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Rapid Responses: Rapid Responses published:
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Spiritual and Integrated Healing
- Michael J. Meredith (23 December 2002)
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H Control his somatic hallucination by practising relirious rituals like praying?
- Abdul Karim Al-Sheikhli,MRCPsych,DPM (24 December 2002)
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spirituality and medicine
- dr.manan vasenwala md,mrcp (25 December 2002)
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Prayer helps
- Leopold Reinecke (26 December 2002)
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Spirituality & Addiction: Not Everyone's Cup Of Tea
- Ed Day, Simon Wilkes, Alex Copello (31 December 2002)
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placebo or not? or will we never know?
- Daniel R Nethercott (31 December 2002)
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Re: placebo or not? or will we never know?
- Daniel J Benor, MD (1 January 2003)
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Spirituality and the clinician
- Alfredo D. Espinosa-Brito (3 January 2003)
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the limits of scientific medicine, pts. are people not cases
- stephen r. kettle (3 January 2003)
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Spiritual care based primarily on happiness is dangerous
- Matt J Hawker (8 January 2003)
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Re: Spiritual care - a confusing term
- Mike D Williams (9 January 2003)
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Spiritual Care; An Unmet Training Need
- George El-Nimr, Emad Salib (11 February 2003)
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Spirituality:A necessary complement to holistic care.
- Ademola, B Adeponle (27 June 2005)
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Michael J. Meredith, Consultant Sunflower Health, 4 New Close Farm Business Park, Lolworth, Cambridgeshire, CB3 8TL
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Dr. Culliford's review is much appreciated - a gust of holistic fresh air to balance any tendencies towards over-investment or over-reliance in technology and historical research data (EBM) in clinical care. Spiritual perspectives and attitudes continue, thankfully, to be a key component of most clinical care services, but it is gratifying to see the resurgence of conscious consideration and positive regard for the potential direct impact of one human being on the healing resources of another via compassion, caring, unconditional love, connectedness and high standards of personal conduct. Those interested in this topic may find the recent review by U.S. nurse Ruth Tanyi is also helpful ("Towards Clarification of the meaning of spirituality", J. Advanced Nursing vol.39 500-509, 2002). Here in Cambridge we were fortunate to have a conference on "Spirituality and Healing" in October this year, hosted by the University's Faculty of Divinity. One of the principal speakers was Philadelphia surgical oncologist, Michael Torosian, who reviewed the extensive literature evidencing the significant impact of social and personal "well-being" factors on cardiovascular and oncology patients. Dr. Veruschka Biddle, founder of the International Institute for Spirituality and Healing spoke of her practical experience in drawing on spiritual healing techniques to help people who had suffered severe traumatic experiences. I look forward to seeing more publications in the BMJ on this topic in general and especially on the practical experiences and techniques of spiritual healing. The integration of spiritual, physical and psychological aspects of healing (psychoneurobiology and psychoneuroimmunology) is an especially exciting challenge. Competing interests: I am a holistic health consultant and shamanic healer |
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Abdul Karim Al-Sheikhli,MRCPsych,DPM, Loc.Consultant Psychiatrist 2 Manor Court Avenue,Nuneaton ,CV11 5HX,UK.
