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  Anthroposophy and Psychiatry

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By: James Dyson, M.D.
(Based on the opening lecture given at a conference on Mental Health held at Triform Community, Hudson, New York on 29 February 1996 slightly elaborated by the lecturer.)

It is a great pleasure have been invited to an event which is, I think, embedded in the tradition of the Camphill Movement in America. I actually met the Camphill Movement originally during my first visit here in 1970 through Carlo Pietzner. Something of that encounter has lived on in me and contributed to the modest beginnings that we have made in the British Isles in anthroposophically-based residential medical care, particularly in the Park Attwood Clinic.

As Bernard said in the Mental Health Seminar in Great Britain, we occupy ourselves with this theme for 32 days over a three-year period, and this only provides an introduction. All I can imagine achieving in this initial contribution is to alert us to some of the core issues that psychiatry is bringing forward at the present time and to do so in such a way that we recognize the challenges cannot be satisfactorily addressed without a spiritual understanding of the human being.

If we go back to the early 1920's when Steiner was beginning to develop his medical work, medicine stood at a crossroads. A few years after Steiner gave his medical lectures, insulin and vitamin B12 were discovered. Shortly after that, in the early 1930's, the sulfonamides were developed; then followed antibiotics during the Second World War, and in the 1950's there followed the main impact of psychiatric medication, which has transformed the management of a great deal of mental illness. I am referring particularly to the major tranquilizers, the anticonvulsive drugs, the antidepressants, and so on. At the time when Rudolf Steiner was speaking, manipulation of the bodily basis of much that we would now call mental functioning had not even started, yet at that time psychoanalysis had already made a beginning.

Freud's work was becoming established, and it wasn't long before the work of Carl Jung came into the foreground. Steiner had major reservations about psychoanalysis, but it is important for us to understand what these were based on. He did not, for instance, deny the validity of the concept of the unconscious. He stressed, however, that without an understanding of the spiritual nature of the human being, including reincarnation and karma, and without an understanding of how substances in the body really support the life of soul, any attempt to penetrate into the sphere of the so-called "unconscious" or "subconscious" would be fraught with misunderstanding. He stressed that any attempt to penetrate this realm would involve an awareness of the threshold between what belongs essentially to the soul-spiritual nature of the human being as it has evolved over many incarnations and the everyday conscious experience of the self. This corresponds to the threshold between the point-centered consciousness of our earthly, waking ego and the peripheral consciousness of our life of will. Although an awareness of the existence of an "unconscious" had surfaced during the early part of this century, its interpretation - without a basis in spiritual scientific training and understanding - was, in Steiner's view, at best misleading and at worst dangerous. He was particularly concerned with some of the more specifically sexual interpretations which dominated Freudian methods at the beginning and which, in his view, had already created many illusory interpretations.

Steiner gave a particular insight with respect to our understanding of mental illness which redresses the one-sidedness of the psychoanalytical approach. He emphasized that one must first understand the bodily basis of the soul life before trying to interpret what comes to expression in the soul as such. Alongside this statement he suggested that, with respect to the nature of organic physical illness, one should search for its origin more in the realm of the soul and spirit.

You can see how he was both anticipating and countering a trend that was to increase in momentum during the following decades, a trend which to this day dominates current thinking as strongly as ever. I am referring to the trend to separate our understanding of the human being into a biochemical model on the one hand and a psychotherapeutic, psychoanalytic model on the other - the former without reference to the soul and spirit, the latter without reference to the actual bodily basis of consciousness. It might seem that Steiner was anticipating the biological basis of psychiatry in pointing to bodily dysfunction as underlying much mental illness. He was speaking from a very different perspective from that which has since evolved and given rise to the current "psychopharmaca". He was challenging us to see physiological processes and substance transformations within the body as the basis or expression of the soul-spiritual element while at the same time seeing soul-spiritual processes as being accompanied on some level by physiological ones. I would say that the central challenge of the anthroposophical contribution to psychiatry lies just in this: to bring together the realm of creative spirit with an understanding substance and metabolism.

