A Symposium on Meditation, Prayer and Spiritual Healing · A Symposium on Meditation, Prayer and...

Special Feature

62 The Permanente Journal/ Summer 2005/ Volume 9 No. 3

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Tom Janisse, MDEditor-in-Chief

A Symposium on Meditation,Prayer and Spiritual Healing

At the 2005 Kaiser Permanente National Primary CareConference in Maui, I convened a distinguished panel,diverse in disciplines, to address the topic of medita-tion, prayer, and spiritual healing. The following sym-posium is an edited transcript of that session.

Meditation in the form of a relaxation response wasfirst brought to conventional medicine by HerbertBenson, a Harvard cardiologist in the 1970s. Prayer?Isn’t that something people do in church or on theirknees by their bedside? Spiritual? Is that different from

religion? How is it experienced now? Healing? The onlyreference to healing when I went to medical schoolwas wound healing. Can meditation, prayer, and spiri-tual healing be part of clinical practice? And what arethe outcomes of their use?

This panel was brought together in Maui to illumi-nate the areas of mind, body, and spirit in clinicalpractice. We feel that this subject is so importantthat we are publishing it in this issue on health andhealing. ❖

At day’s end, who do Isee in my patient’s eyesas I look in to listen?Automated chart note?CPT 99214?or overbook five?

I view in her faceMrs Yinder’s twitch,Mrs Olive’s tear,Mr Sila’s droop,Mr Garren’s wink;all visit for care.Close air clouds our face.

A spot of blue! Ryan,blinks then winces, clutcheshis ear, his sole concern.I too am a parent,a child, and a patient.

Insight for me nowat another day’s end:Can that be enough to feeltherefore I am?My schedule, my watch,my palm pilot don’thold my heart.

My heart holdsmy head inmy hands.

What I give in visitafter visit aftervisit all day longI take home.Ryan meets my son,Mrs Yinder greets mywife, Mr Sila callsmy dad acrossthe country.With these peopleat wit’s end at homeI feel fulfilled.

Is this Tuesday?Thursday?It’s day’s end.

Ode to Physicians

By Tom Janisse, MD

Spirituality Symposium

63The Permanente Journal/ Summer 2005/ Volume 9 No. 3

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Meditation, Prayer and Spiritual Healing:The Evidence

Marilyn Schlitz, PhD, is the Vice President of Research at the Institute ofNoetic Sciences and Senior Scientist at the Research Institute of the Califor-nia Pacific Medical Center. She completed a bachelor of philosophy degreefrom Monteith College, Wayne State University, a master of arts in social andbehavioral studies from the University of Texas, San Antonio, a PhD in socialanthropology from the University of Texas in Austin, postdoctoral fellowshipin cognitive sciences laboratory, Science Applications International Corpora-tion, and a postdoctoral fellowship in psychology at Stanford University. Shehas published more than 200 articles in the area of consciousness studies andis the co-editor of Consciousness and Healing, Integral Approaches to Mind-Body Medicine, by Elsevier. She conducted research at Stanford University,Science Applications Internal Corporation, the Institute of Parapsychology,and the Mind Science Foundation. She has taught at Trinity University, StanfordUniversity, and Harvard Medical School, and has lectured widely, includingat the United Nations and at the Smithsonian Institution. She served as aCongressionally appointed advisory member for the National Institutes ofHealth Center for Complementary and Alternative Medicine and is on theboard of trustees for the Esalen Institute and on the board of directors for theInstitute of Noetic Sciences. She also serves on the scientific program com-mittee for the Tucson Center for Consciousness Studies.

on one hand and diverse religious,spiritual and cultural traditions on theother. Nowhere is this more clearthan in the case of medicine.

There are various ways of re-sponding to the unprecedented con-vergence we now experience. Oneis conflict; we need only turn onour radios to see how widespreadthis response is at a global level.Another response is co-option,where one tradition—typically theWestern technological, scientificallybased rationalist model—overpow-ers indigenous wisdom, often invery covert ways. A third responsetakes the form of creativity: As dif-ferences come together, we have theopportunity to birth new ideas andnew ways of being together as acollective humanity.

My focus this morning is on theresearch perspective that lies at theinterface of science, spirituality, andmedicine. How can science beginto offer insights into these wisdomand spiritual practices? And how arethese wisdom practices influencingscience and medicine in ways thatmay lead to a more integral ap-proach to health and healing?

Primary Areas ofEvidence

There are five primary areas ofdata or evidence: the crossculturaldata, survey studies, public healthresearch, basic science related tomind-body medicine, and clinicalstudies of distant healing.

Crosscultural PerspectivesIndigenous cultures hold no sepa-

ration between healing and a con-nection to the sacred. If you exam-ine various traditions, it is onlywithin our own culture that we makethis demarcation between what is therationalist approach and what is ourdeep engagement with the mystery.From the survey studies, it is clearthat people are hungry for a deepersense of meaning and for a connec-tion to their spirituality. Seventy-threepercent of adults believe praying forsomeone else can help cure their ill-ness; this is based on a CNN poll.Fifty percent of patients wanted phy-sicians to pray with them. This sayssomething about what people arecalling for; how people will feel hap-pier, more contented; how they feelsatisfied in terms of the therapeuticencounter. A recent survey1 published

Dr Schlitz: This is a remarkabletime in human history—never be-fore have so many world views, be-lief systems, and ways of engagingreality come into contact. On onehand are the remarkable successesof science and technology: an orbit-ing space station, cloned sheep andcats, and a computerized chesschampion that has outsmarted eventhe best of the human chess cham-pions. On the other hand, throughthe Internet, awareness of the world’swisdom and spiritual traditions hasexpanded: we now have access topractices that were once isolated inthe Himalayas or deep in the Ama-zon and available only to a very smallgroup of adepts. Today we are ex-periencing a convergence of thesedifferent ways of knowing, science

Marilyn Schlitz, PhD

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by the National Institutes of Healthlooked at the ten most commoncomplementary and alternative prac-tices or modalities that are used byAmericans today, and they found thatof the top ten, three involved prayer:prayer for self, 43%; prayer for others,24%; and prayer groups, a very com-mon modality for people to engage in.

Public Health StudiesIn terms of public health research,

through the use of epidemiologicalmethods and tools, we are begin-ning to understand the correlationsbetween spiritual and religious prac-tice and physical outcomes. JeffLevin, a social epidemiologist, notesthat more than 1600 studies havebeen conducted examining the cor-relation between religious and spiri-tual participation and health.2 Theevidence is overwhelming. Findingspersist regardless of religious affili-ation, diseases or health conditions,age, sex, race or ethnicity, or na-tionality of those studied. This find-ing is positively correlated with edu-cation. People who have a strongeducational background believe thatthese kinds of practices and prin-ciples are important for health andwell-being.