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23rd Dec 2002 Dear Editor,It was very interesting to read the Editorial of Culliford,Spirituality and clinical care,BMJ(1). My comment on a paper by Hawten & Willams(2),that religious practice got a place in the treatment and prevention of suicide and attempting suicide(3). Bereavement could be other area in which religious practice with psychiatric treatment will enhance improvement. So i think religious practice got a place in managment of many medical and psychiatric illnesses ,in which research work is needed. References, 1.Culliford.L,Spirituality and clinical care,Editorial,BMJ,2002,325,1434- 1435. 2.Hawten.K,and Willams.K,Influence of media on suicide,BMJ,2002,325,1374- 1375. 3.Al-Sheikhli.A.K,Suicide and religion,BMJ.com/cgi/eletters/325/7377/1374#27820,13 Dec 2002. Competing interests: None declared |
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dr.manan vasenwala md,mrcp, consultant-cardiologist (non-invasive) k.k.heart center, aligarh.202002,INDIA
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we are spiritual beings within a body. we cannot be just living bodies because this does not fit in with the achitecture of the cosmos, its intricate design, precision of movements and efficiency all of which point to an intelligent power.in the last few decades, medical family, drunk with sucess of new conquests in field of medicine and surgery began to scoff at the existence of spirit within us. however, growing disillusionment with current available medical and surgical treatment, an increasing number of people are now turning to faith healing. many studies have revealed that those with 'faith' do better with the same medical treatment. even if a patient is "prayed for", by his friends or relatives, he does better and recovers faster than his counterpart who is not "prayed for" distinct religion centers have been identified in the cerebral hemispheres`.stimulation of these centers lead to calmness. it is no wonder that in this materialistic age, stress is rampant and all major health disorders stem from stress. yet 'faith' can reduce stress. it appears that faith and stress are inversely related. the more the faith and spirituality, the less the stress. the west is now looking to the east, and many rich but wearied westerners are scurrying to the foothills of himalayas seeking solace and doing meditation.. yet the spirit is within all of us. we just have to look inwards. i entirely agree with the authors that spirituality and clinical care must go hand in hand. Competing interests: None declared |
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Leopold Reinecke, Radiation oncologist Donald Gordon Medical Centre, Parktown 2193 South Africa
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When I was a medical student in my 6th year I was introduced to Dr. Paul Tournier's "Meaning of Persons" he was a practicing psychiatrist in France in the 20's and 30's. He has also written many other related books. I was most impressed with his approach to his patients. It involved the patient and the doctor (himself) praying together with impressive results. Later as a general practitioner I would do the same with those who were desiring such an approach. It goes without saying that not everyone is happy with a "praying" doctor. I learnt to not invade the patient's privacy - esp. with regard to their religious beliefs (or lack of it). But, found that many remarkable things happened during the course of my 15 years in general practice - as a consequence of this approach (as part of the "normal" medical history/examination). Now as an oncologist - I have found it rare indeed that patients who are in dire straits do not appreciate it that they come to a physician who is not embarrassed to pray for them. This may sound strange to those who have not practiced medicine in this way - but, as with all things "He sets....the time for silence and the time for talk" (1) Great wisdom and a lot of experience is needed to not offend or hurt those who are already suffering. But a kind and loving doctor is always appreciated by those in distress. At the moment after death - even those who profess to be atheists when asked "should I pray?" Always say "Yes please doctor, would you?" Reference: 1. Ecclesiastes 3:6,7 Today's English Version:1966:690 Competing interests: None declared |
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Ed Day, Specialist Registrar In Addiction Psychiatry Addictive Behaviours Centre, 120-122 Corporation Street, Birmingham B46SX, Simon Wilkes, Alex Copello
