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The Biology of God: A review of the Harvard Medical School Conference on
(c)Patti Harada
Abstract
Karl Marx's condemnation of religion as the opiate of the people, may have been an inappropriately negative, but prophetic, explanation of a new understanding of its role in our health and evolution. Nearly a thousand participants gathered in Massachusetts during an unprecedented conference4 on Spirituality and Healing in Medicine sponsored by the Harvard Mind/Body Institute, in December of 1995, 1996 and again in Southern California in March of 1997, to hear religious leaders and medical professionals ponder the biological bases of the effects of religiosity and spirituality on our physical and mental health and well being. One might wonder, in light of the prevailing 20th century
attitude toward religion, what has brought about this willingness for scientists
to say the "R" word in public and be seen sharing a podium with religious
leaders who so freely discuss God in connection with healing. It has not
been so during the past 50 years.
Economics has certainly laid the groundwork for this change. In a colloquium at the University of Arizona Medical School on the implications of alternative medicine in psychiatry, Dr. Andrew Weil8 reminded the participants that the economic burden of our technologically invasive medical procedures is bankrupting hospitals across the nation. And he says that is the good news, because it is paving the way for acceptance of less traditional treatments by medical professionals, hospitals and insurance companies. Others wrestle with economics on a more direct level: "I don't talk about peace and love," Dr. Dean Ornish said in a pre-conference interview about negotiating with insurance companies, "I tell them they'll save $50,000 per patient" -- the approximate cost of heart bypass surgery. "If I started talking about spirituality," he says, "they'd show me the door".7 The change, however, is not purely economic. "'There is a growing sense that traditional medicine is coming to its limits,'" said internist, Dr. Dale Matthews, Associate Professor of Medicine, Georgetown University. "'There have been breakthroughs, such as organ transplants, but we're approaching our technological limits'".7 Setting aside the economic sanctions, or lack thereof, of the insurance companies for a continuation of our present medical focus, much of the country's population remains uninsured, and a significant percentage of our population is moving steadily into its years of increased medical need as the "baby boomers" reach their fifties and sixties. Basically, we are in trouble and more willing to listen to new ideas. This, then, is the setting for an examination of the relationship between spirituality and healing from the perspective of major world religions, the scientific evidence for the effects of spirituality on healing, the physiologic and neurologic effects of healing resulting from spirituality and the relationship amongst healing, spirituality and mind/body effects.
In fact, this conference is a direct product of the discovery of the phenomena of meditation thirty years ago by the conference director, Dr. Herbert Benson. As Associate Professor of Medicine at Harvard Medical School and the Chief of the Behavioral Medicine Division of Deaconess Hospital, Dr. Benson had been working to establish a model in animals of behaviorally induced hypertension. Some students came to him and suggested that he study them, because they thought they could lower their own blood pressure through meditation. He resisted, but "finally agreed to have a crack at it". In his initial study, he had the students sit for an hour getting
used to the instrumentation on and in them for the measurements to be made
before, during and after the experiment. During the first measured twelve-minute
interval, the students were instructed to simply sit and think their normal
thoughts. During the second twelve-minute interval, the students were instructed
to perform their relaxation meditation. And in the final twelve-minute
interval, the students were instructed once again to perform their normal
thoughts. The only difference between the pre, post and relaxation periods
was that the students changed the content of their thinking. And here are
the physiological changes they found:
Significant chemical changes take place: There was an average 17% decrease in oxygen consumption paralleled by a matching decrease in carbon dioxide elimination, and a decrease in rate of breathing from 14 to 10 breaths per minute, all of which equates to a decrease in metabolism. Later studies with the Dali Lama showed that advanced meditators can change their energy consumption(1) 64% with meditation.
Dr. Benson examined the components of this transcendental meditation technique and defined two distinguishable functions:
Armed with this discovery, Benson established a program at Harvard which offered the "Relaxation Response" for training in stress and hypertension reduction. Years of success in facilitating improved health in Benson's program and many others like it created a growing awareness on the part of the medical community that some form of spirituality could be incorporated in medicine along with pharmaceuticals and surgery.
