Constitution Typology
in Curative Education

By Martin Niemeijer

Summary

Children´s development happens in a field of polar creative processes. This leads to a continuous balancing act initiating an individual, dynamic equilibrium. This activity and its resulting processes are fragile and must not remain stuck in the one-sidedness of either of the poles. Three polarities were developed in Rudolf Steiner's Curative Education Course concerning six constitution pictures that encompass the fundamental dimensions of the child's organism. These pictures can be used to describe the child’s constitution, which can be followed by individualized curative education and therapeutic support and treatment. An instrument has been developed for coordinating treatment in the use of these pictures as well as for training. We show how the instrument has proven itself in research and practice since it was first developed.

Keywords

Constitution typology

Polarity

Balance

Basic processes in child development

Picture-forming diagnostics

Development of an instrument

Introduction

Learning that their child has a developmental disorder is a profound experience for parents leading to fear and uncertainty about the future. What was taken for granted in the life of parents and child initially disappears and a period of grief sets in. Over time, a new balance and perspective can be found. Parents and their social environment must develop a new outlook in order for life to go on. In his course on curative education in the 1920’s, Steiner emphasizes that healing and education are very closely related (1). In the twelve lectures of the course, he gives prospects and tools for a healing education. This article presents how these findings have inspired us to new activities.

Three Polar Types in Constitution

In the third to fifth lectures of the Curative Education Course (1), Steiner outlines six pictures of when child development becomes unbalanced and one-sided. In previous lectures, he explains how the child's soul (psyche) and spirit (I) take ownership of the body, which is built up according to the rules of heredity. The incarnating being shapes the nervous system and senses making it into a whole (synthesis). Thus organized, this system can be the basis of our thinking. On the other hand, the incarnating soul and spirit differentiate as they shape the diverse individual organs in the metabolic system and limbs (analysis). The differentiation in this part of the human organism makes it suitable for our willing and directed movement. In between, in the middle of the human organism, in the lungs and heart, a rhythmic process of connecting (synthesis) and letting go (analysis) develops with breathing and circulation; this rhythmic process is the basis of our feelings.

In this context, Steiner develops six constitution pictures in three polar contrasts. Constitution pictures are not the same as a clinical diagnosis; they rather show processes in children’s organization that express balance or imbalance. Steiner refrains from a definitive systematization in favor of a lively phenomenological description: the terms "constitution picture" or "polarity" are not found in the course; they are the result of efforts to grasp its fundamental principles. In this article, this has led us to employing terms that have been used for the past twenty or so years to characterize the constitution pictures (2):

Consolidating/Compulsive Shaping Dissolving/Forgetful Nervous System and Senses

Closed/Congesting Connecting Open/Out-Flowing Rhythmic System Processes

Sluggish/Heavy Moving Restless/Light Metabolic System and Limbs

The Closed/Congesting and Open/Out-Flowing Constitutions

In the third and fourth lectures, Steiner contrasts the picture of a closed/congesting one-sidedness with that of being open/out-flowing. He describes how when waking up, the I and our conscious awareness active in the psyche connect with the organism, especially the organs; and how this organizing connection dissolves when we fall asleep. In waking consciousness, these organizations of I and the psyche’s conscious awareness first connect with the organism and its organs and permeate them, before they can link with the forces and elements of the world.

The closed/congesting one-sidedness is characterized by a strong resistance and constraints on the surface of one or more organs such that the organizations of I and psyche are held back and cannot manifest in the outside world. This leads to congestion in the organs. An epileptic seizure may be considered an attempt of these organizations to break through the congestion. In children, this constitution picture may also show a general difficulty connecting to the outside world and in acquiring moral competence. Clinical examples of other symptoms are "breath-holding spells" in small children, asthmatic symptoms, colic-like cramping, and contact-problems with people and the environment.

In the open/out-flowing one-sidedness, the possibility to hold back the psyche’s activity in the physical-physiological activities of the organs is too weak or the latter are too permeable, which leads to an out-flow of feelings into the outer world; the organs do not provide sufficient support. This can manifest itself in symptoms such as a characteristic smelly odor, perspiration, or bed-wetting. It may also lead to being allergic (hay fever) or to eczema. In addition, the lack of boundary can express itself as a "feeling wounded," hypersensitivity, feeling at the mercy of fear, and depressive moods.

