Medicine and Faith in 1910: Immeasurable

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Title: Medicine and Faith in 1910: Immeasurable

1
Medicine and Faith in 1910 Immeasurable

Nothing in life is more wonderful than faith --
the one great moving force which we can neither
weigh in the balance nor test in the
cruciblemysterious indefinable known only by
its effects faith pours out an unfailing stream
of energy while abating neither jot nor tittle of
its potency.
Sir William Osler (1910). The faith that heals
British Medical Journal 11470-72.

2
The Forgotten Factor
3
Are Religion and Science Mutually Exclusive

Religion and science are mutually exclusive
realms of thought whose presentation in the same
context leads to misunderstanding of BOTH
scientific theory and religious belief.
National Academy of Science (1984). Science and
creationism A view from the National Academy of
Science.

4
Are Religion and Science Mutually Exclusive

Religion and science seem to be mutually
exclusive perspectives.
Stark (1963). Journal for the
Scientific Study of Religion 33-20.

5
Scientist and Clinician Beliefs Rates of
Atheism and Agnosticism

U.S. Population 6
American Men and Women
of Science 1916 and 1996 55
Vermont Family Practitioners 36
Psychologists 28
Psychiatrists 21
Bergin and Jensen Psychotherapy 1990 273-7.
Maugans and Wadland Journal of Family Practice
1991 32210-213.

6
Religion Has Been Labeled

A universal obsessional neurosis...infantile
helplessness...a regression to primary
narcissism.
Freud S. Civilizations and its Discontents
1959.

7
Religion Has Been Labeled

Borderline psychosis . . . a regression an
escape a projection upon the world of a
primitive infantile state.
Group for the Advancement of Psychiatry.
Mysticism Spiritual Quest or Mental Disorder
1976.

8
Religion Has Been Labeled

A psychotic episode.
Horton PC. American Psychoanalytic
Association Journal 22(1-2) 364-380 1974.
Temporal lobe dysfunction.
Mandel AJ. In The Psychobiology
of Consciousness. Ed. by RJ Davidson 1980.

9
DSM-III-R Misrepresentation of Religion

Of 45 case examples used to illustrate
psychopathology in the DSM-III-R Glossary of
Technical Terms
10 (22.2) had religious content.
2 (4.4) had occupational content.
1 (2.2) had family content.
NONE had sexual ethnic racial age gender
educational or cultural content.
Larson DB et al. (1993). American Journal of
Psychiatry 15012.

10
Unresolved Religion Dynamics

In their training our generation of analysts
have not received the detailed understanding I
think is necessary to appreciate the specific
contribution of the God representation to psychic
balanceAs in many other areas if the analysts
personal analysis has not helped them to come to
terms with their religious beliefs or lack of
them there is a risk of unchecked
countertransference in this realm.
Rizzuto A. The Birth of the Living God.
University of Chicago Press 1979.

A national survey of psychologists found that
Only 5 had received training on handling
religious issues during their education.
Yet
More than one-half of psychologists believed that
religion was a relevant topic for training and
Nearly two-thirds believed that such supervision
and training was desirable.
Shafranske EP Malony HN. Psychotherapy 1990
27(1)72-78.

A recent survey of members of the American
Association of Directors of Psychiatric Residency
Training found that while religion was viewed as
an issue of significant clinical importance
religious issues were infrequently addressed in
training.
Sansone RA et al. Academic Psychiatry 1990
434-38.

13
The Art and Practice of Medicine

Medicine is the art and practice of understanding
and treating physical and emotional illnesses so
as to
1) Prolong life
2) Restore health
3) Fend off death
Levin Vanderpool (1990). Journal of
Religion and Health 299-20.

14
Religion and spirituality are among the most
important factors that structure human
experience beliefs values behavior and
illness patterns.

Lukoff D et al. Journal of Nervous
and Mental Disease 180673-682 1992.

15
The R Word
16
The R Word

Religion is a comprehensive picturing and
ordering of human existence in nature and the
cosmos.
Levin Vanderpool (1990). Journal
of Religion and Health 299-20.

17
Perspectives Concerning The R Word

Abraham Joshua Heschel
Religious thinking then is an intellectual
endeavor out of the depths of reason. It is a
source of cognitive insight into the ultimate
issues of human existence.
Heschel AJ. The abiding challenge of religion.
The Center Magazine. March/April 1998 pp. 43-51.

18
Perspectives Concerning The R Word

Clifford Geertz religion and stress
The force of religion in supporting beneficial
social values rests then on the ability of its
symbols to formulate a world in which those
values as well as the forces (e.g. stressful
events) opposing their realization are
fundamental ingredients.
Geertz C 1973. The Integration of Cultures.
Basic Books.

