- The Washington Times - Tuesday, September 10, 2002

Few medical professionals argue anymore about the importance of emotions in helping to treat illness. It is the more abstract concept of the role played by the spirit and, by extension, a person's religious faith that has been considered controversial by many in the medical community.

Plenty of books have been published for the layman touting the power of prayer to enhance one's physical and mental well-being. Until now, few scientific papers have been published in professional journals and elsewhere presenting research that sheds light on the influence and importance of the spiritual realm.

For several local doctors who have contributed to the literature, the part that faith and prayer play in healing is unquestioned. Both Dr. Christina Puchalski at George Washington University and Dr. Dale Matthews, formerly of Georgetown University, have written extensively on the subject, and will on occasion pray with patients as part of the healing process.

"As a doctor, I attempt to enter into each patient's way of looking at the world," Dr. Matthews writes in a 1999 paperback, "The Faith Factor," published by Penquin Books. "If I want a good relationship with my patient, I must understand his or her worldview and incorporate his or her vocabulary and viewpoints into our discussions."

Prayer can be part of such discussions, he says.

The two doctors are part of an expanding movement in the medical field, helped along by the existence of several key research institutes and foundations. Among them are the George Washington Institute For Spirituality and Health (GWish), led by Dr. Puchalski; Duke University's Center for the Study of Religion/Spirituality and Health, under the direction of Dr. Harold Koenig; and Boston's Mind/Body Medical Institute, whose founder and president is Dr. Herbert Benson of the Harvard University Medical School.

Lending support in a major way is the John Templeton Foundation, in Radnor, Pa., which awards an annual prize to an individual for "Progress Toward Research or Discoveries about Spiritual Realities" and whose board of advisers includes Dr. Benson as well as renowned Princeton physics professor emeritus Freeman Dyson and Georgetown University professor John Haught, founding director of Georgetown's Center for the Study of Science and Religion.

A recent video produced for medical professionals in conjunction with a group called the Johns Hopkins [University] Community Physicians, and moderated by renowned Hopkins surgeon Dr. Ben Carson, is titled "Give Me Strength: Spirituality in the Medical Encounter." The film talks about how to introduce spirituality in the encounter with patients, especially in the context of "bad news." A majority of medical schools in this country now offer courses on the general subject of spirituality and health.

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Judging by the rank and reach of involved members, calling it a "fringe" movement would be a misnomer. The greater difficulty arises in describing their work and actual effect since, by necessity, most doctor-patient relationships are private, and the "spirit" and spiritual healing often works in mysterious ways, its proponents agree.

But not in totally unpredictable or unrecognizable ways in the view of Dr. Puchalski, an internist and geriatrician who says each medical doctor involved in research "has a different focus, with people coming at it from different points of view. Some, like Dr. Koenig, study only the religious influence on health. Others don't want to talk about religion but about how people find meaning and purpose."

Her three-person institute focuses on educating medical personnel about how understanding a patient's belief system interpreted broadly to be whatever gives "transcendent" meaning to life is a vital part of the doctor-patient relationship and to the healing process.

"When students learn about [medical] history-taking, spiritual history is part of that," she says. "They have a class involving communication strategies, one of which involves how to communicate about breaking bad news and death and dying issues."

She will pray along with patients, but always at their initiative.

"I let the patient lead. I might hold hands if that is what they want when the patient is praying. It happens usually when people are really suffering either going through depression or someone who is going home basically to die or someone very frightened before surgery.

"What this is about is compassionate care, and being of service to the patient and bringing back real spiritual roots. Unfortunately, medicine now is a business that, with the insurance problems, has lost the caring, altruistic nature of the profession."

While taking a patient's history during a physical exam, Dr. Puchalski routinely asks about "social history" and whether the person has any spiritual beliefs to help them cope with stress.

"Nowadays spirituality is such a buzzword. Most people know and don't ask what you mean," she says. A practicing Catholic, she doesn't immediately answer if a patient asks about her own faith "because the relationship may be equal on a spiritual level but not on a clinical level. I don't want them to adopt my beliefs and it is important that the interview be focused on my patient."

