In Steiner's 1920 medical course, neurasthenia is a functional excess of the upper nerve-sense sphere and hysteria its mirror excess in the lower metabolic sphere.
Neurasthenia and Hysteria as Sphere Excess in Anthroposophy is Rudolf Steiner's account of the two basic directions in which the human organism falls ill, given to physicians in Spiritual Science and Medicine (GA 312), the first anthroposophic medical course held at Dornach in 1920. Neurasthenia names a functional excess of the upper, nerve-sense sphere: processes that should pass downward through the heart remain above and never enter the lower organic currents. Hysteria names the mirror excess of the lower, metabolic sphere: external chemical activity the upper pole is too weak to master. Steiner uses both words far more widely than the clinic of his day, as the two poles of every disease physiognomy. The irregularity begins in the etheric body, what Paracelsus called the Archaeus, as disturbed function before any organ changes. In practice this trains the diagnostic eye clinicians now apply to functional disorders.
Neurasthenia and Hysteria as Sphere Excess is the polarity at the centre of Steiner's 1920 medical course: illness leans either upward, when nerve-sense activity refuses to descend through the heart, or downward, when metabolism runs on with a life of its own. Read this way, the two old clinical names become directions of imbalance, a physiognomy of disease that a physician learns to see before any organ shows damage.
In Steiner's Own Words
Neurasthenia is a functional excess of the upper sphere. The organs of that sphere are too much occupied, so that processes which should be transferred and conducted downwards through the heart, take place in the upper sphere and do not pass into the lower organic currents (harmoniously mediated by the damming up in the heart). You will observe that it is much more important to become aware, so to speak, of the specific physiognomy of the disease than to study by post-mortems the organs which have become defective. For post-mortems reveal only the results and symptoms. The essential thing is to form a comprehensive picture of the whole morbid condition; to visualise its physiognomy. This physiognomy will always reveal a tendency in one or the other direction towards the Neurasthenic or the Hysterical Type.
What it Means Today
A century after the Dornach course, mainstream neurology has circled back to the territory Steiner marked out as functional. When the American Psychiatric Association published DSM-5 in 2013, conversion disorder, the direct descendant of nineteenth-century hysteria, was renamed functional neurological symptom disorder, and the old requirement to prove a hidden psychological cause was dropped. The condition is now diagnosed by positive rule-in signs, such as Hoover's sign of functional leg weakness, rather than by exclusion. Jon Stone, professor of neurology at the University of Edinburgh, has led much of this shift; his patient resource neurosymptoms.org, launched in 2009, tells patients that their symptoms are real, common, and arise from a disturbance of function rather than of structure. That sentence could serve as a plain-prose summary of Steiner's claim in the second Dornach lecture: the irregularity is real, and it lives first at the level of function, in the etheric organisation, before it stamps itself into the organs.
Where the two accounts part company is direction. Functional-disorder research describes a disturbance; Steiner's physiognomy reads which way it points, upward into the nerve-sense pole or downward into the metabolic pole, and lets that direction guide the remedy. Thalira synthesis: the rule-in sign that modern neurology prizes is, in Steiner's terms, a first exercise in reading sphere excess directly, catching the etheric gesture of a disease while the post-mortem still has nothing to show.
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