Spirituality and Health By Laurel Marshfield Reprinted with permission from January 1999, Issue 78 This fall, the Hospital of the University of Pennsylvania hosted a spirited, well-attended symposium on the role of spirituality and religion in patients' lives and on how recognizing that role may enhance the practice of medicine. "Spirituality and Health: Exploring the Relationship Between Mind, Body and Spirit" was sponsored by the Department of Pastoral Care and Education at HUP and the Interest Group On Spirituality, Religion, and Health. The symposium was only one recent indicator that the general topic of spirituality and health has drawn increasing interest in the last year. Pastoral Care, for example, was designated Research Center of the Year by a national association, and the Interest Group also has a working group drawn from Penn's Institute on Aging, Pastoral Care, and the Health System's development office. That working group currently spearheads a broad initiative to establish a joint UPHS-University of Pennsylvania Center for Spirituality, Religion, and Health that would be housed at the Institute on Aging. The proposed center would engage in continuing research, education, consultation, and collaboration on issues similar to those raised by the fall symposium. The symposium, in fact, seemed a community-oriented way to further this initiative while at the same time highlighting Pastoral Care's research. The presentations and panel discussion were open to the public as part of "The First Annual New Health Symposium," a Delaware Valley-wide event that ran over an eleven-day period. (It was not sponsored by Penn.) In opening remarks for "Spirituality and Health," the Rev. Ralph C. Ciampa, director of Pastoral Care, observed, "There is a growing interest, both in our area and nationwide, in exploring and providing truly comprehensive health care. Institutions like Penn have been pioneers in the Western, scientific development of medicine, but increasingly, broader traditions and perspectives -- such as spirituality and religion -- are finding appreciation here and at the other health-care systems of this city." According to the first presenter, Andrew B. Newberg, M.D., that appreciation is well-founded in scientific research. Said Newberg, a fellow in nuclear medicine and an instructor in the Department of Psychiatry, "A large number of studies exist in a wide variety of literatures -- including many well-done studies with randomized, double-blind control trials, as well as many that are not so well-done -- which look at the relationship between medicine and religion, medicine and spirituality." But for this talk, Newberg explained, he would draw on generalized results taken from the report of a 1997 "Scientific Research on Spirituality and Health Conference" in which he participated. According to Andrew B. Newberg, M.D., "Religious participation has been found to be associated with fewer physical, social, and psychological symptoms." The report consolidated the findings of 80 or 90 scientists from around the country who met under the auspices of the National Institute for Healthcare Research to discuss the relationship of spirituality and medicine in four primary areas: physical health, mental health, addiction disorders, and neuroscience. Basically, said Newberg, "These four groups were to sit down and talk about what we did know and where we needed to go in the future." In the "what's known" category, Newberg continued, "Religious participation has been found to be associated with fewer physical, social, and psychological symptoms." But in the specific area of physical health, "The more people go to church and the longer they attend, the lower their rates of coronary artery disease, emphysema, cirrhosis, and even suicide. Increased church attendance is additionally associated with decreased mortality, generally -- as well as among cardiac patients, specifically." According to Newberg, there is an additional correlation between the strength of feeling associated with such religious participation and, for instance, lower blood pressure. Some studies suggest that religious participation is associated with enhanced self-esteem and a reduction in anxiety, depression, and substance abuse. And meditation-based interventions (which often have a spiritual component) were also effective in reducing anxiety, depression, and the abuse of alcohol. As Newberg sees it, "There is certainly a connection between health and active religious or spiritual practice. But we need to ask, what is it? And why is it happening?" Part of the answer, he suggested, is that meditation and prayer achieve positive results by activating the parasympathetic nervous system which then produces what Herbert Benson, M.D., of Harvard Medical School's Mind/Body Medical Institute calls the "relaxation response." Newberg emphasized that more in-depth answers to these questions could only be found in future research -- in particular, research that studied various populations over time, and research based on clear definitions of the terms spirituality and religion. Although he acknowledged the need for rigorous definitions, John Ehman, M.Div., research chairperson of the Department of Pastoral Care and Education, presented findings from a study that did not specifically define the terms. That study was an investigation of the attitudes of pulmonary patients when their physicians asked them about their spiritual or religious beliefs. It was written