This is a challenge which has not yet fulfilled its potential although very encouraging and exciting beginnings have certainly been made. Behind this, there lies the deeper challenge of understanding the nature of matter or substance in its soul-spiritual aspect. This is, of course, the challenge of anthroposophical medicine. The part which belongs specifically to psychiatry is to see how the substances and processes which these substances undergo in the organs are connected to possible deviations or aberrations of consciousness, which psychiatry describes and attempts to address.

Steiner describes two streams of time. The one which we are aware of in our everyday consciousness goes from the present into the future. The other stream works in the opposite direction and comes from the future into the present. These two streams of time, the former connected more to the conscious astral body, the latter more to the etheric, meet within the human being. They meet in the realm of the ego, which is the only instrument of consciousness that can really integrate past and future, thereby bringing the destiny that we bring with us from former incarnations into the freedom- space from which new impulses may be born.

Much mental and soul confusion arises in the encounter between these two streams of time, even some forms of mental illness may arise from this. The substance-processes taking place in our organs contain within them the seeds for our future consciousness. If these seeds are released prematurely from their etheric basis in the organic life and enter consciousness too soon, they will produce delusion, deception, hallucination, fear, anxiety, mania. All possible forms of soul aberrations may come about through the tendency for the etheric forces within the organs to rush forward into the future too soon. On the other hand, when the forces working from the past bind us too strongly to our organs, then tendencies to hardening and sclerosis take hold of the body. We become locked into our earthly personalities, and therein lies the basis for the more characteristic physical illnesses. In the healthy human being, the latter processes predominate in waking life and the former during sleep. During waking life, the etheric up-building processes in our organs become subordinate to the more conscious experiences of soul life and vice versa. The two streams of time also oscillate between our waking experience and our sleeping, hence the possibility for dreams with prophetic overtones.

Most of us know that Waldorf education emphasizes the fact that the organic forces, which build the body during the first seven years and which also belong more to the state of sleep, become released to some extent at the age of seven. In fact, they only become released from the head and nerve- sense organization, where they become available after this time for thinking and memory. The etheric substance which has formed and shaped this part of our body is the same substance through which, at a later stage of development, we are able to think. We must imagine that this is only the first of many etheric metamorphoses that may take place during the course of life. The etheric forces that release themselves for thinking belong essentially to the instrument of the brain. The brain is an organ whose development proceeds faster than any other organ; by the time we are seven, it has reached a certain completion. We call this stage neurological maturity which is witnessed, for example, in the establishment of dominance and in nerve myalination in the central nervous system through which the basic pathways of sensory integration are laid. We also know that the actual nerve cells in the brain, from before the time we are born, have been slowly dying and degenerating. In fact, degenerative processes accompany our brain and nerve sense system during the course of our life. This is the corollary of the fact that our brain and nerve- sense system form, for the most part, the basis of waking day consciousness.

This "slow death" of the physical body in the brain is that which allows the etheric forces, which formed and sculptured it and which contributed to its organic development, to be used for conscious thinking activity. With the other organs, however, this process does not take place to the same extent. If we consider an organ which stands in a certain polarity to the brain, namely the spleen, we find an organ which hardly appears to be a physical organ at all. In contrast to the brain it lacks internal form and structure. Also, unlike the brain, it is an organ which is continually regenerating itself. If we consider the spleen, however, we have an organ which carries within itself the basis not of our self-conscious image memory but of our substance memory.

In the modern world, we call substance memory the science of immunology. In recent years, the importance of our physiological uniqueness in the form of our immunological memory has become almost general knowledge. Without it we are unable to maintain our identity against the outside world. The spleen can be removed without apparent detriment to health, although, in a child, its loss leaves some degree of compromised immunity, depending amongst other things on the age when this happens. It is an organ with a kind of peripheral sphere of activity. I am referring to the millions of smaller lymph nodes throughout the body which have a kind of satellite function in relation to the spleen itself, but which can exist independently after the foundations of immunity have been acquired.

