Is prayer good medicine? Is it possible images formed from prayer can shape a nonlocal bond between individuals that can heal? The purpose of this paper is to examine the research and history of guided imagery and intercessory prayer and look at potential ramifications for medical practice. A major component of exploring the nature of prayer, imagery, and healing is not so much an etymological study, but rather a discourse in the commonality of language. In this era of “energy medicine”, there are many healers and patients that often use words not understood by the medical community. While the medical community is not the ultimate authority on healing there is a need to be accepted by the realm of allopathic medicine before we as a culture see a paradigm shift associated with a therapy. Therefore, if medicine is to accept the potential that prayer, through imagery, can heal, then there will be a need to show through the medium by which medicine understands, research. Dossey (1997) discusses this when he describes the Beef Stroganoff Principle. He describes the struggles of a friend who could not sell beef stroganoff until he renamed it beef and noodles; there needs to be a discussion within a language that is understandable by the target audience, in his friends case the customers understood beef and noodles. As we look at the power of prayer, nonlocality, and the images created in this healing process “we are designing the menu, deciding what to call it” (Dossey, 2002, p. 2). The main issue with this type of healing process is that there is no current agreement on how to present this material to the medical community. Agreement on the double blind randomized trial or the meta-analysis is uniform but there is a muddling of the water when it comes to perceived religion and medicine. In this country where we protect the rights of individuals and separate the church and state it is difficult to bring the two together even when the research is evident.
Herbert Benson et al (2006) recently showed that individuals recovering from cardiac bypass surgery did not benefit from the prayers of others when it came to postoperative recovery and leaving the hospital; it might have actually made patients worse. His paper created a maelstrom of debate on both sides of the issue with medical materialists claiming a study had been done (in their double blind prospective language) and the results where what they knew all along; prayer is nothing more than wishful thinking. Transpersonal scientists and medical professionals rallied to the cause and found flaws in the study including the fact that it took the researchers almost five years to analyze the data. Benson’s research exemplifies the character of the debate and the need for more research on the topic. It is because of this debate Cadge (2009) states: Is Prayer Good Medicine?
Personal and institutional factors that shape research and teaching in religious studies are clearly different from those that influence intercessory prayer researchers, they may similarly shape the conceptions of prayer and religion we do (and do not) imagine possible and, as such, require continued attention in our conversation, teaching, and research. (p.302).
Sir Francis Galton (1822-1911) conducted one of the first studies into the effects of prayer in health. Galton (1872) discovered sovereigns or royalty and clergy, both sets of men being prayed for had shorter life spans than professional such as lawyers and doctors; royalty having the shortest life spans of all groups. He made the assumption that prayer was not enough to overcome the excess afforded to the lifestyle of the political leader in that time period. What is important is that he compared clergy to physicians. One assumption made is clergy prayed for the sovereigns and not physicians, and that physicians and sovereigns cared for their health in similar manner. Medical studies on intercessory prayer were published as early as 1965 (Cadge, 2009). The initial studies done in intercessory prayer were taken in the form of God-imagery prayer we see in Protestant worship. Joyce & Weldon (1965) first used imagery in their study by asking the prayor to set an image of the person they were praying for and the person’s name but not the disease. The person praying was then also asked to view the patient enveloped in the love of God. Ultimately the authors found that intercessory prayer did not improve the health outcomes of those being prayed for, but they did suggest altering the study in order to improve subsequent outcomes if repeated. Collipp, (1969) utilized Protestant prayer groups and biblical imagery to intervene on behalf of patient with leukemia and he concluded that prayer was indeed efficacious. In many studies the intercessors were laypeople rather than clergy (Cadge, 2009, p. 309). Other studies with positive patient outcomes were conducted by Harris et al. (1999) and Byrd (1988) both showing more rapid recovery and decreased complications; these studies being in direct conflict with the more recent study by Benson et al (2006). Nineteen studies were reviewed by Cadge (2009) and between 1965 and 2004 only the two studies mentioned above were deemed to have a positive result from intercessory prayer. One other study concluded that retroactive intercessory prayer was cause for shorter hospital stays and decreased fever duration. Lebovici (2001) looked at 3393 patients that were hospitalized between 1990 and 1996 and prayed for them in 2000. His conclusions came under scrutiny by medical peers when it seemed strange that he would pray for them already knowing the outcomes. Lebovici was later quoted as saying he “intended lightheartedly to illustrate the importance of asking research questions that fit with scientific models” (Bishop & Stenger, 2004, p. 1444). With his admission of jest, Lebovici metaphorically gave credence to the fact that there are three kinds of lies; lies, damned lies, and statistics. This statement has been attributed to Minister Benjamin Disraeli (1804-1881), but is not seen in any of his works. What we see here is the fact that statistics needs to be interpreted without inherent bias or the research suffers, and so does the cause. Is Prayer Good Medicine?