In spite of Benson's recognition that every religion promotes these two components of spiritual practice, the topic of discussion -- in fact, the title of the conference -- does not bear the word, "religion". Acceptance of the term, spirituality", now very much in vogue, is as much a product of an attempt on the part of the religious to accommodate the fundamental differences between themselves as it is a new wave of reaction to religion's history of "abusing their moral authority by claiming political, financial, sexist, and moralistic power over their members".6 Traditionally, much religious theology has focused on morality, dogma, the interpretation of scriptures, and the philosophical underpinnings of belief, all of which, for the sake of argument, might be conceded as valid issues. But they are not always seen as relevant to the individual's search for the spirituality that brings about an improvement in well being. At a minimum, dogmatic religious theology has helped substantiate and validate a closed mindedness on the part of the scientific community as technology has increased the progress of scientific inquiry. But Benson's position and findings opened the door to a change. Contrary to the conviction of many religions, the positive effects of meditation could be evoked without alliance with religious customs. It could, in fact, be evoked just as easily by repeating the number "one." In reality, using terms of another's religion -- Catholics using the Hebrew greeting, Shalom (health be with you), for example -- creates a more numinous and thus effective experience (Matthysse in Video). Benson's studies continued by studying the effects of prayers of religious people, and the same changes in physiology occurred -- as long as it wasn't a beseeching prayer. It had to be a repetitive prayer: an Allah, Shalom or Rosary; it didn't matter what prayer or sound. Repetition and a passive return when thoughts wandered produced the same physiological changes. With research showing that stress leads to 60% to 90 % of the visits
to physicians, this is a significant finding, because pharmaceuticals and
surgery do not work effectively on reducing hypertension or stress. In
fact, Benson's relaxation response has been demonstrated to be effective
in these areas as well:
Science brings spirituality back to religion Along with the direct medical benefits, Benson, working with colleagues, Kass, Friedman and Sudermeister, found a recurring phenomenon. As the work evolved, Benson says, "patients kept saying thank you for teaching me these approaches, and isn't it remarkable that I feel more spiritual." People were reporting feeling, "spiritual", as a result of these meditation exercises, and claimed to "feel the presence of a power, a force, an energy -- God, if you will -- and that presence was close to them". People became more religious from experiencing these feelings. So, as the work evolved further, they started training ministers, rabbis, priests and nuns how to elicit this state within their respective traditions, and it is being used in seminaries all over the world. And then, they decided to try and bring together the seemingly disparate worlds of religion and medicine with this ancient evolving, yet "new", information on the healthful changes brought about by the quiet state directly related historically to prayer and spirituality. They wanted to bring together scientists and world religious leaders to discuss this research and to anchor the discussions with existing physiological and neurological knowledge. Thus was born the December, 1995, conference on Spirituality and Healing in Medicine.
On that basis, the premise of the conference could easily be interpreted as evidence that a stripped down version of religion was the healing agent in these studies. However, Dr. Matthews and his colleague, Dr. David Larson, Adjunct Professor of Psychiatry at Duke University and Northwestern University Medical Schools, presented research to the contrary (detailed in Appendix A) that makes two essential statements: Religious people have a better health record by far than those who don't. The more devout, the better the health; and Scientific inquiry into the value of religion and prayer has been negatively biased because of the prevailing scientific attitude toward it, and that has been accepted in peer review with the same bias: because "it's only religion." Matthews quoted a Gallup poll that showed 95% of Americans believe in God, three fourths of whom are afraid to discuss their spiritual needs with their doctors for fear of ridicule. It is interesting to note that among health professionals, who are significantly less religious than the general public, psychologists were the least religious, with only 40% professing a belief in God. The premise that religious education as it is being taught today does not seem to be effective is not supported by the data presented by Matthews and Larson. Eight studies they presented show patients with deep religious beliefs live longer. "People think religion just reduces risky behaviors", says Larson. "Yet, people who smoke and go to church have four times less high blood pressure and hypertension than people who smoke and don't go to church, and people who smoked and went to church were the same as those who didn't go to church and didn't smoke." Conference participants joked that the future may find doctors admonishing their patients to "go to church!" instead of the traditional, "lose weight and stop smoking." In a study of 91,909 individuals in Maryland, those who attend church once or more per week had:
Matthews and Larson also emphasized that future research must evaluate the distinction between intrinsic (healthy) and extrinsic (not healthy) religious commitment. They describe intrinsic religious commitment as God-oriented, with internalized beliefs that reflect an individual's underlying nature, character and actions. Intrinsic beliefs are associated with positive health benefits. Extrinsic religious commitment, on the other hand, is that used as a means to another end like status, security or self-justification, is self-oriented and is subject to outside pressures and conformity. There is no association between this type of commitment and health benefits. In fact, paradoxically, it appears that if health is the reason one practices religion, one does not seem to get the benefit that one does if intimacy with God is the objective. In short, it will not work for medicine to treat prayer as technologically prophylactic any more than it did for religion to treat it as theologically inoculative. It is important, Dr. Larson says, for future research to define religious and spiritual overlap to make clearer what is at work in these studies. There are spiritual people who are religious, religious people who are not spiritual and spiritual people who do not go to church. Are there differences in the effects of their practices? Dr. Benson, among others, wants to see a series of neurobiological studies which take those categories of prayerfulness and identify what is going on in our brains when we have a religious experience. Does this seemingly reductionist approach invalidate the existence of God? He thinks not. "It would give us a basis on which to build that would link to both good and ill health. Paradoxically, people have been killing each other for centuries over their claim to their specific religious words. Somehow physiology and science will be able to demonstrate that underneath it all, we're having the same experience. Perhaps it can lead to peace." Conference participants seemed to be unanimous in their support of Dr. Matthews' assurance that they are not claiming that physicians should supplant clergy, that prayer should supplant medicine, that saints are healthier than sinners, that prayer is a panacea or magic bullet or even that religious/spiritual issues should be addressed in every clinical situation. But they are saying that physicians can help patients by acknowledging and respecting individual experiences, beliefs, practices and autonomy in matters pertaining to religion; that religious beliefs and practices are usually beneficial for health; and that the medical effect of faith depends more on the intensity of one's religious commitment than on the particularity of a faith's traditions. Devout people of all faiths get the same effects. Physicians can and should encourage their patients' religious beliefs, and as Dr. Matthews said in an interview prior to the conference, "considering recent research, it may be unethical for them to not [practice their religion or spirituality]".7
During the balance of the conference, representatives of major religions made presentations on their respective healing practices. It would be impossible to detail all of them now, but several points were made that are representative of the consensus. Dr. Diana Eck, Professor of Comparative Religion and Indian Studies at Harvard reminded the conference that Ayurvedic and Tibetan medicine have been demonstrating the effects of spiritual and religious practice for the past 2700 years, and that "to claim meditation is nothing more than a technique of relaxation is like saying that firing a 357 magnum is nothing more than a technique for exercising the finger." It has far reaching effects. She adds that belief is irrelevant. "What matters is cultivation of attention, and that can be accomplished only with practice." Rabbi Rachel Cowan, Director of the Jewish Life Program, combined the personal, the spiritual, the traditional and communal in her presentation of Jewish spiritual healing practices. In her very moving talk, she may have inadvertently explained a physiologically adaptive basis for religion: "[Religious] ritual", she says, "gives you a bearing in time and space. It connects you with a source of hope. It makes you yourself again in the face of crisis. It helps resolve the ache for comfort, connects you with your ancestors and your progeny. It helps you believe in the future." And she voiced what many in the conference espoused: "Healing does not mean curing. You live in deep emotional and beautiful spiritual discovery, and it makes you feel authentically loved." It changes the experience of illness. Many others in the conference had similar descriptions of the healing versus curing phenomenon in terms of its value in producing a profound change in the patient's value and meaning in life. Dr. Margaret Caudill's talk took a similar vein. Dr. Caudill, an Assistant Clinical Professor of Medicine at Harvard Medical School, opened the first alternative medicine clinic 10 years ago. When asked what she does, she says, "I help people cry and grieve and get on with their lives". She says that though pain may be a mandatory part of living, "having someone there to care for you and support you prolongs the amount of time -- twice as long -- that we can tolerate pain." It also decreases the amount of time people spend in pain. It is especially true for women in childbirth. Since the treatment of chronic pain is so specific, studies in this area using prayer and emotional support reveal a great deal about its effects. According to