We are dependent not only on our image memory for an earthly biography but on our substance memory too, although it is not so immediately obvious why this is the case. Animals, for example, do not have individually- based immunological specificity. Immunological identity belongs more to the species. Animals, however, do not have individual biographies. The animal's identity is "species-based," not "specimen-based." In recent years, immunology has become threatened as never before. Indeed, it is no longer something which can be taken for granted.

Without our brain, we would not know who we were when we woke up in the morning; without this, earthly consciousness would be chaotic as, indeed, it becomes in certain conditions of cerebral degeneration. If image memory is connected with the brain and substance memory with the spleen and immune system, must it not follow that our image memory is the basis of our waking-day consciousness of self and our substance memory the basis of our sleeping or unconscious self? This may be identified with our true individuality or higher-self working and weaving between incarnations.

From this perspective, it is perhaps possible to make the connection between individual human immunity and personal karma although I am aware that this may appear as a big jump to make. Our normal habits of thought would lead us to assume that metabolism proceeds in its own way and that we meet our karma from a completely different realm in a somewhat metaphysical manner. I strongly suspect, however, that this is another trick of dualistic thinking. We meet the outside world in essentially three ways: through the portal of the senses, the portal of the breath and the portal of metabolism. In all three, substance is involved: in the metabolism, the connection is very obvious; in the breath, we meet the substance of air; and through the senses, we meet light. Just as in our metabolism we first have to break down and digest what we eat before it is rebuilt, a similar process must also take place in our senses. Our entire nerve-sense organization has the characteristic that it first has to hold back sense impressions and digest them, as it were, before they can become integrated and internalized in the life of soul. The processes of sensory digestion and substance digestion are working together all the time, continually playing into one another. It is quite clear that we meet our destiny and karma from that which we encounter via our senses. What we have breathed in and digested through our senses unites itself inwardly with that stream of substance which has first been broken down in our digestive organs. In this way, individual destiny becomes imprinted within the very substance of our bodies. Can you sense how the normal boundaries of logic, which separate substance from spirit, begin to disappear. The dualistic distinction between these two realms is not quite so clear. Ahrimanic forces have taken hold of the material realm, and are continually trying to widen the gap between their realm and the realm of creative spiritual being. On the other hand, however, the substances we eat have been created by photosynthesis from the light. The substances of earth and light essentially belong together, although these two concepts have become mutually estranged.

During the time of our embryonic development and, to a lesser extent, throughout our childhood, the substance-building processes of our body are at their most creative. The child's unconscious life of will is working with those very etheric forces which will later develop into forces of consciousness. At the beginning of life, these forces are involved in the forming of the sense organs themselves, which become built and inter-connected like resonance chambers, through which what is received from the outside world can take shape within bodily substance. The etheric processes whereby this happens have been called by Steiner the life processes. The eye, with a lens and so forth, is the most obvious example of a sense organ. Mediated by the eye, an interaction takes place between that which comes toward it from the outside world in the form of outer light and that which we bring toward the perception from inner experience.

In theory, we can imagine that we first experience the light as a pure sense perception or percept. However, for a human being a pure percept can scarcely exist. The moment the outer world impinges upon any sense organ, it is taken up and "digested" by inner processes working on a more or less unconscious level. Contrary to theories of ordinary sensory psychology, which attribute everything of a cognitive nature to the nerves, these are connected to processes in the blood which carries the element of will.

Through this digestion of the percept in its encounter with blood- processes there arises an entire spectrum of possibilities of soul life. Broadly speaking, the life element of the blood brings the instinct and drive towards the percept, and between these two poles there arises everything connected with concept, memory, feeling and judgment. The formation of a concept in relation to a percept, already involves a degree of judgment. Against this backdrop we can see that the seven life-processes actively transform what, to begin with, came toward us as a purely outer phenomenon into something internalized and incorporated into the sphere of soul and body. This process which is most active in the developmental period of embryonic life and childhood is, of course, liable to all manner of aberrations through, for ecample, sensory deprivation or overstimulation. If a child meets inconsistent behavior or even frank abuse, the judgment-forming processes of the soul will be impaired. The earlier this takes place, the more deeply rooted will be the aberrant forms and structural developments in the body arising from it.

