Coping Through Spirituality and Prayer

Hope, a sense of purpose, inner peace, and strength -- these are benefits people with cancer say they receive from prayer or having a spiritual belief. The World Health Organization includes spirituality in its definition of quality of life, a concept that describes one's health and well-being.

A topic once viewed as "don't ask, don't tell," spirituality is now one of the fastest growing areas in health research. Why the renewed interest in such an age-old practice? What do prayer and spirituality offer to people that modern medicine cannot achieve?

What Americans Think About Prayer and Healing

David Larson, MD, MSPH, reports, "Spirituality and religion have been seen as ‘bad and ugly' for decades by health professionals." Larson is a psychiatrist and the president of the International Center for the Integration of Health and Spirituality, and has studied the impact of spirituality on health for 20 years.

In his early psychiatric residency, Larson recalls that the negative aspects of religion were emphasized. These might include patients feeling rejected by a higher power, or that a serious illness was judgment from the higher power for something the person had done.

"But when looking objectively at all the published medical studies out there, I was surprised to find quite the reverse," he says.

Larson found that most of the studies on religion and health showed a positive link. More surprising results came later from the patients themselves. National patient needs surveys and Gallup polls revealed that people thought spirituality and prayer were important topics. They also wanted their doctors to talk about it. "The numbers were stunning," says Larson.

• A 1999 Gallup survey showed 94 percent of Americans believed in a higher power.

• A 1996 Time magazine poll revealed 82 percent of Americans believed that prayer could bring healing, and 77 percent believed a higher power could cure serious illnesses.

• A 1996 USA Today poll found that 79 percent of Americans believed spiritual faith could help people recover from illness or disease; 63 percent said that doctors should ask about their patients' spiritual faith.

The Revival of Spirituality and Prayer

Mary Vachon, PhD, RN, a psychotherapist and consultant in private practice in Toronto and associate professor of psychiatry and public health sciences at the University of Toronto, believes there is an increased interest in spirituality in healthcare. But "exactly why is an interesting question," she says.

Vachon notes that conventional medicine may not always meet the emotional and spiritual needs of people with life-threatening illnesses, such as cancer. "One begins to explore the issues and questions that modern medicine cannot answer."

Larson adds, "Even though we've had wonderful technological advances, we've maybe forgotten about how patients are feeling emotionally, especially those with chronic diseases. The more serious the illness, the more important the spiritual factor seems to become."

In the early 1990s, three medical schools offered courses on religion and spirituality. With the growing popularity of the subject, there are now over 70 schools that offer courses. Many of the schools have made these courses a requirement for medical students.

The amount of research on spirituality and health has nearly doubled in the last decade.¹ The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), includes prayer and spiritual healing under its new Frontier Medicine Initiative. Frontier Medicine is defined as complementary or alternative practices that have no biomedical explanation but are used widely by the public.

The Frontier Medicine program has funded a new 6-month study at the Johns Hopkins Center for Cancer Complementary Medicine in Baltimore. The study will see if prayer affects cancer recurrence and the immune systems of 40 African-American women with stage I and II breast cancer. The women will meet to pray once a week in a group and also on their own.

What Are the Benefits?

Studies suggest various health benefits from prayer, spirituality, or practicing a religion. Vachon describes spirituality as "a belief that people have in something bigger than themselves or something deep within they can draw on." That belief may allow people to feel comfort, assurance, or that the "higher power is doing something for them."

But, Vachon adds, "That certainly doesn't mean everyone will be cured. Receiving healing does not always mean being physically cured." She refers to the concept of "inner healing," in which people learn to deal with unresolved conflicts in their lives -- with other people or within themselves. Vachon has seen inner healing in some patients so that "even when they realize they are going to die from their disease, they have peace."

Some studies have shown that prayer and worship service attendance may lower stress and improve immune function.² Research looking at people with cancer found that religion helped them to overcome fears, have a better understanding of death and dying, and find hope, meaning in life, and peace of mind.

A January 1997 study published in the American Journal of Obstetrics and Gynecology found that 93 percent of women with various stages of gynecologic cancer said religion gave them hope during their illness. Forty-one percent said that it supported their sense of worth.

Another study published in the October 1999 issue of Psycho-Oncology found that 91 percent of elderly women (ages 65 years and older) with newly diagnosed breast cancer credited religion with giving them emotional support to cope with their illness. About two-thirds of the group said that it also gave them social support and helped make meaning of their cancer experience.

For more research on health and spirituality, visit the web link at the end of this article to view a slide presentation by Dr. Larson.

The Role of the Health Care Provider

Patients who value spirituality may expect their health care provider to address it. "One reason may be that patients want affirmation and their doctors to support them by saying ‘sure that's something that could help in handling your illness,'" says Larson.

But religion and spirituality can be a sensitive and uncomfortable arena. How involved should health care providers be? A study published in the Journal of Family Practice found that the top two barriers to doctors not addressing their patients' spiritual concerns were a lack of time and not knowing how to take a "spiritual history" or spiritual background.

Despite the recent trend for schools to include courses on spirituality, "most doctors never learned about this in medical school," says Larson.

So what can health care providers do if they are uncomfortable talking about it with their patients?

Larson explains, "It's really just part of the social history. Doctors can ask patients about their spiritual beliefs and how those beliefs might be used to cope with illness or stress. Patients seldom have a problem with it, and if they do, they'll let you know."

The following are questions that doctors, nurses, and other members of the health care team can ask to take a "spiritual history" from their patients. Follow the patients' lead -- if they want to address spiritual issues, they will talk about it openly.

• Do you consider yourself a spiritual person?

• What gets you through the day? How are you coping with your illness?

• What gives meaning to your life?

• Do you participate in spiritual practices (e.g., meditate, attend places of worship, find comfort in talking to a priest, rabbi, or minister)?

A more difficult situation is if patients ask their doctor or nurse to pray with or for them. Larson says, "We're not saying it shouldn't be done, but we urge caution. We strongly encourage health care providers to work with hospital chaplains, especially when providers are not comfortable with spiritual aspects." A patient may also choose to see a trusted religious elder outside the hospital.

Vachon, who has prayed for and with patients, says, "Prayer with patients can happen, but there needs to be permission from both sides within the relationship."

The Prayer Wheel

Sometimes prayer can be intimidating for people who have never practiced it. Even those experienced with prayer may feel too overwhelmed by their diagnoses or treatments to pray. Vachon offers prayer "guides" for her patients who want to pray and need direction. One popular tool is called "The Prayer Wheel," which was developed by John Thornton, MD, FRCPC, a psychiatrist in private practice in Toronto.

The wheel consists of a progression of steps, such as giving thanks for one's blessings, asking for protection or guidance, and forgiving oneself or others. Vachon says that "The Prayer Wheel" can be useful to help patients "connect with the divine or whatever one believes in." She describes its effect on one of her cancer patients.

"One young fellow said that he could actually see himself being held in the arms of God. He said to me ‘God isn't telling me whether I'm going to live or die, but He's telling me that whichever happens, it's going to be okay.' He went on to die, but throughout the whole time he felt that he was safe and held by God."

For more information on "The Prayer Wheel," visit the Chatelaine web site linked below or send an e-mail to praywheel@hotmail.com.

References: Handbook of Religion and Health, by Harold Koenig, et al, Oxford University Press, New York, 2001 Ann Pharmacother 2001 Mar;35(3):352-9; Int J Psychiatry Med. 1997;27(3):233-50