New York, USA - Harold G. Koenig, M.D., has written extensively on the role of faith in healing.
Last year, two days before Christmas, Christina Puchalski, M.D., made a house call. The front door opened directly into the living room, where a hospital bed had taken the place of the couch. Puchalski's heart fell at first sight of her patient, 83-year-old Angela, who was staying with her daughter's family. Throat cancer had spread throughout Angela's body; she was thin and gray and could barely sit up.
Angela was dying; everybody knew that. She was out of medical options when she first met Puchalski — a specialist in end-of-life care — 11 months earlier. At the time, Angela's surgeon had given her two months, and objectively, Puchalski agreed. The only help medicine could offer was some pain relief. "I was really trying to get Angela to understand that this disease would kill her — soon," she says. But Angela wanted to make it through one last holiday season with her family.
So Angela prayed. She loved the rosary; she loved hymns. Her parish priest and another old friend in the clergy visited regularly. Each month, Angela grew weaker, but she held on. In November, shortly after her husband died, Angela didn't open her eyes for two days. When she finally awoke, family members were gathered around, telling her it was okay to let go. "What are you talking about?" she asked with typical spunk. "I'm not going anywhere."
But with Christmas only two days away, Puchalski stood at the doorway, filled with concern for her patient. Then Angela's family came trooping in, and the gloom vanished. Puchalski was drawn into Christmas revelry, Italian-American style. Music played; a small Nativity scene sat near the tree, along with a picture of Mary and a rosary. Angela's exuberant 7-year-old granddaughter presented the doctor with a gift.
And Angela started laughing. She made it through that Christmas, and New Year's to boot. In February, a year after she'd been given two months to live, she died.
A DOSE OF PRAYER
Could prayer account for Angela's remarkable endurance? Many Americans would say yes. According to a recent CDC survey of more than 31,000 adults, 43% had prayed for their own health, 24% were prayed for by others, and 10% had prayed as part of a group on behalf of others — what's called intercessory prayer. The survey found that prayer was by far the most commonly used method among complementary and alternative therapies. The National Institutes of Health has sponsored at least $3.1 million in research over the past few years to study prayer's effect on heart disease, cancer and AIDS, among other conditions.
But despite all the money and effort, it's still tough to pinpoint what prayer can do for the ailing. Almost as soon as promising results on prayer's powers are released, they're marred by controversy or questions about the data.
For a true believer like Puchalski, a Catholic and director of the George Washington Institute for Spirituality and Health, the desperate chase for proof that prayer works smacks of "testing God." "I believe in God because of faith," she says. "I'm not waiting for an experiment to prove his or her existence."
She doesn't need data to tell her that a spiritual life matters to her patients and helps keep them healthy. It's that faith that has led her on a mission to get doctors to recognize patients' beliefs — to make room for spirituality in treatment.
For thousands of years, spiritual leaders and healers were one and the same. Religious orders founded the first hospitals, and it wasn't until the 1800s that medical science finally broke free of faith. But the separation of body and spirit was pursued vigorously by medical science as it advanced. Sigmund Freud went so far as to compare religion to a neurosis.
Now the pendulum is swinging back ... a bit. Scientific evidence that prayer and faith can protect health has been building slowly over the past few decades. This controversial inquiry divides into two major questions: Can a person's spiritual faith and practice affect his or her health? And can religious or spiritual practice — particularly intercessory prayer — affect the health of those being prayed for?
The first is a complicated puzzle; scientists must try to tease out the benefits of religious participation from other health factors such as diet, exercise and family history. As for the second, intercessory prayer suggests divine intervention at work, and there's no lab test for that.
RELIGION AND RELAXATION
To make a case for the health benefits of faith, prayer would have to activate a healing mechanism in the body. Herbert Benson, MD, of the Mind/Body Medical Institute in Boston and Harvard Medical School has discovered one possible mechanism. In 1970, Benson and colleagues at Harvard described the relaxation response, a simple technique where, through rest, deep breathing and repetition of a word, people can change their physical and emotional reactions to stress — reactions that can lead to high blood pressure, heart trouble and insomnia. He also found that prayer could elicit the relaxation response.
"We can effectively treat any disorder —to the extent that stress is contributing to it — by a once- or twice-daily elicitation of the relaxation response," he says.
But this isn't strictly a religious phenomenon. Recent research shows that stress-management tools, exercise or transcendental meditation can have similar heart benefits.
"It doesn't matter where the relaxation comes from. The mechanism is within us," says Benson. "Your own belief system will determine whether you believe it's God-given or whether it's evolution-derived."
Harold G. Koenig, M.D., agrees, but he also believes that religion offers benefits beyond those of meditation and exercise. As co-director of the Center for Spirituality, Theology, and Health at Duke University, Koenig has produced dozens of journal articles on spirituality's role in healing and has edited the Handbook of Religion and Health, a scholarly volume that makes the case that religious people live longer, healthier lives.
Koenig has been searching for biological evidence that prayer or religious practice tacks on years. In 1997, he found that regular churchgoers had low levels of interleukin-6, a protein linked to inflammation. Research has shown that chronically high levels of the protein can indicate increased risk of many types of disease, such as cancer, heart disease and diabetes.
