Es ist nichts Gesundes an meinem Leibe

Andreas Kruse

Stepping through a borderline situation

Whether Bach’s cantata “Es ist nichts Gesundes an meinem Leibe” (BWV 25) or poems by Andreas Gryphius and Paul Fleming: Baroque literature and music are of great importance today for a personal reflection on a serious illness.

Why do people who suffer from a serious, chronic illness or who have an illness leading to death not infrequently feel addressed and touched by texts and music from the Baroque period? Why do these people perceive a poem or a composition from the Baroque period as a spiritual enrichment? My answer is: poems and compositions written in the Baroque period address a psychological and existential situation that is in part similar to that which people also experienced in the Baroque period: This is the confrontation with one’s own vulnerability, with a borderline health situation, with the fact of approaching finitude. Of course, the borderline and vulnerability experiences made in the 16th, 17th and early 18th centuries cannot be compared with those people are confronted with today. To take an example from the 17th century: The Thirty Years’ War (1618 – 1648), epidemics and the “Little Ice Age” (a drop in temperature with famine winters occurring in the middle of the 17th century) confronted people in the Baroque era with unimaginable suffering and made them aware of their own vulnerability in a special way. For this reason, poems by Andreas Gryphius, to choose one of the most important representatives of Baroque literature, when they speak of “illness”, do not only address the physical illness, but also and above all the illness, i.e. the profoundly disturbed order of the world. And yet the metaphors chosen in the Baroque period, especially those related to illness, are also not infrequently close and immediately comprehensible to the individual in the present. And not only the disease-related metaphors, but also the growth-related metaphors that point to the potential of soul-spiritual development in the case of a serious, chronic illness that may lead to death.
I now turn to two poems by the poet Andreas Gryphius to illustrate this statement – namely, the potential for being touched by Baroque literature even in the present day. The first poem, Thraenen in Serious Illness, emphasises the experience of vulnerability, frailty, the finiteness of life; the second poem, Contemplation of Time, emphasises man’s ability to be creative in all situations of his life – thus also in the borderline situations of life. It is precisely in this connection of the experience of limits with the experience of the creative moment that lies an essential message of Baroque poetry, which can help us to approach the situation of a sick person with sufficient sensitivity – a sensitivity that not only perceives and specifically addresses the limits but also the strengths or powers of that person.

Thraenen in serious illness

I am not who I was
the forces have disappeared
The gliders are withered
as a burnt-out soot:
Black death looks out to both my eyes
I am no longer found within myself.
(…)

So am I also wetted with dew of thrace:
So I die before the time. O earth, good night!
My stuendlein runs to the end
Now I am awake
And am taken by the sleep of death.

In this poem, the experience of vulnerability and decrepitude leads to a confrontation with one’s own finitude: the order of life and the order of death become more and more intertwined in the human experience, until gradually the order of death dominates the experience. The statement “I am no longer found in myself by myself” is of particular significance for the psychological situation of the seriously ill person, indicating that the individual is in danger of losing more and more of himself, of forfeiting more and more of his identity.
This poem contrasts with Betrachtung der Zeit, a poem by Gryphius, which is to be interpreted as an expression of individual reflection on the personal past and future as well as an expression of the contemplation of one’s own strengths and powers arising from this reflection: these strengths and powers are seen in the current shaping of the self and the world (present). The emphasis here is entirely on the transcendental reference: God has given us time (and thus also the possibility of shaping ourselves and the world), which ultimately merges into eternity (timelessness).

Contemplation of time

Mine are not the years that time has taken from me /
Mine are not the years / that might come
The moment is mine / and I take it into account
Then he is mine / who made year and eternity.

