Prayer in the ICU
By Stephen W. Crawford, MD
"Faith in the gods or in the saints cures one, hypnotic suggestion another, faith in a plain common doctor a third."William Osler, MD
Care of patients in the intensive care units is a demanding profession that increasingly is dependent on technology. We rely on electrocardiography, pulse oximetry, pressure transducers, ultrasonography, radiology, pharmacology, and numerous surgical techniques, among other systems, to diagnose, monitor, and treat our patients. However, these patients come to us with the gamut of emotions, passions, prejudices, beliefs, and values found in society. For many of them, the technology we take for granted is mysterious, mystical, and frightening. While we possess great faith in the ability of the technology to help us diagnose, palliate, and cure, patients often place their faith in God, religion, and prayer. This essay examines the basis for supporting the spiritual beliefs and needs of our patients, and the relevance of prayer in the ICU.
We may have the expertise to manipulate the impressive array of technologies in our hospitals, but I suspect we are not all that far removed from the beliefs of our patients. Who of us have not questioned whether there was a "higher power" that controlled the outcomes of our patients in the ICU, or has not told a patient or family to "Go ahead and pray: it can’t hurt"? Who has not at least muttered, "We’ve done all we can; it’s up to God, now," and who of us has not been amazed by a miraculous recovery we would not have predicted?
Attitudes of Physicians about Religion in Patient Care
Empirical evidence suggests that religion remains very strong at all levels of society. However, training in medicine, and in critical care in particular, does not appear to foster an appreciation of the spiritual aspects of healing. Many patients desire more frequent and more in-depth discussions about religious issues with their physicians, but physicians generally do not discuss these issues with their patients.
King and Bushwick found that physicians rarely question patients about their religious beliefs.1 This lack of inquiry may be contrary to patients’ wishes and detrimental to patient care. They interviewed 203 family practice adult inpatients at two hospitals regarding their views on the relationship between religion and health. Many patients expressed positive attitudes toward physician involvement in spiritual issues. Seventy-seven percent said physicians should consider patients’ spiritual needs, 37% wanted their physicians to discuss religious beliefs with them more frequently, and 48% wanted their physicians to pray with them. However, 68% said their physician had never discussed religious beliefs with them.
Goldfarb examined the attitudes of medical students and patients toward religion and spirituality in the recovery process from substance abuse and general psychiatric disorders.2 Similar to the findings of King and Bushwick, cited above, this study found that the medical students responsible for treating substance abuse were significantly less religiously and spirituality oriented than the patients they treated, and that the students did not indicate that spirituality was an important component in the care of these patients.
Table 1
Demonstrated "effects" of prayer
1. lower blood pressure
2. better mental health
3. improved recovery from surgery
4. improvement in psychiatric symptoms
5. improved hospital course in coronary care unit
6. reduced electromyographic activity
Relationship between Spirituality and Health Status
Spirituality may play a role in maintaining health and in recovery from illness (See above Table). Studies have found that people who regularly attend religious services have lower blood pressure, better mental health, and better recovery from coronary artery bypass surgery.3-5 A controlled study in 1957 demonstrated effects of non-traditional, "spiritual" interventions. Parker showed that a program of regularly scheduled prayer, in contrast to random prayer, was as effective as individual psychotherapy in treating psychiatric problems.6
The most significant and intriguing study of prayer came from cardiologist Randolph Byrd in 1988.7 He randomized 393 patients admitted to the coronary care unit at San Francisco General Hospital to a protocol that was prospective and blinded to all physicians and patients. A prayer group (192 patients) was prayed for daily by Christian followers outside of the hospital. The control group (201 patients) received no intercessory prayer as part of the study.
There were no significant differences in age, duration of CCU or hospital stays, or primary cardiac or non-cardiac diagnoses. Surprisingly, the prayer group did statistically better by several criteria. The prayer group had fewer episodes of congestive heart failure (8% vs 20%), cardiopulmonary arrest (3% vs 14%), pneumonia (3% vs 13%), antibiotics (3% vs 17%), and intubation and ventilation (0% vs 12%) (P < 0.03, each). In addition, when the hospital course was scored as "Good" (prayer group = 85%, controls = 73%), "Intermediate" (prayer group = 1%, controls = 5%), or "Bad" (prayer group = 14%, controls = 22%), the prayer group again did statistically better than the control groups (P < 0.01). Byrd attributed the differences in outcomes to the act of a Jude-Christian God.
Physiologic Effects of "Non-Contact Therapeutic Touch"
The effects of prayer and other non-conventional healing modalities may have beneficial origins in realms other than "God." Wirth has recently examined the effect of non-contact therapeutic touch (NCTT) in isolation and in combination with holistic healing techniques, and intercessory prayer on the healing rate of full thickness human dermal wounds using a randomized, double-blind, within subject, crossover design.8 The treatment group was compared to a group treated by "sham" practitioners. The protocol incorporated an integral biofeedback, guided imagery, and visualization/relaxation component in order to assess the influence of psycho-physiological factors on the healing process. The NCTT method is a non-religiously-based technique that is considered to be mediated by an energy exchange between the practitioner and subject. The practitioner positions his/her hands 2-6 inches from the subject to consciously attune, redirect, and balance the energy fields in areas of blockage or tension.
