A Positive Future for Medicine: Interview With Alicia Landman-Reiner, M.D.
  

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By: Alicia Landman-Reiner, M.D.

Alicia Landman-Reiner, M.D.  is a physician and board member of the Physicians’ Association for Anthroposophical Medicine (PAAM). She is also the course director for the PAAM-sponsored training course for doctors. The training is comprised of six four-day intensive workshops over two years, taught by anthroposophic physicians and therapists from North America and abroad. It is held in several locations around the U.S. where anthroposophic medicine is being practiced, including the Fellowship Community, Camphill Beaver Run, and others. LILIPOH publisher Claus Sproll interviewed Dr. Landman-Reiner about the PAAM training program at the August 2005 Artemisia conference, a  meeting of anthroposophic therapists.  


LILIPOH: Why would anyone do the PAAM training?

Dr. Landman-Reiner: To become enthusiastic about medicine again. It will not be news if I say that our medical system is currently broken in many respects. A great combination of problems is to blame – political forces, economic inequalities, uncritical use of technology … but, while we agree heartily that these are problems, we in anthroposophic medicine uniquely focus on: how can we see our patient as an integrated being of body, soul, and spirit; and what therapies can evoke healing – a return to wholeness – and why.

The whole way medicine is conceived and taught in universities today is based on the idea that the body is an elaborately complex machine – and our methods of investigation and of treatment and healing – are no more nor less than an extension of this idea. We are taught to reduce everything to its biochemical, molecular level if possible. We are taught to quantify everything, and to mistrust the qualitative. And we are deeply reinforced in our habit of dualism – which is the idea that the body has a purely external, objective reality, independent of how we observe it and conceptualize it – i.e., that as scientific observers we have no effect on what we study. These ideas – besides actually being based on physics that was surpassed with relativity theory and beyond – are contradicted by every wisdom tradition throughout human history. That is to say, if we look deeply into wisdom traditions we find more complex and nuanced views of the body. Yet these assumptions are not recognized as controversies by our scientific training today. We are dealing with what Rupert Sheldrake calls “institutionalized science.” We are taught these assumptions, unquestioned, at the highest educational levels. Andrew Weil, the M.D. and botanist, comments that modern scientific medicine is the only healing tradition in the world which claims to have no underlying principles. Well, every healing approach has principles. The reductionism and dualism I just described – these are our principles. But in our institutions, our universities, these underlying assumptions are unexamined. This makes it hard for doctors, who may have a deep personal intuition that the human body is not merely a machine, to hold onto their conviction that healing has a spiritual component, and to find a language to express this conviction. And that is very painful for these doctors and medical students. They become disillusioned, and later they can burn out.

Medicine today has nearly completely lost the concept of intuition. In anthroposophic medicine we work towards developing our intuition. In practice this is not even remotely a fuzzy, vague, dreamy capacity. It is a kind of knowing. It just happens to be a kind of knowing we don’t understand very well, today. Doctors are often highly intuitive people. Rachel Naomi Remen, M.D., who has written inspiringly about doctors and patients (Kitchen Table Wisdom) teaches doctors to consider using their intuition, in a situation where it could clearly do no harm. This is wonderful. Anthroposophic medicine works to develop, in a thoroughly conscious, systematic and sober way, our capacities in the direction of intuition. As doctors, if we are to develop the medicine of the future, we need to change. To go beyond the reductionist model of the human being in illness and health, we need to develop our capacities. We cannot develop a new model with merely our old ways of thinking and seeing. This is what you might call, “holistic basic research.” This is something which Anthroposophy has been working with – soberly, methodically, scientifically – for 80 years.

We in the profession can become enthusiastic about medicine again, when we see that our dream of a medicine which is scientific, but which goes beyond scientism, can be realized.

