Several years ago, Michaela Gloeckler, M.D., spoke to a group of Waldorf teachers and doctors. I was moved to hear her discuss chronic illness, which comes to nearly all of us at some point in our lives, most often in mid-life. The phenomenon is familiar to me from my medical practice. Patients in their mid-thirties and early forties begin to come in, worried. "Something is not right," they say, noting poor digestion (if they eat a large, spicy meal, which they used to relish, they don't feel so well!) Or, they are fatigued. I ask them about stress at work, and how much sleep they are getting. "Yes, it's true," they will admit, "there have been lots of tough deadlines at work and we're up late working after the children are asleep. But I've always done it and it's never been like this!" Or, that knee that was injured in high school is aching when it never did before. These patients are worried: what on earth is happening?

Dr. Gloeckler outlined—and I have to agree from my own clinical and personal experience—that these intimations of chronic illness come to us as we begin to age. If we're lucky, we merely find, for the first time, that we have limitations. In our teens and twenties, if blessed with health, we can "push our limits" and generally get away with it. But by the thirties for many, and the forties for most, we come up against physical and physiological limits. And, Dr. Gloeckler adds, "We don't like it."

We don't like it! It's not fun to be reminded of our mortality. That is what these "mid-life limitations" remind us of. They are like the poetic raven who sings out "Nevermore." Once we had iron digestion. Once we were invincibly energetic. Once we could bend our limbs into any shape, play soccer, dance without warming up, stay up to see the sunrise, and never know the difference. And of course, no one likes this news: we may be healthy, but we have limits. It's a subtle intimation that we will age.

That is what chronic illness is. High blood pressure, aching joints, back pains, digestive problems, diabetes, thyroid insufficiency, gall bladder problems; all typical problems of ordinary, generally healthy people in mid-life.

Then there are those who may contract chronic illnesses and face limitations earlier in life. Diabetes often starts in childhood. Asthma. Allergies. Colitis. Multiple Sclerosis. These are conditions not all of us will face, but they have the same characteristics; they present us with limitations. We find we can't do as we like, freely. Of course we rebel. And we seek healing.

Must we just accept these chronic limitations? Standard allopathic medicine often offers medications designed to suppress symptoms without healing the underlying process. For example, antihistamines for allergic symptoms or anti-inflammatories for arthritis and asthma. Sometimes we can do without these medicines, and 'just sneeze,' but more often we run into real danger if we don't take the medication. Asthma cannot be left untreated—it's dangerous. The same is true for many other conditions. And they don't just go away.

Dealing with chronic illness and with the minor chronic ailments of aging becomes a journey. Many people find they can live with or even heal their chronic illness; but there is no one simple path. It takes courage, persistence, and patience to walk this path.

Anthroposophical medicine looks at chronic illness in light of the individual person who is suffering. The therapeutic answer is unique for each one. However, some general principles can be applied. Mary Kelly Sutton, M.D. 2 gave a workshop on chronic illness several years ago. She suggested some basics in healthy life-style as a step towards healing.

First, attend to your warmth. This is a concept we hardly hear about in standard medicine—yet many patients I see, especially women, frequently feel cold. Feeling warm is fundamental to healing. If your whole metabolism has to work just to keep you warm, you are using up forces on "maintenance" which could be used for healing. Many people can't tell if they are warm or cold. They say they feel warm, but their hands and feet are cold. I tell my patients: layer clothes till your hands and feet are warm. Don't put on gloves and extra socks (though they don’t hurt); warm the core of your body. Wear an extra silk camisole or long underwear—top and bottom. In our New England weather and with air conditioned offices in the summer a silk underlayer is useful all year round. In a cold climate three layers of silk, wool or cotton on top, and two on the bottom is just about right. Don't pay attention to "what other people are doing." There are other ways to get warm. One of them is to avoid ice cold drinks. And enthusiasm about what you are doing is another way to generate warmth.

Second, attend to nutrition. Eat wholesome meals and avoid "dead" foods such as highly processed white sugar. Emphasize whole grains, organically and biodynamically grown produce, and food cooked at home with love. A beautifully prepared meal with those you love is another aspect of true nutrition. Pause for a moment at mealtime to remember the earth and sun which have brought forth the food, and the farmer who has labored to grow it. If you are well-nourished, you have taken a second step towards managing chronic illness.

A rhythmical lifestyle is a third element of healing. Taking our meals at the same times daily, sleeping and waking at the same times, needed breaks from work, and noticing and responding to the rhythm of the year, can help to promote the body's own healing forces.

Doing some kind of creative and constructive activity, just because you love it, is a fourth very important part of life, especially when dealing with chronic illness. Whether it is painting, playing music or singing, craft activity, or gardening, it is valuable to experience the creative part of us. Here we are limitless. To create anew is a kind of inner answer to-chronic illness.

These are things we can all attend to, as a kind of "first response" to chronic illness, and to the limitations of aging. These measures can take us very far. Beyond this, it can be very helpful to work with an anthroposophical doctor, homeopath, or naturopathic practitioner on our healing path. Several years ago, I had what seemed to be a sinus infection that just wouldn't go away. I sniffled for months and was always tired. I used all the remedies I had handy. A doctor colleague said, "Why don't you just take an antibiotic? What's the matter with you?!" Finally, it occurred to me to call my local homeopath. Just having her listen to my story and prescribe a remedy made me feel better. Her remedy helped, and over the next weeks I really got completely well.

With a long-standing, chronic illness, so much the more. It is very helpful to have a doctor whom you trust working closely with you. Therapies such as massage, art therapy, eurythmy, baths, and compresses, which a knowledgeable doctor can orchestrate, can be powerful catalysts for change. Remedies (anthroposophic, homeopathic, herbal) can be very important in chronic illness, requiring knowledge and experience to prescribe.

We each face our limitations, seemingly alone. We will each ultimately face our mortality, seemingly alone. Walking the path of chronic illness can feel terribly lonely. Reminders that we are not all alone are therefore especially important. An ongoing relationship with a doctor who will listen and is willing to go the path of chronic illness with you, can be very important in itself. Seek till you find the doctor you can work with! A "support group," whether formal or informal—friends and family who love you and will pitch in and help can also contribute to your healing. In these ways each of us is supported to find the courage, persistence, and patience with ourselves and others, that can be the real, hidden, fruit of chronic illness.

1. Dr. Michaela Gloeckler is head of the Medical Section at the Goetheanum in Dornach, Switzerland

2. Mary Kelly Sutton, MD has a family practice in New Hampshire

Alicia Landman-Reiner, MD is the consulting physician for the Hartsbrook Waldorf School in Northampton, MA. She works in a group practice with the anthroposophical approach and remedies shining through. This year (2001) she is organizing a training course for anthroposophical medicine, which will open next summer.