Making a Place for Spirituality.

in ancient societies, the "medicine man" not only helped relieve physical suffering, he provided spiritual guidance. Indeed medicine and religion have been linked for centuries. The first hospitals, for example, were opened by monks, and religious orders have historically cared for the sick and infirm.

But as scientific discoveries advanced, religion and medicine were firmly divided into two camps. Armed with antibiotics and other modern medicines, physicians no longer needed to call on a god or spirit to heal people.

Today, the longstanding wall between medicine and religion is crumbling, due in part to the disillusionment of many Americans with what they see as high-tech, impersonal health care. Indeed, there is a growing interest among patients in simpler, "holistic" approaches to healing--through the use of such remedies as herbs and meditation--which, say proponents, aim to treat a host of ills, not just specific symptoms. For an increasing number of Americans and their physicians, this whole-body approach includes spirituality.

Doctors as Believers

Although many physicians are skeptical of alternative remedies, mainly because most remain untested or unproven, some evidence suggests that doctors are surprisingly open to the possibility that religious beliefs can heal. At the October 1996 meeting of the American Academy of Family Physicians, a survey of 296 doctors indicated that nearly all of them felt a person's faith could help the physical healing process. And 75 percent said they thought the prayers of others might help as well.

Because it is scientifically impossible to prove that belief can heal, the next-best way to understand the role of belief in health is to conduct studies that look for an association between the two. Such studies cannot prove a cause-and-effect relationship, but they can uncover apparent connections.

In one small investigation, published in Psychosomatic Medicine in 1995, Dartmouth Medical School researchers reported that older people who underwent open-heart surgery for either coronary artery or aortic valve disease--and who lacked either social support from an organized group or said they received no comfort from religion--were three times more likely to die within six months of the operation than those who said they got solace from community groups or religion.

In another study, Duke University researchers found an association between increased immune function and regular attendance at religious services. The investigation, reported in the October 1997 issue of the International Journal of Psychiatry in Medicine, involved 1,718 men and women over 65 who were being tracked as part of a larger study on aging and health.

Those who attended services at least once a week were about half as likely as nonattenders to have high blood levels of interleukin-6, a protein that regulates immune and inflammatory responses in the body. Elevated levels of interleukin-6 have been associated with some cancers, autoimmune disorders, and heart disease.

One caveat of this study is that healthy people are more likely to attend religious services than those who are sick. The researchers, however, noted that many of the study participants reported that they regularly attended services despite severe illness or disability. The investigators suspect that attending services somehow counteracts stress, which is believed to play a role in immune function. Religious participation not only involves worship of a higher power, but probably also promotes feelings of belonging, both of which may reduce stress and enhance well-being, said the researchers.

A group of Israeli investigators came to a similar conclusion. In a report published in the March 1996 issue of the American Journal of Public Health, researchers compared mortality rates in religious and secular communities known as kibbutzim. After accounting for age, sex, and socioeconomic differences, the religious Jewish community had consistently lower mortality rates than the secular group throughout a 16-year period. Living in a supportive religious environment, a belief in God, and frequent prayer may reduce stress and bolster health, the authors noted.

A State of Calm

Herbert Benson, the Mind/Body Medical Institute associate professor of medicine at Harvard, has long believed that prayer elicits the "relaxation response," a form of meditation and the title of his pioneering book on the subject. Dr. Benson found that people who induce this state of calm by focusing on a word, phrase, or prayer for 10-20 minutes a day can decrease blood pressure, heart rate, and breathing and metabolic rates.

In his latest book, Timeless Healing, Dr. Benson proposes that the beneficial effects of the relaxation response are enhanced when combined with belief. He calls this union the "faith factor."

Dr. Benson, who believes that humans are "wired for God," is embarking on his most unusual study yet: he will try to measure the effects of praying for others. His team will follow three sets of patients in different parts of the United States who will undergo heart bypass surgery.

One will be prayed for by religious groups and will know that prayers are being said for them. Those who say the prayers, from various faiths, will be told the first names and last initials of the patients for whom they pray. Two other groups won't know if they're the targets of prayer, but one of them will be. Neither the patients nor the physicians will know which group is which. The study will begin shortly and is expected to last for two years.

Confronting the Issue

Doctors typically don't broach matters of religion with patients. Mainly, they worry that raising such issues would violate an individual's privacy or feel that religious discussion does not belong in the doctor-patient relationship.

But this is beginning to change. Eight U.S. medical schools have recently received small grants from the National Institute for Healthcare Research and the John Templeton Foundation to implement courses that explore the relationship between spirituality and health and teach students how to address religious issues in patient care.

At Loyola University Chicago Stritch School of Medicine, for example, students will observe and assist hospital chaplains as they visit patients, and an internal medicine course will focus on how the human spirit confronts chronic pain, long-term illness, and death.

Meanwhile, Harvard Medical School recently held its fourth conference on spirituality and healing for health professionals. Participants learned about the potential physiological and psychological effects of faith on health

Kenneth B. Schwartz, a health care lawyer in Boston who succumbed to cancer in 1995, believed that physicians and nurses should pay more attention to the non. medical needs of patients and that broaching personal or emotional issues could be a major source of comfort for patients as well as for the health care workers themselves.

After his death, Mr. Schwartz's friends and family set up a center at Massachusetts General Hospital that sponsors, among other programs, four-month fellowships that enable health care professionals to participate in a pastoral care program, focusing on the spiritual needs of patients and their families.

Although researchers continue to investigate the links among faith, health, and longevity, people who already accept that belief can console and heal don't need scientific studies to convince them Those who are skeptical may find the results intriguing, but science will never be able to fully assuage their doubts.

In reality, most people probably don't look to religion or spirituality to extend their lives but to provide day-to-day meaning and comfort.

The best part about medicine's growing interest in faith is that some patients may finally get what they have been yearning for: doctors who recognize the needs of the soul as well as those of the body.