Physiology and Therapeutics
GA 314
Lecture I
7 October 1920, Dornach
The scheduled lecturer is not here yet. I hope he will come soon, but I wouldn't like you to have to sit and simply wait, so I will make a few remarks. It is obvious that this series of lectures is particularly important in our course, for it needs to be shown in a practical realm how our anthroposophically oriented spiritual science is really able to take hold in the practice of life. The realm of practical life concerning medicine and therapy is one of the most important, as everyone can experience it in his own body. For just this reason we must not fail to carry anthroposophy into medicine, even at the outset of our anthroposophical efforts.
In this course we have tried particularly to represent the various specialties with externally acknowledged specialists, for it is necessary, in presenting spiritual science to the world, that these various subjects be represented by professionals; otherwise they will not be accepted in the way they ought to be. Nevertheless, before the scheduled lecturer arrives, I will make the effort to say something to you about physiology and its relation to therapeutics from the viewpoint of spiritual science. Our theme today will touch on this. I will show you how spiritual science is being called upon to influence the study of medicine and also the practice of medicine, the entire art of medicine.
You know that in our higher education the actual study of medicine is ordinarily preceded by a preparatory study of natural science, following which is the actual study of medicine. After becoming acquainted more with the biological-physiological phenomena, therefore, one devotes oneself more to pathological phenomena in order to struggle through to therapy. Many of my listeners, however, are well aware of what short shrift therapy receives in this kind of study of medicine. Through its natural scientific orientation, the study of medicine is certainly led to comprehend natural processes in the human being. Then when the budding physician enters the realm of pathology, however, he approaches it with a particular view of natural processes by which he can scarcely gain a correct relationship to pathological processes.
It seems to me that a belief has arisen with a certain urgency in recent times. We have become accustomed to gaining a definite view of natural processes, of their inner coherence and underlying causality. In the healthy human being we must obviously search for the necessary causal connections between certain natural processes in accordance with this presupposition. In the ill human being, however, or, let us say, in the diseased organism, what can we look for except natural processes also proceeding basically with causal necessity? We are constrained to say that what confronts us in illness in these totally evident, causally determined natural processes is abnormal in relation to the healthy organism, falling out of the causal connections of the healthy organism in a certain way. In short, when we penetrate into the realm of medicine, we are immediately made uncertain and skeptical in relation to the approach to nature that underlies our modern view of natural events.
This paradox led to skepticism among many physicians, especially to the skepticism that I have described here previously, a kind of nihilism in relation to therapy. I was acquainted with the famous professors who were active on the medical faculty at the university in Vienna at the time when this faculty had reached its pinnacle; they were fundamentally therapeutic nihilists. Choosing an illness in their discussion to which their view was particularly applicable, they said that one can only allow an illness, pneumonia, for example, to take its own course, guiding this course along the proper path by means of calming, supportive measures or other outer measures until the crisis comes, whereupon the whole illness subsides. They said that it is not actually possible to speak in the true sense of what for centuries, for millennia, had been called healing.
If such a view were to lead to its logical consequences, medicine would gradually develop into a mere pathology, for in relation to the investigation of diseases, especially from the viewpoint of a materialistically minded natural science, therapeutic nihilism has been brought to an extraordinary fulfillment in our time.
At this point I would like to warn against a misunderstanding, that of believing that from here, and from the side of an anthroposophically oriented spiritual science generally, the great significance of modern natural science could go unrecognized and undervalued. This is absolutely not the case. Anyone who has looked even a little into the advances of the pathological method of investigation during the second half of the nineteenth century would have to be astonished, amazed, at its truly remarkable progress. In addition to this, however, he would have to penetrate to quite another recognition. He would have to say to himself that while materialism has certainly made its appearance, materialism alone cannot satisfy certain demands of human feeling; it is also unable to illuminate vast areas of human knowing.
