Is There a Place for Spirituality in Medicine

There are a few things David Larson wants you to know about your doctor:

He or she is less likely to be a person of religious faith than you are, is quite unlikely to offer to pray with you even if you are terminally ill and request it, and is almost certain not to ask how you would like your faith to factor into your health care treatment.

Larson himself is a medical doctor and psychiatrist and president of the National Institute for Health Care Research in Rockville, Md., who collects his own and analyzes others’ data on religion and health. His presentation of recent findings at Fuller Theological Seminary in Pasadena last week included evidence that psychologists and psychiatrists have a higher level of skepticism and atheism than the general population, as well as a lower level of familiarity with religion.

This is only to set the stage for Larson’s growing file of evidence that most people who are ill would welcome some care of the soul along with chemotherapy treatments or post-operative exercise programs.

In what is not his most scientific data but certainly his most accessible, Larson compares the difference between the way sick people are portrayed on “ER,” the popular television series set in a hospital emergency room, and “Rescue 911,” a show that catches real-life emergencies on tape.

“Watch ‘911’ and you hear people calling on God all over the place,” he says. “You never hear it on ‘ER.’ In real life, religion is a coping mechanism and coping is as important for illness or other high stress situations as are a lot of other things.”

In long-term and chronic illness, he says, a 1992 study of elderly patients shows that 50% of those interviewed said religion is very important to coping with their illness. In a study of terminal cancer patients, the positive response was even higher.

Scientific research shows that the “ER” routine of ignoring spiritual ills in emergencies is common in real life. Larson quotes a study in the Journal of Family Practice from 1994, measuring what patients really want from doctors. In it, 77% of patients interviewed said physicians should consider their spiritual needs, 48% said their physician should pray with them.

“Especially with serious medical illness, patients want God included,” he says.

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Among many recent attempts to measure spirituality in relation to health, heart surgery patients help make a point. A 1995 Dartmouth study of 232 such patients compares the recovery rate of the nonreligious to that of the deeply religious in the group. Six months after surgery, 11% of the nonreligious had died. None of the deeply religious died in that time.

“You’d think doctors would recommend going to church as part of treatment,” says Larson, whose conversation speeds along on quick humor, with frequent skids to avoid cuss words that are his habit.

He has been a researcher and analyst of religion and health for more than 10 years. This is particularly unusual considering that Larson spent most of that time working for the federal government. On the staff of the National Institutes of Health and later with the Department of Health and Human Services and the office of Mental Health Services, he analyzed health studies. There in the den of the nation’s watchdog for the separation of church and state, he labored to find the place of religious faith in human fitness.

It began with a startling discovery:

“The government is the most liberal organization in the world,” he says. “In medical research it is truly open to new things, as long as there is data to support it.”

An Episcopalian whose own religious beliefs are very important to him, Larson never intended to expose his faith on the job. “You didn’t want to ruin a career by mixing religion and medicine,” he says.

“As a student I was taught that religion is harmful in medicine,” says Larson, 49, who completed his residency in psychiatry at Duke University Medical Center in North Carolina. “In the ‘60s and ‘70s, religion was not an ‘in’ thing. If you were doing clinical research with a spiritual or religious factor, you were considered fringe. Some of my colleagues are still influenced by those attitudes.”

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It was his boss and colleagues with his first government job who encouraged him to look at the effect that spirituality has on health. “The scientists conducting the research were not coming from a religious place,” he recalls of his earliest findings. “Based on the data alone we could see that more research was worth pursuing.”

Still, it was a risk for a man intent on a mainstream career. Larson cites a medical journal article of 22 years ago that compares a religious experience to a psychotic episode. And he quotes a National Academy of Science manual that instructs, “Religion and science are not to be mixed.”

More disturbing for him at this point is recent data showing that religious beliefs can be harmful to a person’s health. A 1990 study of the elderly shows that three-fourths of those interviewed see good health as a blessing from God. Conversely, one-third believe that illness is a punishment.

Nearly half believe a moral life can protect them against illness. Three-quarters of those interviewed attribute illness to perceived sins.

“Clearly we have a problem here,” Larson says. If positive attitudes about religion seem to encourage health, negative attitudes might jeopardize it, he reasons. He recommends that doctors broach the topic and even bring up the study as a way of opening a conversation with patients.

“The research is there so please cite it, not John Calvin’s treatises,” he suggests. Those who agree with the study might quote the austere French theologian to support it.