Spirituality: A Fresh Breeze in Minnesota Health Care

Alan L. Pritz

Reprinted with permission from the May, 1999 volume of “Minnesota Physician”

One of the most significant health care developments in the past 25 years has been the evolving relationship between empirical medical-science methodology and an old-new domain: spirituality. Throughout history, people have petitioned a higher power for aid in illness or disease. From a faith standpoint that makes sense, but for medicine, the cornerstone of quality practice is scientific proof.
The question of whether religious belief and prayer have true healing power is currently being explored with scientific rigor. Because many people today incorporate spiritual themes into diverse aspects of their lives, it should come as no surprise that spirituality is manifesting itself in the medical arena as well. The reactions from physicians include confusion, rejection, indifference – and sometimes the curiosity to investigate and implement.

History

The emergence of spirituality in modern medicine, on both a local and a national scale, had its roots in the early wellness movement. The wellness paradigm addressed health concerns in a holistic fashion, touting a triune model of body, mind, and spirit.

During the slash-and-burn economics of the 1970s and 1980s, many industries found themselves confronted with the distasteful by-product of their own machinations. Prolonged stress associated with ongoing economic upheaval caused rampant employee burnout and attendant financial inconveniences – increases in absenteeism, medical leave, and turnover costs.

Growing research in behavioral sciences and psychoneuroimmunology showed that physical fitness and a positive attitude could mitigate the effects of stress and reduce health care expenses. Enter a corporate platform for physical health through wellness programs.

In 1975 Herbert Benson, M.D., a Harvard cardiologist, pushed the wellness envelope further by writing The Relaxation Response. He demonstrated that certain meditative practices produced a relaxation effect that lowered blood pressure without medicinal agents. Benson’s work was the catalyst for gradual acceptance and use of mental tools in clinical settings to promote physical health – tools such as focus words, guided imagery and visualization.

Reading up

Subsequently an array of works addressing related topics began appearing. Some of the more significant books are: Anatomy of an Illness by Norm Cousins describing the author’s victory over cancer through laughter and humor; Minding the Body, Mending the Mind by Joan Borysenko; Full Catastrophe Living, by Jon Kabat-Zinn citing the beneficial use of mindfulness meditation and hatha yoga with chronic pain patients; Reversing Heart Disease by Dean Ornish, M.D., using yoga and meditation in conjunction with strict diet modification; The Faith Factor, by Dale Matthews, exploring from a Christian perspective the specific benefits of religious commitment; and Healing Words: The Power of Prayer and the Practice of Medicine, a landmark work by Larry Dossey, M.D., citing evidence that prayer can affect humans positively.

Mindful of possible placebo concerns, Dossey references studies of the effects of prayer on mice, chicks, enzymes, fungi, yeast, bacteria, and cells of various sorts - with results similar to prayer’s effect on humans. He also raises ethical considerations regarding using prayer as a healing agent: If prayer works, shouldn’t it be used routinely in conjunction with standard medical treatment?

Definitions

It is fair to say of spirituality and religious belief that the two are compatible though not identical; they may or may not co-exist. Spirituality typically allows for and supports religious beliefs, but the reverse isn’t always so.

The Mayo Spirituality in Healthcare Committee has defined spirituality as “a process by which one discovers inner wisdom and vitality that give meaning and purpose to all life events.” And in my Pocket Guide To Meditation, I use this definition: “the essence of all traditions, the Truth hiding behind and within every form. It is the medium through which individuals establish direct communion with God, regardless of formal orientation. Spirituality is both the immediate experience of That-Which-Is-Holy, the Higher Power by whatever name, and living by those principles and practices which foster this relationship.”

The Mayo Spirituality in Healthcare Committee defines religion as “a formalized system of beliefs and practices shared by a group.” I like to use a definition from a workplace training program I deliver: “the organization of spiritually based rules, rituals, and doctrine surrounding, and developing from, the life and teachings of a Founding Individual or Revelatory Source.”

In clinical settings, it is crucial to exercise tolerance and appreciation for the healing potential inherent in and relevant to the spiritual paradigms of an ideologically diverse and vulnerable patient population.

The question of how to address spiritual matters is unresolved. Some providers say the spiritual domain is beyond their scope of training and hence beyond their responsibility. Others believe spirituality represents a vital component in the healing process; those providers feel ethically responsible to include it as part of standard treatment protocol.
In the latter camp, still very small, are clinics that have begun acquiring relevant spiritual information during patient intake. Although a significant step, acquiring information will be more effective if reinforced by staff training in how to use it.

Minnesota

What we are seeing is a serial progression in America of health-inducing practices that began with a physical focus, expanded to include the mind and finally embraced the spirit. Minnesota activity reflects that pattern. With the rise of complimentary medicine and the 1992 establishment of an NIH Office of Alternative Medicine (mandated to explore such medicine), the presence of nonallopathic modalities became more prevalent.

In 1993 Hennepin County Medical Center opened an Alternative Medicine Clinic using traditional Chinese medicine. In 1995 Abbott Northwestern’s Health Psychology Services piloted a Mindfulness Meditation program modeled after Jon Kabat-Zinn’s work. Healthful agents, including massage, yoga, meditation and therapeutic touch, have become increasingly visible in chronic-pain and cancer-treatment facilities (the Virginia Piper Cancer Institute, for example). Today spiritual care and related matters command ever more attention.

Among recent developments in the state, three stand out. In 1996 the University of Minnesota’s Academic Health Center sanctioned the formation of a Center for Spirituality and Healing. Its cutting-edge mission: “to promote interdisciplinary education, research, and patient care that integrates biomedical, complementary, cross-cultural and spiritual aspects of care.” The center has attracted national attention by investigating and working toward the transformation of modern health care. It offers a wide variety of progressive educational and experiential programs.

Fairview Health System, under the stewardship of its Spiritual Health Services director and chaplain, Chuck Ceronsky, has developed innovative internal pilot programs providing spiritual approaches to health issues. Ceronsky is also current coordinator of the Minnesota Forum on Spirituality and Health and Healing, which was established in 1997.

Mayo developed in 1998 its own Spirituality in Healthcare Committee, which focuses on education, research, and appropriate inclusion of spirituality in health care settings. The committee sponsors monthly meetings and an in-house lecture series. Mayo’s Paul Mueller, M.D., M.P.H., has developed a special slide presentation on spirituality and health care that also is used regularly. The committee is concluding a study on the effects of intercessory prayer (prayer for the benefit of others) on heart attack patients. Steve Kopecky, M.D., a Mayo cardiologist, says a second study of similar scope for by-pass patients will begin soon.

National Interest
On the national scene, questions about the healing value of spiritual and religious belief are undergoing increased study. In one example, Georgetown University School of Medicine evaluated numerous studies to gauge the effect of religious belief on illness and recovery. In at least 80 percent of those studies, religious belief correlated with increased survival rates and lower levels of anxiety, depression, anger, high blood pressure and the use of drugs, alcohol, and cigarettes.

In the context of particular practices, some research suggests prayer works, but why it works hasn’t been determined. But prayer has been shown to have a positive effect on living organisms, to be most effective when done with love and faith, and to work regardless of the patient’s proximity to the person praying.

Medical science is investigating new spiritual frontiers. The challenge is to accept the possibility that certain domains of reality exist beyond the scope of modern measures and that they may be highly useful when treating patients. Although incorporating prayer, faith and worship with traditional practice may enhance results, the use of it is still a very personal decision for providers. Those who are exploring the spiritual dimension in health care may well foreshadow the shape of things to come.