Dr. Caudill, pain is the richest sensory stimulus experienced by human kind, people without a pain system usually don't live past adolescence, and pain is always associated with a negative emotional response because nerves go to the limbic system first. It makes sense from an evolutionary standpoint that since we need pain to survive and cannot cure it and we have to find a way to help the patient heal, we must have developed a mechanism for coping with that. Her explanation is that it is critical for humans to find a reason for spirituality in their pain because in doing so, it reduces pain by reducing the anxiety, anger and depression created by the pain in the first place. Bringing the conference back into more operational focus, Dr. Richard Friedman, who is Professor of Psychiatry and Behavioral Science, SUNY at Stony Brook, and Director of Research for Harvard's Mind/Body Medical Institute, made the point that the question of whether you are better because Jesus loves you or because you are using Jesus as your cognitive restructuring tool, is a fundamental question that may not need an answer. He says the patient who prays gets there quicker, and "only a fool, or a gatekeeper for an insurance company, would fail to acknowledge that power. Our job is to maximize that without abandoning the scientific principles we believe in." He went on to say that nobody should have to make a choice between faith and reason; that "just because we can't measure something, doesn't mean we shouldn't use it. A real change is coming in medical practice; not dramatic or flashy or spectacular, but a subtle, gentle alteration." In keeping with the clarity and gentle wisdom demonstrated in this conference was a profound talk on placebo-effect healing from Dr. Anne Harrington, Professor in the History of Science at Harvard and a consultant to the McArthur Research Network on Mind/Body Interactions. She said that in spite of our "epistemological vertigo", research on the placebo effect has the potential to help us get our questions right on the issue of prayer, meditation and spirituality, and she described several theories about what is obviously the body's ability to heal itself. The placebo effect is extremely fragile according to the anecdotes Harrington shared with the conference about patients who have had striking placebo-effect recoveries followed by a tragically equal physiological return to pre-treatment conditions following their reading of newspaper articles on the purported ineffectiveness of their treatments. It is hard, she says, to get reasonable answers to the question of placebo efficacy because most physicians ponder placebo healing with condescending questions about "what kind of person gets better from imaginary medications." Many think that those who experience the placebo effect might be "less intelligent than the rest of us." No clear evidence has turned up, but what is emerging is that situational factors matter more than any particular personality traits. The bigger the placebo, the more effective: A big pill is more effective than a little pill, and an injection is even more effective than that. The relationship between the doctor and the patient also has a strong effect on placebo. A patient's relationship with an authentic, confident, enthusiastic doctor who listens with a caring attitude and shows concern predicts a good placebo response. In the area of pain management, there is also some possibility that the hopefulness patients get knowing they are getting a therapy can reduce anxiety, and since anxiety intensifies pain, that could have something to do with the placebo effect. It was discovered several years ago that when you give a patient a placebo for pain, his or her brain actually secretes endorphins that function in ways chemically similar to narcotics. Any or all of these may turn out to have some bearing on the effectiveness of prayer and meditation in the healing process. In the meantime, ideas for research are being created in the hopes that the continued separation of spirituality from religion will skirt the issues of separation of church and state and will free government funding for further research.
We are, by most admissions, a product today of what we had evolved to thousands of years ago. It goes without saying that our evolutionary adaptations were predominantly social, since we are barely fit to compete for resources with our physical attributes. There is little argument about this concept. As I look at our lives today in light of ourselves as an animal species, I am convinced that as a culture, we have lost our ancient wisdoms. We have let fall to the wayside experiences that were born of adaptions essential to our survival, and we are on the verge of coming full circle with the wide-spread acknowledgment of the value of spirituality in well being. In dismissing religion for its fundamental ineffectiveness, science seems to have given us a safe enough vantage point from which to examine its values. I believe its value is historic. Our species used to be very spiritual, and lived lives of sacred awareness, if estimations by anthropologists are at all accurate. If you don't know where your next meal is hiding, you might live a much more serene life as a result of your belief in spiritual ritual, which would in turn maintain in one the eagerness to live which would insure survival. Those with the greatest capacity for spiritual connection would live best. It may be an absolute requirement for human consciousness, and it makes sense to me that in a non-technological culture, spiritual voracity would