Depressive Disorders: Insights and Therapies using Anthroposophic Remedies and External Applications
  

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By: Wolfgang Rißmann

The incidence of depressive illnesses has increased considerably over the last years in all countries of the Western world.  They pose a special challenge not only for the psychiatrist, but for all medical specialties.

Diagnostically we can differentiate between the depressive syndromes accompanied by numerous physical and emotional illnesses, and those which can be understood as depressive in a more narrow sense.  The more specifically depressive disorders are:

Bipolar affective disorder (ICD-10 F31)

Depressive episode (ICD-10 F 32)

Recurrent depressive disorder (ICD10 F33)

Dysthymia (ICD-10 F34.1)

Adjustment disorder: brief and prolonged depressive reaction, mixture of fear and depressive symptoms (ICD-10 F43.2)

These more narrowly-understood depressive disorders cannot, however, be understood as a uniform clinical syndrome.  One is really dealing with the most varied forms, with different causes, degrees of severity, and clinical courses.  In much the same way, no single unified Anthroposophic understanding of depression can be offered, but instead general disease processes described which can present themselves differently in each situation and always with individualized expression.

A first important insight into the human being is revealed through Rudolf Steiner’s differentiation of two constitutional types, the hysteric and the neurasthenic constitution (1).

In addition, deep seated causes for illness can be found in functional metabolic disturbances in the lower man, the so-called organ picture disorders of the lungs, liver, kidney, heart, as well as other organs (3.5).

A true therapy, in the sense of Anthroposophic medicine, will ultimately always need to be individualized.  The method for this comes through a typological understanding of the being of illness and of the individual constitution, and also how these relate to typical remedies and healing methods.  In a similar way, not every remedy and healing method needs to be used for specific disease processes, but can also be primarily oriented through these kinds of typological criteria.  The practical experience of working through similar kinds of typological cases always gives significant support and encouragement to the practitioner.  The following indications are intended to bring similar encouragement.   They are intended to be helpful in a practical way for therapeutic work, but make no claim for completeness.

Naturally, an appropriate therapy for depressive illnesses will always need to be comprehensive, and in addition to Anthroposophic remedies and external applications one should keep additional possibilities in mind, including:

Psychopharmacotherapy

Movement therapy (therapeutic eurythmy, gymnastics, dance therapy, other movement therapies, any kind of natural movement)

Art therapy (sculpture, painting, music, speech formation)

Work therapy, ergo therapy

Client-centered therapy, psychotherapy

An kind of social assistance

Self help groups

Pastoral care


Hysteric and Neurasthenic Constitutions

Hysteria and Neurasthenia were commonly used psychiatric concepts at the beginning of the 20th century and designate two distinct syndromes.  These two concepts are, however, no longer used as clinical concepts in current psychiatric nomenclature.

Steiner used these two concepts in his first medical course of 1920 for two constitutional types, which he placed in the context of his medical understanding of the human being.  He spoke of an “hysteric” and “neurasthenic constitution,” and described in this way two constitutional types, with corresponding typical physical and emotional disease tendencies and which require corresponding therapeutic procedures (1,2).

The description of the two constitutional types is not oriented towards the external anatomic phenomena of the human form, but rather aims at an inner functional relationship within the etheric formative forces.  It is these forces which maintain and constitute the life of the human organism.  This inner functional relationship exists between two force-centers, which behave in a polar fashion to one another and stand in dynamic tension with each other.  One center for these forces is located in the “upper man,” the other in the “lower man.”

The processes and forces of the upper man are centered in the region of the head and form the basis for all processes related to consciousness, as well as all sensations through the sense organs, imaginative representation, conceptualization and thought processes, and finally for the maintenance of a condition of wakeful consciousness.  The breathing activity of the lungs also is related to this upper center.  Processes of the upper man lead in a noticeable way to the breaking down of organic substance, which then has to be excreted, or will contribute to a solidifying and sclerosing tendency.  Premature fatigue and aging are the result.  The activity of the upper human being intensifies the life of the soul and the experience of consciousness. 

In contrast, the processes and forces of the lower human being are centered in the abdominal region and support the taking up of nutrients, the processes of digestion, and the wider metabolic processes found in all tissues which lead to the incorporation of substance into the body’s own anabolic processes.  They are the foundation for growth, energy expenditure, warmth formation, and even processes of reproduction.  It is these purely vegetative life processes which proceed in a fully unconscious manner.  Through the activity of the lower human being consciousness is damped down or extinguished. 

