Anthroposophy and Science

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1  Introduction

The international and increasingly expressed public desire for holistic or complementary methods in medicine – which includes anthroposophical medicine – is substantiated by numerous studies and is generally accepted as fact. There is a large overall number of different complementary medical methods on offer and a considerable volume of complementary medical preparations are sold, something which is also of economic importance. There is therefore a need for evidence-based scientific validation of the safety and efficacy of complementary methods. An increasing number of scientists and centres, including those in academic institutions, are currently working on this. As little as 20 years ago complementary medicine was mainly a matter of alternative practitioners and practising doctors; there were only a few inadequately trained researchers, only a few – almost all small – clinical facilities for complementary medicine (as is still the case!) and, in contrast to orthodox medical research which is largely supported by a massive pharmaceutical industry, funding by the manufacturers of complementary medicines was and is insignificant. The scientific evaluation of complementary medicine was (and is) often correspondingly inadequate, which continues to be a frequent cause of conflict between the different approaches.

However, this situation seems to be gradually improving. State research funding has contributed to systematic evaluations, such as the German Federal Ministry of Education and Research project “Unconventional Medical Therapies” (Matthiessen et al., 1992), the Swiss National Science Foundation’s “National Research Project 34” (NFP 34) (Baumann & von Berlepsch, 1999), the Swiss national Complementary Medicine Evaluation Programme (PEK) (Melchart et al., 2005), and the numerous grants from the US American National Center for Alternative and Complementary Medicine (NCCAM)¹ at the National Institute of Health (http://nccam.nih.gov/) and the Office of Cancer Complementary and Alternative Medicine (OCCAM) at the National Cancer Institute (www.cancer.gov/CAM/). Chairs or professorships in complementary medicine have been established at universities, in German-speaking Europe for example in Witten/Herdecke, Berlin, Freiburg, Zurich and Bern²; and an increasing number of international peer-reviewed journals have appeared. All this has considerably improved the capacity and quality ← 17 | 18 → of research in complementary medicine, and it is clear that complementary medicine has learned a great deal from traditional conventional medicine in this process.

This change is also reflected in the nomenclature. While 20 years ago the preferred term was “alternative medicine”, 10 years ago the more cooperative term “complementary medicine” was adopted and now the even more unifying expression “integrative medicine” is used. In the USA in particular, leading universities such as Harvard, Stanford, John Hopkins, the Universities of California, Texas and Michigan and others have quickly set up centres for “integrative medicine” and joined forces in the “Consortium of Academic Health Centers for Integrative Medicine” (CAHCIM)³ which includes more than 50 centres. This consortium defines integrative medicine as follows: “Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing” (www.imconsortium.org)⁴. A few years ago this trend also started in Europe with congresses (www.ecim-congress.org) and, since July 2009, an “Institute for Integrative Medicine” has been built up at Witten/Herdecke University – the first of its kind amongst German-speaking universities.

This has brought research on complementary or integrative medicine to a new and more profound stage. Up until now the focus was mainly a practical one on the scientific proof of safety and efficacy, to a certain extent irrespective of the nature of the various methods and their underlying concepts. The relevant research methods have been established and the efficacy and safety of many methods are gradually becoming better defined. However, the result is an “integration” of conventional and complementary medical methods and concepts, which are often very different from one another and indeed seem logically to be contradictory. While in conventional medicine, molecular biological events are viewed as the ultimate cause of physiological ← 18 | 19 → and pathological occurrences in life and consciousness, in complementary medicine there are explanations for the same occurrences which are attributed to non-material causal factors, such as “chi” forces in Chinese medicine, “prana” in Ayurvedic medicine, “life force” in homoeopathy, “etheric” and “astral” forces in anthroposophical medicine, “information” in neural therapy and various “energetic” factors in other systems. And the therapeutic methods used correspond to these: tai chi is intended to harmonise the chi forces, curative eurythmy to work on the etheric body, homoeopathically potentised substances – which, at a dilution beyond the Avogadro limit, no longer contain any molecules – to stimulate life forces, etc. So conventional and complementary methods are used alongside each other without a real mutual understanding. This is more like an “aggregation” than an “integration”.

