By Laurel Marshfield
Reprinted with permission from
January 1999, Issue 78
This fall, the Hospital of the University of Pennsylvania
hosted a spirited, well-attended symposium on the role of
spirituality and religion in patients' lives and on how
recognizing that role may enhance the practice of medicine.
"Spirituality and Health: Exploring the Relationship Between
Mind, Body and Spirit" was sponsored by the Department of
Pastoral Care and Education at HUP and the Interest Group
On Spirituality, Religion, and Health.
The symposium was only one recent indicator that the general
topic of spirituality and health has drawn increasing interest
in the last year. Pastoral Care, for example, was designated
Research Center of the Year by a national association, and the
Interest Group also has a working group drawn from Penn's Institute
on Aging, Pastoral Care, and the Health System's development office.
That working group currently spearheads a broad initiative to establish
a joint UPHS-University of Pennsylvania Center for Spirituality,
Religion, and Health that would be housed at the Institute on Aging.
The proposed center would engage in continuing research, education,
consultation, and collaboration on issues similar to those raised by
the fall symposium.
The symposium, in fact, seemed a community-oriented way to further
this initiative while at the same time highlighting Pastoral Care's
research. The presentations and panel discussion were open to the
public as part of "The First Annual New Health Symposium," a Delaware
Valley-wide event that ran over an eleven-day period. (It was not
sponsored by Penn.)
In opening remarks for "Spirituality and Health," the Rev. Ralph C.
Ciampa, director of Pastoral Care, observed, "There is a growing
interest, both in our area and nationwide, in exploring and providing
truly comprehensive health care. Institutions like Penn have been
pioneers in the Western, scientific development of medicine, but
increasingly, broader traditions and perspectives -- such as spirituality
and religion -- are finding appreciation here and at the other
health-care systems of this city."
According to the first presenter, Andrew B. Newberg, M.D., that
appreciation is well-founded in scientific research. Said Newberg,
a fellow in nuclear medicine and an instructor in the Department of
Psychiatry, "A large number of studies exist in a wide variety of
literatures -- including many well-done studies with randomized,
double-blind control trials, as well as many that are not so
well-done -- which look at the relationship between medicine and
religion, medicine and spirituality." But for this talk, Newberg
explained, he would draw on generalized results taken from the report
of a 1997 "Scientific Research on Spirituality and Health Conference"
in which he participated.
According to Andrew B. Newberg, M.D.,
has been found to be associated with fewer physical, social, and
The report consolidated the findings of 80 or 90 scientists from around
the country who met under the auspices of the National Institute for
Healthcare Research to discuss the relationship of spirituality and
medicine in four primary areas: physical health, mental health,
addiction disorders, and neuroscience. Basically, said Newberg,
"These four groups were to sit down and talk about what we did know
and where we needed to go in the future."
In the "what's known" category, Newberg continued, "Religious
participation has been found to be associated with fewer physical,
social, and psychological symptoms." But in the specific area of
physical health, "The more people go to church and the longer they
attend, the lower their rates of coronary artery disease, emphysema,
cirrhosis, and even suicide. Increased church attendance is
additionally associated with decreased mortality, generally -- as
well as among cardiac patients, specifically." According to Newberg,
there is an additional correlation between the strength of feeling
associated with such religious participation and, for instance,
lower blood pressure.
Some studies suggest that religious participation is associated with
enhanced self-esteem and a reduction in anxiety, depression, and
substance abuse. And meditation-based interventions (which often have
a spiritual component) were also effective in reducing anxiety,
depression, and the abuse of alcohol.
As Newberg sees it, "There is certainly a connection between health
and active religious or spiritual practice. But we need to ask, what
is it? And why is it happening?" Part of the answer, he suggested,
is that meditation and prayer achieve positive results by activating
the parasympathetic nervous system which then produces what Herbert
Benson, M.D., of Harvard Medical School's Mind/Body Medical Institute
calls the "relaxation response." Newberg emphasized that more in-depth
answers to these questions could only be found in future research --
in particular, research that studied various populations over time,
and research based on clear definitions of the terms spirituality and
Although he acknowledged the need for rigorous definitions, John Ehman,
M.Div., research chairperson of the Department of Pastoral Care and
Education, presented findings from a study that did not specifically
define the terms. That study was an investigation of the attitudes of
pulmonary patients when their physicians asked them about their spiritual
or religious beliefs. It was written by John Hansen-Flaschen, M.D.,
associate professor of medicine and chief of pulmonary and critical care
at HUP, as well as members of the Pastoral Care research team: Ehman,
chief chaplain at Presbyterian Medical Center; Ciampa; Barbara B Ott,
R.N., Ph.D., assistant professor of nursing at Villanova University; and
Thomas H. Short, Ph.D., assistant professor of mathematical sciences at
Villanova. The study has been accepted for publication by the
Archives of Internal Medicine and published as an abstract in
CHEST (the journal of the American College of Chest Physicians);
and the findings were also presented at national conferences held by the
American Association of Bioethics, the Society for Health and Human
Values, and the Amencan College of Chest Physicians.