This polarity’s basic gesture is connecting and letting go. Both occur rhythmically in all life processes--such as in our breathing when we inhale and exhale. We connect with the world around us through our senses in a "refined breathing" process and close ourselves off from it again when we internalize the assimilated impressions. Food intake may be considered a "coarse breathing" process in this sense.

In the transition moment from inhaling to exhaling, from cardiac systole to diastole, is a moment of stillness: this is where consciousness is possible. Our consciousness awareness at this crossing point, with the possibility of making decisions, co-determines what we connect with through our senses and through our food, what we take in and what we let go of. Connecting and letting go are inherent in life and a prerequisite for development. They ensure both individuality and a feeling of wholeness in our organism. Children with attachment problems’ central difficulty is developing connections and letting go.

The Consolidating/Compulsive and Dissolving/Forgetful Constitutions

Steiner describes how the interrelationship between the organizations of the I and the psyche mentioned before with the physiological and physical organizations in the organism, is different in the head from in the limbs (1, blackboard drawing VII). In his course on curative education, in its fifth lecture, he describes an inward-directed, centripetal arrangement in the head system--with the organization of the I in the center and in the periphery the physical organization. This is the organic basis of being able to form ideas and thoughts. In the limbs, an outward-directed, centrifugal arrangement prevails in which the physical organization is central and the organization of the I is in the periphery. This arrangement is the organic basis of our being able to express our will and imaginations, among other things.

Steiner goes on to show how this arrangement is reflected in the sulfur/iron ratio in the body, with iron expressing a centripetal and sulfur a centrifugal dynamic. The polar arrangement of the head and nervous system compared to the metabolic and limb systems makes movement and memory possible. A disturbed sulfur process leads to insufficient mental abilities to remember and forgetting: a consequently poorly developed metabolic system results in proteins with too little sulfur in their conformation. As a result, sense and other impressions do not receive appropriate resonance in the metabolic system, “radiate back” into the head, and remain present in conscious awareness: they cannot be forgotten.

The picture of a consolidating/compulsive one-sidedness becomes visible in phenomena such as compulsive disorders, i.e. in compulsive thoughts and actions. This leads to rigid thinking and a fixation on topics that then cannot be let go of properly. People with autism often have these problems, since they have excessive formative forces which bring on a one-sidedness in thinking and feeling. As they are trapped in their own thought process, the fixations can take on an obsessive character and lead to compulsion and tantrums. Stiffness can also manifest itself in posture and stiff motor skills. A long-lasting imbalance will result in excess break-down processes in the metabolism, with the possible consequence of stone formation in organs such as the gallbladder and kidneys. Craniosynostosis, for instance, is an expression of a too robust early embryonic tendency to consolidation.

In the dissolving/forgetful one-sidedness sense- and other impressions tend to dissolve: they disappear from consciousness. This manifests as a centrifugal dynamic, a dispersing tendency, as a lack of shaping activity in organic processes. It can lead to forgetfulness and loosing things. Conscious awareness is clouded, which can bring about delusional ideas, possibly violent outbursts, and disintegration. A preponderance of up-building processes in the metabolism may lead to chronic inflammation and poor wound healing. Before birth, a lack of shaping activity may lead to malformations such as persistent fontanelles or spina bifida.

The basic gesture of this polarity is shaping and dissolving.

The Sluggish/Heavy and Restless/Light Constitution

The third pair of polar pictures is found in the area of will and action. Steiner reminds us of the interrelationship of the organizations of I and psyche with the physiological and physical organizations in this area of the organism. He points out that they may not fit well together; the physical organization, for example, may be too dense, too heavy. Consequently, intentions and impulses of the I and conscious awareness active in the psyche do not sufficiently vitalize the physical and physiological organizations and they become sluggish. Activation by the I and conscious awareness are weakened, as can occur in young people during adolescence, which is known for instance in Hikikomori syndrome.

