|
|
By Lewis
Mehl-Madrona, M.D., Ph.D. Lewis E.
Mehl-Madrona, M.D., Ph.D. [ Other Pages on
Lewis Mehl-Madrona ] Summary : Increasingly,
traditional Native American healing practices are being requested by Native
Americans and non-Natives alike. A series of meetings among traditional Native
American healers and the author resulted in a dialogue between the Native
American world view and that of biomedicine. Recommendations arose for how
treatment should proceed in the modern world and how best to introduce
interested non-Natives to Native American healing practices. An approach was
developed for bridging cultures to facilitate the interaction of non-Natives
with traditional healers. One
hundred sixteen patients were treated in this manner by the author in
conjunction with traditional Native American healers. More than 80% of patients
showed significant, persisting benefits of a time-intensive treatment program.
A comparison group of patients derived from the author's emergency room
patients showed significantly lower rates of improvement. The author suggests
that an intensive treatment experience (inspired by Native American practices)
over 7-10 days for treating chronic physical illness achieves both health
benefits and improved cost utility. The
treatment philosophy underlying this approach and communicated by the
traditional healers is best described as general systems theory, or that of
dynamic energy systems. Within this theoretical framework, physical illness can
be treated by counseling and ceremony, since illness is viewed as
simultaneously spiritual, mental, and physical. Because of the interaction and
hierarchical embeddedness of these levels, intervention at any one level should
affect any other. Introduction : Recent years have shown
a surge of interest in the therapies of traditional cultures, in patients' use
of alternative medicine, and in the desire for mind-body therapies and for
spiritual treatment, as well as for behavioral medicine treatments for chronic
medical illness. Some hospitals have included traditional Native American
healers as part of their staff. Harvard University has created a Center to
study alternative medicine. Dossey has documented the healing power of prayer.
Religious practices and beliefs appear, for the most part, to be good for one's
health. The medical effect of prayer and healing seems to be more related to
the intensity of one's own practices and belief system, than to the particular
denomination or religious tradition with which one is affiliated. Devout people
of various religions appear to have similar medical effects. Americans
frequently participate in religiously based healing activities.2 In
a 1985 study of 200 elderly women, participants were asked to indicate what
resources they called upon when they become sick. Ninety-one percent of the
women reported praying when in trouble, and 86% reported thinking of God or
their religious beliefs. Ninety-six percent of patients undergoing heart
surgery reported praying with most reporting positive benefits from their
prayers. One of seven persons reported experiencing a divine healing in a 1986
random telephone survey. The most common problems healed were viral, but some
respondents did report healing of cancer, back problems, and emotional
problems.8 Gallup
found that 95% of the American population believes in God, more than 50% of
people pray daily, and 40% attend church weekly. Nearly 75% of Americans claim
that their entire approach to life is grounded in their religious beliefs.
There is a large gap between what patients would like regarding spiritual
involvement in medicine and what health professionals are providing at this
time. Many patients want their religious beliefs and practices respected and
their spiritual needs acknowledged as part of their medical care. They would
like to incorporate their spiritual beliefs into their medical care. This
integration is not generally occuring at the present time.3 One
of the spiritual practices which patients may request (especially in the
American Southwest) is Native American healing (NAH) to complement their
conventional medical treatment. Some patients even voice a preference for
exclusive NAH. On reservation settings, tension may exist between Native
American healers and conventional physicians supplied by the Indian Health
Service (IHS). Native American medicine has been practiced on the North
American continent for at least 10,000 years, depending upon one's theory of
origin or arrival. When Europeans arrived in North America, the native
population were a healthy lot. Plagues and epidemics from Europe soon changed
that, but do not mitigate against the effectiveness of Native American methods
for attaining long-term survival and the treatment of chronic disease. Native
Americans stressed development of the inner life which was seen reflected in
the outer world. The events of the outer world spoke to inner processes for the
person. A fire is burning on the mountain. The person is in agony. An awareness
comes which dissipates the agony. Rain comes to quench the fire. The events are
seen as related. The fire and the rain were messages about the internal
processes of the person. Such ideas are more consistent with a dynamic energy
systems (DES) approach in which systems interact in complex ways, actually communicating
and creating shared memory through their reciprocal effects upon each other
during that communication. While preposterous to the conventional
psychotherapist that a human being can communicate agony to nature, modern DES
theory parallels the traditional belief that the mountain could have responded
with fire and then the sky with rain, both in response to the human and now
also the burning mountain. Conventional
psychotherapies have ignored the potential utility of ceremony and ritual as
treatment. Through the reifying effect of action, fears and internal emotional
processes are re-presented as dolls, shields, objects, or paintings and
participate "object-ively" in a process of implied transformation
during a ceremony. Ceremonies couple the patient's intention to heal with the
power of belief and faith in the ceremonial process. Conventional
psychotherapeutic approaches are not necessarily helpful for helping to
alleviate symptoms of psychobiosocial illnesses. Insight-orientied
psychotherapy, for example, is not generally effective with physical symptoms.