The bodily basis for the future life of soul depends intimately on how the life-processes interact with the sense organs, particularly during the developmental stage. It is also through this process that the adult relationship between the etheric and the astral bodies is slowly established in the organs. In fact, the character of this relationship is distinct for each organ - and organs are just as much sense organs as they are metabolic ones. In this way the developmental basis is established for much that later on expresses itself in the form of psychiatric illness.

I will have to assume for the moment that what Steiner has described about the seven life processes is not entirely unfamiliar to you. They are connected, of course, to the seven planets, which Steiner has also described as having a connection to the seven main internal organs. During the course of embryonic and child development, the astral forces, which belong to the planetary realm, and the etheric forces work very closely together. Through the particular affinity between the organ and the planet, a kind of resonance chamber arises in the body for each of the seven planetary spheres which, when taken together, comprise the entire astral body. The moon sphere, which is most closely connected with the earth, forms the brain. The Saturn sphere, which is the most removed from the earth, forms the spleen. The Jupiter sphere and the Mars sphere work together in the formation of liver and gall bladder. Mercury works into the lung and Venus into the kidney. The planetary forces working within each organ help the etheric forces of the organ to remain held and integrated in the body. They bring boundaries to bear on the otherwise expansive tendencies of the etheric body. During the developmental period, the relationship between the etheric body and the astral body is laid down in the organs themselves. Astral forces have more of an affinity to connect with the sense impressions from the outside world, in relation to which they then unfold as faculties of soul. As I have said, each organ is in fact just as much a sense organ as it is a metabolic organ. In the brain we see an organ whose substance comes closest to death - thereby it is particularly suited to forming the basis of waking consciousness. In the spleen we see the opposite processes at work. Here the blood processes, which belong to the very depths of our unconscious life of will, have taken hold of everything coming from the outside world and metamorphosed it into bodily substance. In the brain, the forces of the outer world, i.e., the sense impressions, become dominant and the astral body and the etheric body both withdraw from the physical body after creating their most complex imprint within it. This may be seen in the language of modern brain physiology in terms of the complex network of nerve growth factors, which are activated only to the extent that the child's life of will is aroused to a creative relationship to sense perceptions. Perhaps we are seeing in these processes what Steiner has described in referring to a co-operation between blood and nerve processes. After the imprint has been created they become emancipated from the body, thereby becoming free for the conscious life of soul. In the brain the outer world is always in danger of conquering the inner world; that is to say, through the brain we lose touch with our inner being.

In the spleen, however, we can say the opposite, namely that the inner forces of self are continually triumphing over the forces of the outer world. The astral and etheric bodies remain active metabolically in the blood pro- cesses and the spleen therefore retains a strong connection to the unconscious ego which remains active in the body directly rather than via the kind of structural imprint which is to be found in the brain. We may therefore say that the way the life processes take hold of these two organs expresses a polarity.

Between the spleen and the brain we find the inner organs of the liver and the lung. In the lung we see an organ which is, in many ways, similar to the brain. It has a very strong and hard endoskeleton in the form of its bronchial tree, composed of cartilaginous rings. Steiner has characterized the lung as having the closest relationship of all the organs to earthly thoughts - that is to say, to the brain. Steiner connects the lung, for instance, to the ability to memorize facts and figures, quantity rather than quality, for example, telephone directory memories. He describes all our memories as being imprinted into the etheric sheath or etheric surface of our organs - and the actual etheric forces through which the lung has been formed have a particular affinity to earthly thoughts, to everything that lends itself to being weighed, measured and quantified. Steiner has called this aspect of our etheric body, the life ether. These life ether forces which work on a bodily level in a kind of additive way, as is expressed, for example, in the continuous growth pattern of a fungus, these life ether forces in the lung become something like the guardians of those sense perceptions which belong to the essentially earthly element of cognition based on factual memory.

