The Spirit in Health Series - Owned by Illness
An interview with Gerald Karnow, M.D. by Walter Alexander, LILIPOH Senior Editor

We interviewed Gerald Karnow, M.D., at the PAAM (Physicians Association for Anthroposophic Medicine) conference in Ann Arbor, MI. Dr. Karnow has been a practitioner of anthroposophic medicine and a co-worker at the Fellowship Community in Chestnut Ridge, NY, a residential com­munity for the care of older individuals, for 28 years.

LILIPOH: How did you first meet anthroposophic medicine?

Gerald Karnow, M.D.: When I grew up in Germany, we only went to homeopaths or anthroposophic doctors. When I did my training at the University of Chicago, I already knew that I wanted to be good at both conventional, allopathic medicine and homeopathic and anthroposophic medicine.

LILIPOH: Do you have a specialty?

GK: I specialize in human beings. I'm an internist doing general practice. But because I was very interested in the media­tion between the soul, spirit and body, I went into a joint degree program that in­cluded research in neuroendocrinology.

LILIPOH: Does the neuro-endocrine study still enter into what you do, or how you think about your patients?

GK: Yes. The exciting research we heard presented today at this conference con­firms a viewpoint where you don't think of the body as being primary. And you don't consider the nervous system as fixed in its functions and dead like an electronic device.

LILIPOH: You mean not dead in ways beyond the fact that the individual cells are alive?

GK: Very much beyond that. The ner­vous system has a plasticity, and you can directly influence that plasticity if there are problems with it through what you do with your consciousness—through what you do with your soul and your spirit. The cardiology presentation showed that very clearly, also. The kind of person you are, and your daily life and lifestyle—all have big effects on your health status.

LILIPOH: So this already is a very differ­ent health paradigm.

GK: Yes. One in which there is a primacy to the spirit, of the active "innerness" of a person, one in which we are spiritual beings who dwell in a body for a lifetime or lifetimes. So the issue becomes not just the manifestations of an illness in a body, but the connection with the human being whose body it is. To me, that's central.

LILIPOH: So it's not a disease-centered paradigm.

GK: It's a human-centered one, not pa­thology-centered. And that raises then the whole issue of the meaning of illness.

LILIPOH: We tend to shy away from that one.

GK: If you don't approach it, then people think, you know, "Why am I suffering this when there is no sense to it at all." But there is significance and a meaning that can be arrived at if one really struggles to look at every illness.

LILIPOH: Can you give me an example of such a meaning?

GK: That is obviously not a simple issue, but it can be approached by living with the idea that every illness is also a learn­ing process for both the patient and the physician. And a crucial aspect is then the therapeutic relationship, is the nature of the human connection.

LILIPOH: For both physician and patient.

GK: Yes. For the physician, it means be­coming aware of the patient as a human being, and for the patient it has to do with their feeling really at home at being a spiritual being. When that happens, when people become aware of their humanity, then their own spiritual beingness and the illness get carried together as a task for growth and learning.

LILIPOH: That's the ideal. What about when you're not quite there? Not fully in touch with your humanness?

GK: In the extreme, then you're owned by the illness. Almost everything you do is determined by your disability. Your iden­tity is almost determined by—I have ar­thritis or I have cancer. So all your thought life, your feeling life and actions are ruled by feelings and thoughts connected to the illness. And, in fact, it interferes with your living a meaningful life. You're owned by the illness, and you're also owned by the medical profession and you are essentially a slave to your body.

LILIPOH: What's the ideal – or the other extreme?

GK: I treat a 90-year-old woman who has a huge breast cancer. I have taken care of her for 25 years. She didn't want a surgeon to touch her for various reasons. Now her breast is totally consumed by cancer. It's bleeding, and when we dress it every day, she looks at it and then she goes on with her life as if the cancer did not exist. Now you can take somebody else who is frightened to death, who is worried and immobilized and incapacitated because of this tumor. She isn't. That doesn't mean she is denying the existence of it; it just means she is not owned by it. You can have denial of an illness that leads to neglect, and you can have denial that says I am not going to give this excess attention.

