Lecture and Discussant Text

Anne Harrington
Uneasy Alliances: The "Faith Factor" in Medicine; the "Health Factor" in Religion
Thursday April 17 2003, 7:30 - 9:30 PM

Discussant: Francesca Bray, Department of Anthropology
Discussant: Gerardo Aldana, Chicano Studies
Discussant: Barbara Herr Harthorn, ISBER

All text below is in unrevised form exactly as presented. Do not cite without permission of author.

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Lecture Text

I want to begin by rehearsing with you a cultural lament of our time that I believe you all will recognize. Here is how it goes. Something is rotten in the great edifice of modern medicine. One of the great success stories of the modern era, medicine as we know it today has begun to reveal both its ethical and practical limitations. In spite of numerous life-saving and life-preserving discoveries -- vaccines, antibiotics, surgery -- modern medicine's capacity to conquer the great scourge diseases of the modern age has proven to far more limited than many had been expected: the so-called "war on cancer" was not won, the AIDS epidemic caught everyone by surprise, and chronic disorders, from hypertension to arthritis to back pain, plagued more people than ever.

At the same time, the very engine that had once been seen as the prime agent of medicine's success -- its reductionist understanding of disease and focus on high-tech, somatic interventions -- has had the effect of dehumanizing the experience of illness; turning human suffering into something equivalent to the break-down of an automobile; transforming the doctor-patient relationship into an alienating, objectifying, utilitarian exchange.

In 1990, the New York Times essayist and literary critic Anatole Broyard -- dying of prostate cancer --wrote a series of moving meditations on his experience with the world of high-tech health care that seemed to get to the heart of the matter. "[T]he real narrative of dying now is that you die in a machine," he began -- and the irony of course was that none of those machines were going to do Broyard much good, and both he and his doctors knew it. And yet they -- and, in a sense, he -- persisted in subjecting him to one high-tech test after another because in a medical culture where doctors are taught that "death is a scandal" (in the words of critic David Morris), there are no alternatives to the ritual of cure.[1] The result, though, was that Broyard as a person -- his experience of illness -- was rendered irrelevant and invisible. Musing on this fact, he wrote:

I wouldn't demand a lot of my doctor's time. I just wish he would brood upon my situation for perhaps five minutes, that he would give me his whole mind at least once, be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness, for each man is ill in his own way.... Just as he orders blood tests and bone scans of my body, I'd like my doctor to scan me, to grope for my spirit as well as my prostate. Without such recognition, I am nothing but my illness.

Now: usually the argument that medicine needs to find some way to make room for the soul as well as the body is made on ethical and theological grounds, and is made by people who take a more or less critical or combative stance to the reductive, data-driven methodology of scientific medicine: pastors, clergymen, bioethicists, and medical anthropologists. I want to talk to you today, however, about an emerging new voice that seems to want to stake a claim to the same ethical territory as that claimed by the clergymen and bioethicists, that can be heard insisting, like them, that modern medicine needs to make room for the life of the soul. But with one key difference. Instead of blaming modern medicine's spiritual crisis on its reductive, data-driven methodology, this new voice grounds its call for more soul in new kinds of data produced by those methods. Medicine, it says, needs to embrace the life of the soul, not just because it would be nice to do so (although it would be), or even because patients are unhappy and it is therefore professionally advisable (although it is) -- but because new data from clinical trials, epidemiology and the laboratory have shown us something we did not previously appreciate: that being spiritual, being religious, cultivating the soul is good medicine -- is good for your health.