The emphasis on the “moment” – in which people can be creatively active – shows kinship with the psychological concept of self-actualisation, which can be understood as a fundamental human motive to express oneself, to communicate, to differentiate. (With the concept of self-actualisation, we also come close to the creative aspect of the human being). On the one hand, it is important that the “moment” emphasised in Andreas Gryphius’ poem describes the possibility of self-actualisation in all situations in which people feel motivated to shape themselves and the world. On the other hand, it is significant that we explicitly recognise and address the possibility of self-actualisation also in people with a far advanced disease. If we follow this poem, the transcendental dimension of our experience and behaviour must not be excluded – it is even central to the understanding of the poem: in the life given to us by God, in the life given to us, lies its decisive message.

There is nothing healthy in my body – turning to healing
From this attempt to briefly characterise a human attitude towards the world and transcendence that appears in Baroque literature, I now move on to the cantata Es ist nichts Gesundes an meinem Leibe (BWV 25). At the centre of the cantata is first of all the human being marked by serious illness, the description of specific illnesses and symptoms of illness, the mention of therapies, and finally the – albeit rather indirectly expressed – fear of the sick person of being shunned by other people because of his outwardly visible symptoms of illness (“bumps”). The patient’s complaint about the threat to their identity and life leads to the question of where “advice” can be found. Conventional therapy methods alone are not enough. Mental and spiritual advice is also needed: Jesus Christ is interpreted as the “best cure for the soul”. Turning to Jesus Christ is seen as the path to healing, whereby this describes not only physical healing (restitutio ad integrum), but also and above all soul-spiritual healing (restitutio ad integritatem). This soul-spiritual healing is mediated by the promise of redemption: namely, to be transformed in death (vita non tollitur sed mutatur) and to experience eternal life – a life in which every form of illness and dejection is taken away. In this cantata, the physical and spiritual suffering of human beings is not denied: rather, the vulnerability of human beings forms its starting point. In the text of this cantata, the sick person passes through a borderline health situation which at the same time leads him to the limits of his individual (as well as his social) existence. In the face of these limits, despair is clearly audible. But the cantata does not stop at despair. Rather, it shows a way out of this despair, whereby in treading this path, the soul-spiritual resilience – described in psychology and psychiatry with the term “resilience” – becomes visible. The sick person can counteract the physical suffering – whereby, in the words of the cantata, turning to Jesus Christ, thus becoming aware of the insertion of one’s own life into a divine order, forms a decisive basis for this resilience. But another basis must not be overlooked here: the ability of human beings to concentrate on themselves and their own spiritual powers to such an extent and in such a way that the realisation of the integration of their own lives into a divine order becomes possible in the first place.

Border crosser Johann Sebastian Bach
But now the question arises: Is this really referring to the physically seriously ill person, or is it not rather a metaphor for illness as a consequence of sin, as is expressed in Psalm 38: “There is nothing healthy in my body because of your threatening, and there is no peace in my bones because of my sin”?
This is the place to also characterise Johann Sebastian Bach as a border crosser, as I did in the book Die Grenzgänge des Johann Sebastian Bach: Psychologische Einblicke (2nd edition, Springer Spektrum, Heidelberg 2014). According to this border-crosser interpretation, Bach integrates a theological and a musical dimension with a psychological dimension. This means: theological statements, which in their self-understanding touch the core of the human being, are explicitly also considered in their psychological aspects. Thus, when speaking of a sick person, Johann Sebastian Bach’s work does not only speak of the sick person in religious terms – that is, of a person who is aware of the transitoriness of the flesh and relies on the incorruptibility of the spirit (Romans 8:1: “So there is nothing condemnable in those who are in Christ Jesus; who do not walk according to the flesh, but according to the Spirit”) – but also of the sick person in psychological terms: the illness is experienced very directly, as a physical torment, combined with the worry, if not the fear, of no longer being able to control it in its further course, of being virtually at its mercy, of “sinking” more and more into it. Just think of patients suffering from a malignant tumour, patients suffering from Parkinson’s disease or dementia: the worry or fear of being “struck down” by this disease (as many people express it) is a central moment of experience and interpretation for the sick person. This transfer from a religious to a psychological statement succeeds for the border crosser Bach through the music: it touches the person in such a way, it translates the religious statement into a directly life-worldly one, that the listener of the music feels directly addressed, that he relates the statement made completely bodily, completely soulfully to himself. The listener now feels affected by the serious illness of another person and realises that he also perceives his own fate in the fate of the other person. He realises that something profoundly existential is happening here, something that also affects him or will affect him one day. Music in its interpretation of the religious statement is what makes this statement existentially alive in the human being, what makes the psychological dimension of this very statement “vibrate”. Music is, so to speak, the soul-spiritual sounding board of the religious statement. For this reason, the listener is directly affected and touched by this cantata: he feels directly addressed, the music touches him deeply, he transfers the statements of the cantata directly to himself. This is what happens to many listeners when they hear Johann Sebastian Bach’s music: even non-believers who attend a performance of the St Matthew or St John Passion feel touched by the Passion event because it is expressed musically in such a way that they can no longer escape it.

