Cooperation Between Doctors and Pastoral Caregivers
Pastoral Medicine Course
GA 318
12 September 1924, Dornach
Translated by Steiner Online Library
Fifth Lecture
[ 1 ] My dear friends! We are now dealing with the insights we have gained, on the one hand, through the observation of people who, without having any direct intuition, grow into a perception of the spiritual world and thereby exhibit states in their entire human demeanor that may easily remind the physician of pathological conditions, but which are, in essence, something entirely different from pathological conditions alone. This is simply because, as we have seen, the pathological remains in a state of becoming, and there is a continuous possibility of healing emanating from the spirit—as is certainly the case with figures such as Saint Teresa, Mechthild of Magdeburg, and also with male visionaries.
[ 2 ] Now, when we consider these states, we see that in the first stage the “I” organization breaks away from the overall human organization. The “I” organization then draws the astral body very closely to itself and, in a certain sense, separates it from the etheric and physical organizations during the waking state. What results from this? You can easily understand, my dear friends, that this results in the human being falling into a kind of dream state. When we examine the human constitution from a perspective of Spiritual Science—which arises because the “I” draws the astral body toward itself and does not allow it to enter fully into the physical and etheric bodies—a kind of dream state emerges. But again, because, as I have emphasized, due to a particular karmic density, the “I” and the astral body are then strengthened, a receptivity to perceiving the spiritual world is carried into the dream. The dream is transformed into a state that offers the possibility of truly looking into the spiritual world. This is the state in which the person concerned then experiences a sense of the presence of beings from the spiritual world.
[ 3 ] Now we can explore the opposite state, the polar opposite state. This polar opposite state occurs when the astral body draws the “I” organization—which is currently weak—in too strongly. Then, in the waking state, there is not an illumination as experienced by visionaries such as Saint Teresa, but rather, on the contrary, a dimming, a darkening of consciousness occurs in the waking state. A dimming to the point of dreaming occurs.
[ 4 ] You see, we cannot come to know people who are in such a state in the way I have described for others. People who reach such culminating stages as Saint Teresa or Mechthild of Magdeburg—but also those who are numerous, far more numerous than one might think, and who have a sense of the presence of the spiritual—such personalities can best be understood, if one has the necessary predisposition or has developed the appropriate abilities, by having their states of being described to one. They speak—forgive me for saying so—in a more interesting way than the ordinary philistines of our day. Their stories are much more interesting, and above all, they recount things that one cannot experience in everyday life. So these people are indeed interesting, even if they are still in the first stage. One gets to know them by having them tell their stories.
[ 5 ] As for the others—those whose astral body draws in the “I”—it remains interesting to hear their stories; however, to understand the former, one truly needs the depth of soul characteristic of a priest. To understand the latter—who are often no less interesting, and often even more interesting than the ordinary visionaries who do not go far enough to understand them—one actually needs the inner emotional sphere of a physician who perceives the world with sound judgment and reasonable intuition. For the task here is to understand what they do not tell you, since what they do tell you is of little value. It is a matter of interpreting what they say and do in such a way that one can place it in the proper perspective in relation to the human organism. When asked a question, such individuals already display a certain degree of obtuseness, even a reluctance, to answer. They then begin to talk about something other than what the question concerns. But if you pick up on what they say of their own accord—there are also those among them who would like to chatter on and on—if you pick up on what they say of their own accord, you sometimes get the feeling that there is an inner wellspring for their speech that also gives them a special kind of association of ideas, unlike what is the case with ordinary people. Such people tell you—if you let them go, you don’t have to ask them, but rather you have to pick up on what they say as if by chance—such people tell you: “Yes, ten years ago, I was visiting a farmer once. The farmer’s wife gave me coffee. The farmer’s wife gave me coffee in a cup with red roses painted on the outside.” The farmer’s wife couldn’t serve me the coffee right away, because she’d forgotten the sugar in the kitchen and had to go get it first. Then she’d forgotten the milk. She had to fetch that from the cellar first, and then she poured something like an eighth of a liter of milk into the coffee, and then she said, ‘My coffee is very good’; and I said, ‘Yes, I’m sure it is, farmer’s wife.’ - And so he goes on; he recounts details that refer to the distant past and go into the most incredible specifics. You then find yourself thinking: Oh, if only I had a memory as good as his. - You completely forget that if you had a memory like his, you’d be just like him. Well, I’m telling these things in a somewhat exaggerated way and highlighting the typical aspects. You’ll then have to adapt to the corresponding milder variations that you encounter in life—especially those a doctor encounters—and use them as a guide. I’m describing it in an extremely striking way so that you can see what really matters.