The other reason to take this medical training is to learn better ways of helping our patients. The anthroposophic remedies are effective in many situations where conventional medicine offers nothing, or only symptomatic care via medicines with undesirable side effects. The remedies and our therapies – such as movement work, art therapy, massage, bath therapy – help with acute and chronic illnesses. We all know that standard medicine can have pathetically little to offer in many chronic illnesses (arthritis, back problems, headache, menstrual problems, digestive problems, recurrent infections, learning difficulties). So it is a true joy to discover that if we work with homeopathic remedies, with botanicals (plant remedies) and with therapies – there is much healing possible. For acute illnesses – colds, flus and ear infections – a recently published international study, by Harald Hamre and colleagues, directly compared anthroposophic treatment versus conventional treatment, and showed that the anthroposophic approach resulted in quicker healing, far fewer drugs (antibiotics, pain relievers, decongestants), and fewer complications. My own experience as a family doctor bore this out, very much so. It is vastly more satisfying to practice medicine this way. In our training, we are not only teaching theory. We try to be as practical and direct as we can, giving our participant medical doctors tools they can use “on Monday” after the workshop.

LILIPOH: Is there a future for that kind of medicine? Can you make a living with it?

ALR: Yes. Yes.  The future: One study of arthritis treatments showed anthroposophic treatment to be more effective than standard treatment, and was cost-effective. The future of medicine lies in relying less on drugs, and more on approaches that engage the patient in the healing process. Initially it is more demanding for patients to, say, become engaged in movement therapy (called eurythmy in anthroposophic medicine) than to just be given aspirin or ibuprofen for arthritis. But in the long run, wherever the patient is engaged body, soul and spirit, the real possibility of healing arises. Patients are longing for this. A patient of mine came back from the oncologist – whom I know to be a very competent conventional doctor – saying, “I asked her how I can participate in my healing. She told me, ‘there is no way. Just take your chemotherapy’.”  The patient was outraged. She knew there had to be a way she could participate in her treatment.

And it has been demonstrated by research, that women live longer with advanced cancer by having the support of a peer group; and that people with heart disease – with blocked coronary arteries – can unblock them through diet, exercise, and by strengthening their relationships with other human beings; that’s the study by the cardiologist Dean Ornish, M.D. So, the future of medicine lies in engaging the patient in therapy – the whole loving, hoping, sometimes confused, sometimes astoundingly clear, upright, creative human being. And that’s what anthroposophic medicine has been engaged with for over 80 years.

An anthroposophic doctor must go through standard medical training, and is therefore fully licensed (as an M.D. or D.O.). An anthroposophic doctor meets the usual standards and surpasses them. This is not “complementary” treatment, but a larger view of medicine which encompasses standard treatment. Many insurances cover this kind of medical care, because it is offered by an M.D. in the context of the usual medical standards.

Anthroposophic medicine is incorporated into many models of health care delivery. It is integrated into several normal community hospitals in Germany. It is integrated into intentional-community settings in the United States and elsewhere. The McMullens, two doctors in Ann Arbor, Michigan, offer anthroposophic medicine in a cooperative setting, in which the patient group supports the practice, like the “CSA” (community supported agriculture) initiatives readers may be familiar with. You could easily incorporate anthroposophic medicine into an HMO setting; you could offer classes in home care, remedies for acute illnesses, chronic disease programs – it’s completely possible.

LILIPOH: What makes you get up in the morning? What drives you?

ALR: What makes one get up in the morning is not a logical thing. The front page news is frequently tragic. In talking to patients for 25 years, it seems to me that no one gets away without rather a lot of suffering. But it is also a very beautiful world. I hope to be in it for my full 100-year quota. People’s capacity to love each other, to laugh – what an amazing thing. If, when I do die and cross into the spiritual world, there is no humor there, I’m going to be very upset.