These two polar-oriented force-centers correspond in a way to a picture and its opposite (photographic) negative.  They find a dynamic balance through the rhythmic action of the heart and the movement of the blood.  As an example, when there is a preponderance of the lower processes it can lead to a tachycardia, when the upper processes predominate a bradycardia.  In children and young adults the up-building processes of the lower man predominate because the processes related to consciousness only slowly develop.  In contrast, in older adults and the elderly the catabolic and sclerosing tendencies of the upper man predominate, but are accompanied by a strengthening of soul and spiritual capacities for consciousness.  The dynamic balancing between the forces of the upper and lower human being must be continual performed for every human being and is expressed in many individual ways.  This balance can be constitutionally, in other words innately, displaced in one of two directions:  when the forces of the upper human being predominate it results in a “neurasthenic constitution,” when the forces of the lower human being predominate an “hysteric constitution.”

In the hysteric constitution the processes and forces of the lower human being predominate, because in relation to the lower man the upper man is too weak and cannot maintain counterbalance.  Metabolic processes of the lower man become independent, lose their proper form and relationship, and lead to the tendency for organic disease in the lower human being as well as a weakening of the ability to consciously hold the emotional aspect of one’s personality: “Let us assume that within the lower sphere, that is to say, the apparatus of nutrition and digestion in the widest sense, there is a preponderance of the inner chemical or organic forces of the food which has been eaten.  In the healthy organism it is essential that all the forces active and immanent in the foodstuff themselves, which we examine and test in our laboratory work on these foodstuffs, should be overcome by the upper sphere, so that they do not in any way interfere with the efficiency of the inner sphere of the organism and that all activity from external chemistry and dynamics has been entirely overcome.  The upper sphere may be inadequate to the task of penetrating the lower, of thoroughly brewing, or I might say, etherizing it—which is more exact—all through.  The result is the transference into the human organism of a preponderant process which is foreign to the organism, a process such as normally takes place outside the human body and should not operate within that body.  If we wish to find a current term to designate certain aspects of this irregular function, we must call it Hysteria.  We shall use the term Hysteria for the too great autonomy of the processes of Metabolism; and we shall learn later on that the term is not inappropriate.  Specific manifestations of hysteria in its narrower sense are nothing but this irregular metabolism raised to its culmination.” (1) 

In the neurasthenic constitution the processes and forces of the upper human being predominate, are too active in the upper human being, and make too great a claim on the organs of the upper man, leading to an increasing of breaking down processes in these organs (a tendency to illnesses of the head and neck), and an accompanying intensification of soul and spiritual capacity.  At the same time the forces of the upper human being are poorly mediated through the heart downwards: “But the same irregularity of reciprocal action can also arise if the upper process does not take place in the proper way and occurs in such a way as to overstrain the upper organization.  This is the opposite, in some sense, the negative of the lower processes.  It is not that the upper processes are over-stimulated; they cease, as it were, before the mediating action of the heart transmits them to the lower sphere.  This type of irregularity is too strong spiritually, too organically-intellectual, if I may use such a term, and shows itself as Neurasthenia.  This is the other pole…Neurasthenia is a functional excess of the upper sphere. The organs of that sphere are too much occupied, so that processes which should be transferred and conducted downwards through the heart, take place in the upper sphere and do not pass into the lower organic currents (harmoniously mediated by the damming up in the heart).” (1)

The determination as to which of the two constitutional types applies, comes out of an overview of multiple symptoms, as enumerated below.   As the number of symptoms that fall into one of the two categories increases, the constitution becomes more pronounced and one-sided (Table 1).


