F i nt e l mann | unde rstandi ngautoi mmune di s e as e s | De rMe rkurstab Engl i s hI s s ue 2 005 1The issueIn the medicine based onmodern science, a number oftheories and hypotheses have been developed on thecausesofautoimmunedisorders. (1, 2)Examplesarethereleaseofinflammationmediatorsandcytotoxiccells by antibodies, production of antigen-antibody im-munocomplexes which are deposited inthe organism,or sensitized T cells attacking structures in the organism.Genetic and other factors are said to be the causes. (3)Generally a disruption of normal immunotolerance pro-cesses is postulated, and again a number of hypothesesfor this are under discussion. (4) All in all we have here aremarkable lack of knowledge, despite the fact that au-toimmune disorders have become common over the last30 or 40 years and major scientific advances have beenmade in the field of immunology.Can more light be thrown on the matter by conside-ring the phenomena and their non-physical backgroundin the anthroposophical science of the spirit?In the invitation to the Anthroposophical Medical As-sociations Conference on 22 and 23 November 2003 inKassel it said:Autoimmune disorders on the other handreflect disruption in the human organisms self-recogni-tion and self-regulation. Internal organs become foreignelements in the body. This would therefore also affectthe immunotolerance which functions in health, i.e. theimmunesystemattackstissuebelongingtotheorganand to the body as though it were foreign. Quite naivelyonemight ask: Hastheorganismgonemad? (seeingthat it is senselessly destroying itself).A basiclawinanthroposophicalmedicineisthat alarge part of disorders are due to auto- rather than he-terogenic factors. These take effect in the wrong place,at the wrong time, or show excessive or inadequate in-tensity in the site where they normally take effect: (5)Disorders reflect bodily processes whichtake effectin the wrong place, at the wrong time and/or act withthe wrong intensity (too powerful/too weak).Does this basic law also apply to autoimmune disor-ders? This is what we want to explore in what follows.Polarity of I and bodyA first area for our consideration derives from anot-her basic fact in anthroposophy. It is that the differentia-Anthroposophical basis for understanding autoimmune diseasesVol ke rF i nt e l mannTranslation of Menschenkundliche Grundlagen zum Verstndnis der Autoimmunkrankheitenby Volker Fintelmann. Der Merkurstab 2004; 57/5:336-40. English by A. R. Meuss, FCIL, MTA.Anthroposophical basis for understandingautoimmune diseasesI AbstractIn modern scientific medicine, questions concerningthe aetio-logy of autoimmune diseases do not take us beyondestablishing a number of hypotheses with a theore-tical basis. Findings made in anthroposophical spiri-tual investigation by Rudolf Steiner can help us tosee autoimmune diseases as an attempt to makeuntransformed (not individualized) remnants of theinherited body ones own at a later time in the bio-graphy, i.e. create an individual body that accordswith the I or self also in this organic site. Inflamma-tory and digestive processes to destroy matter andthen give a new configuration are pathophysiologi-cal in the case. Suppressing them with anti-inflam-matory drugs or immunosuppressants is counterpro-ductive, for the self is impeded in its efforts to healitself. World substances such as Phosphorus, Quartzor mistletoe treat the causes by guiding and suppor-ting I-activity. Reconciliation with the world of theancestors from whom the body primarily comes isanother element in causal treatment.I KeywordsAetiologyAutoaggression Inherited body Individual bodyRemnants of inherited body ted body (organism) is seen as the instrument or toolof the real human being who is wholly spiritual by na-ture. Rudolf Steiner called it the I. With the help of hig-her (hierarchic) spirits, this I creates instruments for it-self in soul and body so that the intentions it had in thespirit before birth (plan for life) may be brought to reali-zation in existence between conception, birth and death.The body must be seen as polar opposite to the I, withthe soul active between the opposite poles (matter andspirit), alwaysmediatingandmaintainingbalance. Aspecial aspect is that the body is pre-formed and gene-tically determined by the parents, which makes it prima-rily foreign and not self. It only becomes self in long sta-ges of development taking 20 to 30 years. This will be animportant aspect when it comes to understanding au-toimmune disorders.Let us first consider the opposite nature of body andI (spirit). Rudolf Steiner spoke of a fact which his investi-gations had shown and I want to quote him here. Whe-reverthespirit entersdirectlyintophysicalmatterwehaveadestructiveprocess. Asubtledeathprocessco-mingfromthesensesthusspreadsalongthenervetracts in the human organism.