Anthroposophical Mental Health & Addiction Treatment.
By Gabriel Suggate
There is a knighthood of the twentieth century, whose members do not ride through the darkness of physical forests as of old, but through forests of darkened minds. They are armed with a spiritual armour and an inner Sun makes them radiant. Out of them shines healing, healing that flows from knowledge of the image of the human being as a spiritual being. They must create inner order, inner justice, peace and conviction in the darkness of our time - Karl Konig.
The research for my Masters dissertation was on a subject I have been quietly passionate about for some time. The topic was whether an anthroposophical addiction/mental health residential treatment service would be beneficial in an Australasian setting.
Current Addiction Concerns
Addiction is often considered a chronic relapsing condition as the risk of relapse even after treatment is considerable. Around one in eight New Zealanders will have a diagnosable substance abuse disorder during their lifetime. In Australia current long term mental or behavioural problems reported in the National Health Survey increased from 5.9% in 1995, to 9.6% in 2001, then to 11% in 2004/2005 with similar increases also in risky drinking. A recent study in New Zealand found that 74% of those receiving substance abuse counselling also had a current mental health disorder.
Government-funded counselling and short-term residential addiction treatments are available; however, those with more complex substance abuse issues often require longer-term treatment. In Australasia, conventional long-term addiction treatment is most often a Therapeutic Community (TC) approach.
Current Conventional Residential Treatment
In conventional Therapeutic Community programmes, a central facet of the treatment is an elaborate system of rules and consequences with challenging and supportive feedback from peers and staff utilised to elicit desired changes in behaviour. A hierarchical structure of increasing privileges and responsibilities are used as residents move through the program and display the desired behaviours. Studies show that after such treatment, participants demonstrate reduced drug use, reduced antisocial behaviour and improvement on psychological measures. The research investigated shows that the money saved in health and justice systems is greater than the cost of this treatment.
Areas for improvement in conventional addiction treatment services include fairly high rates of relapse after treatment and low retention of clients in these programmes. There are few such services that cater for those with mental illness and little choice in type of treatment service. Some research shows that women may not do as well in the popular Therapeutic Community.
Clients’ Experiences of Residential Treatment
The examination of client experiences of treatment from a conventional residential service and an anthroposophical residential service provided some clarity regarding the differences in treatment approaches. The comparison was between clients’ stories of recovery from Arta, anthroposophical residential treatment program and a conventional New Zealand Therapeutic Community service. I analysed these stories for similarities and differences in themes and found notable differences between the client stories from different services. All the recovery stories talked of the importance of relationships with staff members. Also mentioned across both services were experiences of receiving supportive, honest and sometimes challenging feedback from other community members. Three major differences stood out to me between the client experiences of the different services. The first clear difference was that only the clients from Arta mentioned gaining a connection to nature, the earth and/or the seasons. As one client put it “because of the celebration of the season’s festivals I came to realise that there is a rhythm in me, and one in nature, with a connection between the two… this gives a kind of peace”.
Between the different services, I also noted a difference in how the clients described their process of change in treatment. The conventional service clients described more changes in their behavior (e.g. reduced anger outbursts) and more mentions of the challenging nature of treatment. The Arta clients more often described inner psychological changes e.g. I started to see again that things were worthwhile... experiencing a connection again with what I felt and did’ and the other client “I felt that with my own development I was responsible for other human beings and the earth”. Another difference was that the clients from the conventional service described the motivation process in their recovery more in terms of external pressure to change, for example “(service name)… changes your whole way of life and your thinking, the way you are”. In comparison Arta clients talked of finding their own inner motivations for example “The possibilities I had as a human being were addressed and I felt stimulated to unfold them” and another client “I ... discovered that you could develop yourself, and that this was meaningful” and “…I could grow, and show who I was in my own good time…”.
The more frequent mention of psychological changes and inner motivation mentioned in the Arta client stories seems to indicate that this program is different to the conventional Therapeutic Community approach. Related is Oliver James’ research (author of Affluenza) showing that those who are more motivated by internal rather than external goals are less likely to have addiction and mental health problems. How the anthroposophical approach is different from current treatment available will be explored further in the following.
Anthroposophical Residential Addiction Treatment
If we treat people as they are, we make them worse. If we treat people as they ought to be, we help them become what they are capable of becoming – Goethe.
Anthroposophical understandings of the human condition have much to offer mental health and addiction treatment. William Bento talks of not judging those in mental distress but seeing such suffering as striving to become an ideal human being. Anthroposophical services often emphasise the freedom of the individual and the striving of the co-workers to truly understand the suffering person as a path of spiritual development. Social organisation that allows for the initiative of clients and staff is also considered important in such a service. In contrast to many current residential services, anthroposophical services are most often not hierarchical programmes, although some individuals may attain more responsibilities than others.
Anthroposophical residential addiction services are often located on a Biodynamic farm that provides a natural environment, interaction with animals and the changing seasons as well as meaningful health-supporting work. Anthroposophical medicines and artistic therapies as well as anthroposophical psychological understandings are integral to the holistic treatment approach.