Table 1

Hysteric

Neurasthenic

1. Development and Medical History

Delayed emotional development

Dreamy as a child

Imaginative

Bedwetting

Stays physically and emotionally too young


Accelerated cognitive development

Overly awake, cognitively precocious

Rational, intellectual emphasis

Potty-trains early

Physically and emotionally “aged”

2. Physiologic functions

Tendency to diarrhea

Gas and bloating

Difficulty digesting certain kinds of food

Atonic constipation

Heavy and prolonged periods

Moist, rosy skin

Tendency to sweat

Too strongly exhales

Vitally active, but can be quickly exhausted

Dysplastic physiognomy


Tendency to spastic constipation

Lack of appetite



Very light periods

Dry, pale, “withered” skin, over-formed

Rarely sweats

Too strongly inhales

Fragile vitality

Overly formed physiognomy

3. Consciousness and Emotional Capacities

Tendency to far-sightedness

Extroverted gaze and attention

Strong, instinctive imitation of outside processes

Poorly structured thinking

Strongly perceives external phenomena

Poorly defined boundaries

Intensive expression of feelings and emotions

Aimless hyperactivity

Difficult to awake in the morning


Tendency to near-sightedness

Introverted gaze and attention

Caught up in their own brooding consciousness

Strongly structured thought

Weakly perceives external phenomenon

Strong boundaries

Restrained expression of feelings and emotions

Hesitant, weak actions

Difficulty falling asleep in the evening

Twitches when falling asleep

4. Tendencies for physical diseases:

Inflammatory illnesses of the abdominal organs

Myoma formation


Inflammatory illnesses of the head and neck

Neuralgia

5. Tendency for emotional/soul diseases:

Histrionic behavior

Dissociative experiences

Conversion disorder


Pedantic, anancastic behavior

Hypochondriasis

Pain syndromes


2. Therapies

When hysteric or neurasthenic symptoms stand in the foreground of a depressive disorder it is wise to begin with a constitutional therapy.  This generally leads to a stabilization and unburdening of the entire physical and emotional constitution, and indirectly to a remission of depressive symptoms.


2.1 Hysteric Constitution

Bitters

Absinthium D1 dil.

Amara drops

Anagallis D1 dil.

Gentiana lutea D1 dil.

Gentiana lutea Rh 5% dil.

Gentian Stomach-globuli velati

Bitters stimulate the perception and working through of food

Plumbum met. Praep. D6 trit.

With deficient definition and delimitation of sense experiences, too strongly identifying with colors, tones, etc.

For deficient emotional distancing

Application: 4 weeks

Minim D6 trit.

For tendency towards addiction, particularly alcohol

Application: at least 4 weeks, not longer than 3 months

Plumbum silicicum D6 trit.

Similar to Plumbum D6, but more suitable for physically tender constitutions, or if depressive symtomps have intensified with Plumbum D6.  Mainly intended for long-term constitutional therapy.

Application: at least 4 weeks, not longer than 3 months, then pause for 4 weeks and repeat another 3 months.

Antimonit D6 trit or s.c., in exceptional circumstances, also i.v.: for dissociative symptoms and transient psychotic symptoms.

Application: 4 weeks, then a week’s pause, another 4 weeks, etc.

If therapy was started with i.v. dosing, then transition to s.c. or oral administration.

Stibium met. praep D6 trit., s.c. or i.v. infusion

For deficient emotional structuring and missing delimitation outwards, also with dissociative symptoms and psychotic symptoms

Application: at least 4 weeks, then a pause for a week, etc.

Gencydo 1%, 3%, 5% s.c

For signs of an overflowing fluid organization, also for a tendency towards hayfever, a water-soaked constitution and at the same time a tendency towards dissociative symptoms

For decreased pain sensation in the skin

Also as an acute intervention for hysteriform dissociative conditions, but also suitable for long term constitutional therapy.

Application: subcutaneous injection starting daily with 1% concentration, injected between the shoulder blades or in the calves, later increasing to 3% or 5% concentration as tolerated.

Bryophyllum D1 dil., Bryophyllum 50% trit.

For fearful restlessness and panic

Application: Generally 4 weeks, then a pause

Quartz D10 trit.

For insufficient structuring of the skin and constitution in the upper pole and deficient definition of borders in relation to the surrounding environment.

Application: Long term, e.g. six months

Tea

Bitter teas are particularly suitable, such as yarrow, wormwood, and others

Baths

Not to be used with pronounced hysteric symptoms, only with secondary neurasthenic symptoms:

Arnica essence bath: for a history of past traumatization

Footbaths

Mustard foot baths

Lavender foot baths

Compresses

Mustard calf compress


2.2 Neurasthenic Constitution

Bitters

For stimulating appetite and digestion

Absinthium D1 dil.