Being a doctor is a huge privilege, in that people come to my office, vulnerable. That’s the nature of going to the doctor. I know it myself when I go in and have to say, “I have this pain …” I feel so exposed. Like maybe something is actually wrong with me, not just “my back ...” But see what that means: I get to see my patients at their most beautiful. Because, really, when we are vulnerable, we also reveal our best selves – the part we try so hard to cover up all the time! Children come into the office and are just themselves. They don’t need any coaching. They come right in, and ask, “do you give shots?” Because that is really what they are worried about. After the first visit, they remember just which toys, sit right down, and start to play. No coverup. Adults – we cover up our true selves. But when we are faced with illness, it gets peeled back, and we are just there, just ourselves. And that is an extremely precious thing to be part of: to have the privilege of dealing with people who are reacting to difficult diagnoses, to successes and failures of therapy, to the wearing march of chronic illness – and over and over they do it with such courage, such good will, humor, and imagination. So, to have the privilege of helping them along this journey, is very wonderful.

LILIPOH: It goes without saying, that if you’re offering a training in an “alternative” approach to medicine, that you’re unsatisfied with conventional medical training. Can you say a bit about your discontent?

Dr. Landman-Reiner: Institutionalized science is drying up, conceptually.  It reminds me of trees that grow in very difficult conditions, and get very tough and stunted.  There they are; they’re not going away, but they’re terribly cramped. Once upon a time, in the past, healers could look at a healing plant and know what it could be used for.  And a shaman could undergo a “nighttime” experience that would reveal, as a kind of auditory experience, what was the patient’s soul-problem.  We can’t do these things in the old way. We can, of course, study the plants named in these ancient traditions – or the plants selected by native healers in societies that still can experience in these ways.  But the drug companies, which are very interested in developing products based on these plant traditions, can only grind them up and see what their chemicals do.  In science today we don’t understand nature in anything like its own terms – or as we used to say, “her own terms.”  

LILIPOH: We can’t go back, though, to shamanistic seeing, can we?

ALR: The ideal is not to go back. So let’s be hugely grateful for antibiotics and insulin replacement and ventilators.  The ideal is to take what we have gained with natural science, the phenomenal clarity of thought and analytic capacity, and let’s move on into the future. Let’s further ourselves by incorporating life, soul, and spirit into our scientific considerations. It’s time for that.

LILIPOH: When did you become aware that this kind of change is needed?

ALR: When I was younger, it wasn’t immediately clear to me. I veered from science, as such, to medicine, because at least I could help people. That’s a noble purpose and very rewarding.  As a Harvard undergraduate, even though I loved to study and learn, some spark was missing for me. I had one very specific experience in that regard. I was looking up at the old and beautiful trees in the campus quadrangle and felt very clearly that the trees were something, or contained something, which I was simply not being taught in science. I couldn’t put my finger on what it was. I felt, “I’m kind of depressed, but I think I need a philosopher, not a psychiatrist!”  

LILIPOH: Can you look back now and say what was missing?

ALR: Yes. I wasn’t able to find spirit at Harvard University.  I studied with so many smart, accomplished people.  And maybe some others did find spirit infusing their studies there, but I certainly had the experience that everything I was being taught was missing something crucial, which one could actually contact by looking up at the leafy green canopies of the trees.  

The goal is not only to contact that greater reality that expresses itself in nature in a dim, feeling way, but to explore how to bring together the clarity and discipline of science with the full dimensionality of nature.  People are starting to do this.  Not just commenting on what is lacking in science today, but developing scientific thinking in a new dimension.  People are doing it – doctors here in the United States and Canada, and in Europe, Egypt, the Philippines and India. Those who are working with the anthroposophic approach are doing it, for example Craig Holdrege and Steve Talbott and colleagues at the Nature Institute; the folks at Schumacher College in England, Will Brinton and his work with water and micro-organisms in Maine, and authors from a variety of traditions, scientific, spiritual or both, such as Rupert Sheldrake, Brian Goodwin, David Abram, the Dalai Lama and Seyyed Nasr.

LILIPOH: Could you characterize the common thread?

ALR: Yes. They are bringing a sacred dimension into contemporary science, while building on its considerable strengths.  It’s a beginning.

LILIPOH: Who inspired you to move in this direction?

