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Treating the Whole Person: Spirituality in Medicine

By Christina M.H. Powell

In recent years, public dissatisfaction with managed care has sparked the medical community’s interest in the relationship between spirituality and medicine. More than 100 of the approximately 150 medical schools in the United States have added spirituality in medicine courses to their training programs. Doctors are learning how to take a spiritual history along with the patient’s medical history. Medical students shadow chaplains during an on-call experience. The mid-20th-century shift away from the doctor-patient relationship to disease-focused health care based on technological advances is giving way to a new emphasis on compassionate physicians responsive to the needs of the whole person.

Many current scientific studies demonstrate a connection between spiritual faith and increased mental and physical health. For example, prayer reduces stress, decreases anxiety, and improves a patient’s ability to cope with illness. The sense of purpose that comes from faith gives meaning to those suffering from chronic illnesses. Medical professionals also recognize that a patient’s religious beliefs affect medical decisions.

Hospital visitation, counseling, and praying for the sick remain important aspects of pastoral care. Knowing that young doctors view pastors and chaplains as partners in the patient’s health care team should encourage ministers. Understanding how physicians view the role of spirituality in medicine can help pastors minister more effectively in hospital settings and be better prepared to meet the needs of parishioners receiving medical care.

Connecting Faith and Health

A study led by Farr A. Curlin, M.D., an associate professor of medicine at the University of Chicago and an expert on spirituality and medicine, showed that three in four doctors believe spirituality helps patients cope and gives them a positive state of mind.1 More than half of the 1,144 U.S. physicians responding to this survey believe that religion and spirituality have a significant influence on health, with 85 percent agreeing that the influence on health is generally positive. Contrary to the 20th-century view held by many prominent mental health professionals that religion is irrelevant or even detrimental to mental health, scientific studies demonstrate that faith decreases the likelihood of depression, anxiety, substance abuse, and suicide.2

In a study that analyzed the association between regular church attendance and mortality over a 28-year period for 5,286 survey respondents, those who went to church at least once a week were more likely to stop smoking, increase exercising, increase social contacts, and stay married.3 Another study calculated that those who attend church more than once a week gain the equivalent of a 7-year increase in life expectancy at age 20 compared to those who never attend church.4 A possible physical explanation for this increased life expectancy is the relationship between the immune system and faith. Interleukin-6 (IL-6) is an immune marker that correlates with mood states. Levels of IL-6 increase with stress and depression. IL-6 is produced at any sites of inflammation within the body. Inflammation is a process involved in many diseases such as heart disease, rheumatoid arthritis, stroke, and diabetes.

A study of 557 older adults examined the relationship of church attendance, interleukin-6 levels, and mortality. The researchers found that attending religious services more than once a week correlated with lower mortality rates and lower IL-6 levels compared with never attending religious services. Furthermore, their results were consistent with a role for IL-6 in mediating the relationship between church attendance and mortality.5

Of course, the primary motive for church attendance should be obtaining spiritual benefits rather than improved physical health and increased longevity. Yet, these scientific studies function as a powerful apologetic to those who would deride the value of church. If we consider that God created the whole person, we should not be surprised that taking care of spiritual needs results in meeting our mental and physical needs as well.

Stress weakens the body and contributes to the development of many diseases. Prayer reduces stress, making people calmer physiologically as well as emotionally. The admonition in Philippians 4:6 serves as a great prescription for health: “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.”

Respecting Patient’s Spiritual Needs

Increasingly, doctors are realizing that spiritual care is vital to a person’s complete health care. A reemphasis on service and compassion in medicine has highlighted the importance of respecting a patient’s spiritual needs. Health care professionals receive training on taking a spiritual history in a medical interview, often using the acrostic “H-O-P-E” as a guide. “H” stands for a patient’s source of hope, meaning, and comfort. “O” stands for organized religion. “P” stands for personal spirituality/practices, which includes prayer, reading Scripture, and attending religious services. “E” stands for effects on medical care and end-of-life issues.

By inquiring about a patient’s spiritual needs, doctors demonstrate their respect for the patient and provide comfort. Many patients use their faith to help them cope.

Physicians provide a therapeutic benefit when they show an interest in a person’s spiritual journey. The goal of a spiritual history is for physicians to learn more about their patients’ beliefs, not for physicians to share their beliefs with their patients. The physician may uncover spiritual views held by the patient that could impact medical decision making. For example, beliefs about the sanctity of human life can impact reproductive decisions as well as end-of-life decisions. A physician must guard the patient’s privacy, confidentially, and autonomy while exploring the patient’s spiritual beliefs.

Pastors can serve an important role alongside the health care team in tending to the spiritual needs of a parishioner. For example, pastors can help patients sort through how their faith might impact their medical decisions. Patients may need encouragement to express their concerns with the medical team. Perhaps the most important role for pastors is helping patients find purpose and meaning in the midst of difficult circumstances. The challenges that come from physical illness or injury can strengthen a person’s faith or become a barrier in the person’s relationship with God. The caring presence of a pastor often influences this outcome.

Resolving Ethical Conflicts

Integrating spirituality and medicine can lead to ethical conflicts. If physicians force their beliefs on patients, whether religious or not, they are overstepping their boundaries as a medical professional. A doctor and a patient who both share the same faith can certainly discuss medical issues in the context of their shared belief. Doctors can share their faith in response to a patient’s questions. Even though certain spiritual practices contribute to improved health, doctors should not prescribe church attendance in the same way they might recommend increased physical exercise.

When spiritual beliefs prevent a patient from accepting an otherwise beneficial medical treatment, ethical issues can arise. For example, people who are trusting God for a physical healing may decide to forego medical treatment as an expression of their faith. The medical doctor needs to balance respect for the patient’s autonomy with the responsibility to seek the good of the patient by persuading the patient to follow medical recommendations. A pastor or chaplain sometimes can help the physician resolve these types of conflicts.

The potential for ethical conflicts should not cause physicians to avoid addressing patient’s spiritual needs. Instead, physicians should work together with chaplains toward the goal of treating the whole person. Chaplains, in turn, can work with pastors to provide spiritual support for patients. Both pastors and parishioners can take heart that what is good for the soul is also good for the body. After all, when we seek first His kingdom and His righteousness, all other things are given to us as well (Matthew 6:33).

Christina M.H. Powell

Christina M. H. Powell, an ordained minister, author, medical writer, research scientist trained at Harvard Medical School and Harvard University, and the author of "Questioning Your Doubts: A Harvard Ph.D. Explores Challenges to Faith" (InterVarsity Press, 2014).She speaks in churches and conferences nationwide and addresses faith and science issues at www.questioningyourdoubts.com.

Notes

1. Curlin F.A., Sellergren S.A., Lantos J.D., Chin M.H. “Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health.” Arch Intern Med. 2007;167(7):649–54.

2. Koenig, H.G. “Religion, Spirituality, and Medicine: Research Findings and Implications for Clinical Practice.” Southern Medical Journal. 2004;97(12):1194–1200.

3. Strawbridge W.J., Cohen R.D., Shema S.J., Kaplan G.A. “Frequent Attendance at Religious Services and Mortality Over 28 Years.” AM J Public Health. 1997;87(6);957–61.

4. Hummer R.A., Rogers R.G., Nam C.B., Ellison C.G. “Religious Involvement and U.S. Adult Mortality.” Demography. 1999;36(2):273–86.

5. Lutgendorf S.K., Russel D., Ullrich P., Harris T.B., Wallace R. “Religious Participation, Interleukin-6, and Mortality in Older Adults.” Health Psychology. 2004;23(5);465–75.

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