AAMC Reporter: October 2008

Medicine Should Embrace the Benefits of Spirituality

Rev. Scott Morris, M.D., founder and executive director, Church Health Center, Memphis, Tenn.

Medicine has become too much of an empirical science. We are far too enamored with technology. For many young physicians, if an MRI does not confirm a diagnosis, then the diagnosis is wrong. This, therefore, excludes any consideration of the spiritual dimension in life. Most seasoned physicians, however, recognize that 50 percent of the problems patients bring to a primary care setting have no physical etiology. Patients today come to physicians for reasons that, in the past, would have been taken to a priest. Broken hearts cannot be diagnosed with CT scanners, no matter how fast or how smart the radiologist is.

For the past 21 years, I have practiced at the Church Health Center in Memphis, Tenn. We are a faith-based primary care clinic for the working uninsured, providing care for more than 55,000 patients of record. With eight staff physicians and more than 400 volunteer physicians, we provide quality health care without seeking or relying on government funding. I treat patients daily who initially complain of a physical ailment but literally within 30 seconds of describing their symptoms, begin to cry. Not because the physical ailment is so severe, but because their spiritual disease is so intense.

These days, the public and even many clinicians refer to this as stress. The concept of stress is sufficiently vague as to have very little meaning. It has no religious connotation, is not judgmental, and is so commonly used that most people accept that stress causes problems. Yet it is so ubiquitous as to have lost its usefulness. What I believe is overlooked is that what is "stressed" is the spiritual dimension in life.

It was Plato and then René Descartes and their disciples who philosophically got us off track. Together they have convinced us to accept Cartesian dualism—a belief that the human body can be separated into a physical body and a nonphysical soul or spirit. For Plato and Descartes, it was the spiritual part that actually mattered, and the body just a necessary container. On the other hand, modern medicine has elevated the body to a level of supreme importance and jettisoned the spiritual. Faith communities can dabble in the nonempirical, read fanciful notions of the spirit, while real science and medicine will practice what can be observed, quantified, and objectified. This view of the body does not reflect the experience of most people—religious or not—or most seasoned physicians.

For the past 20 years, both Christian and atheist doctors have argued over the reality of the science of prayer and other spiritual disciplines. Both sides point to their evidence to support their position.

In Memphis, I was part of an advisory group for a large, multicentered, double-blind controlled study on the efficacy of prayer, which tracked participants after coronary artery bypass surgery. The study, funded by the Templeton Foundation, took place at Baptist Memorial Hospital. When the results were analyzed, researchers could not find a correlation between prayer and improved outcomes. (When the results were published, the chaplain at the local Methodist hospital lobbied his public relations department to start running ads saying, "Baptist prayers don't work—come to Methodist.") The study did not convince anyone of the impact of the spiritual domain in life, and I seriously doubt any future study will do so either.

This is not to conclude that the spiritual dimension does not exist. I believe just the opposite to be true, and most physicians intuitively know there is more to life than what empirical science has revealed. We freely admit today that electrical currents are critical to life. When I was a medical student, the idea of bacteria as a cause of peptic ulcer disease was laughed at. Even 10 years ago, acupuncture—which is based on the Chinese concept of “chi” and its flow through the body—was considered quackery, but is now practiced in many major health centers. Spirituality is indeed acknowledged in most medical schools in a way that it was not 20 years ago, but it is still on the periphery and not taken seriously by most faculty.

Technology, on the other hand, is unquestioningly accepted as the key to the advancement of medicine. The cost, however, is enormous, and the small, incremental improvements it provides can often be questioned. Recent disappointing results regarding the evidence of CT angiography is only one example. What if research on the benefit of spirituality was funded at the same level, especially spirituality's impact on preventive medicine? I am convinced we would see an improvement in health outcomes equivalent to the early 20th century, when real technological advances were introduced.

I am not advocating abandoning technological research, but I am proposing we maximize the benefits of spirituality that most physicians have seen at work in their patients' lives. Even if—as cynics would suggest— spirituality is only the placebo effect—as Herbert Benon at Harvard has rightly pointed out—isn't this a good thing?

For 21 years I have observed my patients, who materially have very little, answer the question, "How are you doing?" by responding, "I am fine and blessed." The major assets in their lives are their spiritual strengths. Surely it is time to engage these spiritual strengths in a way that improves health outcomes. To do this will require academic partners willing to take a risk.

Editor's Note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.