The way to address seriously ill people
Let us now ask: What do seriously ill people need? And: What suggestions can the cantata BWV 25 give us here?
Before I turn to this question, I will briefly discuss three contributions to the understanding of health and becoming healthy that are essential to answering this question. The philosopher Hans Georg Gadamer starts from the assumption that the essence of health remains hidden from the healthy person: When asked what he or she understands by health, he or she cannot give a differentiated answer. Only in the case of illnesses does it become clear to the person what he or she understands by health: namely, what he or she is currently lacking. For healthy people, health initially remains hidden; this gives rise to the task of reflecting in times of health on the question of what characteristics characterise health in one’s own understanding, and what one can do oneself to maintain health. In addition, people should look for answers to the question of how far different dimensions of health can be differentiated, for example, a physical, functional, mental-spiritual dimension. In the case of illnesses that have occurred, this differentiation is very important: because even if losses and disorders have occurred on the physical dimension, a high development potential can still be seen on the functional, but above all on the mental-spiritual dimension, which is to be understood as a characteristic of health. As a result of my own research on the internal processing and external coping with chronic diseases in old age, I have differentiated between four dimensions that have to be taken into account when analysing the occurrence of a disease and the processing or coping with this occurrence: a physical, a cognitive, an emotional and an existential dimension. In the course of therapy, all four dimensions must be addressed, “healing” must be sought on all four dimensions. Gadamer has emphasised in several works that a chronic illness, especially the illness-associated pain, encompasses the human being and constantly challenges him anew. He can only “get over” the illness or the pain if he becomes aware of what holds and supports his life. This is linked to the task of a comprehensive evaluation of one’s own life: Aspects of life that previously appeared to be “taken for granted” may now turn out to be the supporting foundations of life. – In his theory of salutogenesis (translated: “How does health come about? How do we maintain health?”), the medical sociologist Aaron Antonovsky identified the sense of coherence as the psychological process that contributes to maintaining mental health even under the influence of (sometimes extreme) stressors. Sense of coherence means: We are bound to individual sections of the world, and this being bound conveys the conviction that life, even in the case of highly stressful experiences, always proves to be coherent, meaningful, meaningful. A sense of coherence also means that we are convinced that we can understand and shape our lives and the world around us despite stressful experiences. Aaron Antonovsky sees the strengthening of the sense of coherence as an important component of an interdisciplinary therapy. – The founder of psychosomatic medicine, the physician and physiologist Viktor von Weizsäcker, emphasises that health is not to be understood as a capital to be accumulated, but that health is only present where it is generated at every moment of life. Similar to Aaron Antonovsky, Viktor von Weizsäcker also emphasises the (physical, cognitive, emotional, social) resources of human beings that enable them to maintain or restore health – this broad understanding of resources is based on a comprehensive concept of the person.