[ 6 ] So when the astral body draws the “I” organization in in this way, a kind of force comes into being that readily reproduces details stored in memory as if automatically, always ready to reproduce them, but refrains from seeking any logical connection; instead, it lists the things one after another, so that one cannot quite understand why the person in question thinks of one thing at one moment and another at the next. It may happen that the person in question says: “The farmer’s wife went out to fetch the milk; while she was going out, I looked into the corner of the room, and there was a picture of the Madonna—it was the same one I saw thirty years ago in a certain place; but there I didn’t get a cup of coffee, but rather a very good soup.” — It may be that he strays completely from the other story; it may be that he returns to it. So one sees that it is a memory that is not logical, but one that operates in space and time with extraordinary fidelity and an almost automatic longing to reveal itself. He has such a memory—a memory in which, upon closer examination, one discerns something very peculiar: namely, the very foundation upon which the matter rests in an even deeper sense. One notices that he takes a certain pleasure in certain sounds of words that he appropriated while experiencing those things. And now one realizes that he takes pleasure in bringing these sounds of words back to life. In short, one realizes that this involves a return to language, which is retained in memory with the exclusion of thoughts—not with the complete exclusion of thoughts, but still with the exclusion of thoughts.
[ 7 ] On the other hand, one also notices a change in the sphere of the will. This must also be taken into account, because it leads one to gradually drift into truly pathological states, which can then actually occur and which we will then have to address. One observes the following. One must be careful again; for approaching such people in any way—trying to persuade them to follow you, to do this or that so that you might observe something in them—does not help much, because they become very stubborn, refuse to comply in any way, refuse to answer the questions you ask them, and refuse to carry out anything at all. But if one approaches them with the help of some kind of external case history—gathering information from their surroundings or other sources—one notices, for example, that at a certain time of year such people experience inner impulses compelling them to wander, to roam through a particular region. Often it is the same region each year that they want to roam, and the inner impulse is so strong that if one employs certain methods to get to the bottom of what is going on with them, one can, for example, observe the following. Take a gourmand; there are also people who take great pleasure in eating. Intercept him during his journey and set before him exceptionally fine meals, in which he takes immense delight. But at most, you can only get him to stay for the first or second day; once that deviates from what he intended to achieve on his journey, he becomes restless. You can see that he wants the good food, since he knows that if he moves on—if he visits the next person on his journey—that person will give him something dreadful; he knows this very well. His memory is exceptionally well-developed. He becomes restless; he wants to leave, because he does not adapt his volitional decisions to immediate external circumstances. Just as, on the one hand, he does not adapt to immediate sensory impressions but instead reproduces all manner of things from his vocabulary, so, on the other hand, he does not adapt to the integration of his volitional-limb system into the external relationships of life. He wants only to follow his own volitional impulse, which guides him from within in a very specific way. It is evident that he has lost all of this, and only a small measure of what depends on the organization of the “I” to connect the human being with the external world remains. His senses become dulled; his volitional impulse prevents him from properly situating himself in the world. He wants to follow it—which is precisely the consequence of the “I” being drawn down into the astral body.
[ 8 ] Now you see, such people—if our medical understanding and the devoted love of theologians were to work together—such people could be helped tremendously, not exactly through immediate therapy, but in the following way. For with such people, there is a very specific fact at play. To arrive at this fact, let us consider the lives of such people between the time of losing their baby teeth and reaching sexual maturity. As a rule, if one observes these people with a superficial eye, one will not notice anything abnormal at all. One might even take pleasure in how precocious these people are, how clever, how incredibly clever, and what clever answers they give. But one should pay particular attention to this clever way of answering questions between the ages of seven and fourteen. For such people, who are overly clever at this age, bring something of what they are supposed to experience in their development after puberty into the second phase of life—the period between the loss of baby teeth and puberty. This is precisely what gives rise to what I have just described. The astral body, which is only supposed to draw in the “I” after puberty so that the “I” can then emerge in its full development at the beginning of one’s twenties, actually begins to draw in the “I” organization as early as the change of teeth—or from the ages of nine, ten, or eleventh—and we notice this abnormal cleverness and are initially delighted by it. But then, as the later years arrive—the eighteenth, nineteenth, and twentieth—the “I” organization is already embedded too deeply within the astral body. This is the state I have described, and then the symptoms I have mentioned begin to appear. And so the point is that such a person, who at the age described causes us concern due to their excessive cleverness, must be treated in a certain way. Above all, certain situations arise—and after we have outlined the characteristic, we will also hear some suggestions as to what needs to be done in detail—where the doctor and the priest must advise the educator so that the educator can understand what he, for his part, must do for the age group in question. But first, I would like to continue with the characterization. The task now is to bring together the reflections of the past few days.
