Allowing spirituality into the healing process
TABLE 2
Propositions regarding the effect of spirituality on physical outcomes
| Proposition Studies | Rating* #-Letter |
|---|---|
| Religious coping aids stress management | |
| Ellison, CG, Taylor RJ. Turning to prayer: Social and situational antecedents of religious coping among African Americans. Rev Religious Research 1996; 38:111–131. | 8/NA |
| Pargament KI, Smith BW, Koenig HG, et al. Patterns of positive and negative religious 8/NA coping with major life stressors. J Scientific Study Religion 1998; 37(4):710–724. | 8/NA |
| Spirituality/religious affiliation prevents substance abuse | |
| Bell R, Wechsler H, Johnston LD. Correlates of college student marijuana use: Results of a US national survey. Addiction 1997; 92:571–581. | 9/NA |
| Religious practices/spirituality decreases the incidence of depression | |
| Idler EL, Kasl S. Religion, disability, depression, and the timing of death. Am J Sociology 1992; 97:1052–1079. | 10/NA |
| Kennedy GJ, Kelman HR, Thomas C, et al. The relation of religious preference 10/NA and practice to depressive symptoms among 1,855 older adults. J Gerontol 1996; 51B:301–308. | 10/NA |
| Religious practice/spirituality lowers suicide rates | |
| Neeleman J, Halpern D, Leon D. Tolerance of suicide, religion, and suicide rates: An ecological and individual study in 19 Western countries. Psychol Med 1997; 27(5):1165–1171. | 10/NA |
| Religious practice/spirituality prevents hypertension/lowers blood pressure | |
| Steffen PR, Hinderliter AL, Blumenthal JA, et al. Religious coping, ethnicity, and ambulatory blood pressure. Psychosomatic Med 2001; 63:523–530. | 7–A/B |
| Koenig, HG, George LK, Hays, JC, et al. The relationships between religious activities 9 A/B and blood pressure in older adults. International J Psych Med 1998; 28:189–213. | 7–A/B |
| Religious practice/spirituality is related to better lipid profiles | |
| Friedlander Y, Kark JD, Stein Y. Religious observance and plasma lipids and lipoproteins among 17 year old Jewish residents of Jerusalem. Prevent Med 1987; 16:70–79. | 8-B |
| Religious practice/spirituality is associated with better immune function | |
| Woods TE, Antoni MH, Ironson GH, et al. Religiosity is associated with affective and immune status in symptomatic HIV-infected gay men. J Psychosomatic Research 1999; 46:165–176. | 7-B |
| Koenig HG, Cohen JH, George LK, et al. Attendance at religious services, interleukin-6, 8-A/B and other biological parameters of immune function in older adults, International J Psych Med 1997; 27:233–250. | 7-B |
| Religious practice/spirituality is related to lower cholesterol | |
| Patel, C, Marmot MG, Terry DJ, et al. Trial of relaxation in reducing coronary risk: Four year follow up. Brit Med J 1985; 290:1103–1106 | NA/A |
| Attendance at church services leads to longer life | |
| Koenig JG, Hays JC, Larson DB, et al. Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults. J Gerontology Series A: Biologic Sci Med Sci 1999; 54A:M370–M376. | 9-A |
| *Ratings Systems: Koenig/Miller | |
| Number = Rating system from Koenig et al. Handbook of Religion and Health. Scale of 1–10 (1=poor, 10=excellent). Based on overall study design, sampling method, quality of religious measure, quality of statistical analysis, interpretation of results, and discussion in the context of existing literature). Methodology validated by outside reviewers. | |
| Letter = Rating system from Miller WR, Thoresen CE, Spirituality, Religion and Health: An Emerging Research Field. A = Methodologically Sound B= Methodologically Sound with at least one methodological limitation. | |
| NA = not rated by this system | |
Barriers and issues
In spite of the evidence showing religion and spirituality to be positive health factors, there are still reasons to be cautious. Many obvious concerns have been expressed by physicians in recent surveys.25,26 More than 50% of physicians surveyed by Ellis and colleagues26 listed such factors as time, lack of training in taking a spiritual history, and a concern about projecting their own beliefs onto patients as barriers to discussing spiritual issues.
Recently a group of articles strongly challenged the entire premise of integration. Richard P. Sloan and his associates, in the “Sounding Board” section of the New England Journal of Medicine, said they are “troubled by the uncritical embrace of this trend….”27 They cite a number of reasons to be wary of this integration:
- Studies suggesting a relationship between spirituality and health are flawed.
- The unique nature of the patient/physician relationship causes physician assumptions and beliefs to have undue influence.
- Physicians have no expertise in spiritual matters.
- Most patients do not truly want to discuss spiritual issues, and interest does not necessarily justify the incorporation of religious matters.
- The integration of spirituality into practice is an attempt to use religion that trivializes a deep and complex reality.
A similar article in the Lancet echoed these concerns.28 Again, the empirical evidence is challenged. Added to that concern is a variety of ethical issues. The first ethical issue relates to boundaries. The authors insist “when doctors depart from areas of established expertise to promote a nonmedical agenda, they abuse their status as professionals.” The second issue involves the ethics of “taking into account” spiritual issues versus “‘taking them on’ as the objects of interventions.” A third ethical problem focuses on the possibility that physicians might actually do harm to patients by linking health status and spirituality.28