We are all very familiar with various clinical ways in which this comes to expression. For the curative teacher, for example, the child will come to mind who can sometimes quite literally remember every single detail of everything that has happened, not only today and the day before, but perhaps last week, last month, last year, or even ten years ago. Some children display remark- able encyclopedic memories of this kind.

We see a similar phenomenon, albeit in a different form, in the adult who displays obsessive tendencies or fixed ideas. In a fixed idea a spiritual happening becomes de-contextualized - it is made into something of an isolated entity. The way the ether body works in the lung is continually appealing to this kind of isolating, fixating tendency. The forces of the outer world are therefore not being so thoroughly internalized, digested and metamorphosed into fantasy as they are in other organs, for instance, the liver. The outer world imposes itself on the soul in too direct a form - hence we can say that in the lung, as in the brain, the outer forces are, relatively speaking, conquering the inner forces.

Just as the lung stands in an intimate relation to the brain and the nerve- sense system, in so far as it isolates the individual elements from the whole being, making a kind of self-contained entity from them, so the liver, in contrast, is an organ which cooperates very closely with the spleen in the whole system of metabolism. Just as the sense organs all converge on the brain, where the sense impressions become metabolized within the life of soul, so does the intestinal tract converge in the liver, through which substances from the outside world begin to be elaborated into the unique substances of our own bodies.

This substance-building activity of the liver, when imbued with the impulses from the spleen, also forms the bodily basis of our will life, but it exerts its influence a little closer to the level of the soul than does the spleen. If the spleen is the guardian of our pre-earthly intentions, then the liver is already attempting to bring these to manifestation here and now on this side of the threshold. It is the organ which gives the bodily basis for the exercising of initiative and motivation, it is the origin of our vitality and, to some extent also, our enthusiasm. All these soul functions are intimately connected with the way metabolic processes interface with what is taken in from our senses. It is possible, indeed up to a point normal, for cognitive life, which has developed itself on the basis of our sense perceptions, to follow a different direction to the life of deeper motivation or intentionality. Without the tension that arises between these two realms, both connected as they are to our life of will, but in very different ways, we would not find the power to pursue our earthly biography from a condition of inner freedom. However, it is possible for the normal healthy tension that should exist between these two realms to diverge to such a degree that the seeds are planted for a real split between the cognitive world and the world of more unconscious will life. This may manifest itself fairly quickly in some form of depression or inability to put intention into deed, or be delayed by years, decades or even life-times! Liver physiology is in turn connected with the biliary system. Secretory processes of the liver are focused in the production of bile, which is stored in the gall bladder before being ejected into the intestines. Here it encounters substances from the outside world and contributes to their breakdown. Biliary processes are even more strongly connected to the more conscious pole of will than is the liver. The liver stands at a kind of mid point between the biliary processes, through which our will encounters the outside world, and the spleen, which is the guardian of the deeper nature of the will. Any obstruction or congestion in the process of bile production or excretion may have a laming effect on the conscious life of the will and this may be often observed in medical and psychiatric practice if one is awake to this possibility.

The liver is an organ with a strong kinship to the fluid realm. If the substances of the outer world overwhelm the liver, then it becomes something like a stagnant pool of water. Substances are taken in, but are not vitalized and may sit there heavily, as it were undigested or impenetrated. When substances are incompletely digested, allergies may arise. Classical allergies are fairly easy to identify but nowadays one meets an increasing number of a more insidious variety which may manifest only through more subtle symptoms such as tiredness after eating, loss of vitality and so on. This tendency is often exacerbated in a clinical depression, or in someone with chronic fatigue syndrome, where a vicious circle of interactions is often seen.