So now back to the question: What do seriously ill people need? What suggestions can the cantata BWV 25 give us here? Against the background of the findings we have gained at the Institute of Gerontology at the University of Heidelberg in our research on the course of illness, therapy, rehabilitation and quality of life in older people, the following aspects are important to me (see also: Andreas Kruse, Lebensphase hohes Alter: Verletzlichkeit und Reife, Springer Spektrum, Heidelberg 2017): an interdisciplinary diagnosis (which integrates medical, nursing, neuropsychological, psychological, social and spiritual characteristics), a drug therapy that is optimally adapted to the course of the illness (this means: medication must be continuously reviewed and adjusted if necessary), rehabilitation aimed at promoting and maintaining physical, mental and social-communicative functions, psychological or psychotherapeutic accompaniment aimed at strengthening emotional and mental processing and coping techniques, social work that shows possibilities for reintegration and social participation, finally spiritual or religious accompaniment that enables the thematisation of questions of meaning and God. Depending on the specific disease, these different disciplines with their different contributions to diagnosis and intervention are to be weighted differently. However, in the case of the treatment of a chronically ill person, especially a seriously ill person, this comprehensive diagnostic and therapeutic concept should be offered as a matter of principle. Understanding, accompanying and counselling a chronically or seriously ill person always means understanding and addressing them from different perspectives.
It is important to remember that every illness is unique, has never been seen before and will never occur again. On the one hand, each disease should be understood in its scientific basis (and thus be classified in a generally valid disease theory – nosology), but on the other hand, it should also be understood in its individuality: Individuality here means above all the individual process of processing and coping with the disease, which in turn is influenced by the values, life goals, life commitments and life perspectives of the individual.
Offering a seriously ill person a professionally sound and tested diagnosis and intervention: this is the first task of care. But it is not the only one. There is another one: to continuously offer this person the possibility to talk about his personal life situation, his hopes, worries and fears, to express and discuss thoughts on processing and coping with the illness as well as on the further shaping of himself and the world in an emotionally and spiritually appealing atmosphere. In other words, this person must be given the opportunity to concentrate more on himself, to perceive and understand his psyche in its various expressions, to become a friend to himself, i.e. to take responsibility also for himself (and not only for other people).
In this process, and this is an important thought for me, reading texts together, listening to music together, even looking at a picture together can be of great value. I have met people (with a tumour disease, a dementia disease, after a stroke) who were grateful to me when, after discussing neuropsychological findings or specific rehabilitation strategies, I came up with the possibility of listening to a poem or a short story or a piece of music together or looking at a picture – and exchanging the experiences made in the process of listening together, of looking at things together. Poems from the Baroque period and the music of Johann Sebastian Bach had a particularly inspiring effect – because they were immediately appealing, comforting, encouraging and opened up new perspectives. It is precisely here that the cantata Es ist nichts Gesundes an meinem Leibe could have a stimulating effect.
It should be added that one of the founders of our medical system, Moshe ben Maimon or Maimonides (1134 – 1204), physician and philosopher, differentiated between (I) the prevention of illness, (II) the treatment of acutely ill people and (III) the treatment and care of chronically ill people. He recognised in the treatment and care of chronically ill people a special task, challenge and opportunity of medicine: here, according to Maimonides, the “spiritual dimension” of medicine becomes apparent in a special way. For the processing of a chronic illness is not only a physical, but also a deeply spiritual process. Consequently, the patient and the doctor must “come together spiritually”, must also “meet spiritually”, so that the doctor can get a picture of how the patient experiences the world, himself and the illness, so that the patient experiences in the encounter the stimulation to deal responsibly with the illness and the further course of life.

