by Dr. Alicia Landman-Reiner
In Face of the Coronavirus Epidemic
As Anthroposophic doctors, we strive for the courage of our convictions about what is real healing, and offer this to our patients, amidst a culture of fear of pain and illness, rejection of the organism’s wisdom, and doubt in face of a more holistic viewpoint. Such emotions lead doctors and patients to suppress fever, causing more harm than good; suppress pain without dealing with its context; use sleep meds to dim hyper-alertness and instability of body rhythms without addressing root causes.
However, precisely because we have these convictions, and because we spend energy and thought in countering the strong forces in society against a holistic perspective, we can – like anyone – be susceptible to a ready-made reaction to an epidemic such as we are now experiencing in the world: there the authorities go again, fearful and without trust in the body’s healing capacity — fear-mongering and panicking.
The Covid19 event confronts us with a complex situation. Of course panicking is, no question, worse than useless. And we can and should work with that, with individual patients or via our newsletters, Lilipoh, etc., offering steadiness and good remedies. We have much therapeutic experience relevant to empirically treating this flu-like illness.
But that is not the only way for Anthroposophic Medicine (AM) to do good in society. This illness has two characteristics which point to what society should do. The first characteristic is its high contagion, about like that of varicella, along with high susceptibility, because current human immunity to it is, apparently, rare. The second characteristic is that a small percentage of folks, folks who are elderly but also some younger folks including health professionals, rapidly evolve into a respiratory distress syndrome that seems specific to this illness, a kind of immune storm, on the order of ARDS.
Because of these two factors, the epidemiology becomes very important. The dramatically simple graphic below shows us that, if the virus is left to spread freely in society, a regional caseload can and has (as in China, Italy) rise to the point where the seriously ill overwhelm the ability of the medical system to provide adequate care.
That is a very sober fact. The percentages of folks who become very seriously ill, that is critically ill, are small, perhaps 2% or 3%, though it is hard to know exactly at this time; but it is much higher than in the typical influenza outbreak, where such a fraction is 0.6% or even 0.1% (depending on one’s source of information). Though the fraction of those infected who will need inpatient or intensive care is small, given the virus’ level of contagion, the absolute numbers could be huge. The epidemic model-makers predict that this rapidly spreading illness with that percentage of very serious courses, can easily overwhelm our capacities for care.
This fact can raise realistic fear and concern, in anyone who understands it. Fear is not a bad thing in itself, but a recognition from within our soul, that something dangerous is about. It’s what we do with that feeling that counts. We have the power to use it as a message, to find the right response without cultivating or sensationalizing the fear. Once we know what to do, the energy that comes with fear, can transform into the force of determination and resolve.
It is so simple in principle. It is remarkable that an absolutely low-tech measure is the best response to this epidemic. It’s not a high-tech shot, not a suppressive medicine. If the virus is contained by the behavioral measure of social distancing, including for people to stay in their homes, and, if they have the luxury, their backyards and the great outdoors, then the rate of rise of illness drops. The curve flattens. Just as many people may well become ill. But the health care system will cope better, hopefully much better, with it.
The more we do manage social distancing, the more prolonged the epidemic will be – but the health tragedies, including the agony of choosing who will be given intensive care, will be reduced.
Of course the economic implications are sobering in the extreme, and we cannot for a moment minimize the suffering of the homeless, the jobless, the laid-off, and the poor. It is not just the poor: parents who work, losing child-care; middle-class folks running thriving small businesses through hard work and dedication, are right now facing awful choices. These are problems of huge proportions, and there is no rosy picture. Here we must step up within our communities, and our legislators must step up dramatically, so that all share the cost, mitigating the sacrifices.
But those of us who, at least for the present, think we will be able to weather the storm economically, have the luxury of examining this new social distancing, the shelter-in-place, that will be needed and mandated. And there is good that can be found in this situation.
In Manifestations of Karma, Steiner says, what Ahriman hates above all, is healthy human judgment. He likes us to do everything by protocol, even “anthroposophic protocol”! which might appear to tell us, “Self-limited viral infections, don’t get hysterical over them.” But we are in a time for nuanced human judgment.