Some early psychoanalysts, including Alexander, even recommended against
insight-oriented therapies in the presence of physical illness, finding that
the therapy sometimes worsened the condition. Additionally,
religious practices may be a potentially valuable form of treatment for
particular health problems.3 Further research is needed to indicate
which clinical situations will be most responsive to spiritual intervention.3
This paper reports the results of a series of meetings between the author and
traditional Native American healers in which a proposal arose for a method of
treating any patient with the principles of the healers. A goal was also to
bridge cultures and to discover how to prepare non-Natives to interact with the
healers. While some Native American people and healers reject all contact of
their spirituality and healing techniques with the non-Native world, the
healers involved in this study had resolved that the wisdom of their ancestors
should be shared freely, both for its power to prevent the coming potential
apocalypse predicted by tribal prophecy, and for its capacity to relieve
suffering of needy individuals. As one medicine man humorously remarked,
"Once I only helped other Indians, but then I realized there weren't
enough Indian babies being born for all the old-time Indians to get back onto
the Earth, so that they had to take any body that they could, and therefore, I
started treating everyone." Methods : A series of meetings
were held with Native American healers and the author, along with selected
colleagues, the purpose of which was to explore how the healers conceptualized
their work, to determine how mind-body medicine and psychotherapy would have to
be modified if it were to accept inspiration from these healers, and to develop
a means of working together on patients, both Native and non-Native. The
meetings were, by nature, informal, and were organized around the author's
questions for the healers, who, thankfully, tolerated his inquiries and
ignorance. Recommendations
arose for a method of treatment that was then applied to 116 patients who
called the author requesting therapeutic work. These patients all traveled to
the author from out-of-state, and no patient was excluded from this study. No
adequate comparison group could be found for these unique patients. A
"rough-estimate" comparison group against which to view the results
of this treatment method was developed from patients enrolled in the author's
computer modeling for prediction of health outcomes research project. These
comparison patients had not requested NAH, but had enrolled in a study in which
a dynamic systems computer simulation model was being used to predict the
course of their health and disease, including the time at which they would
develop a myocardial infarction. A bias toward the study population consisted
of their strong motivation to seek alternative treatment for their health
problem to what was being offered by their conventional physicians. A bias
against the study population was noted from the observation that all patients
in the study population were worsening despite conventional treatment, this
being a major impetus for them to seek additional help. The comparison group of
patients had similar illnesses but were more stable and not necessarily
progressively worsening as were the study patients A
subset of patients' treatment was financed by research grant funds; the
remainder paid for their treatment. The determining factor was economic need.
Grant funds were not used to finance care when other means were available to
the prospective patient. For purposes of this study, we defined healing as the
restoration of health, strength, and vitality to a person who has lost this
through illness. A healer is someone recognized by the person or his/her
community as someone who is capable of helping a sick person restore his
wellness. Sickness was defined in the conventional biomedical manner of having
a diagnosable illness as listed in the International Classification of Diseases
Annal (ICDA). Results : A. Meeting results : Besides important
comraderie and the opportunity to laugh (the healers were incredibly funny
people), a number of important concepts about healing emerged from the
meetings. These concepts are worthy of further study and empirical research.