Ups and downs in Johann Sebastian Bach’s life
Now I would like to turn my attention to the biography of Johann Sebastian Bach – and this under the heading of ups and downs. For the cantata BWV 25 deals with a borderline situation in our lives – and Johann Sebastian Bach’s life was determined by confrontation with borderline situations at several points in time. Do we perhaps also find in the cantata BWV 25 a hint of how the composer might have dealt with borderline situations (since we have hardly any autobiographical sources of Bach’s, we have to rely on assumptions here)?
Johann Sebastian Bach showed a high degree of diligence, of openness, of creative powers in all phases of his biography. Even as a child and at school, he was enthusiastic about music – which also had something to do with the fact that the town pipers of Eisenach regularly rehearsed in his parents’ house (Bach’s father Ambrosius Bach led the consortium of town pipers). At the same time, he was one of the best in his class at school. At the age of 15, he set off with his school friend Erdmann from Ohrdruf in Thuringia to Lüneburg to apply for a “free table” (scholarship) there – at the Michaelis Monastery; this application was accepted, so that Bach was able to take his Matura at the school there at the age of 17. In the further phases of his biography, Bach impressed not only as an organ examiner and organist (he received his first employment at the age of 18 in Arnstadt), but also and above all as a composer, orchestra and choir director (the office of Thomaskantor may be mentioned here as representative of numerous offices). His compositions reveal a creativity that can hardly be surpassed – not only in terms of the scope of his oeuvre, but also in terms of its quality: Bach not only fulfilled the standards of the highest compositional art that existed at the time, but also set completely new standards, for example with the Missa in B minor, with the Musical Offering, with the Art of the Fugue – whereby only three examples from his late work have been cited here. If one were to refer to his middle creative period, the St. John Passion and the St. Matthew Passion would have to be mentioned as examples of compositions with which Bach set standards. In addition to the creative richness of his compositions (as a prominent feature of his creativity, which lasted until the end of his life), Bach was distinguished by his comprehensive education (for example in philosophy and theology, mathematics and Latin) as well as by his great commitment to his pupils (he took in a pupil during the last months of his life).
At the same time, Bach’s life was marked by numerous, heavy and most difficult burdens. These include the loss of both parents at the age of ten (after the death of his parents, Johann Sebastian Bach was taken in by his eldest brother and lived with him for five years), the death of his first wife Maria Barbara in his 36th year, and the death of his first wife Maria Barbara in his 80th year. (whereby, after returning from a six-week concert tour, he learned that his wife had died and had already been buried and that his four children had been divided among several families), the death of eleven of his 20 children, the health restrictions in the last years of his life and, finally, the mortification that a successor to him as Thomaskantor had already been appointed a year before his death. In addition, Bach had to deal with criticism throughout his professional life, criticism that was directed at his music, which was highly modern for the time, and that made him realise that his extraordinary talent and creativity were not recognised by ecclesiastical and secular superiors – a fact that pained him.
But in these stressful situations, a high degree of psychological resilience was also evident, i.e. the ability to process and cope with stress and to develop creative forces in this process, which benefited his will to live as well as his way of life. Resilience was fostered by the composer’s integration into different orders: In the order of the family (Johann Sebastian Bach looked back on fruitful first years of life and even after the death of his parents he found support in the family), in the order of music, in the order of faith (which formed the cantus firmus of his compositions), in the order of social relationships (here above all the co-responsibility for subsequent generations – his children, nephews, pupils – should be mentioned). These orders were to prove very stable and thus supportive over the course of his entire biography. And finally, Johann Sebastian Bach developed his own initiative at an early age, was always open to new impressions, and showed great diligence in all phases of his life. In this way he created the basis for his extraordinary productivity and creativity right up to the last phase of his life.
In the last years of his life, Bach suffered from the consequences of diabetes mellitus type II, he gradually lost his eyesight (his blindness was also caused by two failed eye operations by the London “cataract surgeon” John Taylor), and he was finally no longer able to write down his compositions himself due to severely limited motor skills, but had to make use of the help of his students. Shortly before his death, he suffered a stroke. And yet, despite these health restrictions, he worked on and completed the Musical Offering, systematically continued the Art of the Fugue, which, although it could not be completely written down (the Contrapunctus 14 breaks off after the introduction of the last fugue theme), was very probably completed in Johann Sebastian Bach’s imagination, completed the B minor Mass and, shortly before his death, created the chorale Vor Deinen Thron tret ich hiermit.
If one condenses and combines the biographical statements that can be made with regard to the last years of Johann Sebastian Bach’s life and the musical-symbolic statements that form the basis of his last works, the following themes – expressed in first person – can be differentiated (the psychological term to which the respective theme can be assigned is listed in brackets):