19
Religious and Spiritual Measures

Duke University Religion Index (DUREL)
How often do you attend church or other religious
meetings
How often do you spend time in private religious
activities such as prayer meditation or Bible
study
In my life I experience the presence of the
Divine (i.e. God).
Koenig HG et al. Religion index for psychiatric
research (DUREL).
Am J Psychiatry 1997154885-6.

20
Religious and Spiritual Measures

Duke University Religion Index (DUREL)
My religious beliefs are what really lie behind
my whole approach to life.
I try hard to carry my religion over into all
other dealings in life.
Koenig HG et al. Religion index for psychiatric
research (DUREL). Am J Psychiatry 1997154885-6.

21
The S Word
22
The S Word

Spirituality is a belief system focusing on
intangible elements that impact vitality and
meaning to lifes events.
Maugans (1995). The SPIRITual history.
Archives of Family Medicine 511-16.

Spirituality Self-transcendence which gives
integrity and meaning to life by situating the
person within the horizon of ultimacy
The religious meaning of spirituality is based on
the conception of what constitutes the proper and
highest actualization of the human capacity for
self-transcendence in personal relationships
namely relationship with God.
Conn JW 1987. In The New Dictionary of
Theology. The Liturgical Press Collegeville
MN.

24
Questions That Can Be Used to Facilitate Clinical
Discussions About Patient Spirituality

From SPIRITual History
What does your spirituality/religion mean to you
What aspects of your religion/spirituality would
you like me to keep in mind as I care for you
Would you like to discuss the religious or
spiritual implications of your health care
As we plan for your care near the end of life
how does your faith impact on your decisions
Maugans TA. The SPIRITual history.
Arch Fam Med 1996 511-6.

25
Questions That Can Be Used to Facilitate Clinical
Discussions About Patient Spirituality

From Inspirit
How close do you feel to God or a higher power
Have you ever had an experience that convinced
you that God or a higher power exists
How strongly religious (or spiritually oriented)
do you consider yourself to be
McBride JL et al. The relationship between a
patients spirituality and health experiences.
Fam Med 1998 30(2)122-6.
Kass JD et al. Health outcomes and a new index
of spiritual experience. J Scientific Study of
Religion 1991 30203-11.

26
Questions That Can Be Used to Facilitate Clinical
Discussions About Patient Spirituality

From McBride et al.
How has your religious or spiritual history been
helpful in coping with your illness
How has your belief system been affected by your
illness
McBride JL et al. The relationship between a
patients spirituality and health experiences.
Fam Med 1998 30(2)122-6.
Hatch RL et al. The spiritual involvement and
beliefs scale development and testing of a new
instrument. J Fam Pract 1998 46476-486.

27
Religious and Spiritual Measures

For further reading
Hill Peter C. Wood Ralph W. eds. (1999).
Measures of Religiosity Birmingham AL
Religious Education Press.

28
Measures of Spirituality and Religion

Pargament Kenneth I. (1997) The Psychology of
Religion and Coping Theory Research Practice.
New York The Guilford Press.
Also Pargament KI et al. Patterns of positive
and negative religious coping with major life
stressors. J Scientific Study of Religion
199837(4)710-724.

29
Why Is This Clinically Important

Patient Need
The Forgotten Factor
Clinical Relevance

30
Patient NeedU.S. Religious Beliefs and Attitudes

Item U.S. Population
Feel God loves you 90
Belief in power of prayer 88
God performs miracles today 85
Mind over matter -
God not involved 11
Emerging Trends Princeton Religious Research
Center 1996.

31
Patient NeedPersonal Priorities in the U.S.

Very strongly committed to
90 Family
79 Relationship and friends
54 Job
52 Religion
18 Ones political party
USA Today survey of US adults February 10 1997.

32
Patient NeedU.S. Beliefs Faith Prayer and
Health

82 Believe in healing power of
personal prayer
77 Believe that God can intervene
to cure those with a serious
illness
73 Believe that praying for another
can help cure their illness
Time June 24 1996.

33
Patient NeedU.S. Beliefs Faith and Health

79 Believe spiritual faith can help one
recover from illness injury or disease
56 Believe their faith helped them recover
from illness injury or disease
63 Believe doctors should talk to patients
about their spiritual faith
Only 10 of doctors have done so
USA Weekend April 5-7 1996.

34
Patient NeedU.S. Beliefs Faith Prayer and
Health

64 Believe physicians should pray
with their patients if asked
28 Believe faith healers can make
people well
Time June 24 1996.

35
Patient NeedSpirituality and Religion

Psychiatry Medical/Surgical
Inpatients Inpatients
Consider self
Spiritual or religious 80 86
Deeply religious 48 38
Need for prayer 80 88
Religion important source
of strength and comfort 68 72
Fitchett et al. J Nerv Ment Dis 1997185(5).

