By Fred Rosner, MD

In the beginning, religion and healing were inseparable.

In some societies, the priest and physician were one and the same person, administering spiritual and physical healing with divine sanction.1

The advent of scientific medicine in the middle of the 19th century separated medicine from religion nearly completely. A century later, the direct interrelationship between the body and mind became firmly established, although psychosomatic medicine had already been described in the 12th century by Moses Maimonides.2

Over the past several decades, there has been a broad revival of interest in spiritual healing and religious practice and health. The return to spirituality and religion by patients as an adjunct to their physical healing is no longer ignored by physicians and other caregivers. In a sense, religion can be considered a form of complementary or supplementary therapy.

At the culmination of a century of scientific discovery and medical progress, physicians and their patients are more open to a spiritual direction and alternative/complementary forms of medicine. Despite progress in cancer therapy, for example, complementary forms of treatment are adopted by about half the patients undergoing conventional cancer therapy, often from an early stage of their illness.

Contrary to stereotypes, patients who seek unproven methods tend to be well educated, upper-middle class, and not necessarily terminally ill or even beyond hope of cure or remission by conventional treatments.3

Why do people seek out alternative/complementary therapies, including religion and spirituality? Patients may be discouraged and in despair about the realities of conventional treatment. Fear, adverse effects, previous negative experiences, and a desire by the patient for more supportive care are other reasons.

People may be unhappy with the impersonal technology of modern medicine and seek to emphasize self-care and whole-body fitness: somatic, mental, and spiritual.

Religious or spiritual healing is never a substitute or alternative for standard medical care. Prayers,4 faith healing, amulets,5 and other expressions of belief in spiritual or religious healing have their place of honor alongside traditional scientific medicine.

The therapeutic efficacy of prayer has yet to be proven scientifically.6, 7 One might even say that studies on the "clinical efficacy" of prayer miss the whole point of the purpose of prayer: "Scientists seeking hard evidence of prayer's curative powers misunderstand the nature of prayer in the Western theistic traditions."4

Studies on the influence of religion and spirituality on health, illness, and well-being confirm the presence of spiritual and religious beliefs in medical practice.8 In 1967, JAMA created a medicine and religion department9 and has since periodically published review articles on medicine and religion10 and on religion and spirituality in medicine.11

Statistically significant associations between religious belief and health outcomes have been reported for a variety of diseases in systematic reviews and meta-analyses.12 Much of the research suggests that an active religious commitment is "beneficial for preventing mental and physical illness, improving recovery and enhancing the ability to cope with illness."13

If the above statement is correct, the obvious question is how does religion or religious commitment contribute to good health? What mechanism explains this better health?

Religion may help people cope with stress.

Religion may act as an analgesic to reduce physical and mental pain. Religious commitment may protect against depression and suicide. Religion may promote health by adding social or psychological support (or both) to people's lives, by providing a perspective on stress that reduces its negative impact, or by encouraging people to avoid risky behaviors, such as drinking alcohol to excess.14

Religiousness and spirituality may also be beneficial in medical rehabilitation and in the lives of persons with disabilities.15

Religion and spirituality can improve the quality of life by enhancing a patient's subjective well-being through social support and stress and coping strategies,16 promoting a salubrious personal lifestyle, by providing systems of meaning and existential coherence, by establishing personal relationships with one's deity, and by ensuring social support and integration within a community.17

By contrast, critics of studies that suggest that church, synagogue, or mosque attendance; religious beliefs; and prayer improve morbidity and mortality refute these studies as technically flawed.18, 19 After the confounding variables are removed from the studies, the results are almost always statistically insignificant.

Failure to control for multiple comparisons and conflicting and inconsistent findings are additional criticisms, thus making it "premature to promote faith and religion as adjunctive medical treatments."18 The evidence linking religion to health outcomes is rather meager.

Few physiological studies have assessed the relationship between religious commitment and health promotion. This subject does not easily lend itself to such studies.

