Spirituality and medicine

Nothing in life is more wonderful than faith-the one great moving force which we can neither weigh in the balance nor test in the crucible. Sir William Osler (1470AD) Medical science is the natural expression of human kindness and the human desire to save the dying and heal the wounded. It combines the natural sciences, social sciences, and humanities. Spirituality is the acknowledgment of a feeling, sense, or belief that there is something bigger than oneself, that there is more to being human than sensory experience, and that the greater total of which we are a part is cosmic or divine. Spirituality entails investigating universal themes such as love, compassion, altruism, life after death, wisdom, and truth while acknowledging that certain people, such as saints or enlightened human beings, have reached and displayed higher degrees of development than the average person. Empirical study indicates an enduring relationship between medicine and spirituality and calls into question how medicine interacts with spirituality and religion. The spiritual path begins with mending and affirming the ego, leading to good experiences such as secure self-esteem, conviction in self-worth, and the ability for compassion and kindness. This allows individuals to be less bound by ego barriers. Surveys of spirituality in the general population have always underestimated the role of spirituality and religion in the context of severe illness. There is limited evidence that higher levels of stress are connected with increased religiousness. Patients with advanced cancer report significant changes in daily spiritual practices (e.g. prayer), following diagnosis (47% before vs. 61% after, P = 0001).[1] In a study of 108 women with gynecologic malignancies, 49% reported becoming more religious after their diagnosis, while none reported becoming less religious.[2] This has been called the “foxhole” effect. Recognizing a patient’s spiritual issues may be considered a vital aspect of “patient-centered” medicine increasingly seen as crucial to high-quality patient care. In times of illness, issues about life and death may become more prominent in a patient’s mind. This is especially true in obstetrics and gynecology, which deals with bringing people into the world and terminating pregnancies; palliative care and intensive care, which are largely concerned with people’s exits from the world; and psychiatry, which seeks to help people who are no longer relating to the world in a way that is perceived as functional.[3] Spirituality among humans can be viewed as an advantageous tool over other species to cope with the stresses or challenges of daily life. This has prompted exploring the brain’s neurochemical activity and interplay of the neurotransmitters involved. The chief players are the serotonergic and dopaminergic systems. Spirituality and religious experiences can be understood through two main approaches. The first is regular meditative practices and its relationship with activities in the brain. Second, it is based on the relationship of genes and spirituality as a personal trait. The involvement of the serotonergic system in spiritual experiences has been supported by the observation of the effects of drugs such as Lysergic acid diethylamide (LSD) and psilocybin (5-Hydroxytryptamine (HT) antagonists) which produce perceptual distortions, illusions hallucinations, a sense of insight, spiritual awareness, mystical experiences, and religious ecstasy. Figure 1 explains a model where individuals carrying particular genetic polymorphisms within 5-HTT, DRD4, CYP2C19, 5-HT1A, 5-HT2A, 5-HT6, and AP-2B genes (either directly or interacting together) will have, through different pathways, a relatively higher level of 5-HT and dopamine in specific areas of their brain. As a secondary side effect, this enhances the sense of spirituality in individuals and possibly religious practices.[4]Figure 1: Biological picture of spirituality and religious practices.[ 4 ] HT: Hydroxytryptamine, LSD: lysergic acid diethylamide, DA: Dopamine. Diagram Courtesy: Perroud NA. Religion/spirituality and neuropsychiatry. Religion and spirituality in psychiatry. 2009;48. Page no 61Previously, physicians were taught to detect and cure sickness, with little or no training in how to relate to the patient’s spiritual side. Furthermore, professional ethics demands physicians to avoid imposing their ideas on patients who are especially vulnerable when seeking medical care. A meta-analysis by Moreira-Almeida et al., in 2006,[5]which collected the findings of 147 separate studies including 98,975 people on the relationship between religiousness and depression symptoms, discovered that religiousness is slightly but significantly related to lower levels of depressed symptoms. It was also noted that two specific measures of religiousness, namely, extrinsic religious orientation and negative religious coping, had a positive association with a high frequency of depressive symptoms, while intrinsic religious orientation was associated with low levels of depression. A study by Leigh et al., in 2005, reflected the role of spirituality in addiction and inferred that smoking and frequent binge drinking were negatively correlated with spirituality scores. A meta-analysis focusing on the usefulness of meditation therapy for anxiety disorders showed that transcendental meditation showed a reduction in anxiety symptoms and electromyography scores comparable with electromyography-biofeedback and relaxation therapy (Krisanaprakornkit et al., 2006).[6] The dopaminergic system which includes the basal ganglia is involved in the cortical-subcortical interactions. A positron emission tomography investigation on dopaminergic tone in Yoga Nidra using 11C-raclopride revealed a substantial rise in dopamine during meditation (Kjaer et al., 2002).[7] During meditation, 11C-raclopride binding in the ventral striatum was reduced by 7.9%. This represents a 65% increase in endogenous dopamine release. It is suggested that the increase in dopamine is linked to the gating of cortical–subcortical connections, resulting in the overall decrease in readiness for action associated with this sort of meditation. Meditation is connected with a drop in noradrenaline levels, a rise in amino acid neurotransmitters such as glutamate and gamma-aminobutyric acid (GABA), and a significant increase in plasma melatonin levels. Increased melatonin levels may explain the tranquility and decreased awareness of pain observed during meditation. Increased melatonin levels may explain the tranquility and decreased awareness of pain observed during meditation. Meditation, due to neurochemical changes, can have an anxiolytic impact. Enhanced parasympathetic activity, decreased locus coeruleus (LC) firing with decreased noradrenaline, enhanced GABAergic drive, higher serotonin, and lower levels of the stress hormone cortisol all contribute to reduced anxiety during meditation. Meditation’s anxiolytic benefits are also enhanced by elevated endorphin and Arginine vasopressin (AVP) levels (Newberg and Iversen, 2003).[8] Spiritual activities have caused clear neuroanatomical and neurochemical alterations. As evidenced by several studies, meditation activities have a positive effect on mental health. Meditation activities may also complement psychotherapy interventions. In view of such benefits and political commitments also at the global level, presently Yoga and meditation have been incorporated into medical curriculum so as to achieve a holistic benefit.