The shared metaphor that arose was the comparison of healing to a chemical
reaction or to baking a good cake. The healers seemed intrigued with the ideas
of biochemistry, as much as the author was with their unique viewpoint of
nature. They created elaborate metaphors of the sexual exploits of molecules,
trying to couple with other molecules and produce offspring, only to end up
with too many waste products. The metaphor survived the frivolity, however, to
emerge with the following important concepts. 1.
Healing takes time and time is healing. The healers recognized that one should not start the
job of treating a sick person unless he or she had sufficient time to give that
person to get well. Hours of contact were required, unlike the Hollywood
stereotype in which a short ceremony with a few shakes of the rattle brings the
person back to full strength and wellness. They also recognized that the act of
giving time to another person is healing in and of itself. Cake
baking and chemical reactions also require time to unfold. Too little time in
the oven and the cake is still mush. Too much time, and the cake is burned. The
healers believed that even the act of baking a cake imparted an intention and a
power from the baker to the cake which would be passed on to the person who ate
the cake. This sense of "contained intent or information," is similar
to a story quoted by Schwartz and Russek6 of Claire Sylvia, a former
dancer who received the first successful heart-lung transplant in New England.
Six weeks after her transplant, when she was allowed to drive again, she drove
straight to a Kentucky Fried Chicken, a place she had never been before, and
ordered chicken nuggets, not something she had eaten in her past as a fit and
thin dancer. Later she learned that the 18 year old male whose heart and lungs
now lived inside her had had a fondness for fried chicken nuggets. At the time
of his death, uneaten chicken nuggets had been found stuffed inside the pocket
of his leather jacket. Similarly, the healers believed that one's thoughts were
contained in every object he or she touched, made stronger by the more focused
intention of that touch. 2.
Healing takes place within the context of a
relationship. The healers
recognized that the quality of their relationship with the sick person was
important in helping that person to find wellness. The better the relationship,
the more likely was success. They recognized the relationship as a kind of
container or vessel for the baking of the cake. "You wouldn't put cake mix
in the oven by just pouring it over the bottom," one said. "You have
to put it in something. Some kind of a bowl." The relationship was the
bowl in which the cake baked. 3.
Acheiving an energy of activation is necessary. While the traditionals believed that healing takes
time, they also believed that the time should be intensive. Water doesn't boil
until it's very hot, they said. The medical practitioners likened this concept
to catalysis and the energy of activation. In
both organic and biological chemistry, an energy of activation is required to
initiate a reaction. Once inititated that reaction may proceed irreversibly to
completion. Without sufficient energy of activation, the reaction never occurs.
A minimal level of energy (usually heat) is needed to transform the internal
arrangements of molecules. Traditional healers said that weekly or even daily
hour-long sessions with a patient would not be sufficient to inititate healing
(change on a physical level or, in the biochemical metaphor, to "rearrange
the molecules"). The question of "how many hours over what period of
time are necesary to produce change?" is rarely addressed in psychotherapy
practice. The weekly visit has become normative. Even in intensive
psychotherapy when patients are seen once daily, the question of "what
would happen if we 'raised the heat?'" is rarely addressed. The
Native American healers told us that they typically worked with the client
until the job was done. They typically treated one client at a time, and some
clients traveled great distances to see them. Sometimes they traveled far to
see a patient, and needed to put in maximum effort over a short period of time.
Partly because of long distances travelled, they would concentrate their work
over a number of days with multiple hours being spent each day. When they felt
progress had been made, the client would be sent home with instructions to
return at a later date for further treatment, and often with specific instructions
for tasks to complete during the interval between treatment. 4.
Biological systems behave similarly across
hierarchical levels. There is isomorphism of principles. The traditional medicine people told us that nature
is the same at every level. The same principles that guides the movement of the
stars and the sun work within the body. As a group we returned to the
biochemical metaphor. The traditional healers quickly agreed that
psychotherapeutic or psychophysiological change should behave just like change
biochemical systems. We found ourselves discussing reaction kinetics, which
asks basic questions about the amount of materials that must be present for a
reaction to occur, the amount of energy that is required to start and to
maintain a reaction (and sometimes to reverse it), what catalysts are required
to facilitate the reaction, what enzymes are necessary, etc. For example,
outside the human body considerable heat (thousands of degrees) is necessary to
melt iron. Inside the body the process takes place at 37 degrees. Because of
catalysts within the body, a minimum level of energy is needed to begin the
change process which is then maintained with less energy. They idea emerged for
the biomedical practitioners to try an intensive week of 6 contact hours per
day to start a change process. 5.
