John Lees, Psychotherapist; Associate Professor and Clinical Lead in Psychotherapy and Counselling at the University of Leeds

Published in JHH17.1 – Stories in medicine

I have been in private practice since 1987 and have worked as a clinical supervisor since 1995. I have worked in community counselling agencies in Hampstead and Waterloo, as a GP surgery in Brixton and in student service departments at the Universities of Middlesex, and Greenwich. My teaching has mainly been oriented towards psychodynamic therapy, attachment theory and intersubjective theory but has also included a range of other persuasions, particularly humanistic therapy, and cognitive-behavioural therapy. My international work has involved lecturing and working as a visiting scholar in Australia at Edith Cowan University, in India and in the Netherlands at Leiden University of Applied Sciences.

Introduction

This article examines the contribution of anthroposophic psychotherapy to our understanding of human distress and sickness.1 I begin by examining the relationship between the counselling and psychotherapy (therapy) profession and healthcare systems including conventional biomedicine. In so doing I take a
broader view of biomedicine than is usually the case in order to develop a more ‘humanistic’ complementary and alternative medicine (CAM) perspective on it. The reason for this is that there are many similarities between CAM and the therapy profession and this offers an opportunity for thinking across boundaries and promoting a crossfertilisation of ideas between these disciplines. The Jungian therapist, Andrew Samuels, looking from the point of view of politics, aligns CAM with psychoanalysis, psychotherapy and counselling, environmentalism and the efforts of those supporting the rights of ethnic and sexual minorities.

He does so because in his view they all exhibit ‘political energy’, share an ‘emotional rejection of big ideas’ and adopt the values of ‘living intelligible and purposeful lives in spite of the massive social and financial forces that work against intelligibility and purpose’. Anthroposophic psycho – therapy is both a form of CAM and a holistic approach to therapy. It forms part of an interdisciplinary approach to healing which includes anthroposophic medicine and other therapeutic disciplines and is bio-psycho-socialspiritual in orientation.

Many therapy practitioners are critical of the medical model – for instance, of its emphasis on pathogenesis, or a ‘disease model’ which Rachel Freeth (2007) warns sacrifices ‘the humanistic ideals that have guided the counselling profession for decades’ together with its abandonment of a relational paradigm, in favour of a relatively ineffective, technique-oriented emphasis that discourages clinical judgement, innovation, and adaptation to the individual client. In his longstanding, more general and fundamental critique, Illich (1975) refers to how the medicalisation of everyday life, by destroying ‘the environmental and cultural conditions needed by people to live a life of constant autonomous healing’, is responsible for ‘social iatrogenesis’.

Our materialistic medical system largely developed out of the Enlightenment materialistic scientific tradition, which began in the 15th century and culminated in the ‘victory of official modernity in the scientific revolution of the mid-17th century’. But what came to be called medicine began in ancient Greece in the temples dedicated to the god Asklepios, the god of healing. So medicine is not inherently materialistic, but it has been colonised by the assumptions of materialism
and rationalism over the last 500 years and, more recently, constrained by the systems and protocols of managerialism.

History tends to ignore these traditions, yet even within the last 500 years, doctors have included marginal approaches that are now far from widely known: systems for instance devised by Paracelsus and Robert Fludd in the 16th and 17th centuries, the work of Samuel Hahnemann forefather of homeopathy in the
18th and 19th centuries, and of Rudolf Steiner, the originator of anthroposophic medicine and therapy, in the early 20th century. With the advent of complementary and alternative medicine (CAM) both within and alongside conventional biomedicine, these hidden approaches to medicine re-emerged in the West. So biomedical systems do not constitute a homogeneous and undifferentiated materialistic mass.

Dr Peter Toon, GP and clinical ethicist, identifies three types of doctor: the bio-mechanical doctor, the doctor who uses humanistic models and the anticipatory care doctor. Humanistic doctors arguably resemble psycho – therapists in that they have in common a concern for the purpose of life, and the development of patients’ understanding of their illness and symptoms. According to a report published by the European Committee for Homeopathy in 2008, about 150,000 doctors in the European Union have taken training courses in one or other CAM therapy, including anthroposophic medicine. So what can anthroposophic psychotherapy, which forms part of the anthroposophical CAM system, contribute to our understanding of human distress and sickness? In order to begin to answer this question I will give a brief overview of anthroposophic psychotherapy and its application in practice.

Anthroposophic psychotherapy

With its holistic and uniquely bio-psycho-social-spiritual principles, anthroposophic psychotherapy, is now coming into its own. There are two primary reasons for this. First, towards the end of the 20th century many leading therapists developed psycho-social perspectives on therapy – for instance the work of John Bowlby and Donald Winnicott who incorporated a relational, social and contextual approach to psychological problems. This was followed by research into trauma which linked therapeutic work with social and political factors, as in Judith Herman’s statement that the increased awareness of sexual abuse came about because of the feminist movement in the 1980s. In her words: ‘The study of psychological trauma is an inherently political enterprise because it calls attention to the experience of oppressed people.’ Thus therapy becomes psycho-social (and political) in orientation. But Steiner had incorporated this perspective in his approach to healthcare early in the 20th century in a lecture on trauma in January 1917 (at a time when presumably he was observing traumatised soldiers returning from the World War I battlefields). In the lecture he referred to three distinct types of trauma based on the model of human development on which he had previously enlarged. The type of trauma occurring within the first seven years resulted, he said, in extreme states of mind which take over the client and can lead to psychosis. The second, where traumatic events happen during the next seven years when the child is beginning to learn
about social life in interaction with peers, may lead to extreme polar emotional states. The third kind of trauma having impacted in adolescence, Steiner suggested,would lead to extreme self-preoccupation. In a situation where a trauma has occurred very early, all three states can coexist. Anthroposophic psychotherapists, by adopting these ideas in their work, have been in the forefront of bringing the psycho-social element into psychotherapy.

