Professional Documents
Culture Documents
The role of patient spirituality and spiritual/liminal experience(s; SE) in the clinical setting has generated considerable
equivocality within the medical community. Spiritual experience(s), characterized by circumstance, manifestation, and interpretation, reflect patients explanatory models. We seek to demonstrate the importance of SE to clinical medicine by illustrating
biological, cognitive, and psychosocial domains of effect. Specifically, we address where in the brain these events are processed
and what types of neural events may be occurring. We posit that
existing evidence suggests that SE can induce both intermediate
level processing (ILP) to generate attentional awareness (ie, consciousness of) effects and perhaps nonintermediate level processing to generate nonattentive, subliminal (ie, state of) consciousness effects. Recognition of neural and cognitive
INTRODUCTION
Over the past decade, there has been considerable multidisciplinary interest in spiritual experience and its possible role in
human health.1 In mainstream and many complementary medical approaches, secular, and in certain instances, nonsecular
spiritual practices are being viewed as potentially positive influences on patients (at very least, subjective) wellness.2
However, there is considerable equivocality regarding the importance and/or degree of enfranchisement that clinical medicine should maintain toward spirituality. These range across
diametrically opposing viewpoints, from advocacy of clinicians
complete acceptance and participatory involvement in their patients spirituality3,4 to a more pragmatic stance that disregards or
negates the importance of spiritual issues or effect(s) in the clinical scenario.5 Poised somewhere in between is an ambiguous
neutrality that is somewhat polarized at its borders; on one end,
such neutrality confers benign acceptance, whereas, on the
other, it may represent implicit rejection.6 Hall and Curlin7
maintain that even such neutrality regarding patients spirituality (and by extension, religiosity) is, in practicality, impossible
and intellectually undesirable.
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The reader should draw their own conclusions about the meaning
of this circuitry relevant to spiritual experience(s). Such meaning will
reflect cultural, social, and spiritual and/or religious orientations and
beliefs. We do not intend or desire to superimpose on or oppugn any
such individual beliefs. Rather, we maintain that the theoretical models
and concepts presented herein do not refute any particular orientation
but, instead, serve to enhance further speculation, inquiry, and discourse.
The understanding of how the physical substrate that is the brain
generates consciousness represents what David Chalmers calls the hard
Putative Function
Figure 1. Schematic diagram of neural structures putatively subserving sensory, cognitive, and physiologic sequelae of spiritual experience(s).
As explained in text, provocative input may include external and/or internal sensory stimuli that are produced by specific behaviors (meditation,
and others) and/or rituals (eg, prayer). These may serve as bottom-up, body-brain/mind events. At the intermediate level of neural processing
(ILP), cognitive awareness of the summative effects of engagement of this neuraxis produces distinct conscious experience(s) by engaging
attentional mechanisms (to evoke consciousness of the event) and may engage higher level, nonattentional mechanisms (to evoke state of
consciousness events) as well. Perception of these neural events may be responsible for the qualia of conscious experience. These events appear
to exert positive salutogenic effects and may be important for the induction of hierarchical neural processes and physiologic manifestations. Such
top-down processes are illustrated in bold arrows in the Figure (see text for details, refer to Table 1 for summary of proposed functions of neural
substrates with demonstrated involvement in spiritual experience(s); refer to references 10,14-40). ILP, Intermediate level processing; HLP, higher
level processing; RLPFC, right lateral prefrontal cortex.
considered to complicate this philosophically materialist/physicalist approach. First is that it appears that actual subjective (spiritual)
experience is, on some level, necessary for the induction of the subsequent (physiological) effects. This consideration then leads to the
second, which is that the brain-mind condition(s) induced by expe-
ANTHROPOLOGICAL PERSPECTIVES
However, an important unresolved issue remains: how did such
experiences come to be such a fundamental part of the cultural
repertoire of diverse social groups? We maintain that these experiences represent consciously recognizable events with subjectively
relevant and potentially objective effects and salutogenic benefits
(in certain instances). Humans may have recognized that particular
PRACTICAL APPLICATIONS
For many patients, declining health and/or confronting disease
represent events that both strip away an internal locus of control
(ie, produce a sense of victimization) and often expose them to
an environment that may elude their linguistic capacity and
basis of understanding (ie, medicalization). This perceived loss
of control and increased level of unpredictable unknowns might
be contributory to the enhanced religiosity of the gravely ill,
chronically diseased and aged.1,11 However, as discussed, religion is just one means to incur spiritual experiences. It is important to recognize that the role of religious belief and practices to
evoke the noetically (and perhaps physically) positive effects of
the spiritual phenomenon may be assumed by a variety of other
behaviors and experiences by more secular patients.
Irrespective of whether secular or nonsecular in orientation,
the spiritual experience is essentially composed of circumstance,
interpretation, and manifestation. As presented in Table 2, these
reflect biopsychosocial frameworks that exist in each particular
patient and may provide insight into meaningful cognitive and
social contexts that affect individuals relative construct(s) of
wellness and illness.81
Often, the basis and interactive nature of these factors are not
familiar to many clinicians, and such an applied approach may
require a revision in medical scholarship, both in academia and
at the bedside. How might this be accomplished? First, it is
critical to acknowledge that spiritual experiences exist as neurocognitive phenomena and that these can potentially exert salutogenic and physiologic effect(s). This can help to establish explanatory models that are bilaterally relevant to patient and
clinician. This bilaterality enhances the patient-clinician interaction and may facilitate a more positive healing environment.
Second, the clinician need not be an agent for the spiritual
experience9; however, in recognizing these effects as a possibly
relevant clinical variable in patients health, the clinician should
be participatory in making resources available (and/or supporting patients use of such resources). This further enhances the
therapeutic relationship by promoting the patient as being a
reciprocal partner in their own care. In addition, this avoids
neutrality, which can often be a blind to trivialize the role of
explanatory models and may contribute to nocebo effects.82,83
Such blinds may also allow the clinician to infuse subtly their
beliefs on the patient.84 This may occur implicitly, connotatively, or explicitly but can exert profound paternalistic influ-
Refer to text for complete description; see references 48-55, 57-59, 81-83.
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