You may remember the very famous example from Steiner's Curative Education Course of the child who has difficulty with his will in actually stepping into a tram. Sterner connects this description of a child who is, as it were, paralyzed in his will, who is unable to release himself from the conscious life of thought into the spontaneity of a deed, to a weakness in the activity of the liver. He actually suggests that the disorder may have been inherited. Whenever weakness of will manifests itself in the child or adult in any form, we can ask ourselves if the liver - or for that matter the gall bladder - is in need of support. This sometimes shows itself at times of transition in life, for instance, in the menopause or following a pregnancy. At both these transition-times a person is increasingly vulnerable to suffering from depression. During the menopause, a further metamorphosis of organic etheric forces into the conscious soul life is taking place - or at least the potential is there for this to happen. Forces which have been active on a bodily level in the glands until this time become available for new soul-spiritual activity or development. If they are not appropriately taken up, however, congestion of the liver and biliary system may ensue. Indeed, moderate degrees of this are almost normal at such times, since processes of metamorphosis are usually only gradually accomplished.

On a more day by day level, we also experience physiological transitions at three o'clock in the morning and three o'clock in the afternoon. At three o'clock in the afternoon, blood sugar levels are usually on the low side, signifying that the substance building aspect of liver function is at its weakest at this time. At three o'clock in the morning, however, bile production is at its weakest point. Both these times of transition tend to be difficult periods during the day or night for people struggling with depressive illnesses. Waking at three o'clock in the morning with morbid thoughts - that is to say, thoughts which it is not possible to properly digest and integrate into the waking consciousness, are very familiar examples of this. In more severe forms of manic depressive illness, tendencies of this kind can be much more dramatic.

Steiner has connected the liver with that part of the etheric body which is called the chemical ether. This is also sometimes called the tone ether, the number ether or the sound ether. Through this ether, physical growth is inwardly organized according to the inner harmonies of number and measure, which also become manifest in the inner harmonies of music. When this etheric quality becomes prematurely released into the realm of soul, the stream of time coming from the future to the present is likely to overwhelm the normal state of waking consciousness. All manner of experiences can then arise to which the soul feels connected but no longer in a free way. Such things as ideas of reference, deja vu phenomena, and even deeper states of paranoia, may thereby arise. The etheric forces which are particularly connected with the liver give us the experience of becoming contextualized in our environment. When these forces unfold their activity too strongly in consciousness, a disturbance in our relationship to the surrounding environment may ensue. Paranoia is one of the most frequent forms that such as disturbance takes. One feels threatened by the environment, but in a very personalized way, almost as though the substances of the outside world are working their own life out at our own expense! Paranoia may, in turn, be a fairly transient phenomenon, with a more neurotic character, or it may be major symptom of a severe psychotic depression, or even a schizophrenic illness.

I mentioned a few moments ago that an astral quality from one or other of the planetary spheres works together with the etheric body of a particular organ, constraining these forces and guarding against their tendency to jump, as it were, too quickly out of the body, too quickly into the future. Whenever that planetary or astral activity within an organ becomes weakened - and weaknesses may be inherent or acquired - the soul becomes vulnerable to encountering forces from the etheric body which it should not meet until after death or until one is suitably prepared for a conscious encounter with the spiritual world. Any drug or poison will also to some degree deflect the life-processes from their bodily manifestation, leading to the premature release of etheric forces into the soul realm. This phenomenon forms the basis for the anthroposophical understanding of certain aspects of drug abuse. Different drugs may display certain organ affinities - for instance, the qualitative effects of cocaine may be seen in terms of the lung, of LSD more in terms of the kidney. What one is then meeting as a disturbance of the etheric forces of the organs is also a disturbance on the life-processes of the organs. It is a kind of foretaste of the experience that we meet after death, when we see the panorama of the life that we have just lived. After death this experience - known as the etheric tableau experience - normally only happens when our entire ether body becomes freed from our physical body. At the time of our death this experience is strongly held within the sphere of the Being of Christ and the Spirit of the Guardian of the Threshold. If this happens prematurely, albeit only in a modified form through a drug, the soul may experience later difficulties or impediments in returning properly into the body and this may also sow the seed for different forms of disorientation and dislocation of the conscious life of will. I cannot expand in this talk on the theme of drug abuse or addiction. I would, however, like to point to the close connection that has often been noted between certain drug experiences and certain spiritual experiences. This becomes much more readily comprehensible when we are able to understand it in terms of the organs. The forces that are released from the etheric activities of the organs, the forces more bound up with the inner side of the life processes, are expressions of the living activity of spiritual beings that are still active within the substance of our own body. The threshold to the substance-building processes is indeed the same as the threshold to the spiritual world altogether. We meet the spiritual world where the substance-building processes of our bodily organs are taking place. But it is quite a different thing to meet this through a process of inner training and inner development, or to meet it after death when these forces have been naturally released, so to speak, than it is to do so through substance abuse or through weaknesses within the activity of the planetary sphere belonging to a particular organ. For the anthroposophical doctor and psychiatrist, the field of possible medicinal therapy opens up at this point through, for example, an understanding of the connections between the different metals, the planets and the organs. It is not possible to develop this further, however, at this point.

