things I was just describing did not belong in that physical-etheric body), when too much spirit is experienced by the ego and astral body during sleep (as too much nature was experienced in the opposite condition by the physical-etheric body), then a clairvoyance comes about that borders on a pathological state. The individual carries into sleep a certain power to perceive spiritual things, then afterward carries back memories of spiritual perception into waking consciousness. In particular, these abnormal spiritual perceptions appear in lively dreams. And then, as every initiate knows, we observe that the dreams have the following content.

Suppose the sick person, the physically sick person, is in the former condition I was describing and dips down with the spirit and soul into the physical-etheric body and then experiences the illness in a somnambulistic condition. The sick person experiences a strong catabolic process going on in the physical-etheric body, a kind of reverse process of nature. But now suppose the person is outside the physical body with the astral body and ego. Then the person has experiences of the spiritual aspect of external nature. Suppose the person experiences a sick organ inwardly—sick because it allows some outer process to occur in an unhealthy way. This is experienced in the somnambulistic state, and the inner process is described. If the person is in the opposite condition, the somnambulism works into the ego and astral body when these are farther out of the physical and etheric body. If the spiritual, elemental life of nature comes into dreams, the person experiences what is spiritual in the minerals. And what does the person dream about? The person dreams of the medicinal remedy. Here you have the connection between many aspects of somnambulistic life. The somnambulist alternates between two conditions, as I have described. In one condition dreaming of the illness, in the other condition dreaming of the remedy. And generally speaking, that is the way pathology and therapy were explored in the old mysteries.

In those times there was not so much experimenting as there is today. The sick person was brought into the temple and put into a kind of somnambulistic condition by trained temple priests. This condition was increased to the level at which the sick person could describe the process of the illness. Then the opposite somnambulistic condition was brought about, and the temple priest was told the dream that contained the therapy. This was the manner of inquiry in the oldest mysteries; it led from disease to cure. And so it was that medical science was cultivated in olden times, by seeking knowledge of humanity through the human being itself.

We don't have to go back to those old methods. We have to move forward to methods by which we are able to follow the course of an illness through imaginative experience, and by which we are able to experience the healing process through an intuitive activity that leads not into the human being, but outward. What has formerly been a kind of experimentation in this field will now have to become careful observation. You see the direction in which we are turning. In olden times external physical science was a purely observing science; then it began to experiment and more and more substituted experiment for pure observation. That was right. But medical science did the same thing in imitation, and that was not right. It experimented on human beings with the temple research. We must find the way to change over from experimenting to observing, to an observation of life that is sustained by spiritual knowledge and enriched by scientific research. For whoever really looks at life can catch a view of illness everywhere. In the simplest form of everyday life that has deviated only to the slightest degree from so-called normal, something can be seen that will lead—if considered properly—to a recognition of complicated disease processes. One has only to understand how things relate to one another.

But this shows us that physicians must more and more become really practical individuals—again, the exact opposite of what recent materialistic development has made them. They have gradually become pure scientists. And that makes no sense. A physician should always be able to cope with natural laws in a living way, and not just know them abstractly. With abstract knowledge of them one has not yet even begun to work with them. That's the situation from one side.

Let us look at the other side, the side that the priest must see. We think of the priest's mission as guiding human beings in their approach to the spiritual world, in everything that will help their ego and astral body to find their way in the spiritual world. If it is the physician's task to inquire into the nature of humanity from a spiritual point of view, to explore pathological conditions from a spiritual point of view, then what must the priest look for? The priest has to find what can lead human beings toward the spiritual world; their attitude toward the spiritual world, whether they love the spiritual world, how much they are permeated by the spiritual world—insofar as these things are apparent in normal life. The priest must deal with all the normal or abnormal symptoms that the human soul manifests in this regard in everyday life. For the priest we have to point out the opposite course to that of the physician. We told the physician that if somnambulists are allowed to describe their sick organ, they will also describe the medicinal remedy for it from out of their dreams.

Let us look again at the priests in the ancient mysteries. They were not primarily interested in discovering medicinal remedies, although of course they were intensely interested in healing, for they were first and foremost a friend of humanity. But they did not stop at healing; they were interested in more than that. They were interested in the following: They saw that the somnambulist found his or her own remedy in dreams while in the spiritual world with the ego and astral body. The priests paid particular attention to this soul while it was in the spiritual world, and followed it back again into the body. And what was found? Of course they found themselves again confronting the sick organ. But now, from what they had perceived of that soul while it was out of the body, they knew how the astral body and ego would work in this organ if it were healthy. Upon returning again to the sick organ, they knew what the situation would be under healthy conditions. Now they realized how the astral body and ego out of their divine-spiritual powers take hold normally in the human organism, how they sit normally within it. The priests learned to know them in their healthy normality through the dreams in the spiritual world, and learned how they relate to the physical world when they descend into the physical body. From this, the priests learned to know the inner relation of humanity to the spiritual world.

This knowledge should influence priests as they enact the sacrament in which they are carrying back the spiritual world. For the spiritual world is present in the sacrament through the establishment of the ritual. The ritual unites spirit with physical substance by virtue of deep insight into the relation of spirit to matter. Inspirited physical substance is led back into human beings, and the relation is established in them that unites their astral body and ego within their physical and etheric bodies with the divine-spiritual being of the world. Everything in this relation depends upon the priest's celebrating the sacraments with such an attitude. Everything depends upon our permeating ourselves with such thoughts. For instance, the relation between experience in the body and experience out of the body; secrets of pathology from observing the body when it is left; secrets of therapy from observing abnormal life in the spiritual world as compared to normal perception in the spiritual world. What was established in ancient times in secret temple procedures by prominent somnambulists must now be again established by human beings developing spiritual perception in themselves and observing the connections. In this area, experiment must give way to observation.