A true integration going beyond the present-day situation would mean that these kind of therapies would not only be evaluated at conventional centres and accepted into mainstream medicine if they pass the “test”, but that their nature and the concepts on which they are based would need to be understood, and broader concepts developed which include the conventional and the complementary, the material and the immaterial in one united perspective.

It cannot merely be assumed that the conceptual integration will consist of one day being able to abandon the complementary medical concepts in favour of the conventional ones and of explaining the corresponding therapies as being caused by molecular biological interactions. This is indeed attempted at times, but basically without success, because explanations like these are just as much of an evasion as the ones which explain the phenomenon of consciousness from the functioning of the brain. Consciousness with its real experience of emotional and mental qualities is not “explained” by getting to the bottom of the physical processes in the brain which are necessary for the occurrence of those emotional qualities. The reductionist thinking habit of the last 200 years has led conceptually to a type of negation of those experiences of a non-molecular, indeed non-material kind which every person has on a daily basis and which form a significant part of their humanity, that is, their emotional and intellectual life, achievement and suffering. However it is these reductionist thinking habits which significantly influence medical theory and ultimately medical practice. And this is at least partly responsible for the frequently voiced dissatisfaction of patients with conventional medicine, despite all the credit which is gladly accorded to it, precisely because of its ability to explain the physical basis of the human organism and to use this for the benefit of the patient. A representative study in 2002 by the Swiss Academy of Medical Sciences is an example which shows clearly where the deficits of conventional medicine were perceived to be: 69% of Swiss wanted more humanity in medicine, 58% wanted more alternative medicine but only 27% wanted more basic care and 21% more top level medicine; and in a ← 19 | 20 → direct comparison with the present-day situation, a more holistic view of the patient is seen as one of the most important requirements by far for the future (Leuenberger & Longchamp, 2002). Patients look to complementary medicine for what they miss in conventional medicine (Heusser, 2002a). It cannot be ruled out a priori that there may “be something” in the complementary concept, that human beings may in fact be more than their physical constitution, as patients in fact feel to be the case, and that in this regard conventional medicine can also learn something from complementary medicine. But this would only seem to be possible if a – so far non-existent – scientific debate at the level of anthropological medical concepts and their epistemological basis were to be held between orthodox and complementary medicine which would approach what already exists at the level of clinical studies. Only then would there be a prospect of the true integration which seems necessary if medicine is ultimately to become unified.

Although anthroposophical medicine is the most recent of what are referred to as complementary medical systems, it appears to offer a unique starting point for a debate of this kind. In its roughly 90 years of existence, it has achieved a high degree of integration between conventional and anthroposophical elements in both theory and practice, something which does not apply to any other complementary medical discipline. This integration is already present in its most fundamental basic principle, as expressed by Otto Wolff et al. (Wolff et al., 1990):

Anthroposophical medicine is the spiritual scientific extension of natural scientific medicine. In judging health, illness and healing it relies on the physical laws which are determined by the natural sciences and accords equal value to the laws of life, soul and spirit in their mutual dependencies.

This basic principle is fulfilled through the fact that anthroposophical medicine requires a normal course of medical education at a university medical school followed by further general medical or specialist training and that the anthroposophical aspects are acquired through a regulated further training which, e.g. in Switzerland, leads to a recognised certificate of competence from the Swiss Medical Association FMH⁵. In addition, anthroposophical doctors and hospitals participate in the general hospital provision of their regions, and the services they provide in this framework are covered by the health insurance schemes in the usual way. Anthroposophical hospitals are also acknowledged as training centres for standard postgraduate medical training in various medical disciplines and in some cases in the training of medical students. Another aspect of this integration is that anthroposophical doctors’ practices and hospitals are set up diagnostically and therapeutically ← 20 | 21 → basically just like the purely mainstream ones and that clinical examination, laboratory tests, radiological diagnoses and any necessary conventional treatments are carried out just as normal. The difference from purely conventional medicine lies in the fact that the findings and symptoms in question are not interpreted purely in accordance with natural science and psychology in the customary manner of mainstream medical anthropology, but against the background of a scientifically expanded picture of the human being comprising body, life, soul and spirit. The medical history and diagnostic assessment may therefore contain additional elements and extra treatment methods may be used in accordance with this.