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Sir, Culliford's editorial about spirituality in medicine raises some important issues (1), and the alcohol and drug treatment field is one area where the spiritual dimension can clearly play a part in recovery. The 12- step model as developed by Alcoholics Anonymous has a number of important therapeutic elements, one of which is providing strategies that promote the development of spirituality. Although research evidence for the efficacy of the method has been difficult to obtain, the large Project MATCH study of drinking outcomes found 12-step facilitation to be as effective as other forms of psychological treatment (2). We have recently conducted a questionnaire survey of 60 people attending Narcotics Anonymous (NA) Groups in the West Midlands. The questions asked the attenders to rate amongst other things their level of NA group attendance and participation, their belief in a higher power and the amount of time that they devoted to any form of spiritual practice. The results showed that 90% of the participants had a belief in a power greater than themselves, and on average 50% allowed time for spiritual practices at least once per day. A linear regression analysis showed that spiritual practices, along with attendance and engagement with the self- help groups were significant predictors of abstinence in this group of substance misusers. The finding that participants allow themselves some time to engage in spiritual activities every few days is consistent with the work of Finney and Maloney, who found meditation to be an effective component of relapse prevention in this group (3). It also links to Geisler’s work demonstrating that spiritual practices combined with psychosocial treatment are effective aids to misusers in reducing their drug use (4), and to other work that suggests that prayer and meditation positively influences coping (5). However, it is our belief as clinicians working in this field that the spiritual dimension has the potential to be a double- edged sword when considering engagement in self-help groups. Although the membership of Alcoholics and Narcotics Anonymous is over two million people worldwide, it constantly surprises us how few of the people that we treat utilise this free and readily available form of long-term help. We are currently conducting a further piece of research to analyse this further, but from our clinical experience it seems that the perceived 'religious' or spiritual element of the process is often described as a strong reason to stop attending AA or NA-based self-help groups, particularly in the early stages. Ed Day, Specialist Registrar in Addiction Psychiatry Simon Wilkes, Psychologist Alex Copello, Consultant Psychologist Addictive Behaviours Centre, 120-122 Corporation Street, Birmingham B46SX References 1. Culliford L. Spirituality and clinical care. British Medical Journal 2002;325:1434-1435. 2. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH post treatment drinking outcomes. Journal of Studies on Alcohol 1997;58(1):7-29. 3. Finney JR, Maloney HN. Empirical studies of Christian prayer: a review of the literature. Journal of Psychology and Theology 1985;13(2):104-115. 4. Geisler M. Transcendental meditation as a therapeutic tool for drug users. Journal of Clinical Psychology 1978;7(4):235-255. 5. Hjelle L. Transcendental meditation and psychological health. Perception and Motor Skills 1974;39(1):623-628. Competing interests: None declared |
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Daniel R Nethercott, sho, palliative medicine cardiff cf14 3ld
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I would certainly agree that knowing your patients better makes for a better therapautic relationship. Often, for instance in the setting of terminal care, or otherwise, where physical measures are inefficacious in impacting on any disease, to be able to relate in 'wider' terms can increase the potential for healing. But it is on the question of the methodology that I take issue with the author. Most religions and other arenas of spirituality employ ritualised gestures, incantations, prayers symbolism and rites. Unless you beleive that these processes have effects through the perceived 'extracorporeal being/power/energy' then it is assumed that the effect comes from within the patient themselves. But the placebo effect is inherently based upon its own camoflage. Once you know you're taking placebo then the magic is lost. The entire effect is dependent on one's 'faith' in the procedure. Whilst I might deliberately employ the placebo effect in my pharmacological treatment of patients, is it not an unethical deceit for me to portray a facade of spirituality for their benefit, when I don't believe it myself? And if that is true then what is the author suggesting? Might it be that my deficiencies as a non-believer translate into deficiencies as a doctor? Perhaps I don't really want an answer to that. Competing interests: Practising atheist |
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Daniel J Benor, MD, Psychiatric Consultant, Children's Seashore House, Affiliated with Children's Hosp. of Philadelphia 08401
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Considering that 124 out of 191 controlled studies of spiritual healing (for humans, animals, plants, bacteria, yeasts, cells in vitro, enzymes and DNA) demonstrate significant effects (Benor 2001), the placebo (or self-healing) hypothesis for effects of healing can only be a partial explanation. References: Meta-analyses of healing studies Abbot, Neil C, Healing as a therapy for human disease: a systematic review, Journal of Alternative and Complementary Medicine, 2000, 6(2), 159-169. Astin, John A/ Harkness, Elaine/ Ernst, Edzard, The efficacy of "distant healing": a systematic review of randomized trials, Annals of Internal Medicine 2000, 132, 903-910. http:// www.acponline.org/journals/annals/06jun00/astin.htm Braud, William and Schlitz, Marilyn. A methodology for the objective study of transpersonal imagery, Journal of Scientific Exploration 1989, 3(1), 43-63. Schlitz, Marilyn/ Braud, William, Distant intentionality and healing: assessing the evidence, Alternative Therapies 1997, 3(6), 62-73. Winstead-Fry, Patricia/ Kijek, Jean, An integrative review and meta-analysis of Therapeutic Touch research, Alternative Therapies 1999, 5(6) 59-67. (Summaries of these meta-analyses are posted at http:// www.wholistichealingresearch.com/Research/ Studies.htm#pmahs) Book Benor, Daniel J, Healing Research: Volume I, Professional Supplement to Spiritual Healing: Scientific Validation of a Healing Revolution, Southfield, MI: Vision Publications, 2001. ISBN 1- 886785-12-0 Competing interests: Author of book reviewing 191 controlled studies of healing |
