 Postmodernity reunites faith and medicine By Harold G. Koenig © 2001 United Press International Thursday, February 15, 2001 This is the 10th installment of the UPI series, "Christ and postmodernity."
Nonetheless, there has been growing dissatisfaction among both patients and health-care professionals over the mechanistic, impersonal and economically driven way that health-care delivery sometimes occurs. When people become ill, they want to be treated like whole people, not simply as the malfunctioning kidney or heart in room 405. For many, wholeness means body, mind and spirit. Veteran health professionals long have recognized the importance of psychological, social and spiritual factors in the health and healing of their patients. Until recently, however, they were reluctant to address these issues, especially the subject of spirituality, because they lacked the time and the training or feared that this area was not within the domain of scientific medicine. That rapidly is changing in the postmodern world. One reason is that the doctor-patient relationship is changing from a paternalistic one (the doctor knows best) to an egalitarian one (decisions made jointly by patient and doctor). People wish to have their spiritual or religious needs addressed and are becoming vocal about it, particularly when such beliefs and practices lie at the heart of how they cope, how they give meaning to illness and how they make decisions about their medical care. Two-thirds of patients in a recent study indicated that their religious beliefs would affect the medical decisions they made when seriously ill. Another reason for the change in practitioners' attitudes toward religion is the growing volume of research that is documenting connections between a person's religious involvement and health. While most of the research has been done in Christian populations, there is substantial evidence that Jewish, Muslim and Eastern religious practices convey similar health benefits. The latter research, however, is dwarfed by the number of studies examining the possible effects of traditional Judeo-Christian beliefs and practices on health and well-being. No fewer than 1,100 scientific studies have now explored these relationships, two-thirds or more showing that religious people experience better mental health, better physical health and need and use fewer expensive health services (see The Handbook of Religion and Health, Oxford University Press, 2000). According to some studies, active religious involvement may extend survival by as many as seven to 14 years, equivalent to not smoking cigarettes. How religion actually does this is now being actively investigated. First, a positive, optimistic belief system or worldview may affect the physical body by calming the nervous system and suppressing such hormones as cortisol and norepinephrine. Thereby, the immune system is boosted and the cardiovascular function stabilized. The extent of this "spirit-mind-body" interaction only is beginning to be understood, but likely is to be substantial. Second, religious congregations provide emotional support. Social support serves as a buffer against emotional stress, improves disease detection and encourages timely treatment. Third, religious doctrines discourage behaviors that adversely affect health (smoking, alcohol, risky sexual practices, etc.). Few other social institutions provide this combination of health-promoting resources. In an amazing way, research at the turn of the millennium is discovering the exact opposite of what many health professionals since Sigmund Freud have thought about religion. The predominant view during the 1900s was that religion, Christianity in particular, was either irrelevant to health or possibly even had a negative influence. As health-care professionals become aware of the volume and quality of research connecting religion and positive health, they now are wondering how to apply such findings to their clinical practices. Does this mean that patients should be encouraged to attend religious services, pray more or read religious scriptures? Should religion or Christian beliefs be introduced to the non-religious, adding this to a list of recommendations concerning diet, exercise and smoking? Probably not. None of this research shows that increasing religious activity or turning to Christ, only to improve health, will result in better health. The utilitarian use of religion as a means to some other end (called "extrinsic" religiosity) is not associated with better health. Instead, health simply may be a byproduct of a devout faith that is pursued for the right reasons. More sensible and sensitive application of these new and exciting findings, however, is possible. Many patients already utilize religious beliefs and practices to help them cope with the stress of medical illness; this has been particularly true in studies of Christians. Information about the patients' religious beliefs and the amount of support they receive from their religious community often has direct relevance for patient care. Health-care professionals might inquire about religious practices and find out how patients utilize them to cope and how this influences their medical decisions. Appropriate referrals to chaplains or clergy could be made when spiritual needs come up. Both nursing schools and medical schools are beginning to train healthcare professionals to take a patient's spiritual history, just as they might inquire about the patient's living circumstances and social environment. More than 70 of 126 U.S. medical schools now have courses on religion, spirituality and medicine – a huge change from less than a decade ago when only a handful of schools had such courses. As a result, patients in this postmodern era soon may find their physicians and other health professionals asking about and supporting their religious beliefs and practices, particularly those that do not directly conflict with medical care. Such inquiries should be "patient-centered." In other words, the focus will be on supporting what the patient finds helpful and familiar, not on introducing or imposing new religious beliefs or practices. Some health-care professionals also may be willing to pray with patients, particularly if the patient requests prayer. Most patients greatly appreciate when health care providers are sensitive to and support the religious or spiritual beliefs that matter so much to them, particularly at a time when they are struggling to find meaning and purpose in lives threatened by change. Respect for those without such beliefs also is essential. In the 21st century, we likely will see more and more health-care systems linking with religious communities. The number of older adults is increasing as baby boomers age. The cost of health care is rising. The resources to provide that care are limited, and there is a backlog of people unable to get into nursing homes or acute-care hospitals and, thus, needing care in the community. This will force the trend to link health-care and faith communities. In many cases, a parish or congregational nurse will facilitate this relationship. A parish nurse is a registered nurse, often a member of the religious community, who spends time educating church volunteers, screening for health problems and providing support for sick members of the congregation and their families. By mobilizing volunteers from the congregation and providing support in the home, the parish nurse helps to keep the sick person out of the hospital and avoid expensive institutional care. Studies are beginning to show that religious volunteers who live out their faith by helping others themselves end up having better mental health, greater purpose in life and even greater longevity – a win-win situation for everybody. The research linking religious activity (especially volunteering) with better mental and physical health presumably will end one of modernity's peculiar legacies: The high wall of separation between religion and medicine erected during the 19th and 20th centuries appears to be coming down. Harold G. Koenig, M.D., is associate professor of psychiatry and medicine at Duke University Medical Center and editor-in-chief of Research News & Opportunities in Science and Theology. |
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