The distractions of modern life
"inactivate" catalysts for change. Most traditional therapies stress the need for
self-contemplation. With adequate time, skills, and emphasis upon
self-exploration and discovery much of modern psychophysiological therapy might
be unnecessary. The traditionals believed that the modern world complicated and
vitiated our ability to heal ourselves by distracting us from our study of
ourselves. Television wastes vital hours which can be used for healing. Reading
can both enlighten and deaden. (The great novel brings us face to face with the
human condition and our own similarities with the protagonists about which we
must reflect; popular novels may repeat trite plots with minimum character
development.) Newspapers fill the mind with only slightly relevant information.
The more tabloid, the more useless. Running to friends, relatives, or movies
can fill waking hours with activity as avoidance. The quest to avoid boredom
provides the raw material for many advertising campaigns. This quest also
avoids self-discovery. Without external distractions, consciousness turns
inward for it must direct itself somewhere. Therapy is harder in proportion to
the number of competing distractions. Weekly outpatient therapy is particular
difficult since the therapist must compete with so many more pleasurable or
obsessional distractions to the process of self-discovery. Our traditionals
believed in removing their patients from the distractions of modern life and
working with them in an environment of peace and quiet. This was usually done
within the client's home or within the medicine person's home. Nevertheless,
they advocated an intentional avoidance of newspapers, radios, televisions,
magazines, telephones, computer games, and the myriad of other distractions
available to modern people. Our
traditionals believed that catalysts on the organismic level corresponding to
biochemical catalysts on the molecular level arose from self-exploration and
developing an awareness of emotional states. Knowledge of personal misery
fosters an inclination to do something about it. Excessive business or
exhaustion can prevent reaching a level of emotional awareness from which
change can occur. 6.
Modern culture systematically teaches us to ignore
emotions and to maintain a low level of emotional awarenes. The traditionals pointed to television commercials
as the best examples of this principle. Whatever discomfort we may feel, we are
encouraged to stop at our corner drug store to obtain a medicine to eliminate
it. This attitutde of intolerance for discomfort sells products, which relates
to every entity's goal in an economic society (one operating on money) -- to
make money. Self-reflection does not sell products. Nor is successful
psychotherapy self-maintaining, for those whom we help no longer need us. No
other product sits on the shelf which we can sell them. (Unless we are only
marginally effective and can maintain a client in counseling for years.) Traditionals
pointed out that children are taught in school to ignore their body needs for
elimination until it is convenient for the teacher. They are taught to ignore
their wish to play until scheduled recess. Civilization, as it is now
constructed, requires a level of emotional unawareness for smooth functioning
that the traditionals found sad. They pointed out how strange it was for a
secretary to be unable to take time off if overcome by sadness from a case
history being typed. Emotions are expected to be secondary to efficiency. They
pointed out that theirs used to be a less-hurried society, but that hurry has
become the watchword of modern society; the faster we go, the more money we
make. Traditionals
pointed out that hunting and gathering societies were more realistic about
expenditures of human energy, for the preparation of the hunter was known and
addressed on many levels. Lowered alertness from mental or physical exhaustion
of any member of the group could endanger the hunt and the tribe. Periods of
prescribed inactivity were common. Men rested or fasted before an anticipated
period of great physical activity, purifying themselves on several levels.
Women retired to the menstrual hut to take a deserved monthly rest. Today
television commercials and drug advertisements teach modern society's members
that a product is always available to get a person up and out the door to work
or to play golf or to whatever scheduled activity is next. There are no natural
breaks or allowances for the vicissitudes of the body's own rhythms. 7.