Lucifer, on the other hand, cannot bear morality. Morality in this case, means sacrifice. We do not get to meet together in ways we have looked forward to for months. Special occasions must be drastically modified or postponed. Americans, prizing our individuality, are asked to subsume our mobility and our choices to the greater need: especially, the needs of a relative few, those amongst us who are elderly, or cope with heart, lung and immune conditions – the elderly and vulnerable.
I believe this is a moment of opportunity for the strengthening the true forces of our individuality — our higher selves. In Overcoming Nervousness, Steiner offers three exercises for strengthening the human “I,” the individual, creative, developing self. One is forgoing a wish. Another is withholding judgment. A third is, before taking action, first considering the pros and cons. All three of these involve restraint: a gesture of the I. These are the gestures that are called upon, for successful “social distancing.”
- Forgoing a wish: We postpone gatherings and occasions and friendly events and travel which we want. And we may find that, in face of these sacrifices, we come to realize how very much we value them, the individuals with whom we wanted to meet, and the learning we wanted to receive and give.
- Withholding judgment: We hold back the assumption: this is terrible! and stay open to, What will it mean, holing up in my home, not going to school? The Waldorf Early Childhood newsletter spoke to parents of young children, recommending that they not try to mimic their child’s Waldorf kindergarten; rather, just be with your child at home. Do things, make things, let them play. In some Waldorf kindergartens, the newsletterdescribed, kindergarten teachers are leaving packets each week for parents, with some little project, craft, or story to work with. My 12 year old granddaughter phoned me yesterday (that’s unusual and lovely!): Grandma, I’m out of school, and I’m making supper tonight for the family, she said proudly; mommy said to ask you for your recipe for Brussels sprouts. So we talked through the particulars, real cooks’ talk.
- Considering the pros and cons: After discussions with my 78-year old husband, I phoned my hair stylist and dentist to cancel appointments, with regrets. How are you doing? I asked. We talked about the hardships and how they might be managed. I sent a check to help compensate a little, even as they said “no, we’re ok.” Warmth and mutual concern arose in conversation over the phone.
“Social distancing” sounds like it will be awful – who needs more “distancing” these days?! and it will indeed not be easy, if this epidemic continues for months. But in surprising, even paradoxical ways, it can call upon our warmth. A friend, a lifelong avid sports fan, emailed us: “No sports on TV for two days. Just noticed a woman, sitting on my couch. She’s nice. It’s my wife.” When there are crises, including a crisis of social connection, people at their best, reach out to each other. In Europe, I have read of scout troops delivering bags of grocery supplies to the homebound. In New York City where schools are closed, they keep school kitchens open for children who depend on the school meals.
It is possible to visit at a distance in various ways. I have found that distance-learning events for adults require the leader/teacher to have greater presence – to maintain stronger awareness of who is present, to address them…and sometimes to deliberately leave a silence. Warmth and presence, which we create easily in person, we are called on to create anew and more strongly, in an electronic setting.
I went hiking with a few friends over the weekend. We stayed 6 feet apart. It took some doing – I continually wanted to speak in the normal way, closer to the other. But I became more aware that there was connection, which I had to work on more consciously. In short, social distancing can call up our forces of warmth. We can use this predicament, to strengthen them.
Steiner tells us in the Young Doctors’ Course, that we must approach each patient’s illness with the awareness that their life has brought illness to them, that every biography is filled with a wisdom we cannot grasp in a superficial way. We accept that illness, even the question of who suffers within an epidemic, is part of biography; we must bow before the mystery of our patients’ individual life-course.
But, Steiner goes on, as health professionals, we simultaneously must never abandon our role as a healer; to always seek healing, right up to the end, and in any situation, no matter how hopeless it might seem on the face of it.
Working with this seeming paradox is the extraordinary task of the physician. And learning how to hold both truths is a lifetime task, a privileged one. We have a task before us now, both to fully accept the path our patients and society is walking, hopefully finding good as well as evil, within it; and to fight with all our strength for healing.
Alicia Landman-Reiner, MD 3.17.20