[ 9 ] However, it can also happen that the etheric body, for its part, exerts too strong a pull on the connection between the astral body and the “I,” causing the astral body and the “I” to snap into the physical and etheric bodies with tremendous force while in the waking state. This gives rise to states that, when viewed inwardly, appear as though there is too much astral substance within the organs, preventing it from connecting properly with them. It is a state that is likewise a pathological mirror image of a visionary state—much like that experienced by Saint Teresa—just as the first state I described is a pathological mirror image of the state in which the sense of the presence of spiritual beings is experienced. On the one hand, we have the intrusion of a waking-sleep state into clear consciousness. In such individuals, as I have described, we have the opposite: the carrying over of dream life into waking life, with the accompanying phenomena I have mentioned. Because it is actually a state of wakefulness, dreams do not occur; rather, an active dream life emerges, which manifests itself in the speech we have discussed and in that intimate, exaggerated inward turning of the impulses of the will. This is the pathological mirror image of the dream; it contains activity instead of the passivity that characterizes the dream.
[ 10 ] Now we come to the second stage. We have the drawing in of the “I” and the astral organization through the etheric body. The human being becomes very strongly integrated into the physical organization through the “I,” the astral body, and the etheric body, but this physical organization cannot absorb these elements into the individual organs. Unassimilated astral substance remains in all kinds of organs, failing to connect properly with them. A pathological mirror image emerges of what we have come to know as the second stage in the others—that second stage where, so to speak, sensory perceptions are stimulated from within, and the flow moves from within toward the senses. Now, in this mirror image, the flow goes inward toward the organs; now it takes hold of the organization, and those conditions arise that always occur when a physical organ or an etheric organ is present and is flooded by the astral body and the “I” organization, yet these cannot connect in such a way that one can speak of a fully integrated union of the physical body with the etheric and astral bodies. Something remains in the organs from the higher organ components. That which would otherwise pour into the sense-like, sense-colored vision—which can be a revelation of the spiritual world—now pours inward, seeking to be received by the organ. Instead of, as it usually does, perceiving the spiritual in relation to the sensory more externally, it pours inward, is absorbed by the organ, and manifests itself in convulsive states, in all the forms that occur in actual or masked epilepsy; it manifests itself precisely in the fact that the ego organization and the astral organization snap down too forcefully into the physical organization, which then drags the etheric body along with it into this connection. We now clearly see the possibility that the first state I have described develops into this second one, and often what occurs in life is precisely what should be prevented through the dissemination of genuine pastoral medicine. One does not notice the first state; one finds it interesting. One only notices the second state when it occurs—when convulsions and epileptic symptoms arise—but in this case, it is not the hypertrophy of memory for details, nor the hypertrophy of the inner impulse of will that occurs, but rather because the astral organization and the “I” organization are pushed inward due to the astral organization’s incompatibility with certain organ forms, now memory is erased. Instead of memory clinging to details as in the previous state—where the details were merely not governed by logic, but rather a continuous stream of memory unfolded in arbitrary associations, a stream of memory devoid of logic—we now see interrupted memory; gaps in memory remain. It can go so far that such a patient reveals to us something like two kinds of consciousness. Memory, for example, attaches itself to the higher organs—for the whole person is involved in memory—attaches itself to the higher organs, is absent from the lower organs, and vice versa. In the other part of the rhythmic sequence—for such things can unfold rhythmically—it is the reverse: the upper organs become inactive in relation to memory, while the lower organs become active, and thus two streams of consciousness run parallel in such a person. In one state of consciousness, he always remembers everything that took place in that state of consciousness; in the other, he remembers the other things; but in one state of consciousness, he never knows what the content of the other state of consciousness was. It then descends into this region.
[ 11 ] You see, here we have the reflection—the pathological reflection—of what, well, let’s use the term “saint” so that we have a term for it—modern medicine has no term for this condition—what occurred in the saint in the second state. He is surrounded by a world that is visionary but has a spiritual content; he lives his way out into the spiritual world and receives inner impressions from the spiritual world. The other, the pathological individual, because his karma involves a weak individuality, is drawn toward the physical; instead of spirit-bearing visions, he experiences convulsive states, fragmented states of consciousness, incoherence in the flow of life, and so on.