(6) This relates to the vi-sible humanbeing, i.e. onceagainthebodywhichthroughout life has an invisible human being everywhe-re within it. Essentially all constructive processes origi-nate in this. The body of physical matter, also known asphysical body, is destroyed under the direct influenceof the I, or subject to destructive processes. This leads toa first hypothesis forapossiblecauseof autoimmunedisorders:Autoimmune disorders reflect an excessively power-ful, destructiveinfluenceoftheIontheorganism.(The spirit burns up the body.)Anticipating slightly, let us note that this manifests ininflammatory processes, aboveallthosethat result inpurulence and liquefaction. Inflammation plays a majorroleinautoimmunedisordersandalsodetermineses-sential aspects of modern treatment. It is, however, scar-cely of the kind discussed above but rather involves chro-nicdestructionoftissue. Theimageonemight haveismore that of a smouldering fire.The organ which has turned foreignThe second area for our consideration is that of an or-ganortissueturningforeign. Themost characteristicexample are viral diseases where incorporation of the vi-ruses in cells of the organs will, in the sight of the immu-nesystem, causesuchalienation. Theimmunesystemattacksthematerialaffectedbytheviruses, ofteninaviolent, acutely destructive way. A typical example is ful-minant hepatitiswithhepatitisBvirusinfection, for-merly also known as acute hepatic dystrophy. Essential-ly, however, inflammatory changes with virus hepatiti-des reflect an immune reaction on the part of the organ-ism and therefore attempts to heal and not sickness. Fordecades, acute virus hepatitis was treated with anti-in-flammatory drugssuchasglucocorticoids. Later, whentheimmunologicalprocesswasunderstoodandonecouldseewhysuchtreatment waslargelyineffectiveand did actually in many cases lead to protracted chro-nic evolutions.Autoimmuneprocessesconnectedwithvirus-asso-ciateddisorderscontinuetobeseen, andforatimeitwas therefore also thought that autoimmune disordersmight beviralinorigin, withresearchtakeninthisdi-rection. The second hypothesis for a possible cause of au-toimmune disorders therefore is the following.Autoimmunediseasesindicatethat anorganhasbeenalienatedunderexternalinfluences. (Theor-gan becomes outside world.)This hypothesis is more likely to help us find an ans-wertoourquestionconcerningthecausesofautoim-mune disorders. Viruses or other pathogens clearly can-not be the only external factors to be considered. A vastfield has to be opened up for research to investigate thisand look for answers. There can be no question but thatthe human organism is today exposed to many differentenvironmentalpollutantsinmaterialformoralsoinform of different kinds of radiation. We need only thinkof the indeterminable number of food additives, pestici-de or heavy metal pollution, and both natural and artifi-cially produced radiation of many different kinds. Fromthe point of view of anthroposophy, where existence insoul and spirit is something very real, one must also con-sider if external influences of a non-material kind maynot also cause an organ to become foreign. Think of theindigestibleflood of images and information providedby the media, but also the actions, feeling and thoughtsof others and the effect these can have on us. Any kindof childhood abuse must also be mentioned as a primeexample.Organic focus of destruction within usA third area for our consideration is again created onthe basis of Rudolf Steiners investigations. He describedhow in every human organismthere is an organic andtherefore unconscious area where an intensive form ofdestruction arises which is directed towards the organ-ismsphysicalmatter: Matterisnevercompletelyde-stroyed in the outside world. In more recent times, phi-losophers and scientists for the external world have the-refore spoken of the conservation of matter. This law oftheconservationofmatterappliesonlyintheoutsideworld, however. Intheinnerhumanbeing, matteriscompletely transformed back into nothingness. Matteris there destroyed completely in its essence. Our humannatureactuallybasesonthefact that weareabletothrow matter back into chaos, destroy matter complete-ly at a level deeper than the mirroring of memory.(7)He then referred to the way pupils were taught in ear-lier mystery centres, mainly in Ireland and the West alto-gether, thoughoriginatingfromtheOrient: Beneaththe capacity for memory, you bear something in you asa human being which is out to destroy; without this in-side you, you would not have been able to develop your2 De rMe rkurstab | F i nt e l mann | unde rstandi ngautoi mmune di s e as e s Engl i s hI s s ue 2 005abilitytothink, foryoumust developyourthinkinginthat powersofthought penetratetheetherbody. Anether body filled with powers of thought will, however,have the effect on the physical body of throwing its mat-ter back into chaos, destroying it.