An additional factor is that anthroposophy sees itself as an empirical spiritual science which is similar to natural science in its own domain and which transfers the epistemological principle of natural science to the realm of spiritual perception. Unlike any of the other complementary medical disciplines, it has its roots in recent developments in European science, and applies itself to the active development of this on a spiritual level.

For these reasons anthroposophical medicine appears to be particularly suited to making a contribution to a scientific debate between orthodox and complementary medicine which, in the longer term, can aim towards the goal of making medicine per se into a holistic and, in this sense, conceptually integrative discipline.

The aim of this book is to make a contribution towards this goal. Using an epistemological basis following Steiner and Goethe, I shall first develop a scientific concept of substance which enables the matter in physics, chemistry and biochemistry to be thought of in such a way that it is not at odds with the spiritual but in a certain respect already contains it. Based on this I shall discuss fundamental biological concepts such as genes, genetic information, gene regulation, organic autoregulation, morphogenesis and biological systems so that it is possible to see the connection between modern biology, Goethe’s concept of the typus and Steiner’s concept of the etheric, and to distinguish between empirically justified and purely hypothetical organic concepts of a vitalistic nature. This will lead to an investigation of consciousness, the relationship between body and soul, the issue of psychophysical causation and finally the question of freedom of the human spirit. Amongst other things I shall explain why the human ability for freedom is not questioned despite the much-discussed readiness potential as defined by Benjamin Libet.

Working from this basis I shall establish a fourfold conception of the human being based on the conventional sciences, a conception in which the physical body, its specifically living aspect, the soul and the spirit will be defined by each of the different emergent laws and forces. This leads to an expansion of medical anthropology in terms of a differentiated integrative conception of the human being, corresponding to that of anthroposophy. ← 21 | 22 →

In what follows, anthroposophy will be discussed as empirical spiritual science. I shall briefly describe how this spiritual scientific anthroposophy appeared as a result of the scientific development in Central Europe and how it was then founded by Steiner. I shall go on to mention its application to medical anthropology and explain how the anthroposophical medical concepts which have arisen from this can be logically connected to modern scientific concepts, on the one hand to enable a holistic rational medicine which includes natural and spiritual aspects and on the other to allow – or rather demand – conventional empirical scientific testing of anthroposophical concepts. Finally, on this foundation, I will briefly review the status of the anthroposophically expanded medical anthropology which has developed since Steiner and the body of evidence related to the efficacy and safety of anthroposophical treatments as well as the methodological problems arising from them.

The basis of this entire undertaking is provided by the scientific foundation of anthroposophy, as laid down in Goethe’s scientific method and Steiner’s basic epistemological writings. As these are almost unknown nowadays and also completely unaccepted – or leastways ignored – by critics of anthroposophical medicine such as Franz Stratmann (Stratmann, 1988), Klaus Dietrich Bock (Bock, 1993), Thomas Dinger (Dinger, 1996), Robert Jütte (Jütte, 1996), Barbara Burkhard (Burkhard, 2000) and Helmut Zander (Zander, 2007), some of whom vehemently dispute the scientific method claimed by Steiner⁶, in Chapter 2 I have quoted Steiner himself at length on the concepts of knowledge and reality. It is shown how this results in an empirical ontological objective idealism which does away with the need for reductionism and in its place recognises the phenomena and laws of each of the emerging levels of being in their own reality. The concept of reality and knowledge inherent in Goethe’s and Steiner’s works thus becomes a universal element which on the one hand distinguishes all the differing areas of being, such as matter, life, soul and spirit from one another and on the other combines them in a unified overall scientific view.

It is unavoidable that elements from general epistemological and ontological principles are sometimes repeated in the specialist chapters and are applied in a similar way using examples from the different sciences. This should serve ← 22 | 23 → to increase the internal coherence of the whole and facilitate the assimilation of potentially new points of view by the reader.