I hope that this broad overview serves to indicate how Anthroposophy spans so many aspects of the realm of psychiatry, opening up new possibilities of understanding, of diagnosis and also of therapy. I have also tried to point out the extent to which the realm of psychiatry and the realm of inner development or initiation are intimately connected. I have often had the feeling that much that is met in the realm of psychiatry may be a kind of result or expression of an uncompleted process of initiation in a former life. I would certainly not suggest that this is so in every case, but an insufficiently prepared initiation may be the result of an attempt to cross the threshold into the spiritual world too soon. We see the same gesture becoming manifest when our etheric body in the one or other of our organs wishes to become released too quickly. Thoughts such as this are sometimes helpful in those cases of mental illness in which it is not possible to discern their origin in this life on earth, and with which a person may have to live for a whole incarnation.

It is, however, often possible to understand a great deal of mental illness or psychological disturbance in relation to childhood development. Nowadays childhood development is under threat and it is very difficult for most people to go through childhood in such a way that they achieve a healthy soul-spiritual penetration of the body. Many things are responsible for this, including poor nutrition, an education that has no respect for phases of bodily development and which already draws organic processes too soon from the body into the realm of soul; through a general deprivation of what Steiner has called the bodily senses - that is to say, the senses of touch, life, movement and balance. When the life processes withdraw from these senses too quickly, the astral body is not able to create a sufficiently strong resonance chamber or imprint for itself within the physical and etheric bodies. This may show itself in later life in the form of soul insecurities, anxieties, hyperactivity and so on. Childhood is also threatened through the general dissolution of society. Conventional securities, accepted modes of behavior, and so on, are rightly falling to one side, but all too often parents are not able to replace them from their own individual resources. We continually find ourselves thrown back upon ourselves, needing to rely on personal judgments too soon before the organic basis of our body has been properly equipped to fulfill this task. This crumbling of the social and moral fabric of society throws the developing child all too easily into a state of turmoil. At an increasingly early age the adolescent has often to encounter the sense of inner void, meaninglessness, the realm of inner darkness. Existential questions to do with self-identity confront the adolescent nowadays almost as a normal phenomenon, whereas even 30 years ago the securities that applied to generation after generation acted as a form of protection against this.

When we really meet the existential question, "Who am I?", the answer never can be found in the outside world which we meet via our senses. It can only be found from that same eternal self which lives behind the threshold of our physical organs. Between our conscious experience of self and our eternal being, however, there lies that interface of soul which I mentioned a few minutes ago - the realm in which there is an ongoing battle between our conscious self and our eternal self. The bodily basis of our life often looks for ease, comfort and security. Spiritual intentions on the other hand threaten earthly securities, and deep-seated fears, doubts and so on may be evoked by them in the soul. These forces belong to those instincts and, to some degree necessary, egoistic drives which are implanted within our physical body and which work into our earthly personality at a deeply unconscious level. These forces are constantly enticing us to build our identity on the outside world - on something upon which we can apparently rely and from which we can derive a certain sense of security and predictability. Everything that derives from the outside world and which we meet through our senses - particularly those aspects to which the lung has an affinity, such as obsessions, fixed ideas and so on - all these will tend to offer us apparent solutions in the face of the spiritual challenge in meeting the inner void.