The characteristic feature of the sluggish/heavy one-sidedness is that movements are restrained and carried out lethargically. Muscle tone is reduced, which means that support may be needed in standing and walking. At the same time, there is reduced attention to the surroundings. This can be accompanied by a depressive, melancholic mood. The heaviness can become visible early on in the child's life by delayed motor development, signs of a slow metabolism, hypotonic blood circulation, sensitivity to cold, or a tendency to being overweight and constipated. In children who suffer from congenital metabolic disorders, we may observe that physical and physiological metabolic processes become so dense that the organization of the psyche cannot activate or move the muscles and limbs, or can do so insufficiently.

In the restless/light one-sidedness, the organization of the psyche and conscious awareness cannot take hold of the physical and physiological processes in the metabolism properly. This causes vibrating movements throughout the body, right to the periphery and outside the body's limits. This manifests in a hypermobility with signs of hyperactivity, concentration problems, and emotional instability. The urge to move leads to impulsivity and secondary movements. Attention is present, but only fleeting, and it quickly jumps from one thing to another. Hypermobility and motor restlessness can occur as symptoms in various diseases such as Huntington's chorea and Tourette syndrome. Another well-known disease with insufficient inhibition and control is attention deficit hyperactivity disorder (ADHD).

The basic gesture in this polarity is moving and resting.

The described six constitution pictures can be seen as archetypes of "imbalance" in child development. They describe developmental disorders in which the middle between the polar opposites is not found: "When development goes beyond a certain healthy variability, which is individual for different people, when it goes beyond certain limits, [...] then it results in abnormality, illness." (1, p. 63)

In the continuation of the Curative Education Course, several children are introduced in person. Rudolf Steiner discusses the constitution and diagnosis of these children based on the organizations of I and psyche with the physiological and physical organizations in the organism. He gives pedagogical and therapeutic advice. The six constitution pictures are present in the background, however, are not explicitly mentioned.

Developments since 1924

The three polarities resulting in six constitution pictures have proven to be a source of inspiration in diagnosing and advising by and for caregivers, as well as for the treatment of children with developmental problems and disorders. In his article on the polar approach in Steiner’s curative education course, Grimm (3) gives an overview of how new insights have been added to these pictures and how they can serve as an inspiration for practical work.

Constitution Pictures

Nowadays the described pictures are referred to as "constitution pictures," or "the three polarities of the curative education course" (3). They may teach us how the incarnating soul and spirit of the child connects with physical and physiological processes in the organism and as I organization and organization of the psyche creatively affect the organism. The term "constitution" is used here in an active sense: "to constitute" or "to create." The organizations of I and psyche together with the organism’s physiological and physical organizations constitute and creatively aid the emergence of the individual human organism.

Steiner describes the specific configuration of the organizations of I and psyche in relation to the physiological and physical organic organizations for each of the polar images. The constitution pictures are archetypes of one-sided development in children. We use these pictures to describe, not to define or classify illness or a disorder.

Together as a Whole

Holzapfel (4) regards the "threefold polarity" as a unity, which encompasses the organism’s archetypal constitutional dimensions. "We need all three of the polarities, because their processes are indispensable in human development." (4, p. 97) Each of the three polar pairs has its own area in the threefold human organism in which it is active; their effect permeates our entire life. We all need breathing, waking up and falling asleep, remembering and forgetting, moving and resting in our lives. Life takes place in a field of polarities, but should not get stuck in one of the poles and become one-sided. Steiner repeatedly points out that everything in life presents itself as polar opposites; a balance must be established between them (5, p. 182, 231).

Three Developmental Principles

Each of the three polar pairs reveals a developmental principle. We have described these principles as connecting, shaping, and moving in the Companion From Special Needs to Realizing Your Full Potential (6). These principles are operative in all living organisms; together they form a prerequisite for life. The area from which they develop their activity differs. The rhythmic system makes connecting possible, the nervous system and senses enable a formative quality, and the metabolic system and limbs empower moving. The incarnating soul and spirit of the child uses these developmental principles as a means to develop the physical/physiological organizations and for the development of feeling and experiencing, perception and thinking, will and action.