Abrotanum D1 dil.

Amara drops

Anagallis D1 dil.

Gentiana lutea D1 dil.

Gentiana lutea Rh 5% dil.

Gentian Stomach-globuli velati

Geum urbanum D1 dil.

Argentum D6 trit.

Mainly suitable for intractable conflicts which seem impossible to resolve, past illnesses and trauma

Stagnating course

Hardened, dry physical constitution and premature aging

Application: for 4 weeks, but discontinue earlier if lively dreams or a worsening of depressive symptoms develop.

Sulfur D6 trit.

For constipation, inner coolness

Hardened, dry physical constitution

Stagnating course

Lack of fevers, no fever reaction

Application: Generally 4 weeks, but discontinue earlier if signs of inflammation or a worsening of depressive symptoms develops.

Mistletoe

Mainly in higher potency for chronic depressive states, with a deficient fever reaction, with overwhelming endogenous depressive states.

Tea

Linden, lime-blossom tea, Chamomile tea

Full baths with essences or teas

Calamus tea for significant exhaustion and weakness, for stomach problems and incomplete digestion

Prunus essence for significant exhaustion and weakness, deficient vitality

Sulfur bath for hardened, dry skin and absence of fever

Oil Baths

For general weakness of the life forces, deficient warmth “sheath” and warmth formation, 

Exhaustion: Prunus, Melissa, Thyme, Hypericum, Lavender, Rosemary, Solum-uliginosum oils

“Over-heating” Baths

For symptoms resistant to chemical antidepressants and psychotherapy, absence of fever, low body temperature (under 36ºC)

Contraindicated: history of tuberculosis, heart rhythm disturbances

Footbaths

Rosemary in the mornings

Evenings lavender, mustard, sulfur

Rhythmical embrocations

For stimulation of generalized up-building: arms, back and legs

Whole body embrocations


3. Functional Organ Diagnoses:

In an Anthroposophical understanding of the human being, soul and spiritual experiences are attributed not just to the brain, but directly to the whole body.  Out of  this understanding, psychiatric disease is brought into relation not just with disturbed processes in the brain (neurotransmitter imbalances), but also with disturbed organ processes in the major inner organs, primarily: lung, liver, kidney and heart, and in broader sense also the spleen, digestive tract, reproductive organs and endocrine glands.  Psychiatric diseases can go along with functional disturbances of these inner organs in various ways and to different degrees of severity.  These functional disturbances are not, as a rule, immediately demonstrable in the laboratory, in histologic preparations, through radiologic studies, ultrasound, or magnetic resonance imaging.  It is more a question of the so-called “functional organ disturbances”, in other words disruptions of the etheric formative forces of the corresponding organs which are expressed in functional and psychiatric symptoms.   A precise medical history and investigation of medical findings can then lead to a functional organ diagnosis (3, 5).

The formative forces of an organ can be disrupted in two different directions:

In one direction are the psychotic afflictions.  The formative forces of the organ are to some extent pressed out of the organ, enter into the inner soul space, and then lead to the production of psychotic symptoms.

Going in the other direction one meets the neurotic illnesses and also the personality disorders.  Distant traumas, especially those from early childhood, are not properly worked through.  The traumatic experiences remain lying at the border between inner soul space and the unconscious activities of the formative forces of an organ and therefore cannot be properly integrated.  The results are fear, compulsions, depressive ill-humor and functional organ ailments (4).

The following is given as a guide for making functional organ diagnoses:


3.1 Disturbed Lung Formative Forces

Medical history

History of pneumonia, tendency to bronchitis, predisposition towards tuberculosis, tendency towards other hardening lung diseases (sarcoidosis, fibrosis, etc.)

Characteristic of the solid organism: condensed, hardened, tendency towards stiffness.

Physiology

Disturbed sense of hunger and appetite, undernourished.

