By Dr. Thomas Duffy

My quest or query on the subject of grace in a secular profession has its origins in the circumstances surrounding the care I offered to a patient near the end of his life. The patient was an elderly gentleman with far-advanced leukemia of five years’ duration, during which he had undergone multiple remissions and relapses of his disease. His final hospitalization proved the most harrowing and tortured experience for him as well as for his caregivers. After treatment with an aggressive chemotherapeutic regimen for his recurrent disease, he experienced worsening of his already debilitating physical condition. He developed a bacterial super-infection with Fusarium which had several devastating effects, including blindness and numerous painful ulcerations over his entire body. The recommendation to move from a curing to a caring stance was accepted by the  patient and his family. The decision – his decision – to withdraw therapy was considered appropriate in light of the advanced stage of his disease and the degree of his suffering.

What was unknown to me during this challenging period was a meta-text that was  occurring in parallel to my care of the patient. A hospital chaplain had befriended and counselled him beginning from the onset of his illness and subsequently provided me with an essay describing her experience ministering to him. Her essay describes her painful accompaniment of our patient in word and silent presence as he moved from “roaring against the dying of the light to an acceptance of his journey through the valley of the shadow of death.” She appeared to be empowered and energized from her encounter with the dying patient. In striking contrast, I had come through his illness with feelings of disappointment and defeat, of being bruised and saddened. I was forced to ask why I had come away exhausted and limp whereas the same experience was a source of apparent transcendence for the chaplain. Upon reflection, I entertained the thought that she had access to a resource that I lacked in the encounter.  Her accompaniment had graced the dying of a human being and she had in some way shared in this grace through her actions. Her role as a chaplain afforded her a strength which eluded me. I was left to ponder whether I could share in this resource.  Grace was a fuzzy concept for me. It was an entity that involved the presence of God and a belief in God. And if God is essential for grace where does that leave grace for a non-believer in a secular profession? Had I, in entering that profession, cut myself off from grace and the power it imparted? Is grace an option for non-believers? I couldn’t answer any of these questions until I corrected my woefully inadequate knowledge of grace. This was the initial query which the encounter stirred up and initiated a journey in search of possible sources of grace in the secular procession of medicine.

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By Tracy Balboni

In 2006, the same year I was completing my training in radiation oncology and embarking on a career of caring for patients with incurable cancers, I first read this quote from Dr.DanielSulmasy in The Rebirth of the Clinic: An Introduction to Spirituality in Health Care:

“Illness is a spiritual event.  It grasps persons by the soul as well as by the body and disturbs both. Illness ineluctably raises troubling questions of a transcendent nature-questions about meaning, value, and relationship. These questions are spiritual.”

At that particular time in 2006, Sulmasy’s words contrasted starkly with my experience as a trainee in scientific medicine. Medicine was largely blind to the reality that illness is a “spiritual event”. And yet, I knew viscerally in my nascent experience as a physician that Sulmasy’s words were correct.  In the clash between my training and the truth expressed so poignantly by Sulmasy, I discerned a calling to translate this reality into words that medicine could hear and understand — the language of empirical research.

And so I embarked upon an academic career dedicated to translating the spiritual realities of patients into the language of numbers and the format of scientific manuscripts. I also had my own questions to pose and answer. Do patients want for their physicians and other members of the medical team to recognize and attend to the spiritual aspects of their illness experience? If we do embrace the spiritual aspects of illness, how does this influence patients’ well-being and medical care decisions?

With the above questions in mind, I embarked on research within the Coping with Cancer studyunder the mentorship of Holly Prigerson, PhD, the study’s principal investigator, whose vision and creativity have been transformative to the understanding of psychosocial and spiritual factors in end-of-life care. The study involved interviews and observations of 343 patients with advanced, incurable cancers and their family caregivers.

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By Tyler VanderWeele

It’s said that to err is human and to forgive is divine, but forgiveness may be a health-promoting behavior as well. Though often considered to be a very personal behavior, often linked with ethics or religion, a recent meta-analysis of 54 interventional studies on forgiveness suggests that this act has major health benefits as well. [4]

Forgiveness is sometimes defined as the victim’s choice reduce negative thoughts, emotions, and behaviors and replace these with positive thoughts, emotions, and behaviors toward the offender.[1-3]  It should be noted that forgiveness is distinct from condoning, justifying, or sanctioning the behavior of the wrongdoer, and it is not appropriate in situations of ongoing, sustained violence or abuse.

One example of community forgiveness comes from a 2016 incident in which a young, intoxicated man vandalized a mosque in Fort Smith, Arkansas. He subsequently realized the cruelty of his impulsive act, apologizing to the mosque community and asking for their forgiveness, which they freely gave. [8]. The members of the mosque community did not justify or excuse his actions but they made clear that they forgave him for and did not want to ruin his life. One member of the mosque wrote on social media, “we forgave you from the first time you apologized, don’t let that mistake bring you down  […] we don’t hold grudges against anybody!” The mosque members even asked for a more lenient sentence for the offender; though the case was eventually treated as a felony courts. However, sustained by the forgiveness of the community he had wronged, the former vandal gained a deeper awareness of the effects of his actions on others and become determined to never again commit such a heinous act. [8] (more…)

By Michael J. Balboni

This is the second entry in a four-part series examining the social and historical forces that have led to the current divide between religion and medicine. Drawing on Peter Berger’s theory of plausibility structures (particular social processes that legitimize social beliefs and practices, giving them a matter-of-fact quality), this series examines key factors that lie behind the current state of spirituality in medicine. This post focuses on our cultural beliefs about physicians as scientists, and how the late nineteenth century alliance with science has transforming the meaning of the medical vocation.