The second set of supporting factors for anthro – posophic psychotherapy arrived in the 1990s as new technologies allowed novel ways of investigating brain states. Dubbed the ‘decade of the brain’, there were important developments in neuroscience with the work of such researchers as Antonio Damasio. With the first ‘text book’ on neuroscience for therapy practitioners – Babette Rothschild’s The Body Remembers, in 2000 – psychotherapy became bio-psycho-social in orientation. The impact of infant trauma on the whole of the body rather than just the brain was expanded by notions such as allostatic load out of further research.

It is now quite mainstream to view the individual’s mind as emerging in relation to its social world and to understand that it develops through and in parallel with the biological changes that support the brain’s maturation and integration. Yet many years ago Steiner had anticipated this narrative by proposing that the primary problem facing the health of human beings is brought about as an essentially immaterial, spiritual self struggles as it comes into the world after birth and in the early years of childhood to inhabit a physical body. In recent years as anthroposophic psychotherapy has taken up this view, its part in the treatment of illnesses and psychological problems is to help make sense of the individuality’s efforts to adapt to and ‘inhabit’ its hereditary body. Furthermore it sees the problem as exacerbated by the difficult and challenging materialistic conditions on the earth today. It is for this reason that Steiner was unequivocal, in his first set of medical lectures, in saying that: ‘To talk of mental disease is sheer nonsense. What happens is that the spirit’s power of expression is disturbed by the bodily organism’. In taking up this idea, anthroposophic psychotherapy is not just psycho-social but bio-psycho-social-spiritual.

The practice of anthroposophic psychotherapy

Andrea, in her early 30s, was the third of four sisters.2 She had a frightening and violent father and, as a consequence although she was very clever and artistic, brilliant even, she was chaotic and her attachment style was of the disorganised kind. Of the three trauma styles I took the view that the traumatic problems were present from birth and consequently, in adult life, she was frequently overcome by extremely chaotic states of mind but, because of her natural inner spiritual strength and brilliance, was not psychotic. However, she just couldn’t get a grip on her life.

In one session we explored how she was offered a free ticket to a concert by a friend, but for various reasons could not make a decision and so ended up saying ‘the problem just grew up and I couldn’t make a straight decision’. More generally she spoke about her difficulties managing her thoughts: ‘They just come out and it is a continuous and stressful work to value them. It’s like having dogs in your brain, biting each other and I’m scared to get lost in this battle.’

Andrea’s spiritual individuality (or her ‘I’ in anthroposophical terms), which was pure, moral and undamaged, was having difficulty in ‘inhabiting’ her hereditary body because of the difficult conditions into which she had been born in her family. In Steiner’s terms, her ‘power of expression’ was disturbed by her ‘bodily organism’. After trying to help her for about three months, I was just about maintaining the therapeutic alliance through the chaos, almost becoming traumatised myself in the process of the therapeutic relationship. This entanglement is almost inevitable during in-depth trauma psychotherapy when
the historical trauma repeats itself in the counter – transference dynamics of the therapeutic relationship. But because of her brilliance, I over-estimated her capacity to manage as we reached a crisis point just before a break. She texted before the final session: ‘Hi John, I will be 10 min in late. Sorry’. Then one minute later: ‘Hi John, I’m still at home looking for the keys that I can’t find. I’m in the middle of a panic attack’, then another minute later ‘I don’t know what to do, I’m panicking’. At this point I suggested a session on the phone, and we down-regulated the acute anxiety that had been triggered by the break, and could deal with the dynamics taking place and so everything settled down.

To move the work forward I realised that to bring about true healing I needed some help. So I referred her to an anthroposophic doctor to help with the disturbances to her ‘bodily organism’. He prescribed many medicines. These included iron, the metal of Mars, to give her courage to incarnate her ideals on the earth without fear of the judgement of others; another was quartz, a very formed substance which helped her to form and structure her life to prevent it deteriorating into chaos; another was conchae, or the oyster shell, to protect her thoughts from getting overwhelmed by events. The medicines were intended as organising templates for prompting a biological level of self-education aimed at addressing the embodied disturbances that were disrupting her soul life.
This brought the problems more clearly into her consciousness, thereby enabling the psychotherapy to help her to feel, face and think more clearly about the inevitable challenges that arose out of her unconscious fearful and insecure early experiences. The recovery state of course then brought about yet more challenges as in any recovery state, but there was movement where before there had been dissociation and stagnation.

Final thoughts

In this article I have attempted to give an introduction to anthroposophic psychotherapy and its contribution to our understanding of human distress and sickness. In so doing I have given a merest glimpse of how a complex form of therapy may help with an extremely complex case. It is not always necessary to collaborate with a doctor. But, in the case of traumas which begin in the first seven years, at a time before children can more reliably reflect and form inner narratives, it usually is necessary.

1. Anthroposophic psychotherapy is inspired by the work of Rudolf Steiner.
2. Andrea has given written consent to use the work for the purposes of research and publication.

References

• Freeth R (ed) (2007) Humanising psychiatry and mental health care: the challenge of the person centred approach. Oxford: Radcliffe Publishing.
• Illich I (1975) Medical nemesis: expropriation of health. New York, NY: Pantheon.