36
Patient NeedCoping with Illness

Hospitalized
Most Important Factor Patients
Physicians
The Patients Faith 44 9
Koenig HG et al. Religious perspectives of
doctors nurses patients and families. J
Pastoral Care 1991 45(3)254-67.

37
Patient NeedPatient Views Regarding
Spirituality When Seriously Ill

Pulmonary
Patients
Consider self religious 51
Welcome religious questions in medical history
66
Not welcome religious questions
16
Ehman JW Ott BB Short TH. Do patients want
physicians to inquire about their spiritual or
religious beliefs if they become gravely ill
Arch Intern Med 1999 159 (15) 1803-1806.

38
Patient NeedPatient Views Regarding
Spirituality When Seriously Ill

Pulmonary
Patients
Believe prayer can aid in recovery from illness
90
Agree physicians should ask religious questions
if they became gravely ill
94
Ehman JW Ott BB Short TH. Do patients want
physicians to inquire about their spiritual or
religious beliefs if they become gravely ill
Arch Intern Med 1999159 (15) 1803-1806.

39
Patient NeedTeaching Spirituality in Medical
Schools

Study sample More than one half of U.S. medical
schools have courses in spirituality and
medicine many are required.
Medical school curricula include
Teaching students to make a spiritual assessment.
Viewing and collaborating with chaplains as
relevant part of the health care team.
Puchalski CM Larson DB. Developing
curricula in spirituality and medicine. Acad
Med. 1998 73(9)970-74.

40
Patient NeedTeaching Spirituality in Medical
Schools

Medical school curricula include
Showing students how to care for dying patients
even when disease specific treatment no longer
available.
Exploring major religions to identify aspects
that might affect health care choices illness
coping or social support value.
Puchalski CM Larson DB. Developing
curricula in spirituality and medicine. Acad
Med. 1998 73(9)970-74.

41
Patient NeedProvider and Patient Views-When to
Include Spirituality

Physicians Patients
Counseling terminal illness 69 61
Handling death 68 60
Major illness 45 36
Intake history 31 ------
Birth of a child 23 48
Major surgery 7 47
Maughans and Woodland (1991).
Journal of Family Practice 32210-213.

42
Patient ReligiousnessWhen Should Physicians
Include In Care

Attend church
weekly or more
Doctors should refer to chaplain or clergy 90
Doctors should discuss religious issues 59
A religious evaluation should
be part of medical record 68
Doctors should ask patients about their religion
63
Daaleman and Neare. J Fam Pract
199439564-568.

43
Patient NeedClergy Referral by Physicians

Study sample survey of Am Acad of Fam Med
Study results Family Physicians
80 had recommended clergy referral
30 had referred 10 or more times per year
40 clergy referrals depression mood disorder
20 clergy referrals alcohol drug abuse
Daaleman TP Frey B. Prevalence and patterns of
physician referral to clergy and pastoral care
providers. Arch Fam Med 1998 7548-53.

44
Patient NeedPhysicians Addressing Patient
Spiritual Needs

Study sample 170 Missouri family physicians
Result
1. Considered spiritual well-being an 96
important health component
2. Supported referral of patients with 86
spiritual questions to chaplains
3. Physicians should address their 58
patients spiritual concerns
Ellis MR et al. Addressing spiritual concerns of
patients family
physicians attitudes and practices. J Fam Pract
199948(2)105-9.

45
Patient NeedPhysicians Addressing Patient
Spiritual Needs

Physicians view of top 5 barriers to addressing
patient spiritual concerns
Lack of time 71
Lack of training to take spiritual history 59
Uncertainty about how to identify
patients w/spiritual needs 56
Concern about projecting own beliefs onto
patients 53
Uncertainty about how to manage patients
spiritual issues 49
Ellis MR et al. Addressing spiritual concerns of
patients family physicians attitudes and
practices.
J Fam Pract 199948(2)105-9.

46
Patient NeedFamily Physicians View of
Spirituality

National survey of family physicians
Felt somewhat close to God 77
Attend religious services monthly 74
Daaleman TP Frey B. Spiritual and religious
beliefs and practices of family physicians a
national survey. J Fam Pract 1999 48(2)98-104.

47
Patient NeedFamily Physicians View of
Spirituality

National survey of family physicians
35 pray spend time in spiritual practice daily
5 did not believe in God higher power force
Daaleman TP Frey B. Spiritual and religious
beliefs and practices of family physicians a
national survey. J Fam Pract 1999 48(2)98-104.

Why Is This Clinically Important
Patient Need
The Forgotten Factor
Clinical Relevance

49
Finding the Forgotten FactorSystematic Reviews

50
The Forgotten FactorSystematic Reviews

Assess the quantity as well as the quality of
analyzing a factor in a field or body of research

For many people religion forms a basis of
meaning and purpose in life. The profoundly
disturbing effects of illness can call into
question a persons purpose in life and work
responsibilities to spouse children and
parents and motivations and fidelity priorities.
Healing the restoration of wholeness (as
opposed to merely technical healing) requires
answers to these questions.
Foglio Brody. Journal of Family Practice 1988.