Psychiatric behaviors

Coercive personality structure, with overly correct and pedantic thoughts and behaviors

Clear, abstract, mechanical thinking without an emotional component

Tendency towards pensive, brooding thoughts

Tendency towards illusory, unworldly imaginations (especially with a history of Tuberculosis)


3.2 Disturbed Liver Formative Forces

Medical history

History of hepatitis

Alcohol abuse

Other toxic exposures

Tendency towards sinus inflammations (maxillary sinusitis)

Characteristics of the fluid organism

Tendency  towards local or generalized congestion of fluids, tendency towards a drying up or being soaked, overflowing

Physiology

Disturbed sense of thirst: too little thirst or overwhelming sense of thirst

Disinclined to eat sufficient fats, or fried foods

Disinclined to eat meat

Psychiatric behaviors

Easy going personality with a tendency towards pictorial experiences

Phlegmatic temperament

Pictorial, emotional, seldom rational thinking

Cumbersome thought process, with a tendency towards obstinacy and dogmatism


3.3 Disturbed Kidney Formative Forces

Medical History

History of inflammations of the kidney or renal pelvis

Tendency towards cystitis or ascending urinary tract infections

Tendency towards sinus inflammation (Sinusitis frontalis)

Characteristics of the air organism

Entire organism is either too weakly or too deeply “breathed-through,” flat, or superficial breathing or congested breathing

Physiology

Disturbed need/urge for air

Feeling that can’t get enough fresh air, can’t completely breath in and out

Psychiatric behaviors

Emotional personality with rash, temperamental mood swings, intense emotional experiences and affect

Tendency towards inner tension, overstraining, restlessness, nervousness, hectic

Erratic, superficial thought, determined by emotions

Quickly exhausted


3.4 Disturbed Heart Formative Forces

Medical History

Inflammatory illnesses of the heart

Cardiac malformations (e.g. atrial shunting)

Characteristics of the warmth organization

Disturbances of warmth formation, warmth distribution, ability to transform warmth

Physiology

Disturbed movement habits, particularly not enough movement

Deficient warmth formation

Psychiatric behaviors

Personality structure with a moral tendency

Overly conscientious, fearful being

Tendency towards aggressivity


3.5 Therapies

The Formative forces of all four major organs can be affected in depression.  One particular organ disturbance may predominate, but several organs can also be affected at the same time.


3.5.1 Formative processes for the Lung

Symptoms:  Compulsive thoughts and behaviors to the point of pronounced compulsions, impoverished imagination and sociability, dull brooding mood, with undertones of religious delusions.

Ferrum sidereum D20 s.c. 

For fearfulness and poor drive

Application: s.c. three times weekly in the upper arm for four to eight weeks

Urtica dioica Ferro culta Rh D3 dil. or s.c.

For pronounced compulsiveness

Application:  at least 4 weeks, long term therapy is possible

Cinis Urticae Ferro Cultae D3 trit.

For pronounced compulsiveness and rigid temperament

Application:  at least 4 weeks, long term therapy is possible

Mercurius vivus naturalis D12 trit.

Lack of flexibility in thought, difficulty adapting, illusory basic attitude

Application: 4 weeks at the most, then a pause

Pulmos D6 s.c.

With pronounced compulsiveness in thoughts and activities

Application: at the beginning of any constitutional lung therapy for 4 weeks.

Compress

Ginger compress over both lobes of the lungs


3.5.2 Formative processes for the liver

Symptoms: Primarily weak drive for activity and lack of will power, often accompanied by constipation and intolerance of certain foods.

Cichorium D3 dil.

For loss of appetite and clear diurnal mood swings

Application: at least 4 weeks

Cichorium Stanno cultum Rh D3 dil. or s.c.

For loss of appetite, diurnal swings and a tendency towards chronic depressive symptoms, history of inflammatory liver disease

Hepar-Magnesium D4 s.c.

Depressive symptoms combined with severe exhaustion

Application: at least 4 weeks three times weekly s.c.

Hepar-Stannum D4 s.c.

For intermittent treatment and stabilization

Taraxacum Stanno cultum Rh D3 dil. and s.c.

Lacking vitality, dried out, adynamic

Application: at least 4 weeks

Chelidonium D3 dil., Chelidonium Rh D3 s.c.

Tendency towards subicteric conditions, unable to tolerate fats and fried foods, eczema and inflammatory skin reactions

Application: at least 4 weeks

Chelidonium Ferro cultum  Rh D3 s.c.