[ 12 ] However, a third condition can also arise. This is the condition in which, as a result of karmic circumstances, the physical body has now also become weaker—just as the entire rest of the organism has become weak—so that the former karmic forces no longer exert a sufficient influence on the physical body. You see, in such a person, the ego organization, the astral organization, and the etheric body are not drawn up through the physical body; rather, something entirely different occurs. In such a person, what I am about to describe in the following manner takes place.
[ 13 ] Suppose one becomes sensitized toward the other side—toward the side of the senses, that is, toward the side of the “I” organization; in that case, one is terribly sensitive to everything that flows in through the senses—to vivid colors and vivid sounds. But the exact opposite occurs in people whose physical bodies are weak as a result of karmic circumstances. They do not become hypersensitive from within, but rather insensitive to their physical bodies; instead, they absorb with immense intensity everything from the other side—the side of the will—that exists outside the physical world. They succumb to heaviness, heat, and cold. All of this affects them not at all as it would organic beings, but rather as it would inorganic beings; this then suppresses the manifestations of the astral body and the “I”-organization. They are absorbed by the world; because of their weak physical body, they do not confront the external world with the appropriate intensity; they are like a part of the external world, yet within the physical realm. This is the clear antithesis of what we have described as the third stage in the life of the saint. The saint, through the pain that is transformed within him into joy, progresses to the point where he experiences the spiritual world in its pure spirituality. He calls this “rest in God” or “rest in the Spirit.” The person who develops as I have described rests in the hidden occult forces of the physical world, which, however, do not enter his consciousness; he does not attain peace in God, nor peace in the Spirit; he attains peace in the occult forces of the world, which he, precisely as a human being, is meant to confront with independence. They develop the mirror image of the third state of the Holy—the pathological mirror image—and this is the state of madness, in which the human is extinguished, in which the human being rests in external nature, that is, in the hidden forces, but can no longer express itself humanely, but only in what is naturally carried out within the human being—what represents the continuation within the human being of the external natural processes, the vegetative processes: nourishing oneself, processing food, and moving in the direction dictated by the impulses generated by the internal processing of food; the fully waking sleep, devoted to the function of the physical form, which, however, is not overcome by the weak physical body but remains similar to the processes of the external world; these processes, because they act within the human being, impart human-like impulses to the human being who is set apart from the world because he is too strongly placed within the physical world.
[ 14 ] We are dealing with everything that constitutes the pathological reflection of rest in God. We are dealing with “resting in nature.” We are dealing with various paranoid states, with what in everyday life are called states of madness, whereas the preceding states are more akin to those of mental retardation.
[ 15 ] Thus, in the series of stages associated with the saint, we see a progression from feelings of presence in the presence of beings of the spiritual world all the way to the ability to immerse oneself in the spiritual world in the third stage. We also see the pathological counterpart of the psychopathological inferiority that we can observe in the first stage. We can become particularly aware of this psychopathological inferiority when it manifests as I described earlier: in an abnormal wanderlust, combined with a memory that defies logic. We then see this transition into states of madness, which, however, can certainly render a person capable of performing certain tasks of external life in the early stage. We often see this then transition into the third state, which may already be present from the very beginning.
[ 16 ] We see how the second condition may essentially stem from the fact that we are completely unable to cope with certain states that occur between birth and the loss of baby teeth. If children in this first stage of life do not exactly display exceptional intelligence but rather a strong eagerness to learn—qualities that should only become apparent after the loss of baby teeth— in short, if those qualities—which, as I have described in my lectures on education, normally emerge in everyday life between the loss of baby teeth and puberty—are already clearly present in this first stage, we should be particularly concerned; we should seek out remedies—psychological, spiritual, and physical—that can remedy what is currently pathological. We will speak more about this later. But this is what must be studied in connection with these phenomena: namely, that what is meant to emerge in the second epoch of life—as I described to you yesterday—should not intrude into the first epoch of life, between birth and the change of teeth.
[ 17 ] The third stage, however, can occur in two different ways. In the vast majority of cases, as you have seen from my descriptions, a person brings this with them as their karma. Simply through what they have gone through while forming the etheric body—before entering the physical body—they already enter an abnormal state. They form an etheric body that refuses to fit properly anywhere—that does not want to enter the heart and stomach in the right way, but instead seeks to flood them—and that carries too much of the astral body and the “I” organization into the organs; and we see physiognomic deformities appear already at birth, or at least develop soon after birth, which can cause us concern. This is called congenital idiocy. But such a thing does not exist. There is only karmic “idiocy,” which is connected to a person’s entire fate. We will discuss this in more detail as well, so that one may come to understand how an incarnation spent in such a state of spiritual confusion can, under certain circumstances, even have a beneficial effect on a person’s karma—even if it represents misery in that particular incarnation. This is where the necessity arises to view things not merely from the perspective of finite life, but sub specie aeterni—that is, from the perspective of human eternal life. This is where that which should permeate a compassionate and, at the same time, wise love comes into play.