Organisms are connected to their environment which is reflected, among others, in the exchange of substance. This exchange provides organisms with sustenance for their internal metabolic movement activity. In animals and in humans, this also determines external mobility. Tissues and organs are shaped and modelled in metabolism according to prototypes of the respective organs (7).

At around the age of seven, vital physiological activity becomes available to shape thinking. The three developmental principles become operative in humans with incarnation and remain so throughout life--day and night, from birth to old age. At excarnation, when the organism dies, their activity ends.

Fourfold Structure

Can we describe the activity of the organizations of I and psyche and the physiological and physical organizations in regard to the three developmental principles? In the rhythmic system in which respiration and a sympathetic/antipathetic connection with the environment prevail, the relationship between the organizations of I and psyche with the organic processes is constantly changing between connecting and letting go. The centrifugal dynamic of the organization of the psyche, guided by the I, is in the foreground. It needs organic functions to also manifest itself in motor activity. In its interaction with the I and I-organization, impulse, direction, and intention emerge in the movement.

The centripetally active shaping principle takes place where physiological processes border on physical activity as is seen in the physiology of the nervous system and senses. Depending on the thought, a memory, or even an organ such as kidney or bone, physiological activity generates the appropriate shapes in accordance with the organizations of I and psyche: they mold the idea or the organ into a suitable compactness and external physical shape. In the nervous system and senses, physiological processes and the organizations of the I and psyche are unbound.

We may also look at nature from the point of view of these three principles. Looking at nature through the lens of connecting, moving, and shaping is an inspiring way to recognize and experience the meaning and effectiveness of these principles. They also work in artistic activity: in painting and making music, in eurythmy, and in sculpting. The activity of these principles can be a source of inspiration and provide direction in advice, therapy, and medication-finding in curative education.

The Middle

Life takes place in a field of polarities. Steiner refers to balance as "the middle.” "Being in balance" is not static, it describes the freedom of the center. Steiner made this picture of the middle accessible to us through a work of art: a wooden sculpture called “the representative of humanity.” In the middle is an image of Christ, representing humanity. A path to hardening, ossification, over-structuring, and fear is embodied by a lower figure in the statue; another figure higher up represents dissolution and over-enthusiasm. The Christ figure does not show any hostility to the other tendencies; he represents embodied love.

Everyone seeks and follows their own course on the path of life, and finds their own middle ground. One-sidedness can be problematic, but it can also be an innate gift or become the result of practice and training, for instance in the pianist's finger dexterity or the skill of a magician, the movement of the feet of a dancer, the photographic memory of a person–possibly with autism.

When are the limits of natural variability exceeded to the point where it becomes unhealthy? The concept of "balance" is helpful for grading health and wellbeing. It allows each child to find its own middle on a continuum between polar opposites. This concept of health also implies the possibility of temporary imbalance due to illness and other drastic events. Health is a dynamic process; it refers to the ability to find one's own center; illness is the expression of getting stuck in a one-sidedness.

Diagnostics

The three polar constitution pictures aid in structuring the multitude of phenomena when looking at children’s constitution. What would such an organizing structure look like today? When we examine children we first of all carefully recognize all present signs and symptoms and inform ourselves on how the child has been doing recently. We may assign these phenomena to the three developmental principles: shaping, connecting, and moving.

Diagnosis of the constitution is aimed at recognizing the forces active in the fourfold structure of the organizations of I and psyche and the physiological and physical organizations. Methodologically, this diagnostic approach is based on phenomenology as developed by Goethe. Bortoft (10, p. 18) describes this approach by observing a river. Downstream we see where the water flows, with everything it carries along. Accordingly in diagnostics, we observe, so to speak, "the results" of how the child has developed up to now. In order to get to know these "results" in their origins, we must turn around and look upstream. There we can recognize the activities of the organizations of I and psyche and the physiological and physical organizations as the "creative" forces of all that emerges as downstream results.

