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The healing arts and religion have experienced ambivalent and, at times, conflicting relationships. The ancient Greeks were aware that the whole/"well" person was a balance of different "temperaments" and was simultaneously influenced by several internal and external sources—ecology, lifestyle (including diet), drugs and herbs, and the body's internal fluids—"the four humors." The individual was in optimal health when these humors were in balance. The Christian world also adopted Greek medicine. More spiritually, however, Jesus and the New Testament authors saw physical and spiritual wellness as so intertwined that, for optimal healthiness, individuals had to have right intentions and relations toward both God and their fellows ("neighbors"). Although bodily ills might come, right intentions and relations could produce divinely given "healing"—alleviation of disease, forgiveness for cleansing of the soul, and sometimes miraculous cures of body and mind. Communitywide disease, however, was often viewed punitively, with clergy eventually leading liturgies for alleviation. Much later and at different times, an "angelic connection," whereby selected clergy practiced both pastoral and medical arts in tandem, emerged and was viewed as positive.

Body-Mind/Soul Split

Through the centuries, medicine became professionalized and secularized, especially during the period from the seventeenth to nineteenth centuries. As Western Christendom divided into warring factions and monopolies during the Reformation and its aftermath, medicine went its way, developing separate biomechanical insights and specific technologies in various European regions to form the foundations of "modern scientific medicine." The final shakedown in the last half of the nineteenth century involved the discovery of aseptic technique, germ theory and "magic bullets," anesthesia, X rays, modern surgery, and recognition of the futility of sectarian and cultlike medical wars, which led to government recognition and regulation, medical monopoly, and the rise of hospital-based clinical training.

Lying behind all of these, however, was a landmark dictum pronounced in the mid-seventeenth century by the French philosopher-mathematician-physician René Descartes to the effect that "the body is a machine" and should be investigated solely by natural science methods without attention to mind and soul. Some allege that with this dictum, medicine, now unobstructed, could dissect the "body" while the church could keep the "soul." Perhaps in the short run, this "deal" was positive for freer medical investigation of the body. In the long view, however, this split of body from mind/soul tended to institutionalize mind-body dualism, to ignore the holistic interactions of body-in-environment, and to be too reductionist in explaining the symbolic-cultural in terms solely of biomechanical origins (genes and brain functions). In short, body, mind, (social) role, and soul were no longer seen as mutually interacting and influencing each other. This body-mind split became woven into the warp and woof of modern medicine.

Biomedicine Not the Whole Truth

While biomedicine continued to advance as the final paradigm for medical truth, voices arose to point to its incompleteness and inability to interpret all of the human person. In the nineteenth century, Freud, Jung, and the psychoanalysts began to observe the recurring connections between mind and body in the unconscious, to found the subprofession of psychiatry, and to write of "psychosomatic" medicine. Selye in the mid-twentieth century wrote of "stress" and the ways persons were pushed and pulled from within and without. Challenges to "mainstream" medicine also came from "alternative" forms from the developing world and from Asia and the Far East. Cartesian or mainstream medicine could no longer remain just "medicine" or even "allopathic medicine" but increasingly came to be referred to as biomedicine , mainly dominant but actually only one paradigm of medicine.

Public health technologies, improved sanitation, "miracle drugs," immunizations, and disease control vastly reduced the toll of mortality at the turn of the nineteenth century and beginning of the twentieth. All this resulted in a vast reduction of mortality from contagious and infant diseases. The result was that human populations began to age, and the focus of medicine began to shift from acute to chronic conditions (e.g., alcoholism, diabetes, arthritis, lung cancer). Today, many of these ills are termed lifestyle or civilization diseases, the alleviations or preventions of which more and more have to be put into the hands of the sick persons themselves. This means that the victims' social outlooks, intentions, support networks, peer relations, and personal philosophies—all psychosocial factors—become crucial to living with or slowing the progress of such conditions.

In the 1970s, George Engel came up with the proposal for a new, more holistic medical paradigm he termed biopsychosocial medicine, implying that the reigning and existing paradigm of biomedicine needed to be complemented by an alternate paradigm known as psychosocial medicine. Neither paradigm would replace the other, but the psychosocial, while accepting biomechanical foundations in the body, would see the person-in-body as embedded in varying social group situations, life histories, and symbolic-cultural environments including the individual's spiritual identity.