I have ventured this attempt to outline an epistemologically well-founded overall scientific view of differing scientific fields because the general lack of an integrative overall view is one of the main characteristics of our era of highly specialised individual sciences, not only to the benefit of our patients and our medical practices but also to their detriment. It will be shown that an overall view of this kind is fundamentally possible. This will provide a contribution to the scientific development of an integrative and therefore holistic medical anthropology which has become necessary in our time and which, according to the warning given by Gerhard Kienle (1923–1983), will need to be not merely the familiar natural scientific knowledge but, without doubt, “also a knowledge which encompasses the individuality of the human being” (Kienle, 1980).

What cannot be achieved within the bounds of this work is a systematic discussion of Steiner’s theory of knowledge and the concept of reality based on it in relationship to the more recent scientific theories. With reference to this I would direct you to Helmut Kiene’s “Grundlinien einer essentialen Wissenschaftstheorie” and the section on epistemology in Peter Schneider’s “Einführung in die Waldorfpädagogik” (Kiene, 1984; Schneider, 1985)⁷. There is also no discussion of these publications by the critics mentioned above which is all the more surprising as their dispute with Steiner and anthroposophical medicine is primarily based on the question of scientific method.

This work is also unable to offer a thorough and systematic discussion of other major topics in relation to the prevailing current debate. This refers particularly to the topics of emergence, the concept of substance, biological concepts, the body/soul relationship, questions about the human spirit and freedom, the history of science and philosophy and the methodology of clinical studies. This would far exceed the limits of this book and each topic could easily form the subject of a comprehensive monograph. This could be seen as a weakness of this study, as in many instances the topic is not dealt with fully and completely and may therefore not fulfil some readers’ need for discussion. Given the present-day status of a range of discussions in each of these fields, this is scarcely attainable in a book by a single author.

Starting from a sound epistemological foundation based on observation instead of mere theory, the aim here is to develop an internally consistent overall view of the different realms of relevance to medical anthropology, such as the concept of substance, biology, consciousness and the body/soul relationship, and spirit and the possibility of freedom. In addition, the author ← 23 | 24 → aims to show how the further development of biological and psychological anthropology is possible in a spiritual scientific anthroposophy which complements anthropology, and how anthroposophical concepts in medicine can be verified and developed for medical practice through empirical scientific work. This also includes examples from the author’s own experimental and clinical research.

At the same time, this is the first work in the medical field to attempt this kind of comprehensive anthropological/anthroposophical overall view on an epistemological basis which is internally logically consistent and in agreement with the empirical facts. It will provide an example of the way in which a conceptual integration between conventional and complementary medicine could be envisaged. This treatise also serves as a practical basis for the author’s work as the holder of the Gerhard Kienle Chair of Medical Theory, Integrative and Anthroposophical Medicine at Witten/Herdecke University.

Note on the text: square brackets in quotations are additions or omissions by the author. Emphases by the author in text citations are marked with “ePH” (emphasis added PH) and footnotes in citations are those of the author.

1.1  Summary

A growing trend towards an “integrative medicine” is currently discernable. Up until now this integration has generally consisted of the methods used in complementary medicine being subject to practical testing in conventional clinical studies at academic centres and, if successful, being put into clinical practice. What is still lacking is a conceptual integration in which what at first appear to be the incompatible molecular biological causative explanations in orthodox medicine and the non-material/energetic explanations or methods in complementary medicine are brought onto a common basis of mutual understanding. Anthroposophical medicine provides particular opportunities for this kind of basis of understanding because, due to its very nature, it is based on an integration of natural and spiritual scientific elements in its development, theory and practice, and because, according to its view of itself as spiritual science, it corresponds to a continuation of the natural scientific principle of knowledge at a spiritual level of observation. Both natural and spiritual science are based on a common theory of knowledge.

1 In 2015 the name of the NCCAM was changed to “National Center for Complementary and Integrative Health” (NCCIH) (https://nccih.nih.gov. Viewed 03/12/2015).

2 For example, three professorships for anthroposophical medicine have been established at European Universities: in 2009 at Witten/Herdecke University (Chair for Theory of Medicine, Integrative and Anthroposophical Medicine), 2014 at the University of Bern and 2015 at the Charité Medical University in Berlin.

3 In 2015 the name of the Consortium was changed to “Academic Consortium for Integrative Medicine & Health” (https://www.imconsortium.org/. Viewed 03/12/2015).