As a young medical student 25 years ago at UCSF, I began to notice the role religion was playing in the lives of patients. At that time in medicine, religion was typically ignored by doctors and generally seen as unhealthy—neurotic at worst, irrelevant to health at best, and sometimes conflicting with medical care (Jehovah Witnesses refusing blood products, patients preferring prayer to medications, etc.). This is not, however, what I saw in most of the patients I cared for. I was struck by the fact that those with religious faith often seemed to be the ones most able to cope with their illnesses. When I spoke with colleagues about this, however, the idea was seldom received warmly or with much interest.
These experiences motivated me to begin some systematic research of my own to document both the positive and negative role that faith plays in helping patients with medical illness to cope. This led to studies demonstrating the impact of religious beliefs and practices on depression, anxiety, alcohol use, and smoking, and later, on blood pressure, immune function, overall survival, and need for health services.
Today, more than 1200 studies have examined the relationship between religious activity and health, with more than half of the studies showing a significant positive connection. The results of this work and that of hundreds of other investigators around the world have begun a small revolution in medicine. In 1992 only three medical schools had courses on religion, spirituality, and medicine; today, in excess of 70 of the approximately 125 medical schools in the United States have such courses.
How does prayer fit into all this? What is prayer and what exactly does it have to do with health and healing? In particular, what does it have to do with physicians and the care we provide to patients?
What Is Prayer?
Prayer is viewed differently by different religions around the world. As a physician without any theological training, whose information has been gained largely by being raised in a Christian home and now as a practicing Christian, I admit to being an amateur about such things. However, I have learned much in talking with patients who struggle with illness and whose faith has been tried in the fire of suffering and pain. Most of these patients, however, also have come from a Christian background. This is my particular perspective, while bearing in mind that other religious traditions may understand prayer in other ways.
Prayer is not simply about repeating words. It is not positive or wishful thinking or simply good intentions. Prayer is not like putting 50 cents in a vending machine and out pops a Coke. No. Prayer is perhaps the most important, most basic, most intimate and foundational of all religious and spiritual activities. In essence, prayer involves communication with God on a personal level.
What Exactly Does Prayer Do That Results in Healing?
Prayer brings the person closer to God. As with all relationships, communication is what leads to real love, which casts out fear, displaces worry, and reduces stress. Prayer changes us. It changes our outlook on problems and situations and gives us insight into forgiving others and receiving forgiveness ourselves.
Prayer allows the body to heal naturally. By counteracting stress and promoting positive emotions, prayer frees the body’s natural healing processes. It releases the immune, hormonal, and cardiovascular systems to heal disease, illness, or injury. It is these mind-body mechanisms that scientists are seeking to better understand. Within the past year there has been an explosion of research documenting the negative effects of depression, psychological stress, and social isolation on immune function, coronary artery disease, cancer survival, and other disease outcomes. For those with faith, prayer makes the supernatural possible. These are things researchers cannot understand and may not be able to study or explain with the natural and limited tools of science.
What Does This Mean for Physicians?
Healing, as I use it here, involves physical healing, but also more than that. Healing may involve the healing of emotions, inner feelings, and relationships that may be even more important than physical healing.
I encourage all physicians to take a spiritual history of patients with serious or chronic medical illnesses that challenge their coping abilities. Find out what role patients’ faith and prayer play in helping them to cope (or in hindering it). If spiritual needs are detected, physicians should refer patients to chaplains or other pastoral care professionals.
Should a Physician Ever Pray With a Patient?
This is a controversial topic. Sometimes, a brief prayer between doctor and patient can bring great comfort to the patient, may enhance the doctor-patient relationship, and may even impact medical outcomes. At other times, a physician-initiated prayer can make the patient feel uncomfortable, coerced, and may actually increase stress and impair the doctor-patient relationship. There have even been lawsuits brought against physicians for such activity.
For this reason I suggest that physicians never engage patients in prayer without first taking a religious or spiritual history. If the patient is clearly religious, if prayer is important to him or her in coping, and if the physician is from the same religious background as the patient, then the physician may say something like, “Should you ever wish someone to pray with you, I’m open to doing that. Just let me know.” This avoids putting the patient on the spot and forcing an immediate answer. However, physicians should never be forced or feel obligated to pray with patients if this conflicts with their own beliefs or principles. Following these guidelines will increase the likelihood that prayer will be a positive experience for all concerned.
Prayer is powerful medicine—sometimes for the body, often for relationships, and always for the soul.