Constitution Profile

All children have a unique constitution that reflects how the organizations of I and psyche as well as the physiological and physical organizations, work in their organism. Their constitution is not static, but rather changes and develops throughout life through experience, including disease and disorders, and through the activity of their I, their spiritual being. The development of a child can be visualized as a skipper who sails the ship together with the crew, searching its course. Constitutional diagnostics can be seen as picturing the route on which the skipper navigates with the three polar constitution pictures as coordinates.

The 4-Step Approach in Multidisciplinary Team Meetings

We may employ multidisciplinary team meetings to review and give meaning to phenomena we observe in children. Many approaches have been developed in practice to come to a diagnostic picture. In the Bolk's Companion Group, an approach was developed and described which we called the "4-step approach" (11). This picture-forming diagnostic approach is derived from Goethean phenomenology and can be done alone or in a multidisciplinary team meeting. In the first step, we are attentively, as an interested spectator, without judging, observing the child in its environment. In the second step, we look for connections and patterns in the observations made so far as engaged participants, without judgements.

In the third step, we "turn around" and sensitively and empathically experience the dynamic of the child's developmental processes; in this process, we provide space for the pictures that may emerge. Pictures that emerge in the third step in for instance a multidisciplinary picture-forming team meeting may be experienced as a tableau or painting. They are often images from nature; sometimes they contain depictions of animals or people. These pictures can be examined for the elements they contain: earth, water, air, light, and warmth. We also may look at connection, shape, and movement in the pictures. In the following team conversation we try to put words to what speaks from the images. The images can also refer directly to the relationship between the organizations of I and psyche and the physiological and physical organizations or to the "coordinates" of the three developmental principles.

In the fourth step, we connect with the pictures and are open to what they have to tell us as we try to articulate a therapeutic and pedagogical direction for the child. In order to be able to take the fourth step, we may need a break--time to listen to the pictures and to expand on an intuition for the appropriate therapy.

The multidisciplinary team meeting’s picture-forming quality and the constitution diagnosis are a good training ground for all people involved. It helps to keep reminding ourselves of what we are doing and how we are doing it. In the following section we present two studies that we did on working with the three constitution pictures. One of the results of this research is the development of an instrument for assessing children's constitution.

First Research Project

In collaboration with 22 experts with previous experience in special education in the Netherlands, we investigated how we each work with constitution pictures (12). The aim was to achieve a certain degree of intersubjectivity in the assessment, recognition, and diagnosis of constitution pictures. We used so-called concept mapping as a research method (13).

In a first round, participants were asked to create their own image of each of the constitution pictures and to examine their pictures for characteristic phenomena. This led to an inventory of phenomena for each of the six constitution pictures. In a second round, each expert prioritized the phenomena inventory according to relevance for the respective constitution pictures. The result was a ranking of the phenomena for each of the constitution pictures. Participants were also asked what terms they would use to characterize the phenomena and pictures. This resulted in the concepts used in the section on the Three Polar Types in Constitution at the beginning of this article.

The results of the two rounds of questions, the prioritized phenomena and the terms used to characterize the pictures, were utilized to develop an instrument for assessing children's constitution. It has a Dutch (IKC), English (ICC), and German (IKK) version at www.bolkscompanions.com/ICC (14).

This instrument can be used to assess children’s constitution in two ways. The first, analytical, method aids to determine the degree of one-sidedness or imbalance in polarly formulated phenomena on a seven-point scale. There are a total of 36 pairs of phenomena, i.e. 12 pairs prioritized phenomena for each of the three polar constitution pictures.

The second method aims to bring different observations together and is based on a Goethean-phenomenological approach of the polar pictures. We are asked to empathize with the child on the one hand and with the developmental dynamic between the polar extremes of the constitution pictures on the other. By comparing the picture of the child with the dynamic of the three pairs of constitution pictures, we may assess where the child’s picture belongs on the continuum of polar coordinates of a so-called visual analogue scale (VAS). The instrument offers a VAS scale for each of the three constitution pictures.