52
A systematic review of 2348 studies published in
the four leading psychiatry journals from
1978-1982 found that

2.5 of the studies included a quantified
religious or spiritual variable.
Less than 1 assessed religion or spirituality
with minimal standards of acceptability.
Only 1 study employed a state-of-the-art approach
to measuring religion or spirituality.
The majority of studies measured religion with
denomination -- a much less useful measure of
religiousness.
Larson et al. (1986). American Journal
of Psychiatry 143329-334.

53
Systematic ReviewsPsychiatrys Handling of
Religion - A Second Look

Study sample 1991-95 systematic review of
leading journals of psychiatry 2766
quantitative studies
Study results 32 of 2766 studies (1.2)
included a religious or spiritual variable.
This result was one-half (2.5) of a previous
1978-82 psychiatry systematic review.
Weaver AJ et al. A systematic review of research
on religion in four major psychiatric journals
1991-1995. J Nerv Ment Dis 1998186(3)187-190.

54
The Forgotten FactorFrequency of Study

Systematic Reviews of Clinical Fields
Fields with Religion
Psychiatry I 2.5
Geriatrics 3.6
4 Fields Psychology 2.7
Family Medicine 1.9
Psychiatry II 1.2
Primary Care 1.1
Mean 2.3

55
Systematic ReviewsPsychology Research
Concerning the Clergy

Study sample 1991-94 systematic review of eight
leading psychology journals.
2400 studies reviewed
four assessed the role of clergy -- OR
one in 600 studies
In contrast when in personal distress at least
4 in 10 Americans seek help from clergy.
Weaver AJ et al. What do psychologists know
about working with the clergy An analysis of
eight APA journals 1991-94. Professional
Psychology Research and Practice
199428(5)471-74.

56
Systematic ReviewsSpirituality in Mental Health
Nursing

Study sample 1991-95 systematic review of all
research published in Archives of Psychiatric
Nursing Journal of Psychosocial Nursing and
Issues in Mental Health Nursing
Study results
Of 311 quantitative studies 31 (i.e. 10)
included a spiritual or religious variable.
Like other fields most studies (61) assessed
with a single item.
Weaver WJ et al. An analysis of research on
religious
and spiritual variables in three major mental
health
nursing journals. Issues Ment Health Nurs
199819263-76.

57
The Forgotten FactorExamining Denomination

Findings of the Penn Psychotherapy Project
Christian Jewish None
Penn Study 37 34 29
National Surveys 87 3 6
No Other Category
Luborsky et al. Archives of General Psychiatry
1990 37471-481.

58
Systematic ReviewsAssessing Religious
Affiliation

Could not be determined 12.5
By cemetery type w/reliability 12.5
Pre-death subject interview 25
By cemetery type w/out reliability 50
McCullough ME et al. The mismeasurement of
religion in mortality research. Mortality
19994(2)183-194.

59
Systematic ReviewsAssessing Religious
Affiliation

Five Class Taxonomy 12
Four Class Taxonomy 19
Three Class Taxonomy 63
Two Class Taxonomy 6
Total 100
McCullough ME et al. The mismeasurement of
religion in mortality research. Mortality
19994(2)183-194.

60
The Forgotten FactorSystematic Reviews -
Quality of Study

Research Studies
Method Number With The
Deficiency of SRs
Deficiency
Single item measure 5 79
Denomination only 6 46
No research citation 6 77

61
The Forgotten FactorSystematic Reviews
Clinical Findings

Clinical Harm
or
Clinical Benefit

62
The Forgotten Factor

Of those studies examining religion in the
leading psychiatry journals
83 found a positive relationship
14 found a neutral relationship
3 found a negative relationship
...between religion and mental health
Larson DB et al. American Journal
of Psychiatry 1992 149557-559.

63
The Forgotten FactorPhysical Health

Craigie (1990) evaluating 10 years of the Journal
of Family Practice where measures of religious
commitment were measured demonstrated
- 81 showed positive association
- 15 were neutral
- 4 were negative
Craigie et al. References to religion in the
Journal of Family Practice dimensions and
valence of spirituality. Journal of Family
Practice 1990 4477-480.

64
The Forgotten FactorPhysical Health

Levin and Vanderpool (1987) when examining the
epidemiological research which used a measure of
frequency of religious attendance found results
strikingly similar in proportions
- 81 showed benefit
- 15 were neutral
- 4 showed harm
Levin JS Vanderpool HY. Is frequent religious
attendance really conducive to better health
toward an epidemiology of religion. Social
Science and Medicine 1987 24589-600.

65
The Forgotten FactorSystematic Reviews of the
Findings