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LETTERS: Daniel R Nethercott, Matt J Hawker, Ed Day, Simon Wilkes, and Alex Copello Spirituality and clinical care BMJ 2003; 326: 881 [Full text]

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'Spirituality' a euphemism.

Anne Shaw   (26 April 2003)

Humility: a risk factor in clinical care?

Richard G Fiddian-Green   (9 August 2004)

'Spirituality' a euphemism. 26 April 2003
Anne Shaw, Retired Retired Send response to journal: Re: 'Spirituality' a euphemism.	Larry Culliford's claim that 'spiritual values and skills' are increasingly recognised as necessary aspects of clinical care and the medical jargon in which these idea are promoted does not disguise the fact that religious believers never give up on their need to promote their beliefs. There is ample evidence that stress and anxiety lower the bodies own healing mechanisms. There is nothing magical about this, it is clear that normal physiology - the endocrine system, the sympathetic nervous system, the immune system and brain chemistry etc. are closely interrelated with maintaining mental, emotion and physical well-being. Thought, perception, emotion and behaviour, are physical not spiritual, and it is misleading to try to separate them in the way that those of a religious persuasion seek to do, in order to maintain their belief in the supernatural. Stress and anxiety are known to 'block' or weaken people's natural self healing mechanisms including the auto immune system. Anything that relieves people's stress and anxiety and increases their confidence in their carers, their treatment, and in their ability to cope with the problems of illness and disability will make them happier. Doing so effectively enables patients own bodily mechanisms to protect and heal them. If they are believers then they will use this as a 'coping mechanism'. However 'faith' and 'hope' especially if unfounded, are a poor substitute for sensitive, rational, patient centred care, which includes confidence building through understanding and stress and anxiety reduction. These good results can be gained in many ways; up front relaxation techniques and meditation; explaining the relationship between anxiety and physical health to the patient; alternative therapies many of which work through hypnotic techniques and placebo; all of which will be more likely to sustain people during illness, than belief in supernatural notions that are likely to be suddenly found wanting when the 'great healer' lets them down. The fact that cancer patients say that religion helped sustain their hopes, is not surprising, people faced with this diagnosis or any other fatal illness will clutch at any straw at least in the short run. It is harmful to call the sense of well-being that enhances health 'spirituality' because it implies religious beliefs that are not held by increasing numbers of people and it cannot be conjured up by promoting such beliefs. Any carer who does their job well, will take into consideration their emotional needs, give accurate information, judge the patients readiness to take on board the full implications of their condition, and instil confidence. Good confidence building will be undermined by the obvious desire of religiously inclined staff to attribute emotional and mental well-being to religious belief, whether it is euphemistically called 'spirituality' or not. And from my experience, hospital chaplains are a cause of irritation and distress to many patients when they present themselves unbidden. The medical and nursing professions do not have a "sacred dimension" and professionals should stick to doing the job for which they are trained, which should be to treat people with professional skill, patience, kindness and respect. The way forward is to give rein to natural inquiry, to rediscover and communicate openly about the vital area of patient's psychological needs as well as their physical treatment, but not to foster the rhetoric of spirituality. Ed Day referred to the findings that 90% of participants of an addiction treatment programme believed in a supernatural being. This could as he suggest be because the religious aspects of these programmes appeal to them, and excludes those who do not want a religious slant, but it could also show that those who are prone to the hypnotic techniques of religion are the same people who are psychologically prone to other addictions, and susceptibility to the same techniques used in many alternative therapies. And Mat Hawker refers to the persecution of Christians. But while it has been the norm for religions to persecuted each other for centuries, they have persecuted non-believers and suppressed atheism far more systematically and ruthlessly, as they still do in many countries. Anne Shaw Competing interests:   None declared
Humility: a risk factor in clinical care? 9 August 2004
Richard G Fiddian-Green, FRCS, FACS None Send response to journal: Re: Humility: a risk factor in clinical care?	When he was Archbishop George Carey accused some surgeons of "lacking humility" and warned that society was no longer prepared to accept arrogance from the medical profession (1). This accusation was misdirected. One's errors are all too evident in surgery and one has to live with them. Furthermore it takes courage to make decisions that could end up in failure. Furthermore quiet confidence is a quality in a surgeon much appreciated by those awaiting surgery. When Rowan Williams became Archbishop of Canterbury he made symbolic displays of humility, similar to that of the Pope, in washing the feet of a carefully chosen few. Whilst there is clearly merit in humility sackcloth and ashes should have no place in the modern world. What was the intention of Carey's attack upon the medical profession? Might it have signaled an alliance between the church, communists, and even businessmen concerned with the rising costs of care, to provide afforable healthcare to all peoples? The major cost is employees salaries. The lower these can be kept the more can be employed by the NHS. Even the Tory initiatives, lead by the likes of Lord McColl a devout Christian surgeon and Sir Roger Gibbs former chairman of the Welcome Foundation, might have been allied to such an initiative. Some aspects of the attack on the medical profession, made by others than those mentioned above, have unfortunately been maliciously moralistic and even criminal. The animal rights and anti-aborption terrorism would seem to be closely allied to a moralistic political correctness. Might the exclusion of protein from consideration of obesity in Prentice and Jebb's review of obesity have anything to do with this(2)? Might there even be an hidden agenda to appease Hindus, who consider cows and indeed all forms of life sacred, by eliminating animal experimentation and protein from out diets and substituting it with soya beans or their vegetarian equivalent? Might the strong Hindu influence in Boston being promoted in some segments of academia there have any bearing on the subject? If so might it be part of a movement to impose an politically corrected caste system? The threads that tie these thoughts together were addressed in considerable detail in my earlier communication on Nietzche's proclaimation that, "God is dead" (3). His adaptation of Adler's , "Will to power", is closely allied to this. Whilst there were clearly evils in the Nazi's application of these ideals there are also evils in an undue emphasis upon humility for it breeds the tolerance of mediocrity that pervades the NHS today. There is much merit in not hiding one's light under a bushel, especially in a global society, and in questioning authority and dogma. There is even beauty in power and might (4). Few have captured it better on film than the late Leni Riefenstahl did in the 1937 Olympic games. 1. BBC News, Wednesday, 18 October, 2000, 16:08 GMT 17:08 UK Archbishop warns 'arrogant' surgeons 2. Where's the [specific dynamic action of] beef? Richard G Fiddian-Green bmj.com, 3 Aug 2004. eLetter re: Andrew M Prentice and Susan A Jebb Obesity in Britain: gluttony or sloth? BMJ, Aug 1995; 311: 437 - 439. 3. "God is dead": Richard G Fiddian-Green bmj.com, 8 Sep 2003 eLetter re: Patrick Bracken and Philip Thomas Time to move beyond the mind-body split BMJ 2002; 325: 1433-1434 4. Equestrian sculpture by Nic Fiddian-Green entitled ‘Power and Might’. Sladmore Gallery. Competing interests: None declared