Basic Science on Mind-BodyMedicine

So let’s talk about the mind-bodyconnection. From cross-cultural per-spectives, it appears that peoplebelieve in and practice spiritualityin the context of healing and, in fact,don’t make a separation. Within theHawaiian Kahuna tradition, healersand religious spiritual practitionersare one and the same. It’s clear fromthe correlational studies within theepidemiology data that positive re-lationships exist between religiousand spiritual practice and health out-comes on a variety of different con-ditions. We hear so much about the

placebo effect as a mind-body piecefor example. In our new book,Consciousness and Healing,2 weconsider an integral approach tomedicine in that healing and con-sciousness is not only a part of thismind-body connection but also is apart of our connection to our rela-tionships—our interpersonal rela-tionships, our relationship to the en-vironment, and our relationship tothe transpersonal or the spiritual.Harris Dienstfrey, contributor toConsciousness and Healing, writes,“The mind as a source of medicineis waiting to be explored.”2:p 60 It isvery interesting to me as a re-searcher that the placebo effect issomething that we tend to put aside.It’s the control condition. And yet ifwe really wanted to understand theinnate capacities of the body to heal,wouldn’t we want to focus in thereand look at the ways in which ourbody can take an inert substanceand produce a physiologicalchange? More so, this inert sub-stance knows the whole cascade ofresponses that are necessary to leadto a particular kind of outcome.How does that happen? It is a pro-found mystery and one that needsto be explored more fully.

Wound-Healing StudyWe received an NIH grant to look

at the effects of prayer and spiritu-ality on wound healing; research weare conducting at California PacificMedical Center. This is a three-armclinical trial with women, primarilybreast cancer patients, who are un-dergoing reconstructive surgery aftermastectomy. We have recruited heal-ers from across the country to par-ticipate in this study—people who be-lieve they can use their minds, theirprayers, and their intentions to influ-ence other people at a distance.

These healers include: Chi Gongmasters, Johrei practitioners, Reiki

practitioners, Carmelite nuns, Bud-dhist monks, and Christian groups.All the healers in our research studykeep a daily log that describes theirpractice and their experience.People report making use of tech-niques such as directing healing en-ergy toward the distant person, us-ing some kind of focusing tool,such as a photograph, to focus theirattention on the distant person, ormaking use of petitionary prayerto call on divine help from super-natural forces.

The women who come into thesurgery unit are randomized intotwo blinded arms: Either they re-ceive distant healing or they don’t.In the third arm of a distant healingor prayer and intention healinggroup, patients are called every dayand are told that they are gettinghealing. The outcome in this studyis the rate of wound healing by mea-suring collagen deposition in a littleGORE-TEX® patch inserted in thegroin area, a standardized location.We’re also looking at a variety ofpsychosocial measures. This is anexample of bringing spiritual andreligious practices, what we callcompassionate intention, into alaboratory setting and looking at therole of expectancy and placebo asit relates to the particular outcomemeasure. We are framing the possi-bility that our intention can actuallyinfluence the physical well-being ofanother person, even if that personis unaware of that intention.

Distant Healing ResearchIn the recent National Center of

Complementary and AlternativeMedicine (NCCAM) survey study Imentioned, a significantly high per-centage of the population makes useof prayer for other people. Manypeople believe that if I pray for you,you will become better, or if you prayfor me I’ll become better, and yet

Meditation, Prayer and Spiritual Healing: The Evidence

It’s clear from thecorrelational

studies withinthe epidemiology

data thatpositive

relationshipsexist betweenreligious and

spiritual practiceand health

outcomes on avariety ofdifferent

conditions.



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we know very little of the mecha-nism to explain how this might hap-pen. So this is a frontier area for re-search. To date, more than 180studies have been done in this area,with more than half of them pro-ducing significant results. In these ex-periments, one person through theirintention tries to influence the physi-ology or the physical condition of atarget system, such as cell cultures,animal models, and there are humanstudies. As of March 2004, there havebeen nine controlled clinical trialslooking at intercessory prayer (com-passionate intention at a distance).Six of these have produced statisti-cally significant positive results. Fora complete list of these studies, onecan visit the distant healing researchsite at the Institute of Noetic SciencesWeb site (www.noetic.org).

As an example, Dr Elizabeth Targat California Pacific Medical Centerdid a series of trials looking at AIDSpatients.3 She selected AIDS as a con-dition because, at the time of thestudy, it was very resistant to con-ventional allopathic medical interven-tion. Patients were randomized intostandard care alone or they got stan-dard care plus a booster, which wasthis intercessory prayer at a distance.This was a blinded study. In both apilot study and a confirmation study,the prayer groups had statistically sig-nificant improvements in outcome,suggesting that the intervention hasclinical relevance.

CompassionateIntention and CancerPatients: The Love Study

Anyone who works with canceras a condition knows that partnersof cancer patients can feel verydisempowered: There is very littleto do to help your partner. The LoveStudy is another project that is rel-evant to the translation of basic sci-ence into clinically relevant out-

comes. Specifically, one of our goalswas to promote psychological ro-bustness in the partner of the can-cer patient.

We trained the cancer patient part-ner in compassionate intention.When the training program wasover, we conducted a distant heal-ing experiment in our lab at theInstitute of Noetic Sciences. Wemonitored the patient’s physiology,looking at autonomic measures: skinconductance, respiration, heart rate,and EEGs. One person was situatedin a 2000-pound electromagneticallyshielded room to rule out any con-ventional explanations that mightaccount for the results. We askedthe couple to exchange meaningfulitems—a psychological activity thathelps them stay connected. For ex-ample, a man gave his wife his bootsand she gave him her doll, whichthey held while doing the experi-ment. The job of the partner of thecancer patient, at random timesthroughout a session, is to try tocalm his partner’s physiology. Thisis a “proof of principle” type studyto show that physiological changesoccur as a result of this kind of ex-change. The man watched a closed-circuit television as his wife’s im-age intermittently appeared on thescreen. Neither he nor she knewwhen those viewing periods weregoing to occur. The experiment isbased on a randomized double-blind-type protocol.

This study can be seen in lightof other studies using this sametesting paradigm. A study pub-lished in the British Journal ofPsychology4 examined 35 studiesthat looked at whether the inten-tion of one person can interactwith and influence the physiologyof another person. They found astatistically significant positive dif-ference across the studies.

We feel we have established the

proof of principle that there is somekind of nonlocal or transpersonalexchange of information betweentwo people. So, now the questionfor all practitioners is: How does thatrelate to our practice? How do webring these ideas of spirituality andcompassionate intention into ourpractice, and how do we begin tosee whether or not it helps clinically?