Throughout the history of Western medicine, physicians viewed themselves as invested with a divine mission and purpose. In fact, according to sociologist Jonathan Imber, the initial ascendance of the medical profession during the middle of the Nineteenth century was due in part to the fact that physicians were allied with and morally commissioned by Protestant clergy. Imber suggests that Protestant clergy empowered the medical profession with a moral and spiritual vocation, resulting in a deeply held public trust of physicians.[1] A vivid depiction of this spiritual/medical vocation can be seen in Luke Fildes’ 1891 painting, The Doctor. In this painting, the physician leans pensively over the sickbed of an ill child. The tools of his trade are pushed to the side, as illness takes the upper hand, whereas a light shines on his thoughtful face and gentle expression. He is here not only to offer his medical skills, but also to shepherd the family through a difficult and painful experience. (more…)

Though psychiatric medications are widely used, their diverse effects upon all aspects of patients’ lives are still understudied. In her groundbreaking book Psychiatric Medication and Spirituality: An Unforeseen Relationship, Dr. Lynne Vanderpot focuses her attention on the positive and negative ways that psychiatric medications affect the spiritual and religious experiences of patients.

Alexandra Nichipor of the Initiative on Health, Religion, and Spirituality was able to ask Dr. Vanderpot some questions about her recent book. 

Alexandra Nichipor: One of the most interesting things about your book was the diversity of experiences among interviewees. What were some of the different ways that your interviewees described the impact of psychiatric medications on their spirituality? 

Lynne Vanderpot: It’s really true that the people I interviewed for my research shared a fair range of experiences. There’s an obvious reason for this—each participant had a subjective understanding of spirituality and what it meant to them, so perceptions of how psychiatric medication impacted spirituality were also therefore unique. Modern expressions of spirituality have shifted from their traditional location, and beliefs may come from a variety of religious and non-religious sources. It’s been said that no one has been able to articulate the hodge-podge spirituality that our culture has produced, and yet through research we know it is a significant, even crucial, aspect of recovery from mental illness for many patients.

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By Tyler VanderWeele

About a year ago I delivered an address at the US Air Force Chaplains Corps Summit on “Religious Communities, Health, and Well-Being.” I was asked to speak as a part of their “Faith Works” campaign that is intended to encourage, when appropriate, the airmen in their faith and to encourage greater freedom in talking about these matters, and to make clear the important role of chaplains in the Air Force and the Military. I talked about some of my own empirical research on how religious participation, and religious service attendance especially, has profound effects on improving health and well-being including the associations between religious service attendance and subsequent greater longevity, less depression, less suicide, less smoking, less substance abuse, better cancer and cardiovascular disease survival, less divorce, greater social support, greater meaning and purpose in life, greater life satisfaction, more charitable giving, more volunteering, and greater civic engagement.

Much of that address was just published a few days ago in the journal Military Medicine and is available here. I also talked about the implications of the research for policy, religious communities, medicine, media portrayals of religion, and individual decision-making. Due to journal space limitations, however, I was unable to include in the journal article my reflections on the mechanisms whereby religious participation seems to lead to health and well-being, though that too had been part of the address. (more…)

Professor Elizabeth Sepper is a scholar of religious liberty and health law at Washington University. In 2017, she participated in a conference organized by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. The conference was dedicated to considering complex legal and ethical issues that emerged in light of cases such as the 2014 Burwell vs. Hobby Lobby Supreme Court Case. Perspectives from attendees of the conference were gathered in the manuscript, Law, Religion, and Health in the United States, published by Cambridge University Press in summer of 2017.

Alexandra Nichipor of the Initiative on Health, Religion, and Spirituality was able to ask Professor Sepper some questions about her recent book.

Alexandra Nichipor: What made you decide to edit a volume around the topic of law, religion, and health?

Elizabeth Sepper: Law, religion, and health were in the air when we brought together the contributors to this volume. The Supreme Court had recently decided the landmark case of Burwell v. Hobby Lobby Stores, Inc., recognizing a for-profit corporation’s right to exercise religion and granting it an accommodation from the Affordable Care Act’s mandate to cover contraceptives in employee insurance plans. Related litigation against the contraceptive mandate was ongoing and had brought to the fore central, unresolved issues in law and religion doctrine that affect health.

At the same time, scientific advances increasingly were challenging religious doctrine. Advances in assisted reproductive technology and life-saving procedures muddy moral and legal questions about the beginning and end of human life. Evolving understanding of human psychology likewise led medical professionals to reject, for example, sexual orientation conversion therapy over objection from some religious believers. (more…)

By Michael Balboni

This is the first in a four-part series examining the social and historical forces that have led to the current divide between religion and medicine. Drawing on Peter Berger’s theory of plausibility structures (particular social processes that legitimize social beliefs and practices, giving them a matter-of-fact quality), this series will examine the driving factors behind the current state of spirituality in medicine. This post centers on the evolution of the hospital from the medieval period to the modern day, and how religion came to be of lessened importance in this setting.

Many modern American hospitals (especially in wealthy areas) are palatial and imposing, home to a wide variety of medical specialists and technologies. It can be intimidating to step into the imposing marble entryway of Dana-Farber’s Yawkey building or the labyrinth of Brigham and Women’s Hospital, the hospitals where I work, especially when one is facing a potentially devastating diagnosis. Patients of faith may also notice that for all their technological marvels, modern hospitals offer little by way of spiritual support to help them navigate their experience of illness.

This wasn’t always the case. During the medieval period, hospitals were primarily affiliated with religious organizations, who sought to ensure the comfort of patients and support them as they entered into right relationship with God in their last days of life.
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