influence every aspect of living. For example, dance is a universal behavior, is reported, by those who participate, as spiritually expressive, and appears to have existed in some form or other since the dawn of humanity. It is an important area to explore in discussing our biological need for spirituality because it appears that in the first lineage-based cultures, dance was used as a "means of worship, a way of expressing and reinforcing tribal unity and strength, a framework for courtship or mating, a means of communication and was a therapeutic experience".5 All evidence we have found: paintings, friezes, sculpture, myths, oral expression, and literature -- one can presume created to give form to the substance of spirit -- attest to that. Figurines and art from the walls of cave dwellings show us evidence of dance as a part of culture as far back as 7,000 B.C.E. 3 There is no evidence that dance in ancient civilization was performed aesthetically by a few skilled artists as it is today. It appears that all the people danced in an invisible blend of religious beliefs, hunting and gathering. People danced the harvests, victories and other celebratory feasts with music, movement and re-enactments of their experiences.5 At the winter solstice, people jumped and stamped in a ritual to reawaken the earth to call back life to the dead.2 Dance was thoroughly integrated with the productive life of the tribe,5 and was used for communication with the unseen forces that provided food, fertility, weather, good fortune in war and tribal welfare -- people danced to supplicate the gods on all important occasions of life. 5 In support of Dr. Benson's presentation about the value of repetition of sound or movement, dance appears to have been used intentionally to create a trance corresponding to a medical description of clonic convulsion, resulting in a form of autointoxication through which the dancers surrendered themselves temporarily to a supernatural being or force. In altered states of consciousness, phenomena would occur that would defy rational explanation.5 Regardless of its form, spiritual experience and its expression seems to be embedded in our very being. These suppositions of anthropologists are supported by behaviors of existing lineage-based cultures. For example, the aborigines of Australia who have remained separate from Western European influences continue to use dance now as in antiquity as an integral part of their daily lives.5 Ernest Becker, the famous social psychologist, claims in his Terror Management Theory that our religious beliefs are simply constructs for handling our awareness of our own mortality.1 I agree that giving meaning to life has obvious benefits, and I can think of many examples of how That is true. But I don't believe it is quite that simple. It seems obvious to me, without even arguing the existence of God, that the very core of our survival has been predicated upon the ability to create the numinous internal experiences presently under scientific examination as a healing agent. It seems so abundantly clear that its power to ease the consequences of pain and to effect chemical changes must always have been an integral part of our very survival. And further, the equanimity created by this state of living surrender to grace would enable the interdependence necessary for frail human survival in the wild. It is the experience of Dr. Janet Macrae, Adjunct Faculty Member in New York University's Division of Nursing, that spiritual experience is quality experience and is socially critical because it eliminates depression; it is energizing. The question of whether God is a construct of that experience or that experience is a construct of God remains to be seen. Certainly those of us who have had that experience would be hard pressed to claim that feeling was "just psychological." Dr. Macrae made an excellent point that a benefit of scientific involvement in the nature of God is that it makes God less capricious. And what if we find out that God is a construct of our biology? Have we not demonstrated in just this short period of technological autonomy that prayerful disciplines create health and well being and a capacity for reverence that affects how we care for each other? Author Thomas Moore would argue that the spirit of secularism that
fosters this willingness on the part of science to give credence to the
role of spirituality in health, paradoxically but understandably fosters
spiritual need. He says that:
At present, it seems that we have no inhibition to technological development, the use of nature, and the abuse of human labor. One of the most important gifts of the deep soul is the voice of conscience, which can't be heard when the virtue of piety is absent, and yet conscience plays a central role in human creativity, teaching us where to place limits and how to protect our common humanity. Without this soul, human creativity turns into uninhibited, self-destructive productivity, a sign of an untethered, dissociated spirituality.6 There is much left to be studied in this area of the effects of spiritual practice on health. A participant questioned the presenters early in the conference about the truth in the statement, "Any honest pursuit of truth leads to God." I believe that this question, which was left untouched by the panel of presenters, happens to be the key to maintenance of the spiritual state scientists are attempting to examine, and that in addition to defining overlapping categories of who is spiritual and who is religious, we must look at the physiological effects of rigorous self