I don't know how many of you here are familiar with this idea already, but just a little investigation makes clear that this data-driven argument for the health benefits of religion and spiritual practice is far from a marginal one in our society today. It has penetrated into the consciousness of the elite tiers of the medical academy --through data articles published in prominent research journals, editorials printed in places like the Lancet and the Archives of Internal Medicine, and interdisciplinary exchanges at research conferences that manage to attract star-studded casts of scientists. It has also found its way into the assumptive consciousness of many clinicians, not least through various widely popular continuing medical education courses on "spirituality and healing" that have sprung up around the country in the past four or five years -- Herb Benson's version at Harvard, that regularly attracted upwards of 1,000 people (and in which I twice participated) was the first and remains probably the best known of these. Finally, it has a growing place in popular consciousness -- is an idea that your mother or neighbor outside the academy is likely to be familiar with. If they are familiar with it, they might have learned about it from articles that appeared in media ranging from the New York Times to The Atlantic Monthly to Psychology Today to Readers' Digest. Or they might have learned about it from the small but growing trade book industry that now exists promoting the idea -- most written by clinical researchers or physicians who have also been active in developing the case in on the medical professional front: people like Herb Benson, Dale Matthews, Harold Koenig, Larry Dossey.

With the possible exception of Dossey, who probably has a stronger standing in New Age alternative culture than in the mainstream academy, all of the folk who in various ways are promoting the religion-health connection are respectable parts of the medical academy. They hold prestigious academic appointments and several run one or another kind of research center on religion and health at one or another top-tier university. Here are a few of them.

It's worth saying, as you glance over this list , that, while the universities affiliated with these centers seem happy enough to host them, most of the funds for running the work of these centers comes from external sources -- and, of these, the John Templeton Foundation is almost invariably first on the list. ^[2] In fact, one thing that also became clear to me, as I looked into this literature more carefully, is that, without Templeton, the message in the larger culture of religion as good medicine would not have achieved anything like its current level of visibility. Given that this lecture series has also been funded by Templeton and is enabling our own dialogue, I thought it might be worth being a bit curious about the powerful presence of Templeton in the story I am telling tonight , why this is such an important priority for it. And how it connects to Templeton's own broader vision of how science and religion could and should serve the cause of human experience. I'll be saying a little something about this issue a bit later in my remarks, but it could be interesting to pursue the matter further in the conversation we'll be having afterwards.

The Anatomy of the Argument

So what I have told you so far is that there is an argument out there that religion is good for your health -- and I have now spent some time trying to convince you that it is a culturally significant argument, one that has penetrated into all levels of medical culture: research, clinical practice, popular consciousness, patient consciousness. But what are the grounds for the argument? How does it work?

Well, in fact, when you look more closely, what you see is that we're dealing here, not with a single argument, but with a cluster of arguments -- there really are four -- that are intended to work symphonically with one another. Each has its own database, depends on its own kinds of methodologies, and has its own history of how to think about this matter. As best I can tell, the marshalling of these four claims into one symphonic claim -- religion is good for your health -- is a move that people only started making in the past five years or so.

Given this -- and given my sense that the resulting symphonic sound is betraying dissonance as much as harmony --it seemed as if it might be worth unpacking the overall argument back into its original components and looking briefly at each in turn.. Again, there are four, and this one is the first:

(1) Going to church is good for your health

The origins of this claim lie in epidemiological work that began in the late 1960s: a time of great medical interest specifically in rising incidence of heart disease in the United States, and what lifestyle and environmental factors might be contributing to it. Out of this work, social isolation emerged as one of the new big watchwords. Some work suggested, for example, that living in traditional close-knit communities acts as a protection against heart disease -- and, possibly, other common forms of morbidity and mortality. Other work suggested that more isolated people within a community tended to be sicker and to die earlier than those who were more socially embedded. In the context of the time -- dominated by all sorts of talk about the alienation of the American worker and the breakdown of traditional community and the family -- the interpretation seemed straightforward. Heart disease was on the rise because we were a nation literally of broken, lonely hearts.

Now: from the beginning, epidemiologists had included membership in a religious community as one independent variable among many that might act as a buffer against the medical consequences of social isolation. This work did not originally see itself as asking whether or not religion was good medicine. But then you see some epidemiological studies that look specifically at the relative importance of this variable among other kinds of sources of presumed social support (whether you're married, living alone, a member of a bowling league, etc.)-- and find it particularly high. What these studies start to say is that the more frequently you go to church, the less likely you are, especially in old age, to use hospital services, and to suffer from any number of health problems generally. Some even suggested that going to church could extend overall lifespan.