This materialism nevertheless had a kind of mission, you could say. It developed in an extraordinarily precise way the capacity to conduct experimental research through observation. Something like our modern pathology, tainted as it is by its materialism, is possible exclusively due to this materialism. People are always judged harshly today when they are not one-sided, and when as editor and publisher of the Magazin fuer Literatur I wrote an article at Buechner's death that did not damn him but actually acknowledged his achievements, I was labeled a materialist. Yet this is just what is essential in experiencing and pursuing spiritual science, that one be able to transmute oneself into everything; everywhere one must be able to find the thought-form, the feeling-form, out of which perhaps even the most contradictory directions and world views are able to gather their forces; one must be able to honor the achievements that have proceeded from something like materialism, which, to be sure, must nevertheless be overcome in our time—it is simply a demand of the time.
I would like to draw your attention to something else however. You have heard here in the course of our lectures that we are striving for a phenomenology in science. You have also heard, and with the greatest possible justification, that there must even be a striving toward a chemistry free of hypotheses. I am quite sure that in many of the things that must be presented in relation to medicine and the practice of medicine, someone will discern one thing or another that strikes him as a hypothesis. It is necessary, however, especially if one begins to deliberate on the organic out of the inorganic, to delineate properly the concept of the hypothesis.
What is a hypothesis? Let us consider a very trivial matter from ordinary life. I have gone down a road and have seen a person along this road; I go further and no longer see him; I will not assume right away that this person has been swallowed up by the earth. This would be true in the least number of cases! Instead, I will look around me and possibly see a house. I can limit my thoughts so that I say to myself, “That person went into this house. I don't see him now, but he is inside.” This would not be making an unwarranted hypothesis; rather I am assuming thoughts hypothetically that come to me when something appears in the course of sense perception that must be explained by presupposing something certainly stemming from the sequence of my mental images but not seen directly, not actually able to be observed, which therefore is not a direct phenomenon for me. I would not be making an unwarranted hypothesis if I assumed something like that; similarly, I would not be making an unwarranted hypothesis if by some process I make warmth perceptible with a thermometer and then through congealing or a similar process I see this warmth disappear and then speak of the warmth that has disappeared as latent warmth.
It is absolutely necessary, therefore, especially if one wishes to conduct fruitful research, to pursue the sequence of sense images in one direction or another. An unwarranted hypothesis is one that has been arrived at by conceptions regarding which, were they to be followed through with insightful thinking, it becomes clear that what underlies them could never be perceived. Then one must endow these conceptions—and atomism, molecularism, are such conceptions—with ingredients that could never be perceived. Otherwise they could simply be perceived. For example, one can never surrender oneself to the illusion that, even if one were able to see the smallest constituents of solids through some process, light could then be explained by means of movement, for then light would be carried into these smallest parts.
I beg you on this occasion to make a clear distinction between justifiable sequential thinking within experience and making unwarranted hypotheses.
If we now return to our previous thoughts, we must say the following: we see before us on the one hand the so-called normal human being and on the other hand the diseased human being. By necessity we must recognize in both organizations a process occurring in accordance with nature. And yet how is one process related to the other? It is precisely the separation of physiology from pathology and therapy, which has become customary in recent times, that prevents us, in the transitions from one to the other, from arriving at the appropriate conceptions. Furthermore, the modern physician is basically unable to take the spiritual into consideration at all when he is engaged in the study of physiology, or even pathology, for this spiritual element is still an unknown in modern science's approach. It is therefore missing from all our considerations.
In contrasting clearly and plainly these two processes of nature—the physiological and the pathological—it is possible to offer for consideration certain extreme cases of the pathological, first in abstract form. Out of consideration of such extremes it will perhaps be possible to arrive at fruitful conceptions. In the beginnings of a science, you need not think of the existence, of the demand, of an absolute necessity. What one calls exactness, an inner necessity, can emerge only in the course of the consideration. Thus if a person wishes to consider a certain formation in nature, it is possible, you could say, to begin at any corner. Let us take an extreme case within the diseased human organism, one that presents modern medicine with an extraordinary number of difficulties: carcinoma-formation, cancer-formation.