Practical ApplicationIn the introduction to Conscious-

ness and Healing, Ken Wilber notesthat the most important aspect ofthis integral approach to medicineis the transformation that happensin the healer.2 Rather than thinkingabout this as something outside ofourselves, how do we really bringthese principles into our own lives.Key to an integral approach is notthe content of the medical bag, butthe holder of the bag: one who hasopened herself or himself to themultidimensional nature of healing,including body, mind, soul, spirit,culture, and nature.

Spiritual EducationToday, 101 medical schools incor-

porate patient spirituality in theircurriculum, up from 17 in 1995. Thisfact suggests that these principlesare being incorporated into medi-cal education, albeit at an electivelevel. Some hospitals such as UCLAMedical Center encourage physi-cians to include spiritual historiesin patients’ charts. This acknowl-edges that in fact these kinds of prin-ciples are being incorporated intomainstream medicine. Harold GKoenig, MD, who works at DukeUniversity, recommends that phy-sicians ask every patient if they con-sider themselves spiritual or reli-gious. Doctors should encourageprayer and religious participation ifthat is a source of comfort.5 Reli-gion has the power to heal, and we


Many peoplebelieve that ifI pray for you,

you willbecome better,or if you pray

for me I’llbecome better,

and yet weknow verylittle of the

mechanism toexplain howthis mighthappen.

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have an obligation to value thatpower alongside medicine.

ConclusionBy way of conclusion, each of us

in some way represents both thehospice worker who is helping in avery loving, kind, gentle way to letthe old paradigm die, to watch andrelease it from its own suffering, andat the same time, each of us actingas midwives for the birth of some-thing new. As these different culturesand different world views converge,

we can begin to see the birthing of acreative solution to many of the prob-lems we face today. ❖

References1. Barnes PM, Powell-Griner E,

McFann K, Nahin RL. Complemen-tary and alternative medicine useamong adults: United States, 2002.Adv Data 2004 May 27;(343):1-19.

2. Schlitz M, Amorok T, Micozzi MS,eds. Consciousness and healing. StLouis: Elsevier: Churchill-Livingston;2005.

3. Sicher F, Trag E, Moore D 2nd, Smith

HS. A randomized double-blindstudy of the effect of distant healingin a population with advanced AIDS.Report of a small scale study. West JMed 1998 Dec;169(6):356-63.

4. Schmidt S, Schneider R, Utts J,Walach H. Distant intentionality andthe feeling of being stared at: twometa-analyses. Br J Psychol 2004May;95(Pt 2):235-47.

5. Koenig HG. Spirituality in patientcare: why, how, when, and what.Philadelphia: Templeton FoundationPress; 2002. See also Web site:www.beliefnet.com/story/131/story_13132_1.html.


Fly!You and I are made for goodness, for laughter, for joy.

We’re made for transcendence. Fly!

— Archbishop Desmond Tutu, b 1931, South African cleric and activist



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Meditation

Charles Elder, MD

Charles Elder, MD, received his BA, MD, and MPH de-grees at Boston University and completed his internshipand residency at the University of Michigan in 1990. Hejoined the Northwest Permanente Medical Group as a pri-mary care internist in 1991. He has offered a natural medi-cine consultative group clinic for six years and establishedthe KP Northwest Integrative Medicine Service last year.He organizes the Northwest Permanente Complementaryand Alternative Medicine Journal Club, is cochair of theregional natural products committee, and is clinical leadfor the interregional CAM domain. He is a clinical investi-gator at the Center for Health Research, is principal inves-tigator for two NCCAM NIH-funded clinical trials, and haspublished several papers on the topics of integrative andAyurvedic medicine.

Dr Elder: The glaring discrepancy between our pa-tients’ needs and what we are capable of offering themwithin the confines of allopathic care represents anunderrecognized root cause of chronic dissatisfactionamong adult primary care clinicians. Complementaryand alternative medicine (CAM), including the spiritu-ality, prayer, and spiritual healing discussion that we’rehaving today, can offer us practical tools to help bridgethis chasm. The following discussion focuses on medi-tation: the mechanics of meditation, the evidence baseto support its use, and the practical recommendationswe can offer to patients.

We can understand “science” as denoting any branchor department of systematized knowledge consideredas a distinct field of investigation or object of study.That “science” connotes empiricism is not an a prioritruth but rather a provincialism of our age. An authen-tic meditation technique, then, can be properly under-stood as a scientific pursuit, with the object of system-atic study being consciousness or the self. Meditationdoes not represent a mood-making or counterculturephenomenon but instead a specific set of simple butsophisticated techniques having definable physiologicmarkers and clinical results. Mantra meditation repre-sents one technique, where the meditator sits comfort-ably with eyes closed and focuses his or her attentionon a specific mantra or sound. This procedure servesto guide the mind from active awareness to a moretranquil state rooted in pure consciousness. Once thisrestful state is achieved, however, thoughts may fre-

quently “bubble up,” diverting attention back towardthe external world. The meditator responds by gentlyreturning focus to the mantra and so on, back andforth. The technique thus represents a simple yet spe-cifically directed procedure.

The physiology of meditation has been exhaustivelystudied. When meditating, patients exhibit decreasesin heart rate, respiratory rate, blood pressure, and cor-tisol levels, as well as increased serotonin availabilityand reduced free radical burden. In one classic studypublished by Keith Wallace, MD, in the journal Science,1

subjects demonstrated reduced O2 consumption, reducedrespiratory rate, and increased galvanic skin resistanceduring meditation practice. In another paper publishedin American Psychologist,2 meta-analysis data compar-ing meditation with simple eyes-closed rest suggestedincreased basal skin resistance, reduced respiratory rate,and reduction in plasma lactate in the meditating groups.Thus, the literature clearly describes distinct physiologicchanges that occur during meditation.

Let’s next consider some of the clinical trials data. Apaper published about ten years ago in Hypertension3

compared patients with mild hypertension, random-ized into three groups: an attention control group re-ceiving standard patient education, a physical stressreduction group receiving training in the progressiverelaxation technique, and a meditation group receiv-ing instruction in Transcendental Meditation. At threemonths, this single-blinded study showed statisticallyand clinically significant reductions in systolic and di-astolic blood pressure in the meditating group com-pared with control.

In another study published in the American Journalof Cardiology,4 21 patients with documented coronaryartery disease were tested at baseline by exercise toler-ance testing and were assigned either to meditationinstruction or to a wait-list control. After eight months,the meditation group had a 14.7% increase in exercisetolerance, an 11.7% increase in maximal workload, an18% delay in onset of ST-segment depression, and sig-nificant reductions in rate-pressure product at three andsix minutes and at maximal exercise compared withthe control group.