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Alfredo D. Espinosa-Brito, Calle 51 A and Ave 5 de Septiembre, Cienfuegos 55 100, Cuba Hospital Dr, Gustavo Aldereguia Lima, Cienfuegos 55 100, Cuba
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Congratulations to Culliford for his Christmas editorial. (1) I agree with him that, until our days, "it is more important to know what person is sick than what disease he (or she) suffers". Undoubtedly, the spiritual evolution (in wide sense, not only religious) of the present human being has been slower than the scientific, technological and material development. There is a great gap between these two processes. This lack of equilibrium at the beginning of the third millenium put both, the patient and the clinician, in the same condition as a monkey playing with a missile.(2) We have to take care of this new situation and we have to answer according to this reality in our daily work. Not only in order to recognise spiritual values and skills as very necessary aspects of clinical care, (1) but also improving with our professional examples the spirituality of the society, families and individuals, in the conflicting world that we live today. References: 1. Culliford L. Spiritualy and clinical care (editorial). BMJ 2002;325:1434-1435. 2. PARLATINO-UNESCO.La factibilidad cultural en la planificacion del desarrollo. Sao Paulo: PARLATINO-UNESCO, 2002. 97 p. Competing interests: None declared |
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stephen r. kettle, solo gp c'mundi 4551 Australia.
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good to see sceptics at work but where conventional scientific medicine is less strong; it, holistic medicine, has a place at least for the pts. ideally we should all be practicing total care of the pt.. certainly prayer, laying of hands where appropriate are all helpful esp. in cancer care or children / adults with non-curable illnesses of which many are doubtless fully aware. less so in addiction treatment or with the more manipulative pts. / clients. kind regards Competing interests: solo gp |
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Matt J Hawker, SHO Ophthalmology Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, Worcestershire, WR5 1DD
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EDITOR – Culliford’s editorial reflects a resurgent interest in spiritual aspects of healing through discontent with a purely materialistic world-view.1 Our culture does not believe in a pure scientific reductionist model that says we are made solely of a chemical structure (witness the Princess Diana experience and films like Sixth Sense and Star Wars). Our experience tells us there is a greater depth to life and I welcome Culliford’s recognition of this as central in healthcare provision. However, a case for spiritual awareness and treatment based primarily on outcomes of happiness and well-being is dangerous. Leading patients to believe that spirituality brings happiness may cause upset through disappointment, or more seriously propound disregard for spiritual truth –“it doesn’t matter what you believe as long as it makes you happy.” Of far greater importance is “Is it true or not?” Consider Christianity for example. The experience of many is indeed that faith brings a deep joy that surpasses day-to-day happiness and upset. However, Christianity does not always bring happiness. Christ claimed he was God’s son and was crucified for it. Many who followed Him since have been martyred for their beliefs and countless more suffer daily persecution for being called ‘Christian’. Living out the Christian faith in itself is hard work. Therefore it matters whether or not this faith is based on truth – “if Christ has not been raised, your faith is futile; you are still in your sins. Then those also who have fallen asleep in Christ are lost. If only for this life we have hope in Christ, we are to be pitied more than all men.”2 The spiritual side of clinical care is important. We should be careful, however, to avoid misleading spiritual platitudes that bring happiness at the expense of truth. 1. Spirituality and clinical care. Larry Culliford. BMJ 2002; 325: 1434-1435 2. 1 Corinthians 15:17-19. New International Version. International Bible Society, 1984. Competing interests: MH is a Christian |
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Mike D Williams, Executive Director, Thamas Valley Strategic Health Authority Jubilee House, 5510 John Smith Drive, Oxford, OX4 2LH