Now it is important that the physicians and priests in the anthroposophical movement are already united in their knowledge of such facts as these. That is what really binds us together. We are permeated by a different kind of knowledge from what others have. By contrast, the idea that some sort of union or association or group should be formed is just an abstraction. What really binds us together is the possession of certain knowledge. Those who possess this knowledge obviously belong together, and should feel closely united to one another. Any external association should be an expression of the inner union created by this knowledge.

Our time suffers very much in this respect. For instance, often when I speak today to, say, a youth gathering, even though I fully appreciate their endeavor and even though I myself have the very best intentions, it is extraordinarily difficult to experience their response to the concrete truths that should be filling their souls. It is difficult when I hear them say, “The first thing we must do is to join together!” Well, indeed, everything in these last decades has been “joined together”—ad infinitum! People have gone on and on joining together, but they've never yet got anything real for a result by tacking zeros onto one another indefinitely—00000000 and so on. One empty consciousness to begin with, joined to another empty consciousness, joined to a third consciousness, again empty—that all adds up to nothing. By contrast, you only have to assume a content—a content that is, after all, the basis of all zeroes: one. Then you have something. It doesn't have to be a human being, but it has to be some genuine content. Interestingly enough, this assumes that there is something there to begin with. It doesn't even have to be a human being. It can be real, living knowledge. These are things we should think about in our time. For usually people are much too comfortable to search for the concrete; they are content simply to put abstractions together. Joining together is all right, of course, but it will come of itself if something concrete is there first.

Perhaps this is something that should be understood before anything else by those who work among modern humankind as physicians and priests. Today two conditions can be observed throughout the world. Generally speaking, our ego and astral body do not find properly our physical and etheric bodies, whatever our waking condition may be. Also, truly, for those observing the world as it evolves, materialistic views don't really worry them unduly! Let the monists and the others fight with one another. Nothing is accomplished thereby. But that is certainly not the fundamental evil in the evolution of humanity. If one is observing the evolutionary process, one is not particularly interested to participate in these discussions of worldviews. For actually, whether one thinks this or another thinks that, opinions are frightfully thin little things in the human soul! They're just bubbles in the reality of this world. If one bubble hits another, if one bursts, if another becomes a bit thicker from the bursting of another, none of it matters. What does matter, what should be clearly realized, is that one does not ever becomes a materialist if one is sitting with one's ego and astral body properly in the physical and etheric bodies. In other words, to be a materialist means in a finer sense to be ill. One must fill one's whole being with this knowledge. And it is not surprising in the least that when others, those who are sitting properly inside their physical and etheric bodies, encounter the sick materialists, they turn away to exactly the opposite pole—to all the vague mist of spiritualism.

Here we come to a difficult area, because these things do not take place in those parts of the world that still have a connection with one another; they happen where the world has been thrown into chaos and its pieces lie scattered about. One thing no longer reveals itself as a healing remedy for another, for they are falling away from each other. So long as sick people speak of what is going on in their organs, their dreams will still reveal the corresponding healing remedies in the outer world. But in our present time people who are ill from materialism will not be describing sick inner organs; they have broken free of their organism; they want to describe the external world, as a materialist naturally would. Then they find not remedial dreams but the opposite—false spiritualism, which is certainly not a remedy. On the contrary, it brings on the illness more strongly than ever.

And so we find today in our time—if I may draw an analogy between medical work for individuals and cultural pathology and therapy—we find that spiritualism does not by any means offer a remedy for materialism, but corresponds to the somnambulist's dream revealing his sick organs. Now sometimes a process that properly should have taken hold of a person's inner organism pushes through the organism to the periphery, to the outer world; there is then the pathological condition called a “rash.” This corresponds exactly to what I've been telling you about. One sees with one's own eyes that what had been inside and is now outside is nothing healthy. It is an aberration. The physician should see clearly that materialism is a rash and needs to be regarded as a medical problem.

This will build a bridge to the priest's observation on the other side. The priest sees the symptoms that rise out of sick human souls, out of their need, out of their feelings. Spiritualism is just such a symptom. One comes to realize that in the widest sense sick life wants to sink down into the world, that all the disease in the present world outlook does indeed work itself out fully—insofar as it rests on the will—by working into people and sickening their inner life.

In the present epoch of human evolution it is impossible to see something that could be seen clearly in former times, because people in those days had different characteristics. We cannot see how a false direction of the will, a false worldview, a false view of life—all of which were designated in olden times as sin—cause illness in the organism. For they do not do so immediately in the ordinary way. We are only aware of the connection in the rarest cases, cases that are an intermediate stage between the sin and what can obviously be diagnosed as the resulting illness. These intermediate stages may simply develop into morbid conditions. But in this modern epoch the sin and the real illness are so detached from each other that now they even occur in separate incarnations. In earlier epochs they were able to appear in close connection as cause and effect, but as humanity developed they became separated so that sin appeared in one incarnation, illness in a subsequent one.

Here, then, begins the domain of the priests. Priests may no longer merely continue traditions of olden times, speaking of sin as the cause of illness. But if they have knowledge of repeated earth lives, they can speak of sin from that point of view; then they will again be speaking from the standpoint of truth. Much that priests in the world today say about these things is no longer true; it no longer corresponds to fact. These teachings originated in olden times, and today no one is interested in changing the teachings to accord with what is demanded in our time.

We have to relate ourselves to all this. Then it will be possible to make our study of pastoral medicine fruitful in both directions.

My intention is to give two more lectures for this course: tomorrow, and the day after tomorrow. I am announcing this now so that you can make your plans accordingly.