Physiological change often requires a break in
usual daily rhythms. While we
are in an activated state of running our daily lives, necessary resources are
not always available for the work of change, said our healers. The body needs
rest and quiet to promote cellular repair. Sleep, for instance, is a crucial
ingredient of life. Without sleep, illness ensues. Often, the most important
therapy we can give a client is to put them to bed. In
the days before modern pharmaceuticals, healers did just that. Rest was a key
ingredient of any therapy. Even in conventional medicine examples abound of the
usefulness of rest. Just ten years ago I watched an older cardiologist manage a
patient dying of heart failure by putting him to bed. Rather than encourage his
undergoing a heart transplant (which is of limited utility for long-term
survival), she put him to bed. Six weeks later his heart failure had
disappeared. To this date she receives yearly cards of gratitude from this man
for saving his life, yet all she did was to put him to bed. Traditionals
felt that these same principles were applicable to counseling. Healing may best
begin by putting the client to bed. This disturbs daily routines and breaks old
habits. Hypnotherapist Milton Erickson believed that the effective therapist
confused the patient sufficiently that his old habits began to look strange.
Perhaps this is all effective counseling need to do. 8.
Traditionals mentioned the importance of ceremony
as a means of accessing help from the spiritual dimension for healing. Traditionals mentioned the importance of a number of
ceremonial procedures, including the Vision Quest in which the seeker prepares
through fasting and other methods of purification to journey to the top of a mountain
and sit alone for 1-4 days in prayer and meditation, waiting for a vision to be
revealed. Vision concerns the self (even when it contains social prescriptions)
but also guides personal development and facilitates healing. Traditionals
described purification ceremonies which are also important for the inner life.
During the sweat lodge ceremony, for example, the person fasts and then enters
a lodge -- a low structure covered with skins (nowadays blankets) to retain the
heat. Into this lightless world are brought hot rocks. Dippers of water are
placed upon the rocks. While sweating away toxins and illnesses, participants
are guided to look within and confront fears. As a fear is discovered and
released the inner experience of heat diminishes. Within the lodge participants
receive information and visions about personal lives and inner processes.
Participants learn how to live in balance and harmony with nature and each
other. A communal experience of participation increases social support. B. Treatment Process : The Treatment Process
that emerged from the meetings and discussions of traditionals and
non-traditionals (including the author) resulted in a 7 to 28 day intensive
healing experience. This treatment process (to be described below) was offered
to patients who called the author for help with health problems and who lived
outside of the state. A minimum duration of 7 days was encouraged for all
callers, but, occasionally people would come for less time to sample the
program or for less severe problems. The first seven days consisted of bedrest
away from distractions. There
was no access to televisions, radios, books, newspapers, telephones, computers,
other people with whom to talk, or other distractions. Participants were to
rest face-to-face with themselves. They were fed appropriate food based upon
their personal biochemistry, food allergies, preferences, and nutritional
needs. During the treatment period, they received 2 to 7 hours per day of
therapeutic attention, which could include reading their journal and commenting
upon what had been written, reviewing art they may have produced on assignment,
general discussion and integration of their experiences and what they were
learning; hypnosis and/or imagery; body therapy; projective techniques
including the use of native American images, shields, or animal images; and
ceremony. Participants
were to be introduced to the use of ceremony in therapy and for their own
personal growth. Night sessions often took place outside in the medicine circle
around a fire. The setting was rural desert without other visible dwellings or
structures. Participants were helped to prepare for a sweat lodge ceremony on
the fifth or sixth evening. If they were sufficiently strong and prepared, they
would be taken to the top of a nearby mountain to sit for the night and perhaps
receive a vision, on the night after the sweat lodge. If
they stayed for a second week, clients would perform tasks to beautify the
property and participate in a simple caring for and service to the earth
alongside their continued treatment. They also helped clean up the nearby
National Forest, take hikes, walks, or otherwise engage in physical activity.