Instead, she will counter with a question about whether the information concerning her own beliefs is important for the patient to know. She referred one person who said he was an evangelical Christian and wanted a physician who believed as he did to Dr. Matthews, who is a practicing Christian but prefers not to state publicly his church affiliation.

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Dr. Matthews, now in private practice at 1145 19th St. NW, two years ago published a study in the Southern Medical Journal, done in conjunction with Christian Healing Ministries in Jacksonville, Fla., that showed a positive impact of prayer on patients with rheumatoid arthritis.

"Really what I studied was prayer ministry as opposed to prayer," he says. "It is different from some isolated thing sending out brain waves. It's building a relationship with someone, talking with them, and praying with them. So, accurately speaking, I show that ministry has an effect.

"Religion is complex. It's prayer, singing, community, a series of lifestyle choices. It's not the pew. In a similar way, prayer is an expression of love and caring," says the doctor, who is at work on a second book about the biblical world's view of health.

It's one thing for medical schools to address the topic of how knowing about a patient's religious life can help in caring for a person, Dr. Matthews says.

"The tougher, more dramatic question is should we as doctors encourage patients to pray, or read scripture with patients. It's fraught with peril, in part because you can get proselytizing issues. It has to be treated carefully, but then so is sex. We know it isn't going to be easy, but then so is talking about death."

Dr. Matthews, who restricts his area of study to Christian prayer, acknowledges that "the big change in the past 15 years is that spirituality is on the table and people recognize its impact on health," saying that at least from medical education's point of view, helping patients use their own resources whether it's ESP or vitamins is an advance. However, he questions whether it is possible to compare different religious beliefs in this way. "Is Christian prayer the same as Islamic?" he asks. "That's probably too hot to touch."

Harvard's Dr. Benson, a cardiologist who wrote "The Relaxation Response," about methods for relieving stress, currently is doing a major cross-cultural study of prayer. He won't discuss his approach until it is published, saying only that "classically every culture of humankind has elicited the [relaxation] response through prayer: with Protestantism it is centering prayer on the New Testament; within Islam it is repetitive daily prayer. And exactly the same in Shintoism, Taoism and others. Only the words differ.

"About 10 years ago or so we discovered that people who regularly evoke the response feel more spiritual. It took us five years to define spirituality. In our case, spirituality was the feeling of the presence of an energy, a force, or power. God, if you will. Secondarily, that the presence was within them. Then we found that people who have this have fewer medical symptoms and this was measurable as a direct relationship to the prayer, if you will."

Another prolific author in the field is Dr. Koenig of Duke University, a psychiatarist who is co-author of the 712-page Handbook of Religion and Health published last year by Oxford University Press. His most recent article, in the July issue of the Journal of the American Medical Association, details how an 83-year-old woman with chronic illness survives with the help of her religious faith after traditional medicine has failed to provide much relief.

"I believe strongly that a Christian needs to show genuine honor and respect for people from all faiths." he says. "It's the best testimony a person can make on behalf of his own faith."

A former nurse, he also had written a personal book called "The Healing Connection" before coming to Duke 15 years ago. Dr. Koenig calls himself "a conservative Christian" who is "more comfortable in an Episcopalian church because I like ritual."

In a particularly painful period of his life, he says, he had asked patients how they coped with stress and many answered they did so with the help of their religion. From that point on, he began doing systematic research to see what difference it made, if at all. In one 1985 study, he says, he found that one-third of the physicians in the Midwest prayed with patients at least once.

Admitting the difficulty for someone in science to get a grasp of spirituality, Dr. Edwin Morris, medical director of a cardiac rehabilitation program in Franklin, N.C., points to a backlash against the movement from health care professionals "who think it is unethical to deal with this area because of the power to influence people with their own religious beliefs."

He disagrees, saying "it's like asking a patient about his sexual orientation. You don't necessarily promote one activity over another."

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