The Integration of Health and Spirituality

Are religious practices and spiritual living good for your health? The answer is "yes" according to research presented at The First International Conference on the Integration of Health and Spirituality.

The conference, held on the campus of the National Institutes of Health (NIH) from April 1-3, 2003, featured groundbreaking presentations from many of America's leading academic voices on this emerging topic. The International Center for the Integration of Health and Spirituality (ICIHS), a 501-(3)-C not for profit organization located in Rockville, Maryland, sponsored the conference.

The late David B. Larson, M.D., MSPH, a pioneer in the study of spirituality and health, founded the ICIHS in 1991. Thanks to his systematic reviews of research in the mid-1980s, Dr. Larson, a board-certified psychiatrist and epidemiologist, was the first to bring recognition to the neglect of spirituality in research and clinical health care to the forefront of professional discourse. This conference honored Dr. David Larson's vision.

In the last decade the research on the link between health and spirituality has doubled. Eighty-three percent of those research studies found a positive relationship between mental, physical and emotional health as well as enhanced medical outcomes from spiritual living or religious practices. One very important point to emphasize is that research discloses that at least 63 percent of patients believe their doctor should talk to them about their spiritual health, yet according to conference presentation, only about 10 percent do. The information I'll discuss in this article shows that health care practitioners must embrace spirituality as a healing mechanism in their patients.

The conference was divided into three main topics, each of which was the subject of a particular day. Day one covered spirituality and physical health. Day two was about spirituality and mental health and day three covered the relationship between spirituality and social health.

Ellen I. Idler, Ph.D., professor and chair of the Department of Sociology at Rutgers University, gave the opening keynote address. She discussed how early studies of religion and health noted both the association of religious observance with health and also potential causal mechanisms. Her key point, in my view, was that up until now the health benefits of religious practice were inadvertent. That is to say, the one practicing religion did so because s/he felt good about it, not for any underlying agenda of reaping positive health effects. The implication of that may be that as physicians become more aware of religion's positive effects on health and suggest that their patients follow their spiritual inclinations, an improvement in their well-being may follow. Taking this one step further, perhaps spirituality and religiosity may lower the financial burden for both patient and insurers, including government funding sources such as Medicare. Beyond speculation, however, what is clear is that according to strong scientific research, some of it sponsored by the NIH, spiritual and religious observance has lifelong benefit and their effects are cumulative.

William Strawbridge, Ph.D., of the University of California at Berkeley, presented other important information the first day. Dr. Strawbridge, a gerontologist, has examined the data from the famous Alameda County Study, a longitudinal study of health begun in 1965. The purpose of this work was to determine if good health behaviors could be determined for those attending religious services weekly as opposed to those attending less often. The data showed that those attending services weekly were more likely to stop smoking or not start, to start exercising, reduce heavy drinking, increase and maintain friendships, marry and stay married and improve or maintain good mental health.

Other important points made by speakers the first day were that spirituality and religion, especially via the practice of prayer, meditation or other relaxation techniques, markedly reduce the negative biochemical effects of stress. Moreover, it was stated that cancer patients have an increased quality of life with spiritual practices. It was also pointed out that religious and spiritual coping markedly benefits chronic pain patients. People living with HIV/AIDS, individuals with cardiovascular disease, those who are obese, or suffer from irritable bowel syndrome, the research data show, all benefit from spiritual practice and genuine religious belief.

The second day of the conference was equally as powerful. Harold G. Koenig, M.D., an associate professor of psychiatry and medicine at Duke University School of Medicine, where he is the founder and director of the Center for the Study of Religion/Spirituality and Health, gave the keynote. One of the most significant points made by Dr. Koenig, which was published in The New England Journal of Medicine, is that since 9/11 ninety percent of Americans have turned to religion and spirituality as a way of coping with stress and grief. How else can religion and spirituality affect mental health positively? By impacting forgiveness, as well as giving meaning, purpose, a sense of connectedness to life. All of these are aspects of a high level of positive mental health.