(8) Later he introducedtwo further important concepts, speaking of a focus ofdestruction and a destructive frenzy.These spiritual facts are profound and may well awa-kendefensiveornegativereactionsinsomeonefollo-wing the line of thought. The known facts of research in-to digestion show, however, that such powers do indeedexist in us. Destruction or degradation of matter in theprocess we call digestion involves powerful, aggressi-ve forces located in the different digestive organs, withcorrespondingdigestiveenzymesactingasmediators.Ourorgansofmastication, acidproductioninthesto-mach and bile acids also come under this heading. We al-so find this destructive frenzy in the rejection of organtransplants, a process with an immunological basis. Ma-ny readers may perhaps for the first time become awa-re here of a situation which is experienced and describedallovertheworld, aphenomenonofourtimethat al-most seemsbeyondcomprehension. Thisistheenor-mousincreaseina(seemingly?)incomprehensiblede-structive frenzy as an expression of uncontrolled aggres-siveness which culminates in terrorism. Do we not beco-me aware of a need here for research in medicine as tohow far such aggressiveness discharging itself in an out-warddirectiondoesnot alsoreflect digestiveactivitynot adequatelyput touse, i.e. digestive powers stray-ing into the soul sphere? And should not our attentionturn to causal phenomena in nutrition, fast foods beingbut one form of expression? Reference must also be ma-detothehighlysuccessfulcommercializedworldoffilms which profit from showing such extreme forms ofmaterial destruction, their material also including thehuman being.Thesequestionsconcerningthephenomenaofourtimewillnot, however, helpustounderstandautoim-mune disorders. Here the destructive frenzy woiuld ha-ve tobedirectedtowardspartsoftheorganismitself,which is also an important aspect of self. Suddenly theearlierterm autoaggression gainsfreshnewsignifi-cance. Permit me to refer to an image from the world offolk tales. In Rumpelstiltskin we find an accurate pictu-re of autoaggression of the kind which at the level of or-gans we see in the extreme situation of pancreatitis, forinstance, a situationwhere anorgandigestsitself. Weare thus able to formulate a third hypothesis for under-standing the cause of autoimmune disorders.Autoimmune disorders reflect an (organ-related) de-structive frenzydirectedagainst oneself. (Rumpel-stiltskin type of autoaggression)Acutepancreatitisisnot anautoimmunedisorder,though the triggering factors do in many cases remainunknown. But it is striking how often extreme psycholo-gical stress is seen in conjunction with this disease, of-ten having persisted for a long time and finally findingan outlet. This is the field of psychosomatics, interactionbetweenbodyandbody-relatedsoul. Scientistsack-nowledge that psychological factors can become soma-tic, connecting with it the idea of a pathophysiologicalprocess. This may well play much more of an aetiologi-calandpathophysiologicalroleinthedevelopment ofautoimmunedisordersthanmodernscientistshaverealizedsofar. Andnocarefulobservercanfailtoseehowintensivelythesymptomsofautoimmunedisor-ders also involve the psyche.Untransformed elements of the inherited bodyThe fourth area to be considered takes us deep downinto the true causes of autoimmune disorders. It presup-poses the situation mentioned earlier, which is that theindividual human spirit, the I, can only incarnate if pa-rents create the necessary living body. In every case andwithutterlogicthisisforeigntotheI. RudolfSteinerwouldfrequentlymentioninhiscollectedworksthatthe time needed for human infancy and childhood deve-lopment untilmaturationisreachedisextremelylongcomparedtothewholeanimalworldandcanonlybeunderstood if we consider that the I needs this time totransform the inherited body, also called a model, intoan individual body, which has to happen at all levels ofphysical matter, life, sentience and soul and ultimatelyalso of the spirit. This happens in developmental stagesof 7 years each. Initially the material consistency of theinherited body is transformed and replaced, as is clearlyevident in the changing of the teeth, though it also ap-plies to all tissues and organs in the organism.More work is done on transforming physical matterin thesecondseven-yearperiod, but theemphasisisnow on the sphere of life, most evident in all functionalprocessesintheorganism. These, too, must becomehighly individual to serve the unique (individual) natureof the I as ideal tools for future life. These individuationprocesses come from the above-mentioned invisible orsupersensible human being who is not embodied but in-fluences the body by different routes.