As mentioned above, however, such studies on clinical efficacy of religious practice miss the point: "Religion is more than a collection of views and practices, and its value cannot be determined instrumentally; it is a spiritual way of being in the world."19

Thus, although many researchers conclude that a link exists between religion and health, they speculate about the mechanism. Some believe that religious doctrine incorporates many health-promoting rules and recommendations.

Controversy surrounds the ways in which physicians should respond to the renewed tendency to link medicine and religion.20 Clinical studies continue to clarify how spirituality and religion can contribute to the coping strategies of many patients with severe, chronic, and terminal conditions.

Physician attention must be devoted to the spiritual and religious dimensions of patients' experiences of illness. Physicians must respect their patients' requests for pastoral care and religious services.21

The priest and the physician are no longer one and the same person as they were in biblical times. However, the services each provides should complement and supplement each other for the benefit of the patient and the patient's total physical and mental well-being during health and illness and at the end of life.

Major conferences on spirituality and healing in medicine are being held to bring "acknowledgement of patients' spirituality to the mainstream of medical education, research and clinical care, and to provide opportunities for students and physicians to learn how to assess, respect and incorporate patients' spiritual perspectives."11

Fred Rosner, MD
Mount Sinai Services
Queens Hospital Center
82-68 164th St
Jamaica, NY 11432

References

1.Preuss J.Julius Preuss' Biblical and Talmudic Medicine. Rosner F, trans. Northvale, NJ: Jason Aronson Inc; 1993.

2.Rosner F.Psychosomatic medicine.In: Medical Encyclopedia of Moses Maimonides. Northvale, NJ: Jason Aronson Inc; 1998:183-184.

3.Cassileth BR.Unorthodox cancer medicine.Cancer Invest. 1986;4:591-598.

4.Cohen CB, Wheeler SE, Scott DA, Edwards BS, Lusk P, for the Anglican Working Group in Bioethics.Prayer as therapy: a challenge to both religious belief and professional ethics [review].Hastings Cent Rep.2000;30:40-47.

5.Rosner F. Can an amulet cure leukemia? JAMA.1999;282:307.

6. Astin JA, Harkness E, Ernst E. The efficacy of "distant healing": a systematic review of randomized trials [review].Ann Intern Med. 2000;132:903-910.

7. Harris WS, Gowda M, Kolb JW, et al. A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch Intern Med.1999;159:2273-2278.

8. McBride JL, Arthur G, Brooks R, Pilkington L. The relationship between a patient's spirituality and health experiences. Fam Med. 1998;30:122-126.

9. Rhoads PS. Medicine and religion: a new Journal department. JAMA.1967;200:172.

10. O'Donnell TJ. Medicine and religion: an overview. JAMA. 1970;211:815-817.

11. Levin JS, Larson DB, Puchalski CM. Religion and spirituality in medicine: research and education. JAMA.1997;278:792-793

12. Matthews D, McCullough M, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status: a review of the research and the implications for family medicine. Arch Fam Med. 1998;7:118-124.

13. Hassed C. Spirituality and health [review]. Aust Fam Physician.
1999;28:387-388.

14. Larson DB, Koenig HG. Is God good for your health? the role of spirituality in medical care. Cleve Clin J Med. 2000;67:80-84.

15. Underwood-Gordon L, Peters DJ, Bijur P, Fuhrer M. Roles of religiousness and spirituality in medical rehabilitation and the lives of persons with disabilities: a commentary. Am J Phys Med Rehabil. 1997;76:255-257.

16. Daaleman TP, VandeCreek L. Placing religion and spirituality in end-of-life care [commentary]. JAMA. 2000;284:2514-2517.

17. Ellison CG. Religious involvement and subjective well-being.
J Health Soc Behav. 1991;32:80-99.

18.Sloan RP, Bagiella E, Powell T. Religion, spirituality, and medicine [review]. Lancet. 1999;353:664-667.

19. Sloan RP, Bagiella E, VandeCreek L, et al. Should physicians prescribe religious activities? N Engl J Med. 2000;342:1913-1916.

20. Gundersen L. Faith and healing. Ann Intern Med. 2000;132:169-172.

21. Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med. 2000;132:578-583.

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