Rhetorical Shift from "Disease" to Health and "Wellness"

Aaron Antonovsky has perhaps done the most to couple expansion of the biomedical paradigm into a biopsychosocial one with a whole new rhetoric for the health care enterprise. He says the concern must be not with "disease care" but with "ease care" or wellness, with salutogenesis or health origination. Antonovsky proposes a type of open-systems notion of health. He emphasizes immunology and the whole person's natural defenses against threats to health both from within and from the physical and social environments. The study of the mind/brain's ability to enhance or suppress one's immunity to disease (psychoneuroimmunology) became a new research frontier. In Antonovsky's system of health, major psychosocial factors—generalized resistance resources—intervene between persons and their stressors and assist persons in coping. Included in these resources is the person's "sense of coherence" (SOC). One's SOC includes one's meaning or value system, "philosophy of life," personal theodicy, and concept of religious faith. The SOC provides an interpretive basis for comprehending the near and ultimate meanings of stressful situations. Wellness does not mean attaining "perfect health" but accommodating to a particular point on a continuum between perfect unhealth and perfect health. Further, many of life's stresses need to be viewed positively (eustress) as well as negatively (distress). Unfortunately, there is mounting evidence that modern psychiatric literature seldom deals with religious variables as it seeks to probe what holds people together or pulls them apart. Even much less is biomedicine concerned with a person's biopsychosocial "coherence."

Placebo Effect:
A Window into Biomedicine?

The placebo effect (PE) is a phenomenon that modern medicine, from the mid-twentieth century onward, has attempted to deal with as "interference" with the allegedly positive medical applications of its drugs, procedures, and manipulations. The PE refers to the increments of healing that result naturally and apart from any specific, medical treatments. That is, some of the remissions of disease appear to result from trust by the patient in the authority of the caregiver and his or her ministrations on behalf of the patient. Biomedically, then, physicians should feel that medicine has failed if the patient gets well not from the physician's ministrations but because of trust and a will to live (or, conversely, gets worse, despite medicine's ministrations, because of lack of trust or a will to die). The PE is a bit of "secret" medical knowledge. Probably most caregivers are fairly aware of the bonus effects that PE-related acts of kindness, pleasantness, and truthfulness produce that caregivers can direct to anxious patients. In fact, survey evidence shows that up to half of the favorable outcomes in health care are believed by caregivers to result from these very PEs. Thus caregivers are already practicing biopsychosocial medicine, although the literature does not officially recognize this.

Religious Faith as Psychosocial?

Most theologies frown on advocating "faith healings" as a substitute for professional medicine. Yet scientific evidence is mounting that religious affiliation, practice, and related lifestyles are conducive to greater longevity, reduced disease, better health, and greater life satisfaction. The Protestant reformers concluded that medical "miracles" ceased with the apostolic age. They feared that the promise of "miracle" cures would compromise the idea of genuine "faith" and smack of magic, whereby a medical outcome of "no cure" would be deemed to be due to no, little, or weak faith. Contemporary hospital chaplains have to be careful in this area and so are personally inclined to follow a "two-track" approach, advocating both modern medicine (including PEs) but also religious faith, prayer, and sacraments promising divine "healing" but not necessarily physical "curing" (along with a secret prayer wish for a "miracle" or two).

There is also evidence that contemporary hospital caregivers see religious support and ministering as special, even unique, and not just as an extension of the "psychosocial" (whole-person interaction, social support, doctor-patient equality, mind-over-body). Caregivers may be ambivalent about the healing power of faith, but they do not seem to wish to reduce it to merely human, natural forces either. A recent survey of caregivers in three suburban American hospitals indicates that almost three-fourths prefer a Judaic-Christian, religio-philosophical view that holds that "God suffers with us" and works through human healing agents but does not necessarily promise miracle cures. The remaining caregiver segments embrace humanistic, "New Age," or miraculous "faith healing" views.

The Park Ridge Center is a research and consulting institute in Chicago, founded by Martin Marty and others, to study the relations between health, faith, and ethics. It once produced a journal and a newsletter and sponsored a series of outstanding publications, some of which have dealt with the historical relations of religion and health, such as Numbers and Amundsen, Caring and Curing (Macmillan 1986). Other volumes have featured various denominations' and various world religions' individual approaches to health and medicine.

—Ross P. Scherer

References

A. Antonovsky, Health, Stress, and Coping (San Francisco: Jossey-Bass, 1979)

A. Antonovsky, Unraveling the Mystery of Health (San Francisco: Jossey-Bass, 1987)

G. Engel, "The Need for a New Medical Model," Science 196(1977):129-136

L. Foss, "The Challenge of Biomedicine," Journal of Medicine and Philosophy 14(1989):165-191

D. Goleman and J. Guerin (eds.), Mind-Body Medicine (Yonkers, N.Y.: Consumer Reports Books, 1993)

M. T. Kelsey, Psychology, Medicine, and Christian Healing , 2nd ed. (San Francisco: Harper, 1988)

D. B. Larson and S. S. Larson, "Religious Commitment and Health, Valuing the Relationship," Second Opinion 17(1991):27-40

R. P. Scherer, "Hospital Caregivers' Own Religion in Relation to Their Perceptions of Psychosocial Emphases in Health and Healing," Review of Religious Research 37(1996):302-324

H. Selye, The Stress of Life (New York: McGraw-Hill, 1956)

J. A. Turner et al., "The Importance of Placebo Effects in Pain Treatment and Research," Journal of the American Medical Association 271(1994):1609-1614.

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