by John Hansen-Flaschen, M.D., associate professor of medicine and chief of pulmonary and critical care at HUP, as well as members of the Pastoral Care research team: Ehman, chief chaplain at Presbyterian Medical Center; Ciampa; Barbara B Ott, R.N., Ph.D., assistant professor of nursing at Villanova University; and Thomas H. Short, Ph.D., assistant professor of mathematical sciences at Villanova. The study has been accepted for publication by the Archives of Internal Medicine and published as an abstract in CHEST (the journal of the American College of Chest Physicians); and the findings were also presented at national conferences held by the American Association of Bioethics, the Society for Health and Human Values, and the Amencan College of Chest Physicians. According to Ehman, the study "attempted to bring to bear the insight and rigor of scientific methodology on subjects dear to us -- namely pastoral care and the spiritual needs of patients." The main tool was an 18-item, self-administered questionnaire completed by 177 patients who visited an outpatient pulmonary clinic at UPHS. The goal was to examine patients' response, within a routine medical history, to the question "Do you have spiritual or religious beliefs that would influence your medical decisions if you became gravely ill?" The respondents stated overwhelmingly (90 percent) that "prayer may sometimes influence recovery from an illness," even though only 51 percent described themselves as religious. In addition, 66 percent said they would like their physicians to ask whether they had such beliefs. Interestingly, the same percentage said that such a question would strengthen their trust in the physician. Most unexpected, said Ehman, was the finding that 45 percent of those who denied having religious beliefs nevertheless wanted their physician to ask. (During the question and answer period, a physician in the audience suggested that asking such a question can be a way of recognizing "the whole patient.") The study concludes that "An inquiry regarding spiritual/religious beliefs should be incorporated into the social history of a comprehensive patient evaluation. It is at least an invitation, a way of encouraging the patient to feel 'I can speak to the physician about this if I need to.'" David J. Hufford, Ph.D., an adjunct professor of folklore and folklife at the University of Pennsylvania, discussed the actual nature of spiritual experience. Hufford, who would serve as co-director of the proposed Center for Religion, Spintuality, and Health, said, "I am going to try to overturn and revise the conventional view. . . that spiritual experiences are shaped and possibly determined by one's cultural setting." In addition, he asserted, "Spirituality is not just one more kind of alternative medical practice." People do not become spintual, he observed, to "lower their blood pressure or increase their longevity." Yet after a spiritual experience, the world is seen as "more tolerable, more easily accepted, possibly more joyful." Such experiences, he said, are not uncommon. The study's conclusion: "An inquiry regarding spiritual/religious beliefs should be incorporated into the social history of a comprehensive patient evaluation." According to research conducted by the National Human Research Corporation in 1975, approximately one third of all Americans claim to have been, in Hufford's words, "close to a powerful spiritual force that lifted them out of themselves." Furthermore, the visitation experience was, he said, "positively associated with positive measures of psychological health. And that's surprising, because so many people have assumed that these were delusional symptoms of psychopathology." In the same vein, Hufford pointed out that studies also reveal that education has no negative impact on spiritual beliefs and experiences. This finding overturns the scholarly expectation that, "as education advanced," said Hufford, spiritual experiences "would pass out of currency." As a folklorist, Hufford noted that other cultures discuss such experiences freely -- ours does not. "As we begin to break the 'code of silence' in our society and begin to compare prevalence and distribution cross-culturally," said Hufford, "there is reason to believe that a cross-cultural robustness and stability occurs in some of these classes of experience that is not readily explained on the basis of people's prior beliefs." Spiritual experience appears to transcend not only the individual but the individual culture. In the final analysis, Hufford reminded the symposium audience, "Religion and spirituality are very much the framework within which humans find meaning. And that's meaning in life, also meaning in death, and meaning in suffering -- the 'big' kinds of meaning. Which is why people find it essential when they face illness and make efforts to heal." The fall symposium was not the only one sponsored by the Department of Pastoral Care in 1998. In the spring, for example, it held a symposium on spirituality research that attracted more than 100 participants from local communities. The department's research was recognized by the Association for Clinical Pastoral Education, which designated it the Research Center of the Year. Penn's department was honored in April at the ACPE's annual meeting in Portland, Oregon, attended by some 900 pastoral-care leaders. For more information on research related to spirituality and health, contact Pastoral Care at 1 Dulles, (HUP) 662-2591.