Weak drive with irritated ill humor

Application: at least 4 weeks

Choleodoron Dil

Subicteric conditions, unable to tolerate fats and fried foods, difficulty getting going in the morning

Carduus marianus capsules

For a history of alcohol and other toxic substances

Application: long term

Hepatodoron tablets

Difficulty staying asleep, with pattern of waking about 3 a.m., diurnal ups and downs, tendency towards constipation

Application: long term

Compresses

A hot, wet compress with yarrow, wormwood, or skin temperature compress with Oxalis essence

Organ embrocation for the liver

Stannum met. 0.4% salve (chronic conditions)

Ferrum met. 0.4% salve (for loss of will power or restlessness)

Oxalis salve 30% (tendency towards cramps, history of trauma)

Baths

Sulfur baths for dried up, sluggish, afebrile constitution

Oil baths

Oxalis oil 


3.5.3 Formative Processes for the Kidneys

Symptoms: generally restlessness, tension, agitation, inwardly vibrating, air hunger and emotional irritability

Cuprum met. praep. D6 s.c.

Tension and restlessness combined with inner chill

Application: at least 4 weeks

Chalkosin D4 trit.

For tension and restlessness, especially when accompanied by over-functioning of the thyroid

Application: at least 4 weeks

Chamomilla Cupro culta Radix Rh D3 s.c. or Chamomilla Cupro culta Radix D3 dil.

Inner tension, which goes into a tendency for cramps in the region of the stomach and intestines

Melissa Cupro culta Rh D3 s.c. or dil.

Inner tension combined with fear and chill.

Application: at least 4 weeks

Equisetum arvense Rh D6 s.c. or dil.

Insufficient structuring in the lower human being with a tendency towards water retention and functional fluid congestion

Application: at least 4 week

Carbo Betulae cum Methano D6 trit.

Inner restlessness with bloating and a tendency towards diarrhea

Application: long term

Carbo Betulae D8/Crataegus D2 s.c.

Inner restlessness combined with shortness of breath and heart problems

Application: long term

Compresses

Ginger kidney compress (inner restlessness, tension, air hunger, inner chill)

Equisetum kidney compress (fluid congestion)

Organ embrocation of the Kidney

Cuprum met. praep. 0.4% oil or rose-copper salve

Full baths

Equisetum tea

Oil Baths

Equisetum ex herba 5% oil


3.5.4. Formative Processes for the Heart

Symptoms: feelings of guilt, fear of death, aggressive irritability  or  also aggressive restraint

Aurum met. praep. D12 s.c. or trit., as well as D20 s.c.

Feelings of guilt, anguish, fear of death, remorse

Application: long term

Leonurus cardiaca D3 Dil.

Anguish in connection with “heart restlessness,” pectanginal discomfort

Application: long term

Hypericum Auro cultum Rh D3 s.c. or dil.

Depressive symptoms with gloom, loss of perspective and life weariness, connection with existential angst

Application: long term

Carbo D8/Crataegus D2 s.c.

Fear with pectanginal discomfort and shortness of breath

Application: long term

Crataegus drops

Older adults with early cardiac insufficiency, shortness of breath and simultaneous fear

Cactus comp. II Golbuli Velati

Fear, combined with irregular heart rhythms or pectanginal discomfort

Salve application

Aurum Lavandula Rosae comp. (fearful restlessness and sleep disturbances)

Compresses
Arnica essence (for fearful restlessness and pectanginal discomfort)

Oil Baths

Melissa oil  

Dr. Wolfgang Riβmann

Friedrich-Husemann-Klinik

Fachklinik für Psychiatrie und Psychotherapie

D-79256 Buchenbach


References:

1   Steiner R. Spiritual Science and Medicine, second lecture of March 22, 1920 GA 312

2   Schrauth M. Histrionsich-dissoziative Symptome bei psychiatrischen Patienten and ihre Behandlung im Rahmen eines naturkundlich-anthroposophischen Ansatzes mit einem Extrakt aus Citrus limon und Cydonia oblonga (Gencydo). Diss. Freiburg 2005

3   Steiner R.  Spritual Science and Medicine, 13th lecture of April 2, 1920 GA 312

4   Steiner R.  Spritual Science and Medicine, 16th lecture of April 5, 1920 GA 312

5    Steiner R. Human Development, Soul And Spirit of the World—part one.  Lecture from July 2, 1921 GA 205


Translation by Adam Blanning M.D.







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