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Sir As someone who has just completed an MA in Christian Spirituality I found Larry Culliford's use of terms like 'spirituality', 'religion' and 'faith' being deployed in a manner that does not bring clarity to the undoubted benefits of taking a holistic view of patient care.1 Culliford is correct in pointing our that 'spirituality' is difficult to define. Even within Christian spirituality there are many definitions. 2 Given such difficulty it is important for the author to clarify his understanding of the term 'spirituality' as this article appears, at points, to give the impressions that the research cited cover this broad band of spirituality where in fact some only look at the outcome of religious practices or beliefs. What would be interesting to explore is whether the spiritual and clinical care of patients is different in terms of outcome for those who profess a religious spirituality, for example, Jewish, Muslim or Christian, where belief in God may well sustain hope, against those who have a non religious spiritual beliefs. I hope that the BMJ will not confine this important editorial topic to future Christmas editions as the debate on holistic care needs considerable research, debate and publication space. 1. Spirituality and clinical care. Larry Culliford. BMJ 2002; 325: 1434-1435 2. Lawrence Cunningham & Keith Egan 'Christian Spirituality', Mahwah, Paulist Press, 1996. pp.22-28. Competing interests: Anglican Priest |
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George El-Nimr, Specialist Registrar in Psychiatry Harplands Hospital, Hilton Road, Stoke on Trent, ST4 6TA, Emad Salib
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Dear Editor, We read with interest your editorial on spirituality and clinical care (BMJ 21Dec 2002). Your stimulating article did flag the importance of taking the views of our clients seriously, especially when the evidence from the literature is, for whatever reason, insufficient. In a qualitative piece of research on the views of elderly mentally ill patients and their formal and informal carers on spiritual care, we found that patients are more interested than their carers in this respect. Interestingly, patients and carers think differently as to what we actually refer to when we speak about spirituality. Where the formers’ views seem to evolve around religion, the care givers’ views are multifaceted. More importantly, Mental Health professionals were generally viewed as potential assessors and / or providers of spiritual care. Training needs were acknowledged although poorly defined. In another survey on the same subject, we explored the views of different primary and Psychiatric Health professionals in Warrington. We found that nurses are yet more interested in the subject than other professionals. As expected, the degree of interest of different health care professionals was found to be significantly influenced by their cultural background. Training will definitely have something to offer in minimising the potentially harmful influence of this heterogeneity of attitudes and the lack of agreed, evidence based consensus. It seems to us that training needs in this area should be appropriately addressed. Building some form of basic skills and knowledge along with developing a specialized area for interested staff may be the way forward. Competing interests: None declared |
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Ademola, B Adeponle, Consultant Psychiatrist Federal Neuro-Psychiatric Hospital,Kaduna,Nigeria
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That orthodox medicine is begining to acknowkedge that spirituality might have a place in the care process is gladdening news.Some may argue,and rightly in my opinion, that this is coming rather late,given the fact that we have being talking of holistic/biopsychosocial medicine for over thirty years now.Unfortunately,the overhang of the dictum of seperation of mind and body(dualism) that has guided western orthodox medical practice in past two hundred years is so pervasive,that it continues to blind us to the obvious truth that non-western cultures have known for ages.This truth is that while we(ie,Man)apparently seem to be the lord of the earth, we are able to do so little to influence what becomes of us on a day to day basis.This awareness of our naked vunerability as humans always brings our mortality to our conciousness and in fact is basic question of existence.Irrespective of level of technological advancement or the quality of life being enjoyed by a people,this basic question of our existence continues to haunt us.One might argue that the a-reliogisity and technological advancement seen in the western world is indicative of a conscious wish to be free of the naked vunerability earlier reffered to and at the same time, an unconscious process involving elements of denial,reaction formation and sublimation (all defense mechanisms),of the necessity of God in the live of man.The fact that there appears to be a resurgence of interest in spiritual matters is a testimony to the failure of this seperation from God. In non-western countries,physicians have had to cope with the indiginity of having patients under their care,knowing fully well that whatever they presccribe will still be vetted by some spiritualist somewhere.I am sure we will be free from this embarrassment soon. Competing interests: I am a practising chistain,with a strong conviction that God heals,medicines or not. |
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