In addition to cardiovascular disease, studies havesuggested beneficial clinical effects for meditation innumerous other clinical conditions, including anxiety

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disorders and substance abuse. For example, meta-analysis data have shown a significant effect size formeditation compared with other standard behavioralinterventions in the context of both alcohol and to-bacco abuse. Finally, numerous studies in the litera-ture suggest that regular meditators use less health care.One study,5 for example, compared five years of medi-cal insurance utilization statistics of approximately 2000regular meditators with a normative database of ap-proximately 600,000 members of the same insurancecarrier, showing the meditating group to have lowermedical utilization rates in all categories.

At a practical level, what can we offer our patients?Some KP Regions offer training in various stress man-agement protocols through the Health Education De-partment, and most larger cities offer additional com-munity resources. In Portland, I sometimes refer mypatients to the Portland Transcendental Meditation Cen-ter for meditation instruction or to the Oregon Collegeof Oriental Medicine for classes in Qigong.

In summary, meditation represents a sophisticatedmental technique that is associated with a definable physi-

ology and can render significant positive clinical effects.Through the use of meditation and other evidence-basedCAM modalities, as adjuncts to usual care, primary careclinicians may be able to affect a sizeable number of pa-tients we might otherwise be unable to reach. ❖

References1. Wallace RK. Physiological effects of transcendental

meditation. Science 1970 Mar 27;167(926):1751-4.2. Dillbeck MC, Orme-Johnson DW. Physiological differences

between transcendental meditation and rest. [Editorial] AmPsychol 1987 Sep;42(9):879-81.

3. Schneider RH, Staggers F, Alexander CN, et al. Arandomized controlled trial of stress reduction forhypertension in older African Americans. Hypertension1995 Nov;26(5):820-7.

4. Zamarra JW, Schneider RH, Besseghini I, Robinson DK,Salerno JW. Usefulness of the transcendental meditationprogram in the treatment of patients with coronary arterydisease. Am J Cardiol 1996 Apr 15;77(10):867-70.

5. Orme-Johnson DW. Medical care utilization and thetranscendental meditation program. Psychosom Med 1987Sep/Oct;49(5):493-507.

Meditation

All The AnswersIt is reasonable to expect the doctor to recognize that science may not

have all the answers to problems of health and healing.

— Norman Cousins, 1915-1990, writer, editor, citizen-diplomat



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Spiritual Moments

NaomiNewhouse, MS, CNM

Naomi Newhouse, MS, CNM, completed her graduate study at the Univer-sity of California San Francisco in 1995. She served as chair of the TPMG nursemidwifery peer group for six years and is a California Health Care FoundationFellow. As a board member of the California Nurse Midwife Association, shehas been actively involved in moving legislation to support midwifery state-wide. She has personally delivered more than 3000 babies and practices clini-cal midwifery at three TPMG sites. She and her husband, David Newhouse,MD, are busy raising their two children, Daniel and Elizabeth.

Ms Newhouse: Growing up in asmall rural community, I had the op-portunity to watch the lives of manyfriends and community membersunfold over time. I knew why MrsJones had horrible headaches andwhy her daughter was often sick.By watching, I learned that what iswrong with our lives soon becomeswhat is wrong with our bodies andour minds.

This realization drew me to mid-wifery and sculpted my practice.The care I provide is patient cen-tered. I ask questions and listenhard. The expert is sitting in myoffice. Working with thousands ofwomen over the years, I have cometo appreciate that the patient is inti-mately acquainted with her circum-stances and knows what will or willnot be effective. She ultimately holdsthe responsibility for any choicesmade, and she will bear the conse-quences. This is all about her.

In a culture where we are condi-tioned to ignore our own voice, mygreatest challenge is to create a “sa-cred space” or “safe space” where awoman can tune in and hear what herheart is trying to tell her. As I regardthe value of her voice, she regardsthe value of the message and movesto make the necessary changes.

By its very nature, birth createsthis space for you. New life is

emerging, the lights go down, andthe sacred takes center stage. Thisis the woman’s moment. Holdingthe space without bias or judgmentand keeping her and her infant safeis the essence of the work I havecome to love.

Each family brings their uniqueperspective to birth: a perspectiveaffected by culture, religion, andpersonal experience. Last year, I hadthe pleasure of working with a fam-ily from Afghanistan. When I sayfamily, I mean a family of 12. Theentire family had immigrated theyear before and took turns support-ing the laboring couple. Theyprayed continually butwould stop as soon asa nurse or other clini-cian entered the room.When I assumed care,I mentioned how im-portant prayer was inmy life and encouragedthem to feel comfort-able praying in mypresence and in thepresence of our sup-portive staff. When thefamily began to feelmore comfortable, I noticed that themother relaxed considerably. I en-couraged the family to becomemore involved with her direct care,showing them where they could

access supplies to keep her morecomfortable and asking them howthey felt about her progress. Soonthey were sharing their experiencesand their concerns. The youngmother quickly progressed, and thefemale members of the familymoved with us to the largest deliv-ery room. They stayed with the la-boring woman throughout the de-livery, praying out loud continuallyand offering encouragement as thewoman worked hard to deliver herfirst son. The only man present wasthe father of the baby. Standing offto the side and close to the wall, hesmiled occasionally, comfortablewith the support his wife receivedfrom family members. After I com-pleted the delivery, I felt someone’shand in the back pocket of myscrubs. Quickly taking off mygloves, I turned to see the father ofthe baby remove his hand from mybackside.

I was shocked to discover he’dplaced two hundred-dollar bills in

my back pocket;and turning to thefamily, I knew im-mediately that theywere expecting meto accept their giftgraciously. Thenurse and I ex-changed a worriedglance, and I beganto tell them as care-fully as I could thatI could not accepttheir money. They

were completely offended andphysically turned away from me.Hours spent making them comfort-able had ended in failure. Thinkingfast on my feet, I lifted my hands in

Birth bearswitness to thecreative powerwe all possess.

It’s a time oftransformation,an opportunity

to remind awoman howpowerful she

can be.

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the air and exclaimed in a loud,plaintive voice that accepting moneywas against my religion! To my greatrelief, they quickly turned to faceme and graciously nodded theiracceptance and understanding.

Birth bears witness to the creativepower we all possess. It’s a time oftransformation, an opportunity toremind a woman how powerful shecan be. Many, many times, I have

whispered into the ear of a newmother that she should rememberwhat she did here today. When itgets tough, she should rememberhow strong she is. Honoring herability to self-create, to transformher life, plants the suggestion thatshe can mobilize and realizechanges that will benefit her andher family. These women will trackme down just to tell me they’ve fin-

ished their GED, started college, leftan abusive partner. For those whowill hear their own voice, who willvalue what is true for them aboveall else is the gift of vitality and thepower that comes with it. What isright about her life will soon bewhat is right about her body, mind,and spirit. ❖

Spiritual Moments

Nurturing Spiritual GrowthAlthough the act of nurturing another’s spiritual growth

has the effect of nurturing one’s own,a major characteristic of genuine love

is that the distinction between oneself and the otheris always maintained and preserved.

