Spirituality, Healing and Cancer
Christina M. Puchalski, MD, assistant professor in internal medicine at George Washington University and specialist in spirituality in medicine
This is a summary of a lecture presented on December 7, 1999.
How important is spirituality in helping patients cope with serious illnesses? For years, the medical and scientific community held that spirituality and medicine had little or no bearing upon each other. Recently, however, this relationship has been looked at in a new light. A 1990 Gallup Poll indicated that religion, as one form of spirituality, plays a central role in the lives of many Americans. Other studies and surveys have confirmed this finding as well. When asked whether people believed in the power of personal prayer to heal, 82% of those surveyed reported yes. Seventy-three percent believed that praying for someone else could help that person, and 78% believed that God can intervene as the result of personal prayer. Only 28% believed, however, that faith alone could heal.
Spirituality and medical care
Many patients not only have strong spiritual beliefs, but also want their physicians to talk to them about spiritual issues. In one study, 64% of the patients surveyed wanted their doctor to join them in prayer. In another study, 63% thought that doctors should talk to their patients about spirituality although only 10% reported that this actually happened. The majority of patients surveyed perceived their spirituality as an integral part of who they are, and wanted recognition of their spirituality to be integrated into their medical care.
Sixty-one of the 125 medical schools in the United States now include a spirituality and medicine component in their curricula. Physicians and medical schools increasingly are recognizing that that they do not have all the answers and that there is more to medicine than scientific technique. Spirituality, however, still remains not well integrated into medical care. A 1991 study asked both patients and physicians the same questions about their spiritual beliefs. Ninety-one percent of the patients reported that they believed in God whereas only 64% of the physicians did. The patients also were more likely to believe in an afterlife, to pray regularly and to feel close to God.
The definition of spirituality varies widely according to individuals and cultures. In a broad sense, spirituality can be regarded as “whoever or whatever gives one a transcendent meaning in life.” It is often expressed as a formal religion or relationship with God, but it also can be defined as a higher power, the natural world, an energy or force, a belief in the good of all mankind, or a belief in the importance of family and community. Michael Downey defines spirituality as “an awareness that there are levels of reality not immediately apparent” and notes that “there is a quest for personal integration in the face of forces of fragmentation and depersonalization.”
Illness is a powerful life event that causes most people to question who they are, the meaning of their lives and their purpose. Suffering is often a significant part of illness. Viktor Frankl wrote that “Man is not destroyed by suffering; he is destroyed by suffering without meaning.” When Frankl wrote about the experiences of concentration camp survivors, he noted the importance of finding meaning in the suffering and how that allowed people to transcend their suffering. For many patients, illness produces spiritual growth and awareness that often leads to new meaning in life.
How powerful are the mind and spirit?
Dr. Puchalski believes strongly that the mind is powerful and can change the experience of the illness in many ways. Studies regarding the “placebo effect” underscore her opinion. These studies have found that patients taking a sugar pill often have positive treatment outcomes, suggesting that their belief in the benefit of the sugar pill has a powerful positive influence in and of itself.
Illness creates a substantial amount of stress, which in turn can aggravate the illness and detract from a patient’s well being and ability to cope and get better. Learning and practicing stress management techniques often helps people cope with serious illnesses, which again speaks to the power of the mind over the body. Approximately 60% to 90% of the problems for which patients seek help from their primary care physicians have some stress-related component. Many patients find that their spiritual practices help them reduce their levels of stress. Meditation has been found to be particularly helpful for many in reducing stress.
The Relaxation Response
Herbert Benson, M.D., strongly advocates using the relaxation response, which can be brought about by using a very simple technique in which a person meditates twice a day. Dr. Benson recommends a meditation technique in which patients breathe slowly and focus on one word, repeating it as a mantra. His work and that of others have indicated that this practice lowers the body metabolism, heart beat and breathing rates as well as slowing brain wave function. These techniques have been found to be beneficial in managing many medical-related problems including pain, insomnia, anxiety, hostility, depression, premenopausal symptoms, and infertility. They also have been found to be useful as an adjunct to cancer and HIV therapies. Dr. Benson believes that “to the extent that any disease is caused or made worse by stress, to that extent evoking the relaxation response is effective therapy.” Benson also has studied the use of religious symbols as part of the relaxation response. He found that patients who used religious symbols in their meditation were more committed to the practice, but that such use was not essential to deriving the benefits.
Everyone needs to have a sense of hope. It contributes to almost everyone’s well being. Hope is often a patient’s desire for health and may derive from their remembering their wellness. Spirituality can play an important part in sustaining hope for many patients. Hope is ever changing and is not limited to just hoping for a cure. Even patients who are dying can have hope about their circumstances. St. John of the Cross, a 16th Century mystic observed, “Hope allows as much as it hopes for.”
A growing body of medical literature suggests that all these factors are helpful to patients as they live with illness. Additionally, some new studies are looking at the importance and potential benefits of spiritual factors in coping with illness. They generally suggest that patients do benefit when their spiritual beliefs are integrated into their medical care.
The Alcoholics Anonymous 12-step program illustrates how a spiritual component can be incorporated into a treatment or recovery program. Its practitioners strive to recognize the importance of a higher power and to develop a deepening relationship with that higher power.
Spirituality and dying
Too often, Dr. Puchalski notes, our medical system ignores dying as a process and fails to help individuals with the spiritual questions that come about. Spirituality is an integral part of the dying process and an important part of the developmental task of transcendence. Patients often fear dying more than they fear being dead. Whatever spiritual beliefs or religious beliefs may be held by patients, medical staff can be sensitive and acknowledging of these. A simple question about spirituality in their lives can open doors for communication and understanding.
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