PAAM Medical Letter, Vol. 4, Issue 5, December 11, 2017

PAAM Medical Letter, Vol. 4, Issue 5, December 11, 2017

Crescent Moon over Sand Dunes (Shutterstock Photo)

Dear Colleagues!

December winter greetings! Welcome to another edition of the PAAM Medical Letter! As always, we appreciate your membership and involvement in PAAM. May your inner being become warmer and shine all the more as the winter solstice approaches and outer cold and darkness reigns. This week’s mantra from the Calendar of the Soul seems appropriate.

Please note: This Letter is for your thoughtful consideration and personal research and is not to be taken as something dogmatic to believe in nor promote as something official from PAAM or the international anthroposophic medical movement.

Verse #36 (week of 12/10/2017)

In the depths of my being speaks,
Yearning toward revelation,
Mysteriously, the Word of Worlds:
'Imbue the aims of your life's work
With my spirit light,
And offer yourself through me.' 

One sentence summary: Our task is to live selflessness in the light of the Self.

Verse #17 (week of 7/30/2107, the polar verse)

Thus speaks the Word of Worlds,
Which I, through doors of the senses,
Might lead into the ground of my soul:
'Fill full your spirit-depths
With all my cosmic breadth,
To find in time me in you.'

One sentence summary: I fill myself with nature’s meaning to find her within me.

Another important meditation by Rudolf Steiner is the well-known “Quiet Meditation”. I have translated this differently than George Adams, whose version is usually given in English in the book, Verses and Meditations. Please excuse my temerity to translate Steiner’s verse into English, since I really don’t know German! However, knowing anthroposophy, seeing various translations, knowing some of Steiner’s intentions, and looking at the German (with an English-German dictionary), the following translated version seems more in keeping with the German and the unfolding thoughts,while still maintaining reasonable English grammar in the context of a mantric verse.

I bear quiet repose in me.
I bear within myself
Forces which strengthen me.
I will ever imbue myself
With their warm strength.
I will permeate myself through and through
With my will's [resolute] power.

And feeling the quiet repose
I will pour it out
Through all my being,
When through my steadfast striving,
I become strong
To find within myself
The quiet repose as [source of] strength.

Ich trage Ruhe in mir,
Ich trage in mir selbst
Die Kräfte, die mich stärken.
Ich will mich erfüllen
Mit dieser Kräfte Wärme,
Ich will mich durchdringen
Mit meines Willens Macht.

Und fühlen will ich
Wie Ruhe sich ergiesst
Durch all mein Sein
Wenn ich mich stärke,
Die Ruhe als Kraft
In mir zu finden
Durch meines Strebens Macht.

There are certainly other translations of the above verse available.

ATTACHMENTS

Attachment 1 Buddhist meditation experiences by westerners. This carefully done, methodical and qualitative study discovers many challenging, unexpected, difficult, anomalous, distressing, or functionally-impairing experiences of experienced American practitioners of three common types of Buddhist meditative traditions: Theravada, Zen and Tibetan. The paper makes several good points: 1) The West’s focus on the health benefits of meditation (especially the popular mindfulness-based practices) represents only a narrow selection of possible effects that are acknowledged within Buddhist traditions both past and present. The religious-spiritual context and goals are ignored or de-emphasized and only the physical and psychological effects are sought and discussed; 2) The researchers document not only many types of experiences not related to enhanced health effects but also many adverse, unpleasant effects ranging from mild and transient to serious and health-threatening that require additional support or even hospitalization; 3) Mindfulness meditation is only one type of meditation employed in the various Buddhist traditions, but it is the only one usually talked about in clinical or popular circles; 4) Risk factors for adverse effects of Buddhist meditation include: past trauma history; past psychological or medical history; the amount, intensity and consistency of the meditation experience (e.g., intensive retreats); the type of meditative practice; unhelpful worldviews or explanatory frameworks; absent or unhelpful relationships in the meditation community; and poor health habits (sleep, diet, sedentary lifestyle, drug use, etc.).

In addition, it is clear that westerners doing a mindfulness-based approach for health reasons are often not doing the total Noble Eightfold Path that the historical Shakyamuni Buddha cognized and set forth for his followers. 

There have also been reported adverse effects from other eastern meditation and yogic traditions, including the once-popular transcendental meditation. Frustration, increased anxiety, agitation, reliving past traumatic events and even unpleasant depersonalization, psychosis, seizures and other types of clinical deteriorations can occur from meditation and are found in the DSMV. Musculoskeletal injuries have also been documented in various yoga practices and I have seen that in my practice.