What might be the reason for this? Initially, the tendency still was to reduce church going to social support. Churches, people seemed to want to say, are good for your health because they provide really good community: they reduce stress, they look after their members, they tend to frown on unhealthy behaviors like excess alcohol and drugs, and -- in being publicly concerned about each other's health -- they might even tend to create a culture in which individuals seek medical assistance earlier than they otherwise might have.

Nevertheless, not everyone was satisfied with this understanding of why church going might be good for your health. In 1996, an Israeli epidemiologist named Jeremy Kark looked at mortality rates in a cluster of secular and a cluster of religious kibbutzim between 1970 and 1985, and found that mortality in the secular kibbutzim was twice that of mortality on the religious kibbutzim. The significance of this finding, he and his colleagues began to say, lay in the fact that, on all the scales used to measure social support, both kinds of kibbutzim delivered equally for their members. And yet there was this apparent big difference that remained between the apparent health of the folk who got social support in a religious context and those who got it in a secular context. ^.[3]

So, now people begin to say, maybe there is more to the health-giving properties of an active religious life than just social support. But if so, how could one conceive what these could be? And, more, how could one investigate what these could be using the tools of science and evidence-based medicine?

The answers we begin to see emerging takes us to the next two arguments you see in the religion and health movement:. These arguments are distinct, but they are connected by their shared interest in what has been called "intrinsic" religiosity (roughly, one's private, experience-based sense of the divine, sometimes also called "spirituality") as opposed to "extrinsic" religiosity (the degree to which one publicly participates in the structures of religious life).

Let me take each in turn.

(2) Meditation is good for your health

This claim has its origins in the 1960s popular American romance with meditative practices such as transcendental meditation -- a simple, mantra-based form of meditative practice -- that was brought over to the shores of the United States by such figures as the Maharishi of India . TM, as some of you may even remember, became wildly popular for some years -- a populist phenomenon with its share of celebrity advocates, including the Beatles, who left no doubt about its consciousness-enhancing effects on their creativity (the White Album is the music they produced when they were in India with the Maharishi)

This last point is an important one. In the 1960s, people weren't meditating to improve their health, but to enhance their consciousness. The emphasis started to change -- meditation began to be reconceptualized as a medical intervention -- only in the 1970s, with the work of people like the cardiologist Herbert Benson at Harvard. What Benson and those who followed in the direction he helped to lay out did is to link the interest in meditation with growing concern about a still rather-new conception of human ailing called "stress" (a term that only entered popular consciousness in the form we use it today in the late 1950s). , Against a background of evidence that stress -- a well-characterized physiological state that could be studied in animals -- played a significant role in a large number of diseases -- including (again) heart disease and high blood pressure -- people like Benson repackaged meditation as a fabulous stress-buster. This is nowhere more clearly seen in his effort to rename the practice the "relaxation response" -- conceptualized as the physiological opposite of the fight-or-flight, or stress response.

Slide shown here includes images, not just of Benson's work, but of the work of Jon Kabat-Zinn in Worcester, Massachusetts, who has also been very influential in promoting meditation as a stress-buster, but who worked, not with mantra-based forms of meditation that aim to focus attention but with a form of breath-based meditation widely practiced in Buddhism, called vipassana or mindfulness, that aims to expand and stabilize attention. He began to teach it to patients suffering from a range of chronic disorders -- some of you may have seen this work featured on the Bill Moyers special Healing and the Mind in 1993 -- and reported remarkable results. It appeared to help chronic patients live better with their disorders, and to have an independent salubrious effect on the body in its own right. One of the most recent claims he and scientists who have worked with him are making about this practice is that it directly enhances the functioning of the immune system.