(I) I live in God, in other people, in my work.
(relatedness)
(II) I perceive my creative powers
(self-actualisation)
(III) I shape my life
(self-shaping)
(IV) I penetrate deeper and deeper into music, strive for its perfection
(creativity)
(V) I pass on my work to future generations of musicians (generativity).
(generativity)
(VI) I take on responsibility for other people
(co-responsibility)
(VII) I perceive myself in my vulnerability
(Vulnerability)
(VIII) I perceive myself as part of the divine order
(Gerotranscendence)
(IX) I look gratefully at my life, my life as a fragment
(I-integrity)
(X) I expect the resurrection of the dead, eternal life
(Religiosity)

These themes and psychological terms reflect a rich soul-spiritual life that makes clear which creative forces can also be effective at the end of life, provided that this life stands in references that motivate to sense and realise these creative forces. These references are clearly recognisable at the end of Johann Sebastian Bach’s life: the Great God, family members, pupils and friends, music. Bach invested a great deal of spiritual energy in these references. The relatedness expressed here thus appears as a basis both for the discovery and realisation of creative potentials and for the self-design of life at the end of life.
Many of these themes (as well as the psychological concepts associated with them) are explicitly addressed in the cantata BWV 25. This cantata – this is important here – was published only three years after the death of Maria Barbara (publication date: August 1723). As explained, the death of Maria Barbara was a blow for Johann Sebastian Bach, indeed, it represented a traumatisation. Three years later, a cantata appears that is dominated on the one hand by sighing (think here of the sighing motifs with which the cantata begins), and on the other hand by the promise of redemption. Does this also reflect a very personal form of processing and overcoming suffering?

Soul-spiritual energy reflects the weakening of physical capacity
The cantata seems to me – musically speaking – like the entry into a work that has been sounding for a long time; psychologically speaking, we are not at the beginning of this work, but more or less in the middle of it: this is the impression I get when I hear the first bars of BWV 25. This could lead to an interesting interpretation – of the following kind: at the end of his life, Johann Sebastian Bach worked intensively on the Credo in unum deum and the Confiteor in unum baptisma, two parts of the Missa in B minor that refer in a special way to his faith in the Great God. In both movements, he builds a fugue over the respective cantus firmus motif that captivates every listener: Here the I believe (credo), here the I confess (confiteor) is declaimed with a musical power that one would never believe that a physically highly vulnerable person, already feeling finitude very clearly, had written these movements. The spiritual energy expressed in the Missa in B minor contrasts with the increasingly weakening physical capacity. This shows that even in the face of one’s own death, soul-spiritual developmental steps can be taken – for example, in Johann Sebastian Bach’s case, the affirmation of his faith in the Great God with the increasing certainty that he would soon die. If we now accept the impression conveyed by the opening bars of BWV 25 – namely, that we are just entering a work that has already been sounding for a long time, that we are actually already in the middle of it at the beginning of this work: can we not then say that this work describes a process of processing and coming to terms with things that had already been going on for a long time, that was continued in this work and after it, and that reached its climax and conclusion with the Credo in unum deum and the Confiteor unum baptisma?
I have begun with two poems from the Baroque period and conclude with the Baroque poem An Sich, written by Paul Fleming (1609 – 1640), in which much of what this reflection was intended to say is condensed.

To oneself

Be yet undaunted. Give nevertheless unsuspiciously.
Do not give way to fortune. Stand higher than envy.
Take pleasure in yourself
And consider it no sorrow
And in a moment you will be happy again.
Place
and time conspire.
What cheats and delights you
Consider all things chosen.
Accept your fate. Leave everything unrepentant.
Do
what must be done
And before it is given thee.
What you can still hope for
That will always be born.
What do you complain about
what do you praise? His misfortune and his happiness
is his own. Look at all things.
All this is in you
leave your vain delusion
and before you go further
then go back into yourself.
He who is his own master
and can control himself
the wide world and everything is subject to him.

This text has been translated with DeepL (www.deepl.com).