Completing the questionnaire of this diagnostic instrument when examining a child leads to its constitution profile, once found analytically and once as a whole picture. An example of such an analogue scale with the child’s constitution profile can be found in the Companion From Special Needs to Realizing Your Full Potential (6, p. 77, 86).

The physician and/or therapist’s task is to visualize and find meaning in the constitution profile found with the instrument such that it can contribute to the coaching and treatment of the child.

Second Research Project

A second study has provided insights into the use of the diagnostic instrument. We examined the results of 683 children and adolescents aged 4 to 23 that were documented with the instrument. Of these people, 269 were in outpatient care and 266 in clinical care, 148 belonged to a control group. The results of this research and a methodological study have been published elsewhere (15). We will mention one result of this study here. We researched the possibly of "disability-specific" constitution profiles.

This led to the following results: in 133 children with an autism spectrum disorder (ASD), the consolidating/compulsive tendency of shaping was accentuated. In 74 children with an attention deficit (hyperactivity) disorder, there was a one-sidedness predominance in all three areas of connecting, moving, and shaping that led to the characteristics of being open/out-flowing, restless/light, and dissolving/forgetful. In 62 children with a reactive attachment disorder (RAD), there was a clear shift in “connecting” to being open/out-flowing and in “moving” to being restless/light. In 33 children with Down syndrome (DS), sluggish/heavy movement dominated. We concluded that the diagnostic instrument can provide general guidelines for disorder-specific constitution profiles that may then be employed to support children with a specific developmental disorder.

Specific Suggestions

The starting point for both educational support and therapy is “to arrive at therapeutic measures in each individual situation knowing the principles of going from the underlying diagnosis to what needs to be done” (1, p. 43). The constitution profile’s coordinates that show along which lines the child develops, can provide direction for individual therapy. The aim in this is to help children find their own individual balance.

For education, this primarily means ensuring a healthy rhythm in life, alternating activity and relaxation, waking and sleeping, and intellectual and artistic- and manual work. In addition, Steiner gave many recommendations in the curative education course when he presented the constitution pictures, also when subsequently several children were presented and discussed. These turn out to be a source of inspiration today for developing individual coaching and psychological interventions that are tailored to the needs of the respective child.

Steiner pointed to the importance of the arts and their derived therapy forms as an important therapeutic source. He indicated how each of them is connected to the activity of the organizations of I and psyche and the physiological and physical organizations differently (16). One can derive specific recommendations from this as to which therapy suits which one-sidedness in the constitution profile, so that balance and harmonization can be promoted in shaping, connecting, and moving. The Curative Education Course develops specific recommendations for harmonizing one-sidedness in the constitution.

When we want to bring more harmony in the area of connecting, we must pay attention to the rhythmic process of sleeping and waking (1, pp. 43-49), especially the moments of waking up and falling asleep. In severe cases of one-sidedness, such as epilepsy, specific, including natural, medications may be recommended. Eurythmy is recommended for harmonizing movement in the constitution (1, p. 88f.), specifically the therapeutic sound series RLSI and MNBPAU: a lack of control of movement is treated with directed movement activity.

With the therapeutic interventions we want to provide a healing education that supports children in becoming more healthy as they grow up. Finding one’s own balance point, one's own center in life, is a central task for each individual.

Acknowledgements

I am very grateful to the children and staff at Zonnehuizen in Zeist. There I experienced and learned how special education can help children with developmental disorders and problems, in clinical and outpatient settings. Rüdiger Grimm advised me when writing this article. I have shared my enthusiasm for the constitution pictures of Steiner’s course on education for children with special needs with him for more than twenty years. I would like to thank Erik Baars, professor in anthroposophic health care at the University of Applied Sciences in Leiden, for his collaboration and support with the two research articles. I would also like to thank Christina van Tellingen for her collaboration in the Bolk's Companion Group and her support in writing this article. I would like to thank Martina Neff and Gerhard Hallen for their help in translating it into German.

Martin Niemeijer

Physician for children with special needs

Reseacher Kingfisher Foundation – Bolk’s Companion Group

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Source: Der Merkurstab, Heft 5, 2024

Constitution Typology in Curative Education

Constitution Typology
in Curative Education