Recovering Transcendence in Medicine: Do We Need Mindfulness, Spirituality or Religion?
Tom Peteet, MD, Boston Medical Center
Christine Mitchell, MDiv, ScD (c), Harvard School of Public Health
Moderator: John Peteet, Harvard Medical School
There is a growing consensus that specialization, technology, protocol driven and managed care have contributed to a flattening of the doctor patient relationship and a loss of transcendence. While some proponents of a more person-centered approach to healthcare have advocated secular approaches such as narrative medicine, mindfulness, and behavioral strategies for reducing burnout among clinicians, others advocate greater attention to the contributions of religion and spirituality. This session examines the relationship among mindfulness, spirituality, and religion as potential resources for addressing the erosion of the doctor-patient relationship.
The first presenter will consider how mindfulness as a potential antidote makes space for considerations of value but is neutral regarding its content. Ironically, in an attempt to correlate its effects with neurobiological processes, mindfulness research is moving away from the reflective and existential aspects of the doctor-physician relationship it intended to defend. The result has been that while becoming widespread as a secular practice, mindfulness has shown limited ability to address concerns about the ethical/moral dimensions of clinical care. Nevertheless, a closer look at the literature on mindfulness-based practice as it relates to the well being of clinicians suggests ways to move beyond mindfulness as a behavioral technique toward recovery of lost content, including concepts such as transcendence.
Religious traditions speak directly to transcendence, but lack universal appeal. The second presenter will describe results of a recent survey of Massachusetts psychologists about their religion/spirituality (R/S) and its influence on their clinical practice. Consistent with other findings that a growing number of patients and clinicians are “spiritual but not religious”, 63% of the 50 respondents reported being moderately or very spiritual but only 28% reported that they were moderately or very religious. Almost all endorsed carrying over their philosophical/religious/spiritual beliefs over into their other dealings in life, and their responses to a hypothetical clinical scenario involving assisted suicide differed depending on their worldview. These findings suggest both that interest in spirituality among clinicians is growing and that the spiritual commitments which inform every clinician's practice are implicitly tethered to their view of the world. Whether or not a clinician’s spirituality is identified with a formal religious tradition, both inwardness (mindful awareness) and a valuing community - essential features in a functional definition of religion – seem important in sustaining their relationship to the world view that they inhabit, the ideals it implies and failures to realize them.
The third presenter will describe results of a recent interview survey of 33 Harvard medical students and faculty regarding the psychological, moral, and spiritual challenges students face in becoming professional caregivers. The interviews also explored the values of the medical community as observed by students in the training process, the role and impact of the hidden curriculum, and coping strategies for dealing with the challenges presented. The goal of the study is to rigorously develop an elective course that facilitates reflection on psychological, moral, and spiritual experiences in caring for the critically ill, and trains future professional caregivers in practices of self-care undergirding professionalism. Based on the qualitative data from interviews, the course will be developed to prepare physicians-in-training to integrate their spiritual tradition into their medical practice as well as to protect themselves from burnout and compassion fatigue by encouraging moral and spiritual transformation.
Presenters will encourage discussion by the audience of how much and where clinical education should incorporate principles of mindfulness, religion, and or spirituality, what form such a curriculum should take, and what data can inform its development.
Christine Mitchell, MDiv, ScD (c), Harvard School of Public Health
Moderator: John Peteet, Harvard Medical School
There is a growing consensus that specialization, technology, protocol driven and managed care have contributed to a flattening of the doctor patient relationship and a loss of transcendence. While some proponents of a more person-centered approach to healthcare have advocated secular approaches such as narrative medicine, mindfulness, and behavioral strategies for reducing burnout among clinicians, others advocate greater attention to the contributions of religion and spirituality. This session examines the relationship among mindfulness, spirituality, and religion as potential resources for addressing the erosion of the doctor-patient relationship.
The first presenter will consider how mindfulness as a potential antidote makes space for considerations of value but is neutral regarding its content. Ironically, in an attempt to correlate its effects with neurobiological processes, mindfulness research is moving away from the reflective and existential aspects of the doctor-physician relationship it intended to defend. The result has been that while becoming widespread as a secular practice, mindfulness has shown limited ability to address concerns about the ethical/moral dimensions of clinical care. Nevertheless, a closer look at the literature on mindfulness-based practice as it relates to the well being of clinicians suggests ways to move beyond mindfulness as a behavioral technique toward recovery of lost content, including concepts such as transcendence.
Religious traditions speak directly to transcendence, but lack universal appeal. The second presenter will describe results of a recent survey of Massachusetts psychologists about their religion/spirituality (R/S) and its influence on their clinical practice. Consistent with other findings that a growing number of patients and clinicians are “spiritual but not religious”, 63% of the 50 respondents reported being moderately or very spiritual but only 28% reported that they were moderately or very religious. Almost all endorsed carrying over their philosophical/religious/spiritual beliefs over into their other dealings in life, and their responses to a hypothetical clinical scenario involving assisted suicide differed depending on their worldview. These findings suggest both that interest in spirituality among clinicians is growing and that the spiritual commitments which inform every clinician's practice are implicitly tethered to their view of the world. Whether or not a clinician’s spirituality is identified with a formal religious tradition, both inwardness (mindful awareness) and a valuing community - essential features in a functional definition of religion – seem important in sustaining their relationship to the world view that they inhabit, the ideals it implies and failures to realize them.
The third presenter will describe results of a recent interview survey of 33 Harvard medical students and faculty regarding the psychological, moral, and spiritual challenges students face in becoming professional caregivers. The interviews also explored the values of the medical community as observed by students in the training process, the role and impact of the hidden curriculum, and coping strategies for dealing with the challenges presented. The goal of the study is to rigorously develop an elective course that facilitates reflection on psychological, moral, and spiritual experiences in caring for the critically ill, and trains future professional caregivers in practices of self-care undergirding professionalism. Based on the qualitative data from interviews, the course will be developed to prepare physicians-in-training to integrate their spiritual tradition into their medical practice as well as to protect themselves from burnout and compassion fatigue by encouraging moral and spiritual transformation.
Presenters will encourage discussion by the audience of how much and where clinical education should incorporate principles of mindfulness, religion, and or spirituality, what form such a curriculum should take, and what data can inform its development.