We see something appear within this type of illness that reveals itself even to microscopic investigation as something organic, or at least as something that looks organic; and it appears in the ordinary organism in such a way that it gradually destroys the life of the rest of the organism. At first we can only say that we find something appearing within the bodily aspect of the human organism; this seems to ascend from unknown depths and to insert itself into the ordinary course of nature, disturbing this course.
We can also go to the other extreme of the pathological organism. We can see how something can arise that takes a normal activity in the human organism and develops it excessively into something abnormal. And then we consider a human organism as abnormal. I do not want to dwell particularly on these expressions, normal and abnormal, but they ought to be adequate for a preliminary discussion. In the course of our studies it will become evident that the normal simply passes in transition into the so-called abnormal, but for a preliminary discussion these expressions, normal and abnormal, can certainly be used.
When we encounter the normal human organization, we see that in the soul realm there develops a definite kind of willing, a definite kind of feeling, a definite kind of thinking. In social interchange we have gradually become accustomed to crystallizing a kind of normal picture, as it were, out of the mental images that we create from our association with people, a picture that guides us to consider as normal a person who, out of himself, shapes his willing, feeling, and thinking to a certain extent.
If we now make our thoughts just a bit more concrete, we necessarily reach the point of picturing an organism that functions too strongly, for example, functioning like an object in which there is latent warmth and from which we free this latent warmth, releasing far too much of this warmth into the environment. So much latent warmth is freed that we no longer have the slightest idea what to do with it. If the human organism acted in this way, so that too much was pressed out of it in this direction, certain results in the thought realm would be revealed to us. The emotional element, however, is always playing into the thought realm through feeling. Such a human organism would appear to be burdened within the thought realm by what we call the manic conditions. In such a human organism we therefore see something arising that appears to flood the organism with forces of organization that incline toward sense experience.
In carcinoma-formations, on the other hand, we have a condition in which the organizing force of nature appears within the organism, separating itself off, as it were; we have a condition in which this force of organization inserts itself into the organism. In the pathological phenomena of manic conditions or similar phenomena, something from the organism cannot be held in, as it were, and emanates out of the organism.
If I were to sketch this for you schematically, I would draw it in this way (see drawing): if I draw a circle around the normal formation of the human organism here, I would have to suggest the appearance of a carcinoma by drawing something in a certain spot (red); these are forces of growth that now adhere inwardly to the organism so that in this spot the organism must cast off something that otherwise would pour into the entire organism. If I wished to draw what appears from the other pole, in the case of the manic conditions, I would have to draw something (this is all intended to be schematic, of course) as if it were welling forth from the organism (blue), pressing toward the soul-spiritual.
Now you can imagine weaker versions of these most extreme cases that I have sketched here. Imagine that the first extreme did not reach the point of carcinoma-formation but was stopped on the way to forming a carcinoma. If it were stopped on the way to carcinoma-formation, then an organ (for of course what happens cannot take place in nothingness, cannot take place in the intermediate spaces of the organism) would simply be taken hold of, but the organ would unite itself with the force that normally would strive inward in carcinoma-formation and there fully emancipate itself; it would unite itself with something that is a normal force in an organ, and we would then be dealing with the disease of an organ, which can be designated in the most varied ways, as is customary in medicine.
Now let us consider a tendency toward the manic condition that has been arrested halfway to its culmination. Such a person would not be brought through the abnormality of his organization to the point where the soul-spiritual was fully outside him, as in clinically established mania; he would not reach the point of getting totally out of himself, as it were, the thought element taking its own course in an emotional way. The condition would remain halfway to the extreme, as it were; then we would have to do with various forms of so-called mental illness—“so-called,” I say—which can also appear in the most varied ways, from organically determined illusions, and so on, to conditions that barely manifest organically but that nevertheless are always based in the organism, conditions like hysteria and so on.