— M Scott Peck, b 1936, author, nationally recognized authorityon the relation between religion and science



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Pastoral Spiritual Care

Kurt Smidt-Jernstrom

Kurt Smidt-Jernstrom lives in Canby, Oregon, with his wifeand two children and enjoys work, cycling, fishing, boat-ing and choral singing. He received his theological edu-cation at Fuller Theological Seminary in Pasadena and atthe Graduate Theological Union at Berkeley, California.He took his chaplaincy training and internship at StanfordMedical Center, UCLA Medical Center, and LegacyEmanuel Hospital in Portland, Oregon. An ordained min-ister in the United Church of Christ, he has served as pas-tor of a local church, as interfaith chaplain at a care cen-ter, as pastoral counselor of Kaiser Permanente Hospice,and is a chaplain at Kaiser Sunnyside Hospital in Port-land. He is a member of the KP Regional Ethics Commit-tee; a board-certified chaplain through the Association ofProfessional Chaplains, and a doctoral candidate at theUniversity of California, Berkeley.

Mr Smidt-Jernstrom: I am going to begin by listingmy three main points: First, it is possible for healing tooccur (healing in the broadest sense, meaning a rein-tegration of body, mind, emotion, and spirit that en-ables one to live life fully, with a sense of equanimity),whether or not physical symptoms actually improve.Second, supporting and fostering this healing processis something you can do in the clinic setting. Finally, toprovide effective spiritual support, it is helpful to re-flect on one’s own spirituality.

At the outset, I would like to offer a couple of defini-tions that may be helpful as we discuss spirituality. I oftenmake a distinction between spirituality and religion.

Spirituality is an aspect or condition of human being,concerning:

• relationships (involving love and intimacy)• meaning and purpose for being• letting go of the crippling past (forgiveness)• openness to the future; hope.Religion is:• a system of beliefs and formal practices that are

practiced individually or in community, usually asa focus for finding meaning in life, understandingdeath, and maintaining hope for the future.

As a hospital chaplain, I provide spiritual and emo-tional support (and occasionally religious support asa Protestant Christian clergyman) to patients, some-times to families, and occasionally to hospital staff.One of the tools I use in providing this support is

active listening (listening to a person nonjudgmentallyand compassionately) to try to understand that per-son and not necessarily to fix a problem. Anothertool I use is a supportive presence; in other words,the nonverbal aspects of communicating interest andcompassion when attending to another. Maintaininga supportive presence is important in any patientencounter but becomes especially important whenworking with someone who is struggling with cog-nitive impairment and who finds it difficult, if notimpossible, to communicate verbally, not to men-tion engage in a reflective process. Prayer (and to alesser extent, meditation) are other tools I use toprovide spiritual support and to help enable a per-son to cope with illness or injury or sometimes dy-ing. I work, as best I am able, within patients’ beliefsystems, helping them to tap into their own spiritualresources.

Prayer and meditation are practices that can aidthe ability to cope by enabling a person to modifythe perception of a stressor. (I have a graphic imagethat shows the relation between prayer, meditation,and various coping behaviors.) For instance, somepeople have told me that in their struggles withchronic illness or pain, they have learned to “be-friend” their illness or to “dance” with their pain.These metaphors seem to indicate a certain abilityto cope with various stressors.

A woman I worked with recently had lymphoma.The cancer itself plus the side effects of various medi-cal interventions left her, at times, physically, emo-tionally, and spiritually exhausted. Throughout herlife, she had prided herself on her physical condi-tion and appearance and so occasionally became dis-tressed at the disfigurement that occurred as a resultof the chemotherapy and the progression of the can-cer. For all this, she refused to let her illness (andeventually her dying) keep her from participating infamily and community life. Until quite near her death,she was attending family gatherings, grandchildren’sschool events, and church. She had a very deep faiththat she drew upon continually for inner strength. Asaying that she gave me shortly before her death isan indication of how she was able to modify theway she perceived some of the powerful stressorsshe experienced.

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LIFE’S JOURNEYLife is not a journey to the grave with the intentionof arriving safely in a pretty-well-preserved body,but rather to skid in broadside, thoroughly used up,

totally worn out and proclaiming:WOW!

WHAT A RIDE!This coping or healing can be fostered and supported

in the clinic setting by using spiritual support tools,such as active listening—listening CARE-fully, sensi-tively and respectfully—and attending to spiritual con-cerns when they are mentioned. Occasionally, a pa-tient will explicitly mention a religious preference, belief,or spiritual concern. In that case, it is helpful to follow-up. When I talk with patients, I always listen for open-ings that give me the opportunity to follow-up on spiri-tual issues or concerns.

Some people like to take a spiritual history usingone of various spiritual assessment tools. One popu-lar assessment that has been peer reviewed and listedin medical journals was developed by ChristinaPuchalski, MD.1-3 You might find this or other assess-

ments helpful in developing your mental template andyour own way of broaching spiritual issues. Goodopportunities to conduct a spiritual assessment mightbe when a person is admitted to the hospital, or per-haps during a new patient visit, or during a medicalmaintenance visit.

Sometimes the presentation of spiritual issues can becomplicated, and one needs to tease them out. Forinstance, I worked with a young woman who hadovarian cancer and who was very angry. By listeningcarefully and by establishing a nonjudgmental pres-ence, I offered her the opportunity to talk about andreflect upon her anger, which in turn, allowed her tobegin to understand the effects that her anger had onothers as well as herself. (Editor’s note: Mr Smidt-Jernstrom wrote about this in a story to be published ina future issue of TPJ.)

Referrals are another way of offering spiritual sup-port. When addressing spiritual concerns threatens togo beyond the time constraints of an office visit, it maybe helpful to suggest a referral to a chaplain or socialworker. In addition, in the KPNW, we have health con-sultants to whom patients can be referred, and thoseconsultants can link people to various groups who areopen to reflecting on spiritual concerns as they relateto the patient’s own illness or condition.

Finally, to provide effective spiritual support, it isbeneficial to reflect on one’s own spirituality. Somemay be novices at that, and so I have included a shortlist of questions to reflect upon that can serve as start-ers (Table 1). They prompt reflection on spiritualityin general as well as on one’s own spiritual journey. ❖

References1. Puchalski C. Spiritual assessment tool. J Palliat Med 2000

Spring;3(1):131.2. Puchalski C, Romer AL. Taking a spiritual history allows

clinicians to understand patients more fully. J Palliat Med2000 Spring;3(1):129-37.

3. Puchalski C. A spiritual history [serial on the Internet].Supportive Voice 1999 Summer [cited 2005 Jun23];5(3):12-3. Available from: www.careofdying.org/SV/PUBSART.ASP?ISSUE+SV99SU&ARTICLE=J.