Attachment 2 A collection of quotes and ideas about meditation that Rudolf Steiner spoke or wrote about. These statements and the Quiet Meditation above give a different idea about what meditation is in an anthroposophical sense. Instead of difficult, but passive mindfulness meditation, Steiner’s approach involves the devoted and active effort of the spirit, the “I”, in producing the state of quiet repose or the strengthened thinking that is a reality between perception and thought. This is difficult, to say the least, but as Steiner often says, it is the striving to create this meditative activity or state that is important. In addition, the anthroposophic way of meditation and spiritual development requires much more, such as: the six basic exercises (control of thought, control of feeling, control of will, openness or receptivity, positivity and harmonization of the exercises); establishing the seven conditions for esoteric or spiritual development for each member of the human being; intensive study of spiritual science (which is a training in thought and soul-spiritual development); and further development of the chakras, or spiritual organs of perception, including the six of 12 petals of the heart chakra and the eight of 16 petals of the throat chakra. The development of the eight of 16 petals in the throat chakra constitutes the Noble Eightfold Path transformed for modern times. More information about the spiritual and meditative way of anthroposophy can be found in How Does One Attain Knowledge of Higher Worlds (CW 10) and Start Now! A Book of Soul and Spiritual Exercises by Rudolf Steiner, and edited and introduced by Christopher Bamford (2004). 

There is, of course, much more, but a careful reading and implementation of the suggestions in these two books will give you a sense of the path, and allow you to embark on it with clarity and confidence. Friends and teachers can certainly help along the way. In several places Steiner points out the dangerous and one-sidedness of a spiritual, meditative path, and he therefore emphasizes the importance of the moral and overall character development of the aspirant as a necessary accompaniment to meditation. If one follows the instructions, the pairing of one-sided meditations, and developing one’s moral character, then he feels his approach is safe for modern people and will not lead to disastrous results, including heightened spiritual egoism. There is one golden rule he mentions that must be followed: For each advancing, single step you take on the path of spiritual development and perception (cognition-insight), take three steps to improve your moral and psychological character. 

Attachment 3, Attachment 4, Attachment 5 (subscription only), Attachment 6 and Attachment 7 (subscription only) These next five attachments are the current collection of book reviews (in English) on Peter Heusser’s Anthroposophy and Science: An Introduction (July 2016). Readers have already seen three of the five book reviews in previous PAAM Medical Letters. It seemed helpful to include them all here, in one place, to have as a reference. Reading one after another allows a more nuanced and comprehensive view of Peter’s important, timely and seminal work. It seems to me to be a noteworthy milestone in the history of medicine and science. We should be familiar with it and can then better appreciate the cognitive, methodological and reductive fallacies of modern science, philosophy and medicine. There is a way out!

Attachment 8 This November 2017 perspective article by Walter Alexander nicely summarizes what the placebo and nocebo research seems to indicate. The neurocognitive processes that correlate with placebos and messages received by the patient (verbal and contextual) are often just as important as the drug or substance or procedure being offered. Hence, some researchers do not want to speak of a placebo response but instead of a meaning response, because there is so much therapeutic ritual around treatment and this meaning response plays a crucial role in the therapeutic outcome (for drugs, remedies, massage, movement therapies, and surgery). No one is saying that for hard-end points like cancer, end-stage renal or heart disease, emergency surgery, etc., the placebo will work, but in many conditions of bread-and-butter primary care, placebos have “a clear place”. Early research into the placebo effect was only suggestive and subject to other interpretations and factors that were not properly accounted for (See Kienle, GS and Kiene, H. Alt Ther Health Med 1996 and Kienle, GS and Kiene, H. J Clin Epidem 1997 for further details). Most recent modern research has definitely shown that there are more than one type of placebo response and that three or more psycho-neuro-endo-immunological processes are active that involve opioid, cholecystokinergic, dopaminergic and endocannabinoid systems of the CNS (prefrontal cortex, insula, amydala, rostral anterior cingulate gyrus, nucleus accumbens, periaqueductal gray matter, and ventral basal ganglia). The therapeutic context and relationship, which often work outside of conscious awareness, is also being more subject to research. The importance of continuity and incremental care in a therapeutic doctor-patient relationship is being more recognized as new data suggests a decrease in mortality rates and hospitalization rates in those patients who see their doctor regularly. The British philosopher and physician John Locke (1632-1704) defined as objective and “real” the primary qualities of number, motion, extension, weight and shape, and defined the qualitative sensations produced in the observer such as color, taste, sound, smell, etc., as subjective, secondary qualities. Science and medicine took in this approach and valued the quantitative above the unmeasurable qualitative. With modern research in the placebo, nocebo and the meaning response, the importance of the qualitative in therapy becomes equally important for therapeutic outcomes that matter.

Attachment 9 (subscription only) and Attachment 10 These last two review articles help to provide more information and context to Walter’s above article. The first one, by Kaptchuk and Miller, is a good short summary of modern research findings on the placebo effects in medicine. Placebos are placed in context for the medical profession. The second article, by Benedetti, gives another summary, and focuses also on the similarities and differences between how drugs vs. placebos work and have their effects.

From reading these last three attached articles on placebos, it is clear we are still in the “proof-of-concept” stage in the conscious use of placebos or the meaning response in medicine.

CONTRIBUTIONS, QUESTIONS and ANSWERS

Please send in your contributions, comments, and questions!

Enjoy the winter holidays!

From the PAAM Board and to you, our valued colleagues,
Ricardo Bartelme, M.D.