Here we have attempted to pursue in two directions phenomena that lead us from the normal into the pathological. I would like to show you what actually lies at the basis of this, but I will show this from another angle, not yet entirely from the realm of spiritual science, whose methods I have characterized as Imagination, Inspiration, and Intuition; I will show it from a viewpoint reaching its understanding instead from a kind of instinct, but you will see that this understanding, if it does not wish to break through to the spiritual scientific path, remains stuck in the middle.
In the development of German cultural life we have an extraordinarily interesting phenomenon. Quite apart from how one evaluates Schelling as a philosopher, he is an interesting cultural-historical phenomenon. Even if everything he developed in his philosophy were false and distorted, a certain instinct lived in him for natural events, even in the realm in which ordinary natural science pursues natural events so unwillingly, where it relies more on a very crude empiricism. When the possibility presented itself to him, Schelling also sought to think medically; indeed he was extensively active even in issues concerning the healing process. In the history of modern philosophy little concern has been shown for how Schelling actually came, completely instinctively, to depart from mere abstract, logical-philosophical considerations and to immerse himself in a real study of nature itself, even of the organic. He even put out a journal that occupied itself to an exceptional extent with medical questions. How did this come about? This can become clear if one knows and understands rightly the value of the deep instinctual knowledge out of which Schelling drew his truths and his errors.
A saying thus emerged out of Schelling that was certainly not built on clear knowledge but, you could say, was hewn out of the instinctive element of the soul life, a remarkable saying. “To know nature,” he says, “means to create nature.” Indeed, if what is expressed in this sentence could be directly realized in human knowing, it would be easy for us to approach medicine. If we were able to take up the forces of creation in our knowing, if the forces of creation were present in our consciousness, then we could easily penetrate into the realm of physiological and pathological phenomena, for then we would be able to observe the steps that creative nature follows. The empirical view states quite simply that we cannot do this.
One who then proceeds further can say that it is precisely in the unrealizable nature of this demand exceeding human capacity, which Schelling proposed, that we find something we are not permitted to see into, a process such as the occurrence of new formations. Because we are unable to pursue the creation of nature directly with our knowing, we are unable to see into the place where new formations appear; this means that without something further we are unable to pursue the existence of material processes such as come to expression, for example, in carcinoma-formation. By putting together what is actually denied to us there—our being unable to accomplish the instinctive demand of a highly gifted man that “to know nature means to create nature”—by putting together the unrealizable nature of this demand with what nevertheless appears to us in the carcinomatous process, it will be revealed how one must approach such processes in the body.
Of course Schelling has not spoken out of instinct from the other side. Consider just once the polar opposite to what Schelling has said. His sentence stands as: “To know nature means to create nature,” which we are unable to accomplish; from the other side the sentence would stand as, “To know the spirit means to destroy the spirit.” This sentence has hitherto been expressed only by spiritual scientists, and even then only shrouded in a certain mysterious darkness: “To know the spirit means to destroy the spirit.” If we are unable to create nature, so we are also unable—we wish to present this first through an analogy, for then we can speak of it further—so we are also unable, out of our human capacity, to destroy the spirit. We cannot penetrate with our knowing to the point where the destruction of the spiritual begins. But you may already sense that here there arises a certain kinship to manic or similar conditions, for there too something destructive in the spirit arises. And the relationship must be sought between those normal human capacities that are unable to create nature in knowing it and those that are unable to destroy the spirit in knowing it.
Here I have simply sketched for you the path, something that must lead us directly from a normal, though instinctive, more deeply stimulated consciousness into a relationship of the human being to nature. We will see in the further course of our presentations that this path suggested here can lead us to what actually must be sought in the transition from physiology to pathology.
I hope that it will no longer be necessary for me to be the speaker tomorrow, but if that turns out to be the case I will try in the course of the next few days to continue at least sketchily the considerations begun this evening.