Table 1. A short list of questions/discussion points for reflectionDiscuss the following thoughts and questions about spirituality:• What are some of the barriers to discussing spirituality/spiritual

issues in general and/or with those you care for?• It is often helpful to distinguish between religion/religiosity

and spirituality• Spirituality is elusive. It’s not my mind or my feelings, although

it’s part of them. It’s that part which holds together all the rest. Spirituality refers to an acknowledgment, belief, or conviction that there is more to life than the material … People are looking for commonality—for common ground.

Various ways of describing spirituality:• Journey—with metaphors such as traveling, destination,

or crossing over a

• The business of living—the work one has to do, unfinished or unresolved business, pride in what has been accomplisheda

• Relationships—with metaphors for healing, estrangement, and separation a

• Interpersonal—issues such as fear of suffering or questions of forgiveness, shame, and guilta

• We all perceive life in our own way. Difficulty arises when we cling to a world of perception as though our own perception is the ultimate reality b

• We all ask such questions as: Why? Why me? Why now? Questions for which there are no answers. What’s required isnot a seminary education but sensitivity and ears that canhear and being comfortable with not knowing.b

a Brad DeFord remarks at National Hospice Organization’s annual meeting in Salt Lake City, Utah; 1992.

b Don Dinsmore remarks at Hospice Organization of Wisconsin annual meeting; 1993.

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Spirituality in the Medical Encounter:The Grace of Presence

Elizabeth Sutherland is a naturopathic doctor. She received her bachelor’s de-gree in biopsychology from Tufts University and her naturopathic medical de-gree from the National College of Naturopathic Medicine in Portland. She com-pleted a two-year postgraduate fellowship through the Kaiser Permanente Centerfor Health Research and is currently a research associate with that organization.She is a clinical investigator on the NIH-funded study, Alternative Medicine Ap-proaches for Women with TMD, and the principal investigator on two pilot stud-ies that examine the experiences of chronic pain patients at the Kaiser PermanenteNorthwest Pain Clinic who received an energy healing intervention. Her researchinterest centers on developing methodologies to study the doctor-patient rela-tionship and transformational change, and she has published in this field. In thepast, she studied Classics at Cambridge University.

Dr Sutherland: It is easy to thinkof spirituality as a domain that isdistinctly separate from the practiceof medicine. If spirituality is con-sidered to have a place in the medi-cal setting at all, it is usually envi-sioned as a discussion betweendoctor and patient where the doc-tor gingerly approaches the topic ofthe patient’s religious beliefs to bet-ter assess the patient’s available so-cial support. Sometimes, this discus-sion takes place when the doctorfeels s/he has reached the limits ofmedical knowledge and doesn’tknow what else to do, as with apatient facing the diagnosis of a ter-minal disease or other life crisis. Thegoal of the discussion may then beto refer the patient to a chaplain orother religious expert.

While this type of discussion isvital and admirable, it is possiblefor the doctor-patient relationshipitself to be a profoundly spiritual en-counter, even if the topic of religiousbeliefs is never broached. I livedwithin a spiritual community forseveral years where meditation and

introspective work were built intoa rigorous schedule. The real em-phasis of the practice, however, wasthat spirituality is grounded in ev-eryday life, not separate from it; that,by our nature, we are spiritual be-ings, and that connection is, in asense, the fundamental unit of life.The practice involved becomingaware of this connection and con-sciously serving it. In the medicalsetting, spirituality can be definedas the practice of cultivating aware-ness of a larger and larger context.This may sound like a kind of “off-label” use of the term spirituality,but when we practice cultivatingawareness of a larger context, in es-sence we take a step back and be-

gin to contemplate both ourselvesand the patient, each as a wholeperson. Practicing medicine as aspiritual encounter is really a life-long work of meditation and intro-spection, which can be expressedas three steps:

1. Cultivating awareness ofwholeness within oneself

2. Seeing wholeness in another3. Connecting from the sense of

wholeness within oneself tothe sense of wholeness oneperceives within another.

The language may sound abstract,but if connection is a constant prin-ciple of life, then we are just ac-knowledging and consciously par-ticipating in that connection process.A way to step into practicing medi-cine as a spiritual encounter is tolisten for the meaning of a patient’sexperience, instead of listening onlyfor the reporting of symptoms.Think of this as our attention span,not how many minutes we can con-centrate with our minds, but howfar we can open our hearts and sim-ply behold ourselves and anotherperson in a given moment. This isdeep listening, a facet of spiritual-ity with concrete benefits.

Deeply listening is not just a nice

ElizabethSutherland, ND

Sidebar: The benefits of listening deeplyFor the patient� Improved medical outcomes through better diagnosis� Improved satisfaction leading to greater adherence to treatmentFor the doctor� Greater job fulfillment�

�

Less stress-related illness and burnoutPersonal expansion and growth

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thing to do. It is in itself an agent ofhealing and transformation. Deeplistening is an internal orientationof you, the doctor, that becomesexperience and then a state youtransmit to the patient. (See Sidebar:The Benefits of Listening Deeply.)It may feel like doing nothing, butit can make all the difference in theworld. Knowing one is truly heardand understood gives a sense of self-value and a greaterability to bear what-ever is going on. Theculture of medicinehas become so fraughtwith time constraints,performance mea-sures, and litigationthat it loses sight of thetwo people who are inthe room participatingin an experience to-gether. Medical train-ing essentially trains doctors to takethe person (that is, themselves andthe patient) out of medicine. To helpbring the person back into medicine,consider two concepts:

The First Law ofTheo-DynamicsSometimes, the least is whatyou know; the most is whoyou are.

The Second Law ofTheo-DynamicsHow much time you actuallyspend with the patient isless important than thequality of your presence.

I use Theo here to represent thespirit and creative power of whole-ness or completeness that resideswithin each of us. Being present anddeeply listening brings the person,the humanity, back to the medical

encounter and turns it into a thera-peutic relationship. The practice ofmedicine is a spiritual encounter inwhich the doctor as person is anintegral part of the medicine, act-ing as a catalyst in the therapeuticrelationship to reconnect the patientwith his/her inherent capacity to bewhole. Spirituality in the medicalcontext is about the doctor as ex-pert human being rather than reli-

gious expert. This cantake the form of hold-ing for patients the vi-sion of their wellnesswhen they are unableto connect with itthemselves. It canmean realizing thatfear of giving the pa-tient false hope mayin fact be directingthe patient towardfalse despair.

How to PracticeMedicine as a SpiritualEncounter

Begin every visit with a spiritualorientation toward your patients.This means wanting to know themeaning their experience has forthem. (It may help to hold inside ofyourself the thought: “I want toknow who you are.”) Begin withan invitation: “How can I help you?”