Arta, established in The Netherlands in 1973, was the first anthroposophical residential addiction treatment centre. Treatment there includes focus on the following four (seven year) developmental stages to assist in remedying developmental shortfalls so clients can better reconnect with their potential. The following phases are varied depending on the individual needs of the resident:
a) The first phase is focused on improving physical health with regular rhythms of healthy eating, sleeping, working and rest. Supportive medical treatments such as rhythmic massage and/or homeopathy and a warm social environment are important here. Electronic media, intellectual stimulation, and confrontation is minimised at this stage to create an environment mirroring that of early childhood.
b) The next focus is on the inner emotional and imaginative needs of the residents that reportedly need to be met before balanced thinking and decision-making can later develop. These needs are met through supporting social functioning, nature observation, artistic activities and participating in myths and fairytales.
c) The third stage mirrors adolescence with increasing privileges and responsibilities, opportunities for specialisation in work activities, and a self-chosen project that encourages interest in the outer world. The development of thinking and healthy ideals is given more attention in this phase.
d) The last phase mirrors young adulthood with residents supported to go into the outer world to establish a meaningful lifestyle and livelihood.
Importance is often placed on staff development in anthroposophical treatment centres, as this is seen to have a direct influence on client progress. Bernard Lievegoed mentions that groups are healthiest when their primary focus is the genuine spiritual development of its members. Margaret van den Brink highlights that individuals coming together on a path of development creates a sense of brotherhood that allows higher beings to work in such gatherings and facilitate insight and understanding. She talks of the un-liberated or shadow parts of group members often causing challenges in such group situations and the need of these shadow aspects to be faced again and again to maintain and strengthen the brotherly connection so important for such healing work.
Research for Anthroposophical Residential Treatment
The websites of anthroposophical addiction and mental health services in Europe claim positive outcomes from treatment. There is a shortage of scientific research conducted on the effectiveness of the anthroposophical residential treatment approach. Scientific research I have located investigated client retention rates at Arta. Retaining clients in treatment is known as the best indicator of treatment success in addiction treatment. Arta was compared with a medical and scientific ‘best practise’ service and it was found that drop out rate was not significantly different early in treatment but was considerably better at Arta (4% vs. 50%) later in treatment (Tjaden et al., 2005). The research authors question whether resilience (psychological health) is better fostered in clients at Arta.
Anthroposophical artistic and medical therapies are important in this treatment and focus not just on the physical but also on the etheric, astral and higher spiritual (called ‘ego’ or ‘I’ in this approach). A study in Germany investigated clients with longstanding depression treated with anthroposophical medicine and arts therapy (and occasionally anthroposophical massage therapy) in outpatient settings. Significant improvements were found with two thirds of these clients no longer meeting the criteria for depression after treatment (Hamre et al., 2006). The improvements were maintained over the four-year period of the study. Anthroposophical treatment for depression was also shown to reduce healthcare costs. Positive outcomes were also found in a two-year study of clients with anxiety treated with anthroposophical treatments (Hamre et al., 2009). In comparison to conventional mental health treatment, side effects were limited to loss of voice during singing therapy and a minor incident of nausea. This research indicates that an anthroposophical approach is able to provide alternatives to conventional treatment for the mental health issues that often accompany addiction issues.
Studies have also been conducted showing that a farming environment, biodynamic food and interacting with animals are beneficial for mental and physical healing. Work therapy also is associated with positive outcomes for those with addiction issues. Art and Arts Therapy in general are associated with a number of physical, social and mental benefits.
My research has strengthened my belief that an anthroposophical residential addiction service in Australasia could provide a more comprehensive and human focused approach to treating addiction as well as being a centre for cultural, personal and environmental development. This would broaden the range of addiction services available and could potentially improve treatment outcomes due to better retention rates. Such a service would also increase the few available services that could treat those with concurrent mental health issues. An anthroposophical service is likely to better suit those with traumatic histories (particularly common among women with addiction histories) due to less emphasis on confrontation and a focus on improving psychological resilience. Anthroposophical and non-western and/or indigenous approaches have a number of similarities, for example; spiritual worldviews with similar concepts, e.g. Mauri, chi, prana and etheric, similarities in creation ‘myths’, plant based medicines, connection to the land, balancing the cognitive with social and artistic components and the use of storytelling. This could potentially mean that an anthroposophical residential addiction service would improve the retention rates in addiction and mental health services of clients of western and non-western cultures.
I currently work in the addiction and mental health sector and am interested in an anthroposophically inspired service being established in Australasia. If you are interested in becoming involved or supporting such an endeavour, please contact me on
Hamre H.J., Witt C.M., Glockmann A., Ziegler R., Willich S.N., & Kiene H. (2006a) Anthroposophic therapy for chronic depression: A four-year prospective cohort study [Electronic Version]. BMC Psychiatry 6: 57.
Hamre H.J., Witt C.M., Glockmann A., Ziegler R., Willich S.N., & Kiene H. (2006b) Health costs in anthroposophic therapy users: A two year prospective cohort study [Electronic Version]. BMC health services research, 6(1), 65.
Hamre, H.J., Witt, C.M., Kienle, G.S., Glockmann, A., Ziegler, R., Willich, S.N., & Kiene, H. (2009) Anthroposophic Therapy for Anxiety Disorders: A Two-year Prospective Cohort Study in Routine Outpatient Settings [Electronic Version]. Clinical Medicine: Psychiatry, 2, 17-31.
Tjaden, B.R., Koeter M.M.J, van den Brink W., & Vertommen H. (2005) De invloed van signatuur van de behandelinginstelling op drop-out: een onderzoek bij drie typen verslavingszorginstellingen (C. Josephsohn, Trans.). Tijdschrift Voor Psychiatrie 47(1), 7-17.