examination in an atmosphere of self love. What effect does that have on our well being? How, if at all, does it differ from repetitive sounds or movements? Can those who practice meditation achieve the same results if they are burdened by guilt? Does the discipline of practicing surrendered truth define the difference between the intrinsic spiritual and the extrinsic religious? It is my hypothesis that it does, and that remains to be tested. It seems we are a biologically spiritual species. Though we are creatures of habit, we do not seem to be a disciplined people. I believe that once it is embarked on, maintenance of any spiritual condition requires that it become pervasive within a person. That seems to be its nature. And that appears to require persistent, love-centered, voluntary self examination which is often ego piercing and painful and which seems not an intrinsic part of our nature; though it may appear in a distorted form in the self flagellating many experience in tortured silence. The species that we are, without all our modern conveniences and attitudes, once lived in small groups where there was little place to hide one's secrets and where spirituality was essential to the will to survive and the stability of community necessary to achieve it. Our present culture offers few places to reveal our secrets and less place to express our spirits. Few of us ever examine our own motives and behavior and pray or meditate on a change of heart, let alone move our bodies in spiritual communion with our fears and joys as our ancient ancestors did. Rampant addiction -- a disguise for spiritual hunger -- is our evidence. For us, the healing path -- the spiritual path -- is hard work and requires disciplines that technology has lured us into believing is unnecessary. Author Mark Barasch, whose book, The Healing Path: A soul approach to illness, details his own spiritual path through cancer, says that this is the challenge for those who have grown accustomed to expecting a quick fix from modern medicine. I agree with him. We will have to cultivate the willingness to confront and accept the reality of painful changes in order to create the "spiritual, neuroimmunologic, biopsychosocial" surrender to grace we are seeking.
American Religious Beliefs Spirituality and Medical Outcomes
The most provocative study today is on Intercessory Prayer in the
CCU: 393 patients in a San Francisco CCU were randomized to receive intercessory
prayer from a prayer group (n=192 outside the hospital who never met the
patients or control (n=201). Patients receiving prayer support had less:
Survival: 8 studies that show patients with deep religious beliefs
live longer. In a study of 91,909 individuals in Maryland, those who attend
church once or more per week had:
Social networks and mortality. Prospective cohort of 4725 individuals in Alameda County, California. Men and women who were church members had lower mortality rates independent of socioeconomic status and health behaviors (e.g., smoking, drinking, physical inactivity, obesity) Berkman, Am J Epi 1979;109:188-204
Church attendance and mortality. The Tecumseh Community Health Study of 1432 women, ages 35-69, showed that church attendance was negatively correlated with mortality after controlling for coronary disease, pulmonary function tests, bronchitis, and hypertension. TV watching was positively correlated with death. House, Am J Epi 1982:116:123-40
Mortality patterns of Seventh-day Adventists: Retrospective cohort
study of 522 Seventy Day Adventist deaths in The Netherlands from 1968-77
(they are vegetarians) showed:
Predictors of mortality among elderly poor: In a cohort of 225 elderly persons followed for two years after being forced to move from their homes, after controlling for gender and health status, the more religiously committed elderly were twice as likely to survive the study period. Zuckerman, Am J Epi 1984; 119:410-23
Recovery from elective heart surgery: Six month mortality rates (n-232) in people over 55.
The dangerous aspects of religious practices: When religion is used in place of medical practice, there can be deleterious outcomes. Faith Assembly members don't believe in obstetric care. They have a 3 times greater perinatal mortality and 100 times maternal mortality.
Americans are highly religious Gallup poles show these religious beliefs of the American Public:
Religious preferences in the U.S.:
Faith healing and prayer: Views of inpatients (n=203)
It's often assumed that people who pray don't go to doctors. This
isn't true. Healing Practices in a survey of 325 adults shows:
Health professionals (particularly mental health professionals) are less religious than the general public. Religious beliefs of psychologists, APA members (n=409)
There's a big gap between patients and their professionals. Family Medicine and Religion, Survey of Patients and Physicians: Patients (n=135)MDs (n=115)
The overall effect of religious commitment on health in 212 clinical
studies shows that 150 were positive, 37 were neutral and 15 were negative.
Effects of religious commitment: Documented benefits are grouped in these
categories:
People who pray, go to church have much less prevalence of alcoholism
Apparent clinical range of placebo effects Placebo-Effect Healing -- Implications for Healing and spirituality Anne Harrington, PhD Professor in the History of Science, Harvard University Consultant, McArthur Research Network on Mind/Body Interactions
Placebo-effect Healing is found in these areas:
Disorders of the central nervous system:
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