If a patient reports to you what isin his/her medical records, redirect:“I know all of that. I want to knowwhat is going on for you.” A pa-tient may cry because this is the firsttime anyone has ever asked this. Ifthe person cries, it is actually a goodsign. You don’t have to do anything.Just wait a few seconds. The pa-tient will tell you what is really go-ing on, making connections s/he hasperhaps not understood until now.

In the presence of your deep lis-tening, you have created the spacefor self-awareness. Stop talking. Lis-ten. Listen beyond the mere report-ing of symptoms. Remember, listen-ing from your heart is a state of deepacknowledgment that you will trans-mit to your patients.

Even if you only have a few min-utes, the patient will feel heard,hopeful, and understood becauseyou have deeply listened. Get com-fortable doing nothing. Get comfort-able letting a patient leave withouta prescription. Listening may be allthe medicine your patient needs inthat moment.

ConclusionSpirituality is found in the human

condition; it’s in the connectionbetween people. It takes a relativelysmall investment to connect. It’s notthe time spent; it’s the quality ofyour presence. Connection is thehuman face of medicine; the humanface of medicine is spiritual medi-cine. Listening beyond the report-ing of symptoms will transform yourpractice and will transform you asa person. ❖

The time will comeWhen, with elation,You will greet yourself arrivingAt your own door, in your ownmirror,And each will smile at the other’swelcome

— From “Love after Love,” byDerek Walcott 1:p95

Reference1. Housden R. Ten poems to change

your life. New York: HarmonyBooks; 2001.

Spirituality in the Medical Encounter: The Grace of Presence

A way to stepinto practicingmedicine as a

spiritualencounter is tolisten for themeaning of a

patient’sexperience …



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Spirituality Symposium: Panel Discussion

Dr Janisse: I want to thank our panel for theirthoughtful, informative, and entertaining presentations.I would like to open this discussion up for questions.

TimeAudience member: I love connecting with my pa-

tients, and it’s always the time issue. Once you startconnecting with them, they really want to open upand let it all out as though you were from the behav-ioral science department. So what do we do with that?Do you have something specific that you stay with andfocus on with the patient, and how do you stop themwithout invalidating them when they start to go onand on?

Dr Sutherland: Because I practice on the fringes ofmedical society, so to speak, I have the luxury of spend-ing sometimes an hour, sometimes an hour and a halfwith patients, and maybe I’ll ask two questions in thattime. The first question I’ll ask is, “How can I helpyou?” At which point they’ll either tell me what’s intheir chart, for example, “I’ve just been diagnosed withovarian cancer.” I’ll say that I already know that. WhatI’m interested in is what is your experience: I want toknow your story. Or they’ll cry, and that’s when I knowI’m really doing good work. They’ll cry because noone has ever asked them, how can I help you. So, howcan I help you? And then maybe I’ll ask, “What else?”

What we’re really talking about is the cultivationwithin you, the practitioner, of certain qualities. Howyou describe these qualities, I think, is whatever reso-nates with you. Dr Schlitz talked about compassionateintent. I talk about being fully present and deeply lis-tening. So this is something, as I think all of the panel-ists have mentioned, that a practice we do all the time.Hopefully we’re successful with it in that moment witha patient, but it’s not something that we can turn into atechnique. When you practice it all the time, you canstep into it immediately because it’s a state that is al-ways there so you can connect with it.

When you have that demeanor, your patient is goingto feel you’ve really spent a lot of time with them evenif it’s only seven minutes. You probably heard about astatistic recently that surgeons who don’t get sued spendmore time with patients than surgeons who do. Do

you know how much more time they spend with pa-tients? It’s not 90 minutes. Three minutes. Three min-utes, but it was something about their demeanor. So interms of how to redirect a patient when you’re run-ning out of time: One, is the fact that youhave listened so deeply that patient is goingto feel acknowledged so then whatever yousay (because you will in that state allow thewords to come to you rather than forcingwords), they’ll still feel acknowledged. Youcan say to them: I think what you’re sayingto me is so important that I really want tocontinue exploring this with you. We’ve runout of time, so I’d like you to make anotherappointment. This leads to you, the practitio-ner, getting comfortable doing nothing, be-cause when you think you’re doing nothingthat’s actually when the healing is happen-ing. To send that patient away without a pre-scription, maybe the only thing you say to them is: Inthe coming week, in the coming month I’d like you tospend ten minutes on your own thinking about yourexperience right now and see what it brings up for youand then tell me about it when you come back.

Mr Smidt-Jernstrom: I would add to what DrSutherland has said, only that you can communicatecompassion and understanding and it doesn’t neces-sarily take a long time. I can appreciate that there aretimes that you feel this particular patient has just givenyou something you don’t have time for, and that’s whenhandoffs are good, like referrals, as a way of redirect-ing. You can say, “This is really important, and I’mwondering if you might be willing to talk with some-one else about this.”

As I mentioned about doing a spiritual history, I knowof a physician, for instance, who asks his patients: “Whatare you doing for yourself besides taking your pills?”

Dr Elder: I think the presence of the clinician is, initself, healing. What we can do that doesn’t take a lotof time is just be ourselves and take care of ourselves.Then, when the patient comes in sick, s/he will pickup on that energy, and that is itself therapeutic. Theother point is that it doesn’t take a lot of time to makepositive comments to the patient, because we forgethow powerfully we communicate to the patient through

This leads to you,the practitioner,

gettingcomfortable

doing nothing,because when

you think you’redoing nothingthat’s actually

when the healingis happening.

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our body language and other nonverbal behavior. Thesereflect who we are and how happy we are in our owncircumstance. We also communicate through what wesay to the patient, like, “You’ll be better in two weeks,”or “You’re looking great.”

Dr Schlitz: There’s that expression: The doctor willsee you now. Really seeing someone doesn’t take long.

Applying Meditation in ClinicalPractice

Audience member: How do you think we coulduse meditation, and in what conditions and situationswould this be particularly valuable?

Dr Elder: There’s a lot of data support-ing the use of meditation in cardiovascu-lar disease, that’s number one. Numbertwo, in substance abuse. Number three,depression and anxiety. Learning thesetechniques isn’t inexpensive but is cost-effective in the long run when you con-sider that, for example, the average costof being on a drug is about $1500 a yearper drug. So, if we can give patients alter-natives to medication, we can go a longway in terms of being cost-effective.

Dr Schlitz: Also, just as a resource, on the Instituteof Noetic Sciences Web site1 is a meditation bibliogra-phy, called The Psychological and Physiological Corre-lates of Meditation. There are different illness catego-ries and the research.