The first multicenter randomized prospective study on distant intercessory prayer, music, imagery, and touch therapy was called the MANTRA II (Monitoring and Actualization of Noetic TRainings) study. In this study (Krucoff et al., 2005) 748 patients undergoing percutaneous cardiac procedures were randomized between intercessory prayer or no prayer, and music, imagery, or touch therapy (MIT) or none. Endpoints evaluated were major cardiac complications or readmission or death within six months of the procedure. Equal distributions of patients were seen in the four groups and results showed no significant change in endpoints for any of the four groups. There were findings that patients receiving MIT did have decrease preoperative stress factors, but these patients obviously were aware they were receiving the treatment at the bedside. This study, being double-blinded and prospective attempted to speak the language of the medical profession and in so doing it was a landmark project. While the effects of the study were null the researchers acknowledged, “the trends and behavior of pre-specified secondary outcome measures suggest treatment effects that can be taken pretty seriously when considering future study directions” (Duke Medicine News and Communication, 2005, para. 16). While this study may have shown that there was no specific gain to hospital discharges in those patients with intercessory prayer it does open the discussion that there might be an influence on the preoperative effect of human touch. For any medical provider delivering surgical intervention this will hopefully give cause for them to pause and consider the potential effect of the provider giving way for the patient to become an active participant in the healing process. Criticisms of the potential for prayer and God-imagery in healing stems from the potential risks involved for the providers. If it were deemed that prayer was helpful in healing and a physician were to withhold that healing therapy would this be akin to malpractice? Dossey (1996) also discusses the question of the physician praying for a patient without their consent and the ethical ramifications of that process. Should physicians pray for their patients? Can physicians pray for their patients without their consent? I believe these are questions that allopathic medicine is currently not prepared to answer. Is Prayer Good Medicine?
In 2001, researchers set out to evaluate the effect of intercessory prayer on pregnancy rates in women undergoing in-vitro fertilization. The study was a double blind randomized prospective clinical trial that spoke the same language as physicians. One of the lead physicians, Rogerio Lobo, M.D. was a leading obstetrician gynecologist and the head of the OB-GYN department at Columbia University; Dr. Lobo was also the Editor in Chief of the prominent Journal of Reproductive Medicine. Cha, Wirth, & Lobo (2001), showed that a cohort of infertility patients included in a prayer group had significantly increased viable pregnancy rates than did a group that was not under prayer guidelines. This study’s complex design was eventually challenged by peer review and under this examination it was discovered there was a lack on informed consent on the patients and thus an investigation was launched by Columbia University and the United States Department of Health and Human Services. When the investigation was launched it was discovered that Dr. Lobo had only discovered the study 6-12 months after it had been completed and he only provided editorial comment (Roehm, 2005). With Columbia University in the investigation, Dr. Lobo removed his name from the study thus leaving Kwang Cha, MD who had potential financial gain (since he was the owner of the infertility clinic) in the study. The final author Daniel Wirth was a lawyer and parapsychologist who was subsequently convicted of fraud for using the names of dead people for financial gain (United States of America vs. John Doe aka Daniel Wirth, 2004). Is Prayer Good Medicine?
This study shows the potential need for a seemingly landmark study to stand up to peer review in order to convince allopathic practitioners of the validity of the study’s claims. This study is also a powerful lesson in the fact that once a study is published in a peer-reviewed journal the potential damage has already been done (Roehm, 2005). It is imperative that we continue to study prayer in healing with an eye towards scientific investigation and less towards the supernatural superseding the double-blind set-up.