While both Benson and Kabat-Zinn have brought practices into medicine that have origins in one or another Asian contemplative tradition, both of them in their different ways insist that you don't have to be Buddhist to meditate. You don't have to be a Buddhist to meditate. You don't even have to be religious. The practice does not need a religious context to make sense and to work. At the same time, if you are religious, and your religion happens not to be Buddhist, then you should know that there is almost certainly a meditative tradition in your own faith that you can turn to. In interviews, Benson has talked about how, when he first began spreading the word about meditation -- or what he was now calling the "relaxation response" -- he was "startled at the excitement among the religious pros" in the Christian community. They told him that, in introducing them to the relaxation response, he had reminded them of the power of such practices in their own tradition, that they had largely lost touch with. " 'This is why I came into church work in the first place,' said one, 'and I'd lost it'..."[4]

(3) Belief is a healing power.

So meditation is good for your health, and it doesn't matter what faith tradition you use to ground your practice in. But the religion and health movement doesn't stop there. It also wants to claim that belief or faith is good for your health -- and it doesn't matter what you believe. In the eyes of medicine, all beliefs in a higher power are equal -- assuming, that is, that they demonstrate equivalent capacities to marshall the body's endogenous healing abilities. You can even believe in the power of belief, or in the power of modern medicine itself -- in which case, though, medicine might call the results a placebo effect. As Benson -- who has shifted his own focus in recent years from the power of meditation to the power of belief -- has put it in his book Timeless Healing:

I describe "God" with a capital "G" in this book but nevertheless hope readers will understand that I am referring to all the deities of the Judeo-Christian, Buddhist, Muslim, and Hindu traditions, to gods and goddesses, as well as to all spirits worshipped and beloved by humans all over the world and throughout history. In my scientific observations, I have observed that no matter what name you give the Infinite Absolute you worship, no matter what theology you ascribe to, the results of believing in God are the same.[5]

How do we know that belief is a healing power? The research tradition here is deep and complex. In our own time, it includes ideas about the better odds faced by cancer patients with strong faith, a "fighting spirit": and a "positive attitude." It includes new interest in the physiological mechanisms that might explain how giving people fake pills -- placebos -- could have real effects on their health. But today's ideas rest on foundations that go back at least to the late 19^th-century, when modern medicine found itself caught out by -- needing to explain naturalistically -- the remarkable goings on in a little mountain village in France called Lourdes. People there were claiming all sorts of miraculous healing from bathing in the waters there, that was believed have been released from the earth in a grotto there on the express command of the Mother of God, the Virgin Mary. In the late 1850s, the story goes, Mary had appeared to a simple shepherdess named Bernadette and guided her to the presence of a previously unknown spring of water; miraculous healings began to be declared almost at once; by the 1860s, the Church had set up a medical board to manage a populist phenomenon that it feared could get out of control; and by the 1870s, the Church-appointed doctors had been joined at Lourdes by other, anti-religious and anti-clerical physicians who knew that God wasn't behind these miracles -- not any of them -- but were for that reason all the more impressed by the power of the human mind that they were forced to concede must be.

In the slide you see here, the doctor on the left is the famous neurologist Jean-Martin Charcot who became convinced that at least some of the cures at Lourdes were real and currently inexplicable within medicine -- and who wrote a paper, the last paper he wrote before he died, called "la foi qui guerit" -- the faith that heals, that he closed by quoting Shakespeare's Hamlet -- "there are more things in heaven and earth, Horatio, than are dreamt of in your philosophy."

But if the medical doctors at Lourdes saw the power of mind and the power of God as mutually exclusive explanation -- and, incidentally, both the anti-clerical and the Church-appointed doctors shared this view -- a growing movement during these same years in Protestant America took a different view. They began with a vision of the divine as an entity that is not external to the human mind and in some kind of relationship with it, but already manifest within the human mind. From this starting point, they said: we know that the human capacity for faith brings healing effects; so why not cultivate this capacity deliberately as both a practical and a spiritual practice -- a way of realizing the practical presence of God in one's own life . The result was a cultural phenomenon whose legacy still very much informs the world of thinking and practices around the idea of belief as a healing power today. It was a phenomenon that sometimes called itself "mind cure," sometimes "new thought," sometimes "Christian science" and sometimes "practical Christianity." William James called it "the religion of healthy-mindedness" and talked about it like this: "The blind have been made to see, the halt to walk; lifelong invalids have had their health restored. É One hears of the "Gospel of Relaxation," of the "Don't Worry Movement," of people who repeat to themselves, "Youth, health, vigor!" [6]