One could say there are stages on a spectrum of increasing liberation from being owned by an illness. One of the early stages is one where your soul is already a little bit freed, but still determined by fear. Your concerns aren't necessarily fully focused on the details of your illness, but lead you then to kind of a chaotic searching, a headless searching for all kinds of things. It's a state of chaos, but it actually isn't so bad because it is an attempt at liberation, of beginning to take things into your own hands. You're liberating yourself from the illness but still ruled by it.

LILIPOH: What about the meaning?

GK: That's a hard one—and you can't ad­dress that with everybody. Each situation is highly individual. What's common to each situation is that I, as a physician, try to reach the level of a relationship that ad­dresses the humanness of the other person. That's not always possible, but one always works toward it.

LILIPOH: In a vague general way, or with specific treatment modalities?

GK: In anthroposophic medicine we have a range of approaches beyond or in ad­dition to remedies and medications. We have, of course, a full spectrum of physical treatments. The woman with breast cancer needs physical nursing care. Then there are lifestyle treatments that have to do with the rhythms of the day. Also, we work with the soul through various modalities: music, study life, poetry, art therapies and other activities, work therapy for example. And then there is the activation of the spiritual life with the goal that the person

is really able to separate from concerns of the physical and even concerns of the psychological, and really grow spiritually in their struggle with their illness.

LILIPOH: What's the goal of these non­physical therapies?

GK: To restructure consciousness. To restructure it so that a person's habitual thought life, feeling life and action life is changed and in that change there is hopefully a liberation from having your soul ruled by the illness process. And then you may even have a reversal where the body process can be healed or worked through.

LILIPOH: If I hear you correctly, you are really suggesting that treatment is not just a question of the right pharmaco­logical agents. We can have resistance to their working effectively, resistance to the "body process" being worked through. Is that right?

GK: Yes. My experience is that if you take only allopathic medicines, the rigidity of the soul life is hard to change and will not budge. It will tend to remain rigid and unchanging. With anthroposophic rem­edies and homeopathic remedies a kind of flexibility can develop. Then it becomes possible that the relationship the person has to the illness is not so fixed, and can continue to learn and grow.

LILIPOH: You're saying that conventional allopathic remedies contribute actively to rigidity and fixity of body or soul.

GK: I am of course being a bit extreme here to make a point, but much of what we do in conventional medicine is ruled by a paradigm that excludes the human being. You know, "You have this or that illness. I am the doctor; you do what I say." In that approach, I am giving you medicines that prevent your soul from participating because the medicines make things hap­pen without your participation. So you are made more and more into a passive agent. You are not permitted to be active because of the incredible physicality of the medicines. They do not permit you to be free; they fix you. I strive towards working in a different way while not neglecting the often amazingly helpful discoveries of modern medical science. I make use of them too whenever necessary and indicat­ed. However my question is always "How can I help to make it ever more possible that the human being suffering an illness can become an ever more active participant in the therapeutic process?" Rudolf Steiner once said something like this: "There is a knock on the door. You open it. Who is standing there? The human being." We need to listen to the knocking and make sure this kind of therapeutics is available because we want to be sure that the human being can live on this earth. We do this out of Anthroposophy. What does that mean? That means that you don't imprison the human being in the body. You envision that there is a conductor/instrument rela­tionship to the body and not a slave-tyrant relationship.

LILIPOH: How do things play out dif­ferently if the "humanness" paradigm is applied and received?

GK: If we work on all these levels together successfully, then when people get there, the whole rest of their life is different. Life may then be approached with joy and not ruled by fear of illness and death.

LILIPOH: And if not?

GK: Then there is always fear. But let us work together so that it can change.

 

In part II of this interview, Dr. Karnow discusses working therapeutically with the time dimension, and the importance of a supportive community for human-centered therapeutics.