Another important presentation was that by Neal Krause, Ph.D., a professor of health behavior and health education at the University of Michigan. Dr. Krause discussed the importance of group/social support in fostering positive health related outcomes. My own review of the medical literature has revealed that social and community support are powerful healing factors.

According to research by Thomas Oxman, M.D., patients who had a strong social support system showed a marked reduction in death after open-heart surgery. Another exciting finding presented by Michael McCullough, Ph.D., an associate professor of psychology at The University of Miami, was that spirituality is highly correlated with positive psychological attributes such as maintaining an attitude of gratitude. Although this may sound like "pop-psychology," it has a very good scientific base. According to research presented by Dr. McCullough, positive character traits, such as thankfulness, lower the level of the stress hormone cortisol. This is important because cortisol has many negative effects on the immune system, the cardiovascular system and the brain. Additionally, other traits such as humility enable one to achieve greater happiness, fulfillment and performance in a variety of life domains.

A highlight of the second day was the presentation by Andrew Newberg, M.D., clinical assistant professor of neuroradiology at the University of Pennsylvania. Dr. Newberg has done breakthrough work in the emerging field of neurotheology, which uses advanced x-ray techniques to document the effects of spiritual and religious practices on the brain. For example, it is now possible by utilizing PET scans and functional MRIs to anatomically delineate the parts of the brain that are affected by prayer and meditation. Beyond brain imaging studies, Dr. Newberg has been able to measure various hormone and neurotransmitter changes in the particular brain locations caused by these techniques.

Byron R. Johnson, Ph.D., gave the keynote address for the third day of the conference, which covered spirituality and social health. Dr. Johnson is the director, Center for Research on Religion and Urban Civil Society at the University of Pennsylvania. In his address he discussed the socioeconomic implications of religious commitment. According to Professor Johnson, we need to study rigorously the effects of faith-based initiatives to discover what type of studies are best suited "to analyzing and evaluating the extent, efficacy and cost effectiveness of competing faith based programs, and what species of research projects are most likely to measure and test how, if at all, it's the 'faith' in the 'faith factor' that matters."

Other presentations concerning spirituality and social order covered adult and juvenile crime and delinquency, religion and abstinence from drug use among American adolescents, minority health issues, marriage and the family, spirituality and aging, end of life issues, caregiving, ethics and altruism.

Of final note was a presentation by Michelle J. Pearce, M.S., of Yale University. Her work concerns one of the issues I mentioned previously and that deserves another reference: spirituality and religion may be a very viable way to lower rising health care costs in the United States. The documented increase in spiritual seeking by many Americans, both within and without organized religion, may become an important factor in helping to reduce the financial burden of individuals and government in the ensuing years. Studies show that people who have a spiritual focus in their life reduce the need for medical services by adopting healthy lifestyles. Not smoking, not abusing drugs or alcohol, exercising, practicing prayer and meditation, having a broad social support network, being altruistic and having enhanced mental and emotional health may all translate into lower health care expenditures. The potential effects of religiousness on service demands have important implications for health care providers, institutions, patients, clergy, researchers and taxpayers. While a plethora of research still needs to be done, it certainly appears that spirituality and religion are indeed good for one's health and may go a long way toward improving life in America. One thing is absolutely clear, however. The research that we do have supports health care providers addressing patient's spiritual and religious needs. To the routine questions of, "How's your heart, how are your lungs and how's your memory?" should now be added, "How's your soul?"

To learn more about the work of ICIHS go to their Web site: ICIHS.org

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By Dharma Singh Khalsa, M.D.

Dharma Singh Khalsa, M.D. is the president/medical director of The Alzheimer's Prevention International, in Tucson, Arizona and a leading voice in the field of integrative medicine. In May 2003, Dr. Khalsa was invited to testify before Congress on his work on integrative medicine and Alzheimer's prevention. He is also the author of four critically acclaimed books. To discover more about his work please log onto drdharma.com.

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