What have been some of the specific ways in which New Thought and mind cure have left legacies in our own time? You can probably guess some of them: Mary Baker Eddy's Christian Science Church;l Norman Vincent Peale and his message about the "power of positive thinking"; certain aspects of New Age philosophy -- and, not uninterestingly in light of what I was talking about earlier in this lecture -- at least part of the agenda of the John Templeton Foundation. It turns out that Sir John Templeton himself, whose fortune fuels the work of the Foundation, traces a quite explicit intellectual influence back to these movements, specifically as they were later institutionalized under such names at the Unity Church; and Templeton has promoted the Christianity of mind cure in the publication arm of its efforts.

The power of belief idea has also provided a legacy to broader science and religion dialogue in general: a new way of understanding why so many people are religious in the first place; why -- to put the matter in the way it is often put -- evolution has produced in us an incorrigibly religious animal. What we are increasingly beginning to hear now, from people like Benson and Andrew Newberg (author of Why God Won't Go Away), and others, is that the healing payoff of strong faith gave those endowed with a strong faith capacity a selective advantage over those who did not. We are religious animals, in other words -- "wired for God" -- because it's good for our health to be so.

(4) Prayer works.

So we've covered already a fair bit of ground: reviewed the logic and touched on the history behind the claims that going to church is good for our health, meditating and contemplative, prayerful activity is good for our health, and having a strong belief in a higher power is good for our health. But we're not quite done. There is one more claim that sits among the others -- though how far it is of an order like the others is a separate issue. This is what it says:

Prayer works. Not just the sense of social connection you get from praying in church; not just the special contemplative state you may experience when you pray; not just the strong faith you might have when you pray or know someone is praying for you. No, prayer itself changes people's health in ways that are independent of all of those other factors. And we know this, say the people who make this claim, because when someone else prays for the health of a sick person -- even if that sick person is not aware that he or she is being prayed for -- it has an effect, one that can be captured inside the modern research methods of clinical medicine.

Here, more specifically, is what people have said. When seriously ill patients are randomized into a "prayer group" and a "control group," at least three studies have suggested that the sick people who are prayed by for by others-- so-called "intercessory prayer" ---heal up faster or have fewer complications associated with their recovery than those who aren't. This happens even when they don't know that they are in the "active treatment" group, and even when they don't know they are being prayed for at all -- meaning that the results allegedly cannot be attributed to the placebo effect.

Like the other three claims I have briefly reviewed, there is a larger history to this one. It goes back to the rise of statistics, and more specifically to the rise of a vision of statistics as a powerful new tool in a position to resolve long-standing questions of a policy and social nature.[7] Thus, back in the 1870s, Darwin's cousin, Francis Galton proposed to use statistics to address a long-standing theological question: God's continuing active presence in the modern world, as assessed through the efficacy of intercessory prayer. Galton's idea was to look at the relative lifespan of various classes of English citizens -- paying particular attention to members of the British royal family, who he reasoned were the most "prayed-for" people in the kingdom. What he found, however, was that they were "literally the shortest-lived of all who have the advantage of affluence," even when deaths by accident or violence were excluded. At the same time, among the clergy, lawyers and physicians, the clergy --assumed to be more prayerful than the other two professions--actually turned out to be "the shortest lived of the three."[8]

For the increasingly confident naturalists of the time, it was all a good joke; for many of the clergy, however, it seemed rather unseemly --prayer, they insisted, was a private matter, unquantifiable, with an efficacy beyond the reach of mere statistics. In our own time, however, people have taken up the Galtonian strategy once again, and -- after a couple of further negative findings -- have recently have claimed to find new positive results.