This project exemplifies the nature of respect for the well-controlled research project and how these types of studies can be a major setback for the mind-body medicine movement. Legitimate work done by respected researchers can be erased with reference to this one study. There is no way to make a physician utilize prayer in his or her practice as this is highly dependent on their own spiritual progression and religiosity. Neither this study nor the MANTRA II study looked at whether or not the patients wanted to be prayed for and if the patient had the level of experience to utilize the imagery necessary for the exercise.
In my medical practice there have been opportunities for using imagery in the healing process but none more appropriate than when I perform a hysterectomy. In that surgery I am removing the reproductive organs that have created families and can hold a history for an entire generation In certain patients I ask them to perform a self-guided imagery where they give me their uterus instead of having the feeling of me taking it from them. I do not have a study to show these women leave the hospital sooner or have decreased rates of infections, but I do know that I have women who are thankful I have asked them to be an active participant in the healing process. I am not sure we need a study to see the humanistic impact of this type of doctor-patient relationship.
Prayer conjures up images of deities and angels, sacred places, and instantaneous healing. When one participates in direct prayer they are specifically setting the tone and holding the results they desire. A non-directed prayer is more the open-ended type question or simply saying, “thy will be done”. As with imagery, there is no one method that works better in any group and it is highly dependent on the individual. Prayers rely on imagery, and imagery relies on three factors: a quiet environment, a focus, and a passive attitude (Dossey, 1993). As we have seen it is debatable whether or not prayer has a positive outcome in health related studies, and yet 90% of patients with serious illness will engage in prayer (Jonas & Crawford, 2003). Prayer then could be thought of as a potential form of self-healing through a relaxation response or a coping mechanism. Achterberg, Dossey, & Kolkmeier (1994) refer to this type of imagery as preverbal and that this type of imagery is solely used in self-care (p.51). Achterberg goes on to discuss the fact that preverbal imagery does not need anything to accomplish its task, “the therapist or healer merely serves as a guide for developing the effective imagery strategies” (Achterberg et al., 1994, p. 51). With non-local healing or transpersonal imagery there is a transmission of healing from one person to another. This form of healing is involved in prayer when someone is praying for the health of a friend or family member.
Indigenous shamans are masters of transpersonal imagery and they use these images through ritual and ceremony, dance, exhaustion, hallucinogens, asceticism or mantras. The resurgence of shamanism in the Western world sheds light on the desire of the modern individual to rely on self-healing imagery and techniques of ecstasy to enter those healing states.
Imagery is often used in prayer, but it can also be used outside of prayer (Dossey, 1996, p. 195). Imagery encompasses all works of visualization, ritual, and imagination while prayer is of that same description, but with the caveat of appealing to a higher power. When praying or using guided imagery there are those who question the manner in which the prayer is performed. Is the prayer to be active or passive? Does the individual ask for a specific type of healing and thus invoking a specific type of imagery heal better than the individual who simply gives himself or herself over to the will of God. It has been stated that both types of prayer are effective (Achterberg et al., 1994, p. 57). This is due to the fact that both of these methods induce a state of relaxation. Dossey (1993) expands on this ability to enter a state of relaxation by showing that there are three things necessary in order to enter a relaxed state: a quiet environment, a focus, and a passive attitude.
The negative side of directed prayer or imagery is the potential for mental collapse when the process fails the patient. If a patient or family member believes in the power of prayer and participates in a direct prayer of the patient being healed and that person does not survive, this could shatter their prayer or imagery paradigm. When people attempt to direct the God-imagery to a specified task they are assuming this is the best result, because it is the result they wish. A specific demand may not be the best answer and obviously it may or may not come true. An empty outcome can have tragic results (Stratham, 1996). Prayer can affect those with a belief more than those without. This is seen in those patients with a belief or culture dependent on folk remedies. Loudell Snow (1974) described a phenomenon where patients felt they could not heal because of previous religious transgressions. He stated, “medicine cannot reach the mind nor a heart diseased by sin” (p.84). This concept of either being cursed by a negative prayer or hex carries a potential destruction equal in weight of the power of positive prayer. This type of hex or death imagery was studied by Walter Cannon (1957) and had three essential elements as described by Dossey (1997): The victim, family members and all acquaintances must believe in the hex, all previously know victims of the hex have died, and all of the family members and acquaintances must believe the victim will die. Whereas the power of prayer is more powerful if believed by the individual, the power of a negative prayer or hex must incorporate the victim’s surrounding support.
