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What is medical spirituality and why does it matter?

At first glance, spirituality seems as irrelevant to the practice of medicine as designer jeans. After all, western medicine is based on objective science, not something that everyone agrees is highly personal and subjective.

But spirituality in medicine is gaining a good deal of attention in the nation's medical schools, and I find myself drawn to it when working with certain patients or certain problems. For those who are so inclined, spirituality can be a potent healing force. It has particular potential in relieving suffering, or in illnesses where stress or fear worsen symptoms.

Let me be clear that I am not trying to sell a particular religious tradition or belief system. I am not clergy. I would never want a patient to feel pressured or uncomfortable. I prefer to listen and, where appropriate, be supportive. One's religion and spirituality are more personal and intimate than sex. It would be extraordinarily inappropriate to proselytize.

Yet there is abundant evidence that the potential for religious or spiritual experience resides within everyone. (See William James' classic book Varieties of Religious Experience.)

Here's an analogy. Many of my adult patients have at some time in their lives had really great sex. If you've ever enjoyed terrific lovemaking, you've realized that this highly fulfilling activity is part of our basic equipment. While not everyone has had the experience, clearly the possibility of great sex is part of our human birthright, potentially available to anyone.

Spirituality is also part of our birthright. Sometimes it's a lot more work than sex, but the potential outcome is more rewarding. How you do this is up to you; it must fit within your values and belief system.

While many people equate religious experience to their individual belief system, in fact men and women from various traditions who have worked hard on their spirituality resemble each other more than they do those less advanced within their tradition. Something here is universal. It is the universal that I find most compelling.

To be sure, if your religious approach emphasizes belief in a particular faith tradition, and you're well connected within your religious community, your existing relationships may completely fulfill your needs. Or you may be vehemently opposed to anything that smacks of religious folderol. In either case, feel free to skip this section.

I'm writing on this topic for three reasons. First, it is an undertaking I find intensely and personally meaningful. Second, spirituality has enormous healing potential. Since part of my practice focuses on addiction and alcoholism, the particular example that comes to mind is Alcoholics Anonymous and similar "12-step" programs. People who've worked hard and stuck with these programs regularly experience a whole-life transformation that is unparalleled in medicine. Equally revolutionary change occurs occasionally in nonalcoholic individuals with life-threatening illness. Third, healing available through spirituality does not exist in any other medical approach. Psychotherapy is simply not the same.

Spirituality in the medical literature

The most frequent medical journal references assess the health benefits of participating in a church or similar religious community. This approach is exemplified in Dr. Dale Matthews' book The Faith Factor, which details dramatically improved medical outcomes among regular churchgoers in every illness tested. It turns out that outward displays of faith don't accomplish much. What's needed is called "intrinsic religiosity," i.e., an inner personal commitment to faith/spirituality and religious practice. However, this literature regards religion as something beyond the scope of medicine, like whether you're married or how much money you make.

A second common theme is how to take a spiritual history from a patient, so a physician can determine how a person's religion may affect their medical care. My favorite approach is Dr. Anandarajah's HOPE mnemonic: 1) sources of Hope, strength, comfort, meaning, peace, love, and connection; 2) role of Organized religion; 3) Personal spirituality and religious practices; and 4) what Effects does the patient's religious/spiritual perspective have upon medical care and end-of-life decisions? Similarly, there's FICA: Faith/belief; Importance to you; to which spiritual Community do you belong; and how would you like the physician to Address or include your beliefs? The purpose of these approaches is to respect a patient's spiritual or faith perspective within the context of traditional medical practice.

More interesting is Dr. Herbert Benson's work on what he calls the Relaxation Response, which is a particular kind of daily prayer or meditation. (A recent book is his Timeless Healing.) He and others have shown that regular prayer or meditation decreases metabolism and lowers blood pressure, muscle tension, and respiratory and heart rates. They've proved benefits in treating high blood pressure, heart problems, chronic pain, insomnia, anxiety, depression, low self-esteem, infertility, cancer, and AIDS symptoms.

Similarly, Dr. Jon Kabat-Zinn has studied mindfulness meditation in treating chronic pain. I understand that some of Kaiser's pain management clinics in northern California have incorporated his method in their treatment and find it extremely effective.

My approach

I'll start by describing the ground of being, which becomes available with spiritual practice such as mindfulness meditation, prayer, or the Relaxation Response. The "Opening the Doors of Perception" exercise is another way to taste this experience.

Quieting ordinary mind opens one to a qualitatively different experience. Silence becomes a sacrament, rich and moving. One develops an exquisite intimacy with the ordinary. There may be tears of joy and a sense of finally coming home. One's day-to-day sense of self relaxes and lets go into the bubbly quiet. There is a sense everything is connected and serves a common purpose. Initially, one's contact with the ground of being is occasional and tenuous. But with practice and over time, it deepens and becomes more tangible and real. You'll find you perceive the world around you more accurately and with greater understanding.

A major barrier to experiencing and staying with the ground of being is the emotional distress that arises when we try to stay in the present moment. Which particular emotion comes up changes from time to time. Our culture teaches us that painful emotions are bad and must be avoided, but for the right people, creating a support system to hold and explore emotions moves one through them into exhilarating freedom.

Who should avoid spirituality in medicine?

One problem with putting self-help information on a web site is the possibility people may use it who shouldn't. A good rule in medicine is anything powerful enough to be helpful is powerful enough to cause harm in some circumstances.

Opening to one's deeper self may not be a good idea if you have ever had a serious mental illness or have been a patient in a psychiatric hospital. Avoid these exercises if you hear voices, have suicidal thoughts, or have been told you have manic-depressive illness. If you find it requires a lot of effort to bury painful emotions and other distressing experiences, please speak with your therapist or physician before engaging in meditation. If you are part of a church, work with the clergy and support staff there to determine the best religious practices for you to use.

Sometimes I talk about "ego" as something we need to overcome. But in fact no one can do the work I describe without a healthy ego: a strong sense of self and the ability to function effectively in the world. If you're struggling to do the basics like finding a job, a place to live, and people with whom you can relate effectively, do not undertake this approach. If you try it and bad things happen, stop immediately and get help. Similarly, if you're now actively abusing drugs or alcohol, these approaches won't help and may worsen the factors that keep you stuck.


Last updated Fri, Jun 19, 2015

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©2011, James Gagné, MD