The landmark case here is that of Randolph Byrd, who studied 393 patients admitted to the coronary care unit of the San Francisco General Hospital. The patients were randomly assigned into two groups, one of which would be prayed for and another which would not (though there was no attempt to stop family members and others from praying for the people in the control group, leading to all sorts of odd discussion about the effects of "background" prayer and comparative "prayer dosage"). In any case, te so-called intercessors or :"pray-ers" who were going to pray for half the patients were all self-identified "born again" Christians who claimed to pray daily and to go to church. They were now asked to pray daily for a speedy recovery of the patients with no complications. The results showed no difference in the speed of recovery between the two groups, but Byrd found that, on six out of 26 kinds of possible complications, the prayed for patients did better on a statistically significant leve; than the controls, and the controls didn't do better than the prayed for groups on any.[9]

Since then, there have been several attempts to replicate this study -- one of which in particular, William Harris' in 1999, has gotten a lot of attention. [10] There have also been a large number of virulent criticisms of the design and statistically-based inferences drawn from these studies. Currently, Herbert Benson's lab at Harvard is attempting a definitive replication of the Byrd study-- funded by (guess who) the Templeton Foundation. Apparently, Benson will report on his findings within a matter of months.

At this stage, however, what are we to make of all this? Well, this is no longer now just a matter of arguing for the utilitarian benefits of religious faith -- even if folk like Dale Matthews can insist in his speech to a class of graduating medical students that they had better get ready, because "the medicine of the future is going to be prayer and Prozac." But clearly, utilitarian concerns are only part of the story now -- and in a way that has set this final piece of the overall argument that religion is good for your health in an uneasy and undigested relationship to the other three claims. Proponents of the other three claims always are careful to leave open the option of God's reality, but the force of their arguments does not inherently depend on whether or not God really exists. Matters here are different. If prayer works -- works in a way that cannot be reduced to the placebo effect, social support, or stress-reduction -- then sciences has apparently proved the existence of God -- or at least some kind of divine energy[11] -- operating in the world. This is why you find the prayer studies being discussed, not just within religion and health circles, but as part of various discussions about the ways in which science is finding evidence for the existence of God. There it sits beside reviews of the anthropic principle from physics (the idea that the universe was deliberately constructed to support intelligent life), alleged fundamental problems with evolutionary theory and evidence for Creation, and presentations of the evidence for near-death and out-of-body experiences.[12]

There is another very important way in which this final claim within the religion and health movement differs from the other three. The other three tend, at least implicitly, to see themselves as theologically-neutral. There is something that stands above any and all specific faith traditions that is called "religion" or even "spirituality" and whose health effects can be discussed. But the tenor of discussion around the prayer studies is different. The fact that all the studies to date have tested the efficacy of Christian prayer has not been lost on at least some people. One Christian fundamentalist website devoted to posting evidence from science for the reality of the Judeo-Christian God has crowed: "No other religion has succeeded in scientifically demonstrating that prayer to their God has any efficacy in healing." They go on:

Obviously, science has demonstrated in three separate studies the efficacy of Christian prayer in medical studies. There is no "scientific" (non-spiritual) explanation for the cause of the medical effects demonstrated in these studies. The only logical, but not testable, explanation is that God exists and answers the prayers of Christians ÉThe Bible declares that Jesus Christ has power over life and death and sickness and is able to heal us, both physically and spiritually. He gave this power to His disciples and those who follow Him."

Better Health through Medicine: The Wrong Answer to the Right Question

So, where does this leave us? With, I hope, many questions. Some may be the sort of questions that scientists have asked about the specific arguments: how good is the evidence; how persuasive the interpretations? [13] Others may be the sort of questions that some theologians have asked: what is the relationship between, say, traditional understanding of, say, Christianity and the theologically-neutral, utilitarian vision of better health through religion. [14] Not to speak of the fact that, sitting more or less undigested beside that vision--and drawing on its data -- is a quite polemical strain of sectarian Christian fundamentalism?