(9) It is always thenext highermemberofthesupersesibleorganizationwhich works on this individuation, always guided by theI which on its part has the help of spiritual (hierarchic)entities of planetary origin (Fig 1).After 3 times 7 years, i.e. around the 21st year of life,individuation of the body is complete, the individual hascome of age. The I then works to develop the three soulelements(sentient, rationalandspiritualsoul)out ofthe body which also need to be given wholly individualcharacter. Inourtimethisreachesitsculminationinabout the 28th year, when ideally the human being is atrue individual and takes personal responsibility concer-ning self and world. This is the ideal form of an indepen-dent individual nature. All kinds of problems, resistanceand obstacles do, of course, arise, so that the work willscarcelybewhollysuccessful. Bodilyresidues left in-complete will persist, with hereditary body elements re-maining in them.F i nt e l mann | unde rstandi ngautoi mmune di s e as e s | De rMe rkurstab Engl i s hI s s ue 2 005 34 De rMe rkurstab | F i nt e l mann | unde rstandi ngautoi mmune di s e as e s Engl i s hI s s ue 2 005Rudolf Steiner characterized two types of wrong de-velopment in this connection, calling them premature ordelayeddevelopment.10Hedescribedtheformerasacase where transformation is too rapid, coming to a pre-matureandthereforeincompleteconclusionwhichleads to an inner determination of the individual thatmay be compulsive by nature, for instance. If individua-tion of the body is too slow, and also if it persists beyondthe 21st and 28th years, the body is determined in a wayto which Rudolf Steiner did not give a name, but whichcomes to expression in addictions. The very brief descrip-tion given here may lead to my fourth hypothesis:Autoimmune diseases reflect a late attempt to indi-vidualize residues of the inherited body.This will of course again and again come upon organ-ic regions referred to as such residues. This is not to saythat the I will on principle attempt to individualize themat a later time. The way I see it, this will be a relatively ra-re occurrence, otherwise the number of people with au-toimmune disorders would be much greater. Such resi-dues do, however, persist through life, though they act asforeign elements in the body, and may thus be conside-red to be sources of all kinds of organic, functional andalso mental disorders. Perhaps we can in the light of thisunderstand why cancer manifests in a specific site, in anorgan or as a systemic problem. Autoimmune disordersmay, however, develop in people who do not allow the-se residues of the inherited body to persist but absolu-tely intend to transform them, i.e. make them their ownor individualize them.Inmy opinion, thisiswheretherealcauseofthesedisorders lies. We thus see them as diseases of our timeand can also understand why they are on the increase.Individuationorthedevelopment ofonesownindivi-dual nature is something which more and more peopleenter into at the present time. It is also evident from theabove why the typical time of onset is between the agesof 20 and 40. Earlier or later onset does not speak againstthe type but merely raises the question whyfor the in-dividual concerned.Thenoticeablypsychosomaticsymptomatologyofautoimmune disorders, already mentioned in the above,merits further consideration. The biography frequentlycontainselementsthat havenot been dealt with, di-gested or overcome, and this with reference to the adultworldaroundthedevelopingindividual, aboveallmo-ther, father and siblings, but also other close relations orfamilyfriends, teachersandclergy. Workingthroughsuch problem areas in talks and finally achieving recon-ciliation often proves to be the vital precondition for suc-cessful treatment.We must also learn to differentiate the times (seven-year periods) when transformation did not succeed, andthetrendfollowedbyprematuredevelopments. Foritwill primarily be these which cause the developmentaldisorders and hence the residues. At the very centre ofall diagnostic questions and observations, indispensablepreconditions for rational(causal) treatment, we mustput the relationship between I and body, i.e. congruencebetweenindividualnatureandphysicalbody. It isper-fectly clear that this does not mean making the kind ofdiagnosis learned at medical school. One has to developempathic intuition, which results from the results of ob-servations made in the soul using the methods of mo-dern science (subtitle of Rudolf Steiners Philosophy ofSpiritual Activity).Prospects of a rational therapyTheprocessesconnectedwiththefirst threehypo-thesesareimportant ifwearetounderstandautoim-mune disorders, though they are not of primary