Religiosity in Patients Receiving Deep Brain Stimulation for Parkinson's Disease
Jessica Frey, MD, University of Florida; Janine Lopes, Manahil Wajid, Liam Kugler, and Christopher Hess, University of Florida
Given that Parkinson’s disease (PD) is caused by a depletion in dopaminergic neurons, this disease state is ideal to explore the relationship between dopaminergic networks and religious beliefs. A lack of dopamine has been associated with apathy, which may in turn lead to loss of motivation for religious practices. In addition, dopamine is known to modulate the reward pathways, which have been shown to be activated during prayer. A handful of case control studies have shown a selective deficit in religiosity in patients with PD, whereas qualitative studies have shown spirituality is a positive coping mechanism in PD. However, to date, no studies have evaluated the effect of deep brain stimulation (DBS) on religiosity.
Patients with PD who were being evaluated for imminent DBS surgery (N=30) were led through a guided interview that asked questions on a variety of topics related to religiosity and spirituality. DBS is a procedure in which electrodes are implanted into the brain at either the subthalamic nucleus (STN) or globus pallidus internus (GPi) and electricity stimulates the chosen to target to improve motor symptoms such as tremor or stiffness. The patients included in this study all had significant and long-standing disease to the point that DBS was the best option to help improve their quality of life. Patients were first interviewed prior to their DBS surgery. These interviews were videorecorded and subsequently transcribed. Following their DBS surgery, we plan to do post-DBS open-ended interviews as well.
We conducted a qualitative analysis on the interim data collected from the pre-DBS interviews. Thematic analysis revealed several emerging themes, including the reframing of a neurologic diagnosis through a spiritual lens, the strengthening of spirituality as a coping mechanism for illness, the power of prayer as a healing tool, and the redirection away from religious accountability for receiving a neurologic diagnosis. The stories and experiences collected from these patients were filled with insightful accounts of how a debilitating, chronic neurologic diagnosis such as PD had actually made them more thankful, more patient, more resilient, and more responsive to the suffering of others. We will continue to follow these patients after they undergo DBS surgery to see if any new or contrasting themes emerge, in addition to determining whether neuromodulation of either the STN or GPi leads to alterations in religiosity patterns.
Although the neurology clinic is often a place to conduct objective neurologic exams and impartially analyze the motor symptoms of patients with movement disorders, these interviews opened up a sacred space in which patients could talk freely and without judgment about their experience with PD. During the interviews, not only was it a time for patients to share how their diagnosis had shaped their outlook on life, but it was an important moment for clinicians to sit back and listen to their stories. It is this powerful exchange, where the clinician becomes the learner and the patient becomes the teacher, that opens up a sacred space in medicine.
Patients with PD who were being evaluated for imminent DBS surgery (N=30) were led through a guided interview that asked questions on a variety of topics related to religiosity and spirituality. DBS is a procedure in which electrodes are implanted into the brain at either the subthalamic nucleus (STN) or globus pallidus internus (GPi) and electricity stimulates the chosen to target to improve motor symptoms such as tremor or stiffness. The patients included in this study all had significant and long-standing disease to the point that DBS was the best option to help improve their quality of life. Patients were first interviewed prior to their DBS surgery. These interviews were videorecorded and subsequently transcribed. Following their DBS surgery, we plan to do post-DBS open-ended interviews as well.
We conducted a qualitative analysis on the interim data collected from the pre-DBS interviews. Thematic analysis revealed several emerging themes, including the reframing of a neurologic diagnosis through a spiritual lens, the strengthening of spirituality as a coping mechanism for illness, the power of prayer as a healing tool, and the redirection away from religious accountability for receiving a neurologic diagnosis. The stories and experiences collected from these patients were filled with insightful accounts of how a debilitating, chronic neurologic diagnosis such as PD had actually made them more thankful, more patient, more resilient, and more responsive to the suffering of others. We will continue to follow these patients after they undergo DBS surgery to see if any new or contrasting themes emerge, in addition to determining whether neuromodulation of either the STN or GPi leads to alterations in religiosity patterns.
Although the neurology clinic is often a place to conduct objective neurologic exams and impartially analyze the motor symptoms of patients with movement disorders, these interviews opened up a sacred space in which patients could talk freely and without judgment about their experience with PD. During the interviews, not only was it a time for patients to share how their diagnosis had shaped their outlook on life, but it was an important moment for clinicians to sit back and listen to their stories. It is this powerful exchange, where the clinician becomes the learner and the patient becomes the teacher, that opens up a sacred space in medicine.