The Soul of Medicine: Spiritual Perspectives and Clinical Practice

11. A Secular Perspective

CHAPTER ELEVEN A Secular Perspective David C. Ring, M.D., Ph.D. For many of us, the scientific method (hypothesis formation, objective observation , and reproducible experiments) is the most constructive and fruitful way to address the human experience, particularly health and wellness. The spiritual aspects of illness can be considered equivalent to the psychological, sociological and behavioral aspects of medicine, all of which can be accounted for by using the scientific method. In this chapter I take the liberty of referring to spiritual aspects of health and illness in this way. The medical facts established by scientific experimentation are not typically disputed among various faiths and traditions. The realm of spirituality in medicine begins at the limits of science, at least when operating in the biomedical model of illness. The “art of medicine” may include both the necessary speculation at the limits of science as well as the differences between the biomedical and biopsychosocial aspects of illness. The spiritual aspects of medicine are what we do as individuals and communities at the limits of modern biomedical science to understand the difference between disease and illness—that is, between impairment (the objective pathophysiology) and disability (the impact on daily function and quality of life). A Secular Perspective 189 Insights about Life and Healing Psychology Psychology carries an undeserved stigma. Simply reading the word is likely to engender thoughts of flaws, weaknesses, and shame. We are often reluctant to admit that we are seeing a psychologist. We often fear or resent that a doctor might tell us that a physical complaint is “all in our heads.” Our society operates largely within a biomedical model of illness, according to which the solution to illness is finding and fixing the disease or pathophysiology . Because we are prone to all-or-none thinking, any discussion of the psychological aspects of illness seems to threaten our desired cure and we can quickly lose hope. For me, however, psychology greatly increases hope. Psychology is the science of the human mind—how it works at its intelligent , rational, pattern-forming best. Of course, understanding the healthy workings of the mind can illuminate cognitive and behavioral processes that are dysfunctional as well, but the root of psychology, contrary to common conceptions, is positive. When you stare at a two-dimensional drawing of a cube, your mind automatically tries to resolve the image into a three-dimensional object. As a result, your mind vacillates between seeing one or the other square as the front face of the cube. This action occurs at the level of neurons. It is hard-wired and cannot be changed. There is a basic ambiguity to our perceptions based on our anatomical structure. If you look at a picture of two rectangles of the same size, with legs of a table drawn in with different orientations, your mind takes this additional information and interprets the rectangles as being of different sizes. This may be partly hard-wired and partly conditioned. In any case, the “extra information” contributes to the basic ambiguity of your perception. As Tom Gilovich (1991) points out, humans tend to see patterns in everything , from the “hot hand” in basketball to bombing patterns in London during World War II. Our strength is to rationalize or make sense of things and see the patterns. This is what helps us to recognize faces better than a computer can, but it is also what makes us easy targets for charlatans. An easy, passive, external path to wellness holds great appeal, and we are tempted by anything that offers a convincing rationale. Investment in belief and meaning is a powerful healer, as seen in the placebo effect. This, as well as the tendency of things to regress to the mean and 190 Major Traditions and Medicine the self-limiting course of many symptoms and diseases, are reasons why a treatment may “work” aside from any direct effect on pathophysiology. This has been most clearly demonstrated in clinical trials involving sham surgery, such as the trial that compared sham surgery, simple washout, and debridement during arthroscopic treatment of knee arthritis and found no differences in outcome between the three groups. An appreciation for the workings of the human mind improves our understanding of the differences between disease and illness and between impairment and disability (Vranceanu, Barsky, and Ring 2009). Illness and illness behavior are complex products of biological, psychological, sociological, and behavioral factors. Each of the...