signifi-cance in understanding the causes. They reflect proces-ses which play an essential role in the pathophysiologyofthedifferent autoimmunedisordersandhavebeengivenashypothesesnot forrhetoricalreasonsbut be-cause they are genuine fields where work may be doneto gain deep-reaching insight into these disorders, withthe scientific findings of conventional medicine also ta-kenintoaccount. Manifestationinspecificorgansandaspects of treatment will be considered in detail in thelectures that follow. Before coming to a conclusion, ho-wever, let us look at some of the clinical requirements orconsequences in the light of the above.The key point, I believe, is that inflammation must notbe suppressed or reduced but rather encouraged. It go-eswithout sayingthat thiscallsforgreat experienceand sensitivity. On the basis of many years experience,Fig. 1:Physical develop-ment in the four 7-year periods (IO = I-organization;AB = astral body;EB = ether body;PB = physical body;SS = sentient soul)Sunsupersensible AB + IOsupersensible EB[[[[1stindividuation PBMoonsupersensible IOsupersensible AB[[[[1stindividuation EB[[[[2ndindividuation PBOther planetssupersensible IO[[[[1stindividuation AB[[[[2nd individuation EB[[[[3rd individuation PBConstellation of fixed starsIndividual body devloped,soul devt. at same timeAB as basis for SS2nddentition sexual maturity coming of age freedomresponsibilityBirth 7 14 21 28F i nt e l mann | unde rstandi ngautoi mmune di s e as e s | De rMe rkurstab Engl i s hI s s ue 2 005 5Phosphorus and potentized mistletoe preparations areanelementaryhelpinthis. Secondlythereisneedtohelp the I to perceive both the inner and the outer boun-daries of the body and also achieve them, i.e. actively setboundaries. Quartz has causal activity in this respect.Finally spheres of life must be worked through in thebiography that have created obstacles or trauma in theperiod of development and must be seen as connectedwiththedisease. Reconciliationwiththesesituations,and often also with oneself, is an important element inovercomingthediseaseorbringonesbodilydevelop-ment to a good conclusion.Prof. Volker FintelmannCarl Gustav Carus AcademyRissener Landstr. 193D-22559 HamburgReferences1 Classen M, Diehl V, KochsieckK. Innere Medizin. Urban &Schwarzenberg 1993, 402-4062 Johnson AG. Immunologieauf 70 Seiten. Thieme 2001,58-593 Classen M, Diehl V, KochsieckK. Innere Medizin. Urban &Schwarzenberg 1993, 402-4064 Johnson AG. Immunologieauf 70 Seiten. Thieme 2001,58-595 Fintelmann V. Intuitive Medi-zin. Einfhrung in eine anthro-posophisch ergnzte Medizin.Hippokrates, 4. Auflage 2000,66-736 Steiner R. The Invisible Manwithin Us. tr. A. Wulsin, G. Kar-now. Spring Valley: MercuryPress 1987.7 Steiner R. Cosmosophy vol. 1.Lecture of 23 Sept. 1921. Tr. A.Wulsin. Steiner Books.8 Steiner R. Loc. cit.9 Steiner R. As ref. 6.10 Steiner R. Pastoral Medicine.Lecture of 11 Sept. 1924. Tr. G.Hahn. Steiner Books 1987.6 De r Me r kur s tab | Sol dner Sommer | Autoi mmunedi sordersoftheTyroi d Engl i s hI s s ue 2 0051) Case recordsMrs M, age 33, hyperthyroidismA slenderyoungwomanbrought her8-month-oldinfant fortreatment. Thechildhadbeenbornwithamarked premature cranial suture synostosis and is alrea-dy showing definite psychomotor retardationunabletoturn round, communication not possible inthe wayappropriate to the age. Mental disability had to be con-sidered. Theindicationforsurgicalcorrection, not wit-hout risk to life and prognosis, had to be established. Theinterventionwasduetobedoneat about 12months.Currently the decision had to be made as to which sur-geonwoulddotheoperation. Thepatient cameforaroutine check on the child before going on holiday.Thechildpresentedwithamildupperrespiratorytract infection; the mother seemed exhausted. As atten-tion turns to her, one sees the eye signs of stare and lidretraction, she seems rushed, never taking time for her-self. Asked if there was something wrong she said thatshe had felt weak and exhausted for the last 2 months,something not right. Further questions elicited that shehadlost 3or4kginweight, andhaspalpitationsnowand then. The pulse was 110 120/min, BP 130/75 mmHg,pulsating goitre size 2. Clinically, Graves disease was su-spected, theholidaytripcancelled, bloodtaken, andthen an injection given of- Glandula Thyroidea D30 amp. Wala- Cuprum met. prep. D30 amp. Weleda i.v.,on the assumption of a florid inflammatory autoag-gressive disorder of the thyroid (for this a relatively highpotency of the homologous organ was recommended)and also because experience had shown that mothers ofchildrenwithserious, life-threateningconditionsgainimmediate relief and relaxation with Cuprum met. prep.D30.Laboratory findings. TSHdepressed, T319.6pg/ml(normal < 4.2 pg/ml), T4 7.74 ng/dl (normal < 1.75 ng/dl),TRAB12.4(normal