ALR: Barbara McClintock (1902-1992) was a biologist who studied the DNA and genetics of corn. What made her unique was that her starting point was looking at the plants.  She said she knew every single plant. Colleagues thought she was more than a little nutty. Well, she discovered something about corn genetics that defied a cherished dogma of molecular genetics. Following the organism led her to the new knowledge that DNA is open to influence from the cell, and does not, itself, determine everything, as was originally thought. Her methodology was more to let the corn reveal itself, and less about subjecting it to experimentation.  And the method gave results. The idea that we can do more than 19th century science has done, that we can develop past the limits of dualism, it’s not just philosophizing. Pushing those boundaries a little won Barbara McClintock the Nobel Prize. We won’t all do that, but we can be a little part of this new development in knowledge. To me that is thrilling.

LILIPOH: Is a spiritual practice necessary for a physician in order to be a “good doctor?” If so, what’s yours?

ALR: What is vital spiritual nourishment for each person is different.  Some people sit every day and meditate, others go to church and others try to “live deliberately.”  We must each find our own path. I couldn’t say what is right for everyone. But I do think every good doctor needs to be in touch with what is whole in the universe, to find a way to feel connected to all things and all people, whether through religion, spirituality, or native feeling. That enables a doctor to know, in his or her bones, that whatever the patient is going through, there is some unity, some greater organization to it all. Through this conviction, we help our patients to hope, help them to cope, as George Harrison said.

LILIPOH: What about the physician’s relationship to suffering?

ALR: Every good doctor needs to be in touch with suffering. Usually this means having been present for our own suffering. Usually this means the pain of self-knowledge. Otherwise we can’t be helpful to our patients in their suffering.

Self-knowledge is a path; there are many ways to travel it. For me, the anthroposophic path is what draws me. Rudolf Steiner gave six exercises to strengthen our soul-forces. Michael Lipson wrote a beautiful little book about them (The Stairway of Surprise: Six Steps to a Creative Life, 2002, SteinerBooks).  I worked at these for years. They are simple, but not easy. At this time, I do a meditation three times a day that involves being thankful for what sustains us.  And I try every evening to look backwards over the day, to look at myself from the perspective of a kind, but objective stranger.  

There are other inner exercises out of the anthroposophic path, which we share during the doctor’s training. For example, our conventional medical training teaches us how to be critical. But spiritual teachers tell us that reverence for whatever is higher than ourselves is the crucial starting-point for soul and spirit development. This is a spiritual practice in itself that requires no special equipment. We don’t have to sit in any particular position.

LILIPOH: Is the training aimed at a picture of medicine for the future, let’s say 10 years ahead?

ALR: Actually, anthroposophic medicine has been well ahead of its time all along.  For decades, we have been decades ahead!  Not just the mainstream, but even the forefront of interest in integrative medicine is just catching up with ideas that have been the foundation for anthroposophic activity for a long time.  So I think we are teaching well into the future.

In the past 15 years, we’ve seen integrative medicine – or as many call it, Complementary and Alternative Medicine (CAM), come into public view. When I applied to medical schools in the 1970s it was invisible. In the 1980s, still pretty invisible.  Now we have a Center for CAM at the National Institutes of Health, several peer-reviewed journals, involvement by many medical schools, and more and more research.  In 10 years this will have progressed to where every doctor must be familiar with CAM.  More and more they will be integrating these practices into what they do.  

LILIPOH: How can we spread the word about the training?  And who should take it?

ALR: We could benefit from more outreach.  Many people who are interested in integrative medicine have not yet heard of anthroposophic medicine. Hurdle number one is just to be able to pronounce it. I feel we need more basic lectures and courses so medical people, including pre-meds, can have a first encounter with these ideas and then decide whether they are useful to them. We need to interact more with the many talented people who are creating the integrative medicine arena today. Steven Johnson, D.O. gave a talk on anthroposophic medicine at the national meeting of the American Holistic Medicine Association, and I hope to do the same in 2006. Other doctors offering similar types of presentation are most helpful.

When I ask doctors how they heard about the course, many say, “Through LILIPOH!”  Thank you, LILIPOH!

LILIPOH: You’re most welcome.
 




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