In this complicated, cross-over designed study, the control ("sham") group displayed more rapid wound healingopposite to the results expected by the investigators. They postulated that there may have been a "carry-over" effect of prior exposure to the NCTT among the control group. In a follow-up study, Wirth and colleagues demonstrated delayed autonomic nervous system changes and electomyographic changes associated with the NCTT and holistic healing techniques.9 Their findings support physiologic effects of these "healing" techniques. These authors do not claim a religious connection or deity is necessary or responsible for the effects.
Possible Explanations for the Effects of Prayer on Health
If we accept that there are effects of prayer and other "non-touch" healing techniques, how can we account for them? Conventional views have considered beliefs in healing prayer to be incompatible with rational modern thought, predicting their demise and explaining their persistence in terms of non-rational thinking, "special logics," and psychological compartmentalization. However, attention to the actual beliefs of individuals often reveals them to be rationally ordered and empirically founded.10 Further, strong religious beliefs do not usually involve disbelief of medical knowledge.
A theoretical model that outlines various possible explanations for the healing effects of prayer include mechanisms that are defined on the basis of whether healing has naturalistic or supernatural origins and whether it operates locally or nonlocally.11 Most of the currently proposed hypotheses for understanding "absent" healing and other related phenomena (such as subtle energy, psi, consciousness, morphic fields, and extended mind) are probably no less naturalistic than the Newtonian, mechanistic forces of medicine. These nonlocal effects can be conceived of as naturalisticthat is, they are explained by physical laws that may be unbelievable or unfamiliar to most physicians but that are nonetheless becoming recognized as operant laws of the natural universe.
The precise mechanisms by which many "natural" medical pharmaceuticals produce beneficial effects remain unknown. The effects are accepted as real and based in physical sciences. The concept of the supernatural, however, is something altogether different, and is, by definition, outside of or beyond nature. The supernatural explanation may require a transcendent God who heals through means that transcend the laws of the created universe, and that are inherently inaccessible to and unknowable by science. Such an explanation for the effects of prayer merits consideration and, despite its unprovability by medical science, should not be dismissed out of hand.
Clinical Importance of Prayer and Spirituality in the ICU
Regardless of whether we believe in the beneficial effects of prayer in healing, care givers in the intensive care unit have an obligation to honor the beliefs of patients in prayer. Medicine and religion share a basic respect for persons. Many of our patients have religious beliefs. The nature of the physician-patient relationship underlies the professional’s obligation to respect each person.12
As a matter of pragmatism, religion and prayer serve important functions for the sick or dying patient,13 as summarized in Table 2. First, religion provides a theoretical backdrop in which to make sense of illness and mortality by understanding them as punishment, education, purification, sacrifice, or mystery, and it does so without denying the reality of these experiences. Second, it provides practical resources for coping with sickness, suffering, and mortality such as prayer, social support, and ritual actions directed at forgiveness, transcendence, and healing. And finally, it gives hope in the face of certain death.
Table 2
Functions of religion in illness
1. Provides a theoretical backdrop in which to make sense of illness and mortality by understanding them as punishment, education, purification, sacrifice, or mystery.
2. Provides practical resources for coping with sickness, suffering, and mortality.
3. Gives hope in the face of certain death.
We are well aware of the psychological benefits of religion and prayer. I have reviewed some of the data that support a physiological clinical benefit, as well. Beliefs in spiritual forces and religion, and the desire to use prayer in healing, is not counter to the goals of traditional medicine. These patient-centered beliefs and acts are complementary with our mission in the ICU. We may not understand the origins and mechanisms of the effects of religion and prayer, but to deny them does our profession and our patients a disservice.
"Nothing in life is more wonderful than faiththe one great moving force which we can neither weigh in the balance nor test in the crucible."William Osler, MD
References
1. King DE, Bushwick B. J Fam Pract 1994;39:349-352.
2. Goldfarb LM, et al. Am J Drug Alcohol Abuse 1996;22: 549-561.
3. Graham TW, et al. Behav Med 1978;1:37-43.
4. Wilson WP. Dis Nerv Syst 1972;33:382-386.
5. McSherry E. Care Giver 1987;4:1-13.
6. Parker R. Prayer Can Change Your Life. Englewood Cliffs, NJ, Prentice-Hall, 1957.
7. Byrd RC. Southern Med J 1988;81:826-829.
8. Wirth DP, Barrett MJ. Internat J Psychosomatics 1994;41:61-67.
9. Wirth DP, Cram JR. Internat J Psychosomatics 1994; 41:68-75.
10. Hufford DJ. J Med Philosophy 1993;18:175-194.
11. Levin JS. Altern Therap Health Med 1996;2:66-73.
12. Thomasma DC. Hosp Progress 1979;60:54-57,90.
13. Sevensky RL. Southern Med J 1981;74:745-750.
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