According to Ehman, the study "attempted to bring to bear the insight
and rigor of scientific methodology on subjects dear to us -- namely
pastoral care and the spiritual needs of patients." The main tool was
an 18-item, self-administered questionnaire completed by 177 patients
who visited an outpatient pulmonary clinic at UPHS. The goal was to
examine patients' response, within a routine medical history, to the
question "Do you have spiritual or religious beliefs that would influence
your medical decisions if you became gravely ill?"
The respondents stated overwhelmingly (90 percent) that "prayer may
sometimes influence recovery from an illness," even though only 51
percent described themselves as religious. In addition, 66 percent said
they would like their physicians to ask whether they had such beliefs.
Interestingly, the same percentage said that such a question would
strengthen their trust in the physician. Most unexpected, said Ehman,
was the finding that 45 percent of those who denied having religious
beliefs nevertheless wanted their physician to ask. (During the question
and answer period, a physician in the audience suggested that asking
such a question can be a way of recognizing "the whole patient.")
The study concludes that "An inquiry regarding spiritual/religious
beliefs should be incorporated into the social history of a comprehensive
patient evaluation. It is at least an invitation, a way of encouraging
the patient to feel 'I can speak to the physician about this if I need to.'"
David J. Hufford, Ph.D., an adjunct professor of folklore and folklife
at the University of Pennsylvania, discussed the actual nature of
spiritual experience. Hufford, who would serve as co-director of the
proposed Center for Religion, Spintuality, and Health, said, "I am going
to try to overturn and revise the conventional view. . . that spiritual
experiences are shaped and possibly determined by one's cultural
setting." In addition, he asserted, "Spirituality is not just one more
kind of alternative medical practice." People do not become spintual, he
observed, to "lower their blood pressure or increase their longevity."
Yet after a spiritual experience, the world is seen as "more tolerable,
more easily accepted, possibly more joyful." Such experiences, he said,
are not uncommon.
The study's conclusion:
"An inquiry regarding spiritual/religious
beliefs should be incorporated into the social history of a
comprehensive patient evaluation."
According to research conducted by the National Human Research Corporation
in 1975, approximately one third of all Americans claim to have been, in
Hufford's words, "close to a powerful spiritual force that lifted them
out of themselves." Furthermore, the visitation experience was, he said,
"positively associated with positive measures of psychological health.
And that's surprising, because so many people have assumed that these
were delusional symptoms of psychopathology." In the same vein, Hufford
pointed out that studies also reveal that education has no negative
impact on spiritual beliefs and experiences. This finding overturns the
scholarly expectation that, "as education advanced," said Hufford,
spiritual experiences "would pass out of currency."
As a folklorist, Hufford noted that other cultures discuss such
experiences freely -- ours does not. "As we begin to break the 'code of
silence' in our society and begin to compare prevalence and distribution
cross-culturally," said Hufford, "there is reason to believe that a
cross-cultural robustness and stability occurs in some of these classes
of experience that is not readily explained on the basis of people's
prior beliefs." Spiritual experience appears to transcend not only the
individual but the individual culture.
In the final analysis, Hufford reminded the symposium audience, "Religion
and spirituality are very much the framework within which humans find
meaning. And that's meaning in life, also meaning in death, and meaning
in suffering -- the 'big' kinds of meaning. Which is why people find it
essential when they face illness and make efforts to heal."
The fall symposium was not the only one sponsored by the Department of
Pastoral Care in 1998. In the spring, for example, it held a symposium
on spirituality research that attracted more than 100 participants from
local communities. The department's research was recognized by the
Association for Clinical Pastoral Education, which designated it the
Research Center of the Year. Penn's department was honored in April at
the ACPE's annual meeting in Portland, Oregon, attended by some 900
For more information on research related to spirituality and health,
contact Pastoral Care at 1 Dulles, (HUP) 662-2591.