In so many of the psychiatric illnesses of adolescence, we see particularly clearly how this phenomenon comes to expression prematurely. I refer, for instance, to the phenomenon of anorexia, which has almost become a kind of epidemic at the present time.

In more recent years psychiatry has developed a new interest in the personality, particularly through the descriptions of so-called multiple personality disorders - now referred to as dissociative identity disorders. In this type of condition the tension between opposing elements is no longer held or integrated within the framework of the single person, but different elements become seeds around which apparently independent personalities develop. There is sometimes a lack of continuity of ego consciousness and even memory between the one personality and the other - a fragmentation has taken place. The more severe forms of this disturbance are usually connected with sexual abuse during early life. I am sure that through deepening our understanding of the co-operation of the senses and life processes during the time of childhood development, our insights into this type of disturbance would take on new dimensions. In fact, a number of anthroposophical psychiatrists have already begun to do just this.

As many of us are aware, however, this phenomenon can lead to some of the most frightening of phenomena which we as human beings may have to encounter. When an ego fragmentation takes place, islands of our etheric and astral bodies have become dislocated from the overall sphere of the ego organization. It is here that the borderline between the realm of medicine and psychiatry on the one hand and that of social and personal morality, becomes almost indistinguishable. Those of you who are familiar with the works of Scott Peck, particularly his book "People of the Lie", will be aware that he addresses this problem. He challenges contemporary psychiatry to build a new scientific understanding of the realm of evil, stressing how until the present time this realm has been considered to fall outside the scope of science. This book was not written with dissociative identity disorders particularly in mind, but I am sure that there is a close connection between these phenomena and many of his descriptions. He relates much of what he has to say to possession - a concept which, until recently, was considered to be virtually medieval. I think that this book by Scott Peck is a clear example of the condition that modern psychiatry finds itself in, when it attempts to confront the spiritual nature of the human being. I believe his book is courageous and, in many ways, quite masterly. However, it struggles without having any way of connecting the realm of substance with the realm of the spirit. And, as I began my talk by saying, I think that it is just this potential that is unique to the anthroposophical contribution to psychiatry. The original polarity between substance and creative spirit arose during the time of the Fall on Old Lemuria. From this time onwards the creative world of the spirit and the actual substantial happenings in matter started to separate. We are now at the point in human evolution when out of their own nature these two forces will continue to diverge ever more and more strongly. Steiner forecast that by the end of the century we would be blighted by epidemics of mental illness of one kind or another - and I am sure that amongst other things anorexic disturbances and dissociative disorders are among the examples that could be cited to bear out his prediction. I believe that ultimately the task of mental illness is to stimulate in us the call to inner development, to truly know ourselves. Whereas up until the present time we had a certain license to decide not to follow this path, it is nowadays almost imperative to do so if we are to confront and deal with problems, if not exactly in epidemic, then certainly in escalating proportions. Modes of being that were once regarded as extreme pathologies become ever more and more common. Unless a sufficiently strong impulse is ignited in humankind to hear this call, then this separation between substance and spirit will continue. It will then become increasingly difficult for human bodies to sustain a basis for integrated ego consciousness into the future. They then become the basis for the activity of those evil beings - so called "anti-spirits" of personality to which Steiner has given the name of "Asuras." The loss of immunological identity that we are also witnessing at the present time is, I beheve, the mirror image of this. That is to say, it is the polar expression of the same phenomenon. In the realm of psychiatry, the possibility of the conscious ego to integrate itself with its own karma is threatened, and at the level of immunology, the possibility for the unconscious organization of the ego to penetrate physical substance is also threatened. This theme is obviously one with which we could occupy ourselves not only in coming days, but also in the coming decades and centuries. We live in a time when developments are accelerating around us, but this was something that Rudolf Steiner anticipated at the beginning of this century and which Anthroposophy is intended to help us to master. We are, however, still only at the beginning of doing just this - it lies in the hands of each of us to help to realize this aim.

James Dyson, MD

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