Finally, with regards to the negative side of prayer and imagery, it is the words we use as healers that can directly affect the medical outcomes in patients. Bernard Lown (1999), a practicing physician describes remarks made by physicians to their patients and the power of suggestion conveyed within those comments. Comments like, “you only have months to live” or “you have to have surgery today or you will die” can bring the patient to the brink of death simply by creating a severe stressor and hopeless imagery. It is not to say that the patient may not need surgery very soon, but an otherwise asymptomatic patient may misinterpret words or feel life slipping away upon leaving our offices. “My OB Said What” is a website where patients write in one line statements they heard from their obstetrician during labor. Reading these comments, I can see the context where something was said by the obstetrician, but the patient interprets differently, or the obstetrician simply says something preposterous. Quotes such as, “You’re just asking him to be born with cerebral palsy” when discussing a potential cesarean section with a patient is sending a horrible image to the patient and placing a barrier between patient and physician.
Sellers (2001), determined five spiritual themes were at play in patient’s perceptions in the spiritual dimensions of care. One of these dimensions was nurses (and arguably doctors) can enhance spirituality by establishing a bond between the patient and the family. As seen above with hexing, involvement of the family can be an essential part of the healing process as described by patients. Many academics will debate the power of prayer and the old divide between religion and science. Evans & Evans (2008) describe this debate not based on epistemological differences, because social-institutional studies have shown this relationship to be more fruitful. The many studies done up to this point have been conflicted and even fabricated, but this does not change the fact that some individuals do heal with prayer and sicken with negative imagery. One study has shown that 75% of hospitalized patients would like physicians to be concerned about spiritual welfare, and 50% would like for their physicians to pray with them (Larson, D.B. & Greenwold Milano, M.A., 1995). Physicians, working from the medically materialistic paradigm may feel threatened or confused by this information, because this is not something routinely taught in medical schools.
The preverbal and prepersonal beliefs of current medical practice can be summed up by the following quote:
Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic. It snuffs out Saint Teresa as a hysteric, and Saint Francis of Assisi as a hereditary degenerate (James, 2002, p.16).
The call to heal comes from the familial bonds of the shaman-physician, healing vocation, or from wounds of the past. In any case, it is the spiritual glue that provides physicians and nurses with the ability to become healers. The continuation of spirituality in medicine is a critical conduit to healing the physician and patient. Inner healing of the physician is an important aspect of bridging the gap towards healing the community. Recognizing, utilizing, and sharing imagery and prayer is a potential first step in bridging the gap between the wounded healer and the disembodied local and global communities (Tassone, 2009).
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Shawn Tassone, MD PhD is a double boarded physician in Obstetrics and Gynecology and the American Board of Integrative Medicine. He is a practicing OBGYN, author, speaker, and patient advocate. Dr. Tassone is the author of two books Spiritual Pregnancy: Develop, Nurture & Embrace the Journey to Motherhood (Llewellyn Publications, 2014) and Hands Off My Belly! The Pregnant Women’s Guide to Surviving, Myths, Mothers, and Moods (Prometheus, 2009). He has written and published extensively on topics of spirituality in medical care and he is an advocate for whole foods to heal the human body. He is an instructor in integrative medicine at Arizona State University and he has been on the faculty at the University of Arizona and the University of Oklahoma Health Sciences Center teaching residents and medical students. His belief is that the human body was made to heal itself and that the medical model should involve more patient-centered care with an active patient and a passive healer. He has written for Psychology Today and was the content editor for About.com Women’s Health page.
He currently practices in Austin, TX in an OBGYN practice where he can instruct his patients on the usage of natural therapies as well as those traditionally accepted. His main belief is that we should have an ACTIVE patient with a PASSIVE physician, meaning we need to learn how to care for ourselves by learning as much as we can about our bodies and health.
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