Efficacy and Evidence: Questioning Paradigms Across Religious Healing Traditions
Gila Silverman, PhD(c), University of Arizona
Candy G. Brown, PhD, Indiana University
Linda Barnes, PhD, Boston University School of Medicine
Moderator: Lance Laird, ThD, Boston University School of Medicine
The last several decades have seen a surge in research seeking to conceptualize, measure and document links between religion, health and medicine. Such research has sought to overcome the culturally-framed divide between care of the body and care of the spirit. However, it has often done so by adhering to the body-based methodological and epistemological paradigms of biomedicine, in the pursuit of an evidence-base for spiritual experience (Cadge, 2009). A frequent aim of these studies is to identify quantifiable outcomes of religious/spiritual practices.
In this panel, we ask: How have these biomedical paradigms informed our understanding of links between religion and medicine? What do they help us to see? What may they obscure? How can theories and methods from other disciplines and medical systems expand our understanding of outcomes and efficacy in particular, and challenge us to evaluate more effectively the strengths and limitations of the biomedical research model?
We will both explore anthropological and sociological perspectives on evidence and efficacy (see, for example, Barnes 2005, Barry 2006); and discuss findings from ethnographic research studies on Jewish and Christian prayer, Chinese religious healing, and contemporary “integrative” medicine practices, exploring the phenomenological side of religion and medicine. We intend these papers to provoke audience discussion of often unexamined aspects of the spiritual dimensions of illness and healing, to highlight new directions for research, and to explore possibilities for cross-disciplinary research that may better capture the full extent of religious and spiritual healing.
1. Experiential outcomes and embodied evidence: Ethnographic lessons from Jewish prayer for healing
From an anthropological perspective, healing is a complex process, embedded in cultural ontologies, values and social institutions (Kirmayer 2011). Healing may be physical, psychological, social and/or theological. In this paper, I draw on ethnographic research on prayers for healing among liberal (non-Orthodox) Jews in the American Southwest; I use the lived experience of Jewish prayer to explore the healing effects of religious practices, and seek to understand how participants themselves interpret these effects. In particular, I pay careful attention to the meanings and experiences of bodily sensations (Nichter 2008), examining the role of these embodied sensory experiences in personal determinations of prayer’s efficacy. By using this methodological approach, rather than focusing on particular biomedical outcomes, it becomes clear that prayers for healing change the illness experience, for both the ill and their caregivers, in ways far more diverse than can be captured in standard clinical narratives. These experiential, embodied outcomes are difficult to articulate, and therefore challenging to study. When people can find words for these sensory experiences, the effects of healing prayer they describe include a feeling of connection to community, ancestors and traditions; the transformation of fear and anxiety into comfort, strength and acceptance; spiritual transcendence; and a sense of agency and control at times of vulnerability and helplessness. Furthermore, when determining the efficacy of healing prayer, people are more likely to base their opinions on these personal experiences rather than evidence-based research studies.
2. Medical “Documentation” of Christian Spiritual Healing
Efforts to validate claims of healing through Christian prayer date back to the early modern period. Today, practitioners of Christian spiritual healing experience pressure to provide medical documentation to validate testimonies of healing through prayer. “Integrative medicine” has become a buzzword, but holistic, like conventional, therapies are expected to meet the standards of evidence-based medicine. Even if Christian prayers for healing are effective, providing persuasive medical documentation would be challenging for multiple reasons, including: assumptions of the biomedical paradigm and priorities of Christian practitioners. Instances can be cited of Christians presenting “before-and-after” medical documentation in support of healing claims, but the information provided by such documentation, at its most complete, is inherently limited in what it reveals about experiences of illness and healing. There has been a steady stream of clinical studies of “distant intercessory prayer,” but it is difficult to design double-blinded, randomized, controlled trials that have both construct validity and ecological validity—and other types of clinical studies, even if they offer advantages, do not garner much medical attention. For theological reasons, many Christian practitioners find it difficult to describe their practices using vocabulary considered acceptable in “secular” settings such as hospitals. This in part may account for the increasing “market share,” relative to conservative Christian practitioners, occupied by practitioners of other varieties of spiritual healing (such as Reiki, Therapeutic Touch, mindfulness meditation, and acupuncture) who may find it easier to market their approaches using secular-sounding language. Despite all these challenges, there is substantial empirical evidence that Christian prayer benefits health, whether through direct or indirect mechanisms—and that patients and many of their healthcare providers want to more fully integrate Christian prayer into conventional healthcare regimens.
3. Effica-Qi: The Fluid Dynamics of Chinese Medicine
Abstract: Efficacy is a fluid concept, its specifics contingent on context. The change seen as significant may occur on a symbolic level or through the removal of physical symptoms. It may address conditions of a social body. Some discussions differentiate between “healing” and “curing.” Many of these meanings surface when examining what efficacy means within the larger framework of Chinese religious traditions, which have a historically shared cosmology grounded in the phenomenon of qi. Qi has been defined in terms that range from a biomedical emphasis to a more ephemeral, spiritual one, and translated with fallback terms like “energy” and “vital force,” or denser attempts like “psychospiritualmaterial stuff.” It has also become increasingly common to leave the term untranslated.
This paper will examine different meanings of qi-based efficacy as represented in the practice of acupuncture in the United States. Some practitioners, for example, explain illness through a language of obstructed qi, and healing as a restoration to unimpeded flow. They, at the same time, look for entirely biomedicalized ways of doing both. Manifestations of illness can present as combinations of what, in biomedical terms, may be characterized as physical or mental symptoms and, in religious contexts, as a variety of spiritual symptoms. This example provides us with a way of examining interfaces between religion and medicine within a non-Western paradigm, while also looking at how this paradigm intersects with a biomedical frame of reference.