Mr Smidt-Jernstrom: Practically speaking,oftentimes I suggest a focus on breathing as a way forpeople to clear their mind and slow their breathing.Sometimes people find a certain phrase helpful, andthey use it over and over. Sometimes music. A singleparent I work with in the hospital focuses on her young-est child and uses that as a starting point for her medi-tation. It could be a walk in the woods.

Ms Newhouse: In the Diablo Service Area in North-ern California, we have a trainer in a technique calledmindful meditation, developed by Jon Kabat-Zinn. It’snon-sectarian. It’s available in a course for physicians andalso for patients, for example those with chronic pain. DrKabat-Zinn initially worked with chronic pain patients inhis clinic to discover their own power of healing and hashad a lot of success through applying this technique.

Audience member: I was very interested in the car-diologist who says a prayer before he goes into theprocedure. It reminded me of the JAHCO standard nowto have a time-out in the OR before every case. It’s an

incredibly powerful thing that when the patient isdraped, prepped and getting ready for the procedure,the surgeon has to quiet everybody down, tell a briefhistory of the patient, then the circulating nurse andthe anesthesiologist give their important points aboutthat patient. It’s a powerful moment.

Dr Schlitz: This moment also allows a renewal forthe practitioner because it’s a two-way interaction. Howthey can find, and we can find, our centering so thatit’s a more responsible engagement.

Mr Smidt-Jernstrom: Recently, I met a youngwoman who had surgery, and she had listened to some

wonderful meditation tapes and read abook on meditation. She came up with alist of statements that she wanted hersurgeon to read to her before she wentunder anesthesia. The list contained suchthings as “You will only have minimalblood loss during surgery” and “You willrecover completely and quickly from thisprocedure.” There were six things, andthe surgeon read them all.

Audience member: How long is themeditation that you would suggest pa-tients do? For a lot of people with their

busy lives, trying to start meditating would probablytake some practice.

Dr Elder: Twenty or 30 minutes of practice, once ortwice daily, has been generally recommended for thetechniques that we have studied at our Center for HealthResearch (including Transcendental Meditation andQigong). In our studies, patients have generally re-ported 80-90% compliance. Some patients have told usthat they find the mind-body practice time efficientbecause they can get so much more done with the restof their day.”

Dr Schlitz: In Jon Kabat-Zinn’s work, it’s ten minutes,and it’s just a simple centering exercise that’s distilledfrom a number of different practices, so it can be a deeperimmersion in the practice or it can be something sosimple as just connecting to your core self and relaxing.

Presence At DeathAudience member: Although I’m an endocrinolo-

gist, I still take hospital call, and I’m amazed in this dayand age that I still have to declare people dead. WhenI enter the room, the family is there, and the patient’sdead. I’m entering that sacred space, if you will. That’swhen I take my time-out—before I enter that room—because I don’t know this patient at all; never met them.

Symposium: Audience Questions & Panelist Answers

… if we cangive patients

alternatives tomedication,we can go along way in

terms ofbeing cost-effective.



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I’m not their personal physician, I’m the hospitalist,and it still gives me goose bumps. I would do that untilI stop practicing medicine. And when I entered medi-cine I never thought I would. I thought I would beafraid of death and would not honor it. We’ve talkedtoday about birth, which is a beautiful thing, but thetime of death is also when we can be present with thefamily. That is incredibly healing for the family. I justknow that’s true.

Dr Schlitz: Both birth and death are the transitionalphases where the sacred comes and goes, so they’resimilar. They are so related, it’s almost hard to dividethem, and honoring that space doesn’t take a lot of time.It’s about your willingness to just center your spirit for amoment before you walk into that space, and the moreaware you are of what is going on in your own heart andmind and being able to put that aside for a moment.When you’re interfacing with critically ill patients or withpatients who are very upset or in a state of crisis, holdingthat sacred space can be done in short fashion, and itbegins with how in touch you are with your spirit. Whenthey see you get centered, they get it right away. You canfeel it, you can feel them zoom in on you.

Dr Sutherland: I wanted to give my talk today thetitle: “What is spirituality? Or what do you do whenyou think you have nothing to offer?” And we’ve beentalking about profound experiences, people who aredead, patients who are facing death or birth. I’d justlike to say again that spirituality is the human condi-tion. It’s something that’s with us all the time and wecan connect with it all the time. In the Tibetan tradi-tion, they have mantras, which are like prayers, foreverything. There is a mantra for going to the bath-room, and this is not making something sacred pro-fane; it’s saying that everything’s sacred.

Negative Effects?Audience member: I went to medical school at

Columbia with a surgeon named Emmett Oz. What-ever happened to his work about giving suggestionsduring surgery?

Audience member: He is still out there. People nowbelieve this is very valuable, but what are the side ef-fects of these practices? If you believe it works, then itcould actually have a negative effect. In Emmett’s re-search, he said that when playing music in the operat-ing room, some music would actually reduce blood

loss during surgery but that some mu-sic would actually increase blood lossduring surgery.

Dr Schlitz: That is such a good point.That’s why research in this whole areais so critical. We just don’t know enough.It’s a whole new sort of discipline. Whenyou consider something as benign asprayer, we just don’t know enoughabout in what conditions it is helpfuland in what conditions is it harmful.

Dr Sutherland: Because of this, it’ssafer to keep yourself as the instrument,because if you’re listening, if you’re be-ing fully present, I really don’t thinkyou’re going to do any harm.

Mr Smidt-Jernstrom: I think it is important to re-main patient-focused. I always work within the beliefsystem of the patient to enable them to tap into theirown spiritual resources.

Dr Elder: Your point emphasizes the importance ofthinking good thoughts about our patients, because inthe course of a busy day, when we’re seeing twodozen patients, we can come to a point when we’renot at our best and we start having thoughts that aren’tentirely positive about our worklife and the peoplewhom we serve. If we believe that thinking positivethings about our patients can have a positive impact,then the reverse is probably true, and so we need tobe very mindful of that.

Dr Sutherland: What we’re doing when we’re witha patient is inviting them; we’re not demanding. We’renot saying, you know, I’m loving you unconditionally,what’s your problem? Because we can do that. We canthink our intent is loving kindness and it’s putting energyinto another person that they may not want. So you haveto hold within yourself that: I want to know who you are.Let everything you do be an invitation.

Dr Janisse: Well, thank you all for coming. And aspecial thanks to the panel for bringing knowledge,experience and wisdom to this relevant subject. ❖

Reference1. The physical and psychological effects of meditation

[monograph on the Internet]. Petaluma (CA): Institute ofNoetic Sciences; 2004 [cited 2005 Jun 13]. Available from:www.noetic.org/research/medbiblio/ch_intro1.htm.

Symposium: Audience Questions & Panelist Answers

If we believethat thinking

positive thingsabout our

patients canhave a positive

impact, thenthe reverse isprobably true,

and so we needto be very

mindful of that.

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