Intense education was begun in this time along with continued individual
therapy (using what had proven helpful and useful during the first week). The
first week stressed self-discovery through contemplation; the second week,
self-discovery through service. A
third week was designed to help clients prepare to re-enter their world through
learning problem-solving techniques and learning how to apply Native American
philosophy to their lives. Relapse prevention strategies would be taught, with
a continuing emphasis on self-reflection and discovery and worship in the
manner most appealing to each person. Naturally, we expected that most
participants would be drawn toward Native American or similarly oriented nature
religions. Nevertheless, we planned for the experience to be relevent to
Christians and Jews as well. More information on the actual experience of an
Intensive, along with development of themes encountered, and techniques
utilized is available elsewhere. A
fourth week was designed to consist of a specialized course in Native American
philosophy, desert survival, and other specialized spiritual pursuits
(tracking, stalking, climbing, etc.). Implicit
within the program were the values and beliefs of Native American culture. It
was expected that participants would implicitly learn to use spiritual practice
as suppport and to rely on larger entitites for help with problems and with
healing. All practitioners involved in the program were expected to hold a deep
respect for the participant's individual beliefs and an acceptance of whatever
belief system the participant would bring. The shared value was the belief that
no one path was correct for all people. Spirituality can choke people when it
requires adherence to one conceptual scheme or dogma. C. Evaluation : For such an innovate
treatment program such as this, and for a first report, it was felt that simple
was best. Therefore, five years after completion of treatment, patients were
asked through telephone follow-up call by a research assistant (so that they
would not feel that they had to please the author and tell him they were better
when they weren't) if they were free of symptom or disease, improved, no better
than when they came for treatment, or worse than when they came for treatment.
Death was a final possibility that a family member might report. There were 21
patients who were treated but lost to five-year follow-up. To
give a benchmark for a typical population, the same question was asked of 100
randomly selected emergency room patients (for each of the diseases listed in Table 2) who had
carried that diagnosis at least once during the past five years. (The disease
did not have to be active at the time of their emergency room visit.) Patients
were asked them to look back over the past 5 years and make an estimate as to
whether or not they were cured of that particular condition, improved, the
same, or worse. Patients who came in dead or dying from that particular
condition were rated, obviously, as dead. This
procedure gave a rough estimate for what would happen to 100 randomly selected
patients in terms of our simple, 5 point rating scale. Twelve hundred patients
were interviewed to obtain our comparison population -- one hundred for each
disease. Statistical
comparisons were made with the log-likelihood measure and the chi-square
statistic. Rounding was widely made to call attention to the crudeness of the
measurements and their nature as more of a benchmarking than an experimental
design which would have invited more rigourous numerical calculations. Final Results : Five year minimum
follow-up was available for 107 people who participated in intensive
experiences. They learned of the program through word of mouth and through
lectures given by the author in various cities and at conferences. The author
was the primary therapist, involving local medicine people and traditional
healers whenever appropriate and possible. All clients who came graded their
problem as at least moderately severe ("5" on a 10 point scale), and
had received a minimum of one year of outpatient treatment, including forms of
counseling, which were ineffective. All reported that they had gotten worse
during the preceding year. A wide variety of problems were present (Table 1), including
angina, asthma, back pain, cancer, chronic fatigue syndrome, diabetes,
depression, hypertension, infertility, gynecological disorders,
obsessive-compulsive disorder, and pregnancy-related complications. The
age spread was from 20 to 79, with the mode lying within the fourth decade of
life. No statistically significant differences in age were found between the
intensive population and the comparison group. The treatment group was biased
toward higher socioeconomic status than the comparison group (as judged by type
of insurance; p < 0.05). There were no differences in the number in each
group reporting religious affiliation. The
breakdown of client's improvement was judged simply in the sense that the
problem completely disappeared, was improved, was unchanged, worsened, or led
to death. Patients generally improved more following a healing intensive than
did randomly selected patients in the emergency department, our crude benchmark
(Table 3).
Statistically signficiant differences in outcome included all illness.
Statistical testing was rounded widely, given the crude nature of the outcomes
being compared and the benchmarking nature of the comparisons (different from
the rigor expected had this been an experimental design). The
longest available follow-up was 10 years, although clients may have had their
diseases longer than this. In general the more severe or the longer the
problem, the more difficult it is to change. The costs of care ranged from free
for selected patients to $10,000 (U.S.). the typical patient spends $2100 to
$3600 (1990 dollars) for 7-10 days, plus some food and lodging costs (approx.