The research reinforced something Koenig first noticed as a young doctor during a residency in geriatrics. "If you ask older patients in the hospital, 'What enables you to cope?' they say 'Prayer, my religious faith.'" Religious people are less depressed, he says, a finding replicated in scores of studies. "People who are depressed experience worse medical outcomes," he concludes. "They have more heart attacks, more recurrences of hospitalization, weaker immune functioning. They don't do as well."
NOT TAKING IT ON FAITH
Koenig's assertions seem logical, but generalizations like these drive critics like Richard Sloan, M.D., to distraction. There's an association between religion and health, says the chief of behavioral medicine at Columbia University, but no proven cause and effect. As he points out, it's probably true that if you carry a lighter, you're more likely to die of lung cancer. But lighters don't cause cancer.
Sloan disputes the scientific validity of all the claims regarding spirituality and health. Often, he says, they're not original research but reviews that reinterpret — and commonly, misinterpret — older studies. Sloan calls it "torturing the data until it confesses."
Puchalski's background has prepared her well to straddle the divide between faith and medicine. She has always been a spiritual seeker, always wanted to be a doctor and always seen the two as connected. "I think of medicine as one of my spiritual practices," she says.
An increasing number of health professionals have advocated, at minimum, more spiritual awareness among practitioners. It's a simple recognition that if spirituality matters to the patient, that ought to matter to the physician. "It's good to respect people, to treat them with dignity," says Puchalski. "You don't need data for that."
She has developed a protocol for doctors to get the spiritual history of their patients. And patients can easily incorporate Puchalski's plan:
# Let your doctor know if you have religious beliefs that help you cope with stress or difficult times.
# Convey the importance of spirituality in your life. Indicate the influence it has on how you care for yourself.
# Explain your spiritual community to your doctor. Is it church-based, for example?
# Ask your physician to take action —can she refer you to spiritual services such as a chaplain, meditation or yoga classes?
Puchalski's vision of spirituality and health is not about waiting for miracles. "Spirituality is that aspect of humans that seeks to heal or be whole," she argues. "It helps people find hope in the midst of despair." Whether people locate that hope in Sunday-morning chapel or on a rocky outcrop overlooking a verdant landscape, the spiritual power is the same.
Her best teachers are patients, inspired survivors like her colleague and patient Cornelius Bennhold. A theoretical physicist, Bennhold has been fighting synovial sarcoma, a rare cancer of the joints and tendons, for 13 years. Because of his profession, you might expect him to put his faith in the marvels of modern medicine — chemo, radiation, surgery — and he does. But he also credits a rich and far-reaching spiritual life with helping him rebound from each new finding of the cancer, followed by the brutal invasions of surgery and treatment.
'TOOLS THAT WORK FOR ME'
"I don't need to prejudge something just because it doesn't fit into my theory of the universe," he says of the tenuous scientific evidence that faith heals. "I was probing and exploring the kind of tools that work for me to find my spiritual center and my access to God."
During his last round of hospitalization, he prayed and practiced meditation. He got support from his church and from a spiritual group. One day, Puchalski found him depressed by the hospital food, craving Brie, good wine and French bread. So she went out and got them (substituting sparkling cider for the wine), and they talked into the night.
"That to me is very much a part of spiritual care," she says, but in this case she was the beneficiary. "I walked away inspired. I didn't think he'd walk again, and nor did anyone else. But he is. I think all of that attention either gave him the inner strength to get better, or maybe it was a miracle. I don't know.
"Science can't measure the influence of spiritual grace," says Puchalski. "Much of what happens to our patients has no explanation. Illness causes us to ask questions that are deeply spiritual and unanswerable scientifically: Why am I suffering? What is the meaning of my illness and suffering? Illness, in and of itself, is a spiritual journey, which may include emptiness, joy, despair, hope and mystical experiences. As physicians and caregivers, our job is to assist our patients through this journey."
Another kind of prayer
When most people think about prayer and healing, they think of asking for good health or relief from disease. But another type of prayer asks for nothing, but gives thanks for what has been received. And though gratitude hasn't received as much research attention, there are hints that thankfulness — whether or not it's expressed in prayer — may have its own power.
In one study, psychologists Robert A. Emmons, Ph.D., of the University of California, Davis, and Michael E. McCullough, Ph.D., of the University of Miami, found that volunteers who kept weekly "gratitude journals" exercised more regularly and reported fewer aches and pains than people asked to record hassles or neutral events. In another study, the volunteers were people with debilitating neuromuscular disease. This time, Emmons and McCullough found, keeping a gratitude log didn't reduce physical symptoms, but it did increase the amount of sleep the participants reported getting (by half an hour) and improve its quality.
Gratitude has surprising force, says psychologist Martin E.P. Seligman, Ph.D., former president of the American Psychological Association. Seligman is the guru of positive psychology, which focuses on bolstering emotional strengths. One of the exercises he's developed is the "gratitude visit," which requires you to think of someone who made an important difference in your life, write up the story of how he or she helped shape you, then visit that person to share the story. Expressing thanks in this way has a lasting impact, Seligman says: A full year later, tests show, you're likely to be happier and less depressed than before the visit.