I hope we may have the chance to talk about some of these questions -- maybe some of the commentators will. I am not going to pursue them here, though, because I want in the last minutes I have here to return to where I began this evening: with our wide-spread cultural lament about the spiritual crisis of modern medicine, our wide-spread desire for a medicine that has learned to pay more attention to soul, and the claim within the religion and health movement that they are in a position to help.

Let there be no mistake: the claim is very explicit. The authors of the recent (2002) Handbook of Religion and Health --a compendium review of more than 1,600 studies on the religion-health connection -- identify the timeliness of their work by noting that

Patients are caught - wishing to have their diseases diagnosed and treated competently with the latest technology, yet having social, psychological, and spiritual needs that are being ignored because of an increasingly streamlined health care system that overemphasizes the physical over the spiritual. ..Scientific medicine has been magnificently successful but is challenged to figure out how the ancient and venerable tradition of 'doctor as healer' fits in and how to connect practically at the bedside with the way most human beings deal psychologically with life-threatening disease, which is broadly spiritual/religious.[15]

So, now that we have some fuller sense of what kinds of arguments, historical commitments and stakes lie behind the religion and health movement, are we persuaded that it is in a position to help with the spiritual crisis of modern medicine? Can you use data from scientific medicine to challenge the ethical and existential limitations of scientific medicine?

And my conclusion is that the answer has to be "no". It must be "no," not because the religion and health movement is necessarily a bad thing, or because it does not offer us anything of value, but because this movement is actually about something different than it sometimes realizes itself. For what it is, I do believe that this is a movement worth taking seriously -- that its data (at least some of them) are in a position to contribute to richer, more contextualized understandings of human functioning in health and disease -- understandings that have more room for all of what we are; and that the various practical applications it has developed out of some its findings -- teaching pain patients simple meditation techniques, for example--can be beneficial.

But in the end, this is all still about more research and more therapy -- it is about putting prayer alongside Prozac, or meditation alongside antibiotics. And the reason this move -- not necessarily a bad thing in its own way -- makes the religion and health movement nevertheless an inadequate answer to the spiritual crisis of medicine is that this perceived crisis -- we know this from patients, from bioethicisits, from medical anthropologists, and from many clergy -- is less about a need for more therapy and more about a need for more communion, less about making well and more about making sense. Broyard didn't want his doctor to tell him he should pray because it might help his cancer, or that he should consider going to church for his health (even assuming -- as in fact was not the case -- that he was a religious man). What he wanted was for his doctor to stop trying to fix him and instead to spend a little time beholding him as he was -- listening to what was in his soul, listening to his efforts to make meaning of his experience.

Now advocates of the health benefits of religion, if one or more of them were here, would probably response that they of course know that the values of community and contemplation ago beyond their utilitarian values as adjunct therapies. But an argument like this fails to appreciate what Broyard -- speaking on behalf of himself and many many patients like him -- was trying to say. It is not simply the case that caring, prayer, witness-bearing and meditation remain valuable when they stop being therapeutic. They are actually most powerful when they function as moral antidotes to a form of medical practice that knows no register other than the therapeutic. What many people find so dehumanizing about the experience of being ill in a modern medical context is that they experience a medicine that judges all things according to a utilitarian calculus of health, and that appears willing to go to almost any length in the quest for some new, better, or more powerful therapy --whether in the realm of the body, the mind or the spirit.

If today so many of us are destined -- to return to the words of Anatole Broyard -- to "die in a machine," it is because in the end scientific medicine, and the larger "therapeutic culture" that has sustained it in our time, [16] has so little confidence in any values beyond the individual and the utilitarian. The religion and health movement is many things, but one thing it is, is an invitation for religion and spiritual life to serve those same values. The image that confronts us is of a future in which we all still die in a machine -- but with our passage now eased by meditative mantras and artfully-placed objects of religious significance. And what we surely want or would consider an adequate response to the spiritual crisis of medicine is something more than and different from that -- what exactly it would be, I will perhaps leave to our discussion time.

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Commentary: Francesca Bray

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