Candy G. Brown, PhD, Indiana University
Linda Barnes, PhD, Boston University School of Medicine
Moderator: Lance Laird, ThD, Boston University School of Medicine
The last several decades have seen a surge in research seeking to conceptualize, measure and document links between religion, health and medicine. Such research has sought to overcome the culturally-framed divide between care of the body and care of the spirit. However, it has often done so by adhering to the body-based methodological and epistemological paradigms of biomedicine, in the pursuit of an evidence-base for spiritual experience (Cadge, 2009). A frequent aim of these studies is to identify quantifiable outcomes of religious/spiritual practices.
In this panel, we ask: How have these biomedical paradigms informed our understanding of links between religion and medicine? What do they help us to see? What may they obscure? How can theories and methods from other disciplines and medical systems expand our understanding of outcomes and efficacy in particular, and challenge us to evaluate more effectively the strengths and limitations of the biomedical research model?
We will both explore anthropological and sociological perspectives on evidence and efficacy (see, for example, Barnes 2005, Barry 2006); and discuss findings from ethnographic research studies on Jewish and Christian prayer, Chinese religious healing, and contemporary “integrative” medicine practices, exploring the phenomenological side of religion and medicine. We intend these papers to provoke audience discussion of often unexamined aspects of the spiritual dimensions of illness and healing, to highlight new directions for research, and to explore possibilities for cross-disciplinary research that may better capture the full extent of religious and spiritual healing.
1. Experiential outcomes and embodied evidence: Ethnographic lessons from Jewish prayer for healing
From an anthropological perspective, healing is a complex process, embedded in cultural ontologies, values and social institutions (Kirmayer 2011). Healing may be physical, psychological, social and/or theological. In this paper, I draw on ethnographic research on prayers for healing among liberal (non-Orthodox) Jews in the American Southwest; I use the lived experience of Jewish prayer to explore the healing effects of religious practices, and seek to understand how participants themselves interpret these effects. In particular, I pay careful attention to the meanings and experiences of bodily sensations (Nichter 2008), examining the role of these embodied sensory experiences in personal determinations of prayer’s efficacy. By using this methodological approach, rather than focusing on particular biomedical outcomes, it becomes clear that prayers for healing change the illness experience, for both the ill and their caregivers, in ways far more diverse than can be captured in standard clinical narratives. These experiential, embodied outcomes are difficult to articulate, and therefore challenging to study. When people can find words for these sensory experiences, the effects of healing prayer they describe include a feeling of connection to community, ancestors and traditions; the transformation of fear and anxiety into comfort, strength and acceptance; spiritual transcendence; and a sense of agency and control at times of vulnerability and helplessness. Furthermore, when determining the efficacy of healing prayer, people are more likely to base their opinions on these personal experiences rather than evidence-based research studies.
2. Medical “Documentation” of Christian Spiritual Healing
Efforts to validate claims of healing through Christian prayer date back to the early modern period. Today, practitioners of Christian spiritual healing experience pressure to provide medical documentation to validate testimonies of healing through prayer. “Integrative medicine” has become a buzzword, but holistic, like conventional, therapies are expected to meet the standards of evidence-based medicine. Even if Christian prayers for healing are effective, providing persuasive medical documentation would be challenging for multiple reasons, including: assumptions of the biomedical paradigm and priorities of Christian practitioners. Instances can be cited of Christians presenting “before-and-after” medical documentation in support of healing claims, but the information provided by such documentation, at its most complete, is inherently limited in what it reveals about experiences of illness and healing. There has been a steady stream of clinical studies of “distant intercessory prayer,” but it is difficult to design double-blinded, randomized, controlled trials that have both construct validity and ecological validity—and other types of clinical studies, even if they offer advantages, do not garner much medical attention. For theological reasons, many Christian practitioners find it difficult to describe their practices using vocabulary considered acceptable in “secular” settings such as hospitals. This in part may account for the increasing “market share,” relative to conservative Christian practitioners, occupied by practitioners of other varieties of spiritual healing (such as Reiki, Therapeutic Touch, mindfulness meditation, and acupuncture) who may find it easier to market their approaches using secular-sounding language. Despite all these challenges, there is substantial empirical evidence that Christian prayer benefits health, whether through direct or indirect mechanisms—and that patients and many of their healthcare providers want to more fully integrate Christian prayer into conventional healthcare regimens.
3. Effica-Qi: The Fluid Dynamics of Chinese Medicine
Abstract: Efficacy is a fluid concept, its specifics contingent on context. The change seen as significant may occur on a symbolic level or through the removal of physical symptoms. It may address conditions of a social body. Some discussions differentiate between “healing” and “curing.” Many of these meanings surface when examining what efficacy means within the larger framework of Chinese religious traditions, which have a historically shared cosmology grounded in the phenomenon of qi. Qi has been defined in terms that range from a biomedical emphasis to a more ephemeral, spiritual one, and translated with fallback terms like “energy” and “vital force,” or denser attempts like “psychospiritualmaterial stuff.” It has also become increasingly common to leave the term untranslated.
This paper will examine different meanings of qi-based efficacy as represented in the practice of acupuncture in the United States. Some practitioners, for example, explain illness through a language of obstructed qi, and healing as a restoration to unimpeded flow. They, at the same time, look for entirely biomedicalized ways of doing both. Manifestations of illness can present as combinations of what, in biomedical terms, may be characterized as physical or mental symptoms and, in religious contexts, as a variety of spiritual symptoms. This example provides us with a way of examining interfaces between religion and medicine within a non-Western paradigm, while also looking at how this paradigm intersects with a biomedical frame of reference.