BOSTON — Every morning, Ursula Tisdall makes her rounds at the Colombia Metro West Medical Center in Framingham, Mass., stopping to care for each patient on her list. But Ms. Tisdall is not a doctor, a nurse, or a medical technician. She's the hospital chaplain, a full-time employee of Metro West whose job is to meet patients' growing demand for spiritual comfort.
Traditionally, chaplains such as Tisdall have worked alone, providing their pastoral services separately from the medical treatment doctors and nurses supply. But in the past few years, the emergence of conclusive clinical evidence that spirituality and religion play an effective role in the healing process has changed the playing field for Tisdall and others like her.
"For some [doctors], the change is as simple as listening, letting the patients tell them their concerns and needs," rather than just deciding with clinical detachment what treatment is needed, says Tisdall. "They are learning that listening to [patients'] spiritual vital signs may be just as important as their bodily ones."
A recent survey, released yesterday at Harvard Medical School's fourth conference on spirituality and healing in medicine, seems to bear out Tisdall's perceptions. In a poll of professionals working for health maintenance organizations, 94 percent said they believe personal prayer, meditation, or other spiritual and religious practices "can speed or help the medical treatment of people who are ill." Moreover, three-quarters said they "believe that God, or some higher power, sometimes intervenes to improve the medical condition of people who have serious illnesses."
Spirituality in the emergency room
A few doctors have even begun to adopt some of the spiritual approaches traditionally used by chaplains or visiting clergy. Peter Newsom, an emergency-room physician at the Northwestern University Medical Center in Chicago, says even in the pressurized environment of the emergency room he can often talk to patients about their spiritual lives, asking where they go to church and who their rabbi or priest or minister might be.
"That immediately gives us common ground," Dr. Newsom says. "From there we can even talk Scripture or about passages from the Gospel that have given the patient hope in the past, or have given me hope. It's a sharing both ways, which often brings healing images and leads to inspiration."
Newsom says even patients who have no religious faith can be approached. "If you talk to them in a nonreligious, nonthreatening, nondogmatic way, there are often opportunities to talk about spiritual ideas and concepts, asking them what gives them hope and helping them lay aside irrational fear," he says.
Chaplain Tisdall agrees that "prayer" should be whatever puts a patient at ease. Sometimes that might be the 23rd Psalm or the Lord's Prayer, she says, but her experience is that patients respond less to ritual and rote recitation. More effective, she says is "a willingness to witness God's dignity in them" and a gentle listening and responding to their needs and fears.
Still, many medical professionals believe that spirituality should have no place in the treatment of disease. "There is a small but vocal minority who believe this is a wretched development - that this is going in reverse, forcing medicine back into bed with religion," says Larry Dossey, a physician and executive editor of Alternative Therapies in Health and Medicine. But, he adds, there is far too much clinical evidence for "this to be reversed now."
Most doctors believe any correlation between prayer and healing is simply the result of what they call "the relaxation response" - that calm thought triggers a reduction in stress, creating an emotional and physical tranquillity that allows greater effectiveness of medical treatment. They say there is no reliable evidence that the spiritual element can heal consistently on its own.
"It's not a question of prayer without Prozac," says Dale Matthews of the Georgetown University School of Medicine in Washington, "but of prayer and Prozac."
But some health-care professionals and religious leaders believe that a substantial body of reliable documentation proves the effectiveness of using spiritual treatment exclusively - and that spiritual techniques will ultimately be proven more effective at healing than traditional medical treatments.
THAT is exactly how Giulia Plum of Fairfield, Conn., sees it. A clinical psychotherapist, she found that her medical training allowed her to do some good for her patients, but she worried that her treatments did not provide permanent healing for many of them. She found, too, that her work no longer provided her with a sense of satisfaction or completeness. As a result, Ms. Plum began a search for something better.
"My entire background was in the medical world, so I started there first," she says. "But as my search progressed, it became clearer and clearer to me that I needed to abandon the psychological and physical treatment of my patients and rely on spiritual means alone," says Plum, a participant at this week's spirituality and healing conference who now treats patients exclusively through prayer as taught in Christian Science.
This distinction may be where the disintegrating battle lines between spirituality and medicine will reappear and be redrawn.
"There is still plenty of room for the medical and religious communities to continue to integrate, finding further common ground," says Dr. Dossey. But if spiritual healing should be found to be more effective on its own, totally outside the limits of the "material paradigm," cracks will begin to appear in the alliance, he says. "That's where the real conflict will be."