[ 18 ] On the other hand, however, the second stage I have described to you can certainly transition into the third, and this becomes evident when, even in the first phase of a person’s life—between birth and the loss of baby teeth—not only does the second phase begin to emerge, but also the third, the one in which the person is to develop their sense of self. When a child comes along at the age of four or five with characteristics that often delight those around them—because people say, “He speaks or acts like a twenty-year-old”—it is bad enough if that is the case. For then precisely what happens is that the “I” organization develops too early, overwhelms the physical body, and weakens it. Then it is not the karmically mediated foolishness that occurs, but rather the foolishness acquired in life, which can only be karmically balanced later on; yet this foolishness does indeed manifest in later life. If we look upon life with sound judgment and sound pastoral care, we will be able to learn to master it by simply shaping the child’s upbringing in the right way during the early stages of the child’s development.
[ 19 ] But the person who, through his inner calling, is led to observe such things should not only observe them insofar as they are individual, isolated phenomena—in which case he should, of course, be able to approach them with special love—but he should also develop an understanding when they become general phenomena. He should develop an understanding of how these things are sometimes used.
[ 20 ] My dear friends, we have seen that many things have found their way into the pedagogy of past decades that we, from the standpoint of sound pedagogy—such as that which Waldorf education strives to be—actually oppose; things that have become extremely dear to people. This must sometimes be pointed out with ruthless clarity in our Waldorf pedagogy—for example, as I have noted, the way these Fröbel exercises—which are derived not from life but from the intellect and are carried out in kindergartens before the children lose their baby teeth—are conducted; they are not imitations of life but contrived activities. Thus, what should only be introduced in the second stage of life—between the loss of baby teeth and sexual maturity—is instead introduced into the child’s early years, between birth and the loss of baby teeth. What is effectively drawn upon is precisely what has manifested itself in the early stages of the pathological, as I have described today. Then a mild form of illness is drawn in—one that is often not yet referred to as pathological, and which is better not labeled as such so as not to view everything as pathological—but which must be penetrated and understood as a cultural phenomenon. It should not simply be criticized, but understood, so that one may relate to it in the proper way.
[ 21 ] What is the issue here? The issue is improper upbringing during the child’s early years. The second stage of life is subsumed into the first, which supports everything that arises from automatic speech and from the will stimulated from within without adaptation to the environment. Suppose there is a bit of what I described as the first pathological stage—a hint of it—arising from the fact that the upbringing, in the manner I described to you, was flawed. What comes next? A wanderlust—an addiction that cannot quite be called pathological but bears certain characteristic traits—the urge, at a certain age, to follow only one’s own path and to disregard the world: to escape the outside world, to wander, the thrill of wandering! This is certainly connected to contemporary phenomena that have their origins in what I might call a pathological upbringing—or at least an upbringing with a pathological tinge. You can observe this now. Observe many young people—I do not mean to criticize this; these things are entirely justified—they are there because they connect with what has happened in the Kali Yuga, because there is an affinity between this slightly pathological tendency and what the Kali Yuga produces. These things all belong together, but one must view them from these two perspectives. If you consider this, you will easily see hints of what I have described. This is clearly expressed in wanderlust, but in an extreme form. Just listen to their conversations—one becomes exasperated by how unreceptive they are to what one tells them, and how they endlessly repeat details they refer to as their “experience”; they keep coming back to the same thing over and over again. Do not misunderstand me, I do not in the least wish to present this as something that can be judged in a philistine sense, but I want to suggest that such phenomena can only be properly understood if one truly grasps the relationship I have described to you these past few days—namely, that there is always a step into spiritual life and its polar counterpart within one’s own body. One further step into the spiritual world in the case of the saint, one further step into the body, leading to convulsions and epilepsy in the person who becomes pathological, and so on. Such is the relationship. And if you consider how, even in external electricity and external magnetism, one pole is always dependent on the other, you will understand the precarious state that can exist in life between the one and the other—a state that must not, however, be grasped with such crude hands, as is so often done today by the materialistic worldview, but must be grasped with the subtlety that polar opposites exist and that there is the attraction between one pole and the other—then one comes to understand what may be present in one case and what in another. Only through this does one learn to look into the human being. We will continue tomorrow.