$60/day at present). The average expenditure was $2825. The least amount of
time utilized was three days, the maximum 21. On average, clients stayed 7.8
days. Potential Negative Effects : Every client save two
reported major psychological breakthroughs. One was a client with
obsessive-compulsive disorder. The problem for which he came disappeared, but
his personality did not appreciably change nor did he experience epiphanal
awakening of any kind. His obsessive urination along with other compulsive activities
and his accompanying record keeping kept him fully distracted despite our best
efforts. Another patient with angina did not improve, and returned home with
anger at the cost of his intensive and at the waste of his time. He was invited
to submit a request for refund to the Board (which would have been honored),
but did not. His wife, forty years his junior, was also angry. She felt
"ripped off," though they received more time than they were billed
for, and more time than they had agreed to spend for less money than expected.
They did report a very interesting experience in the week following their
return to California. An earthquake occurred during the third day after their
return home. The street was blocked and their propane gas tank was in danger of
catching fire. The wife described screaming for help from anyone to move the
gas tank from the path of a fire. A strong man appeared and moved the tank and
then disappeared. He was not from the neighborhood and was never seen again.
The roads were closed for several miles into their mountainous area home. The
wife concluded that the man was an angel. An infection in the vicinity of her
husband's pacemaker came to the surface of the skin and drained during this
week, also. The pacemaker was therefore replaced. There
were no other negative results described by clients. Most reported the
experience as one of the more positive events of their lives. Most
clients reported spiritual experiences and a significant deepening of their
faith, regardless of the type. The other two most difficult clients were a
brain-damaged manic-depressive who had trouble following instructions, and a
very depressed man with severe back pain who has been in therapy for the past
26 years. Because of his strong atheistic views he was limited in what he could
partake from the treatment, but nevertheless was doing marginally better in his
home environment with monthly phone calls from the author. Stages of the Intensive Process : The general stages of
the therapeutic process consisted of: 1. Restlessness and anxiety, alternating with sleep - -
2-3 days. 2. Acceptance and yielding with relaxation - - 3rd to
4th day. 3. Stage of rapid insight - - 4th or 5th day. 4. Stage of spiritual connection - - 5th to 7th day. 5. Integration into life routine - - 6th to 8th day. The first stage could
almost be seen as a detoxification from the lifestyle in which the person had
been living or the hectic pace most have been maintaining. An unusual
insistence on promptness was seen in the patients from the large urban areas,
which led to frustration when it was explained that part of the treatment
process was that they would not know when to expect the therapist. "It
would just happen." Even though there was essentially nowhere to go and
nothing to do, these clients used their watches to mark their day and insisted
on structure. As they passed through the lack of structure, then a heightened
level of relaxation ensued. Interestingly, my obsessive-compulsive client beat
me at the "no-structure" game and was able to generate times from me
that I would appear under threat of grave anxiety if I was even five minutes
late. The
majority of clients had powerful experiences as did the author, forming lasting
bonds which still generate cards and letters from time to time, and left happy
that their problem was well on the road to solution. Discussion : The study demonstrates
that a Native American inspired, intensive treatment approach can be
implemented for patients of non-Native cultural backgrounds with positive
effects. The comparison group is crude. A better comparison group might be
attenders of holistic health clinics. Nevertheless, the comparison group showed
a trend toward improvement in their health problems over a five year course, as
did the treatment group. The treatment group's improvement was more marked. Was
this because of the type of person who was willing to carry out such an
intensive treatment program or related to the treatment itself or both? Other
further prospective research can answer this question. The
relative success of this program even with crude measurements of outcome point
toward the value of further investigation into this treatment process. If it
could improve outcome through intensive treatment, perhaps long-term costs of
care would be reduced. This is also an area for further study. The short-term
costs of care were clearly higher than a business of usual approach, though no
measurements were made for long-term costs of care which should be part of a
future study. "...[T]he
oldest mind-body effect [is] the relationship between spirituality and
medicine." Unfortunately, "[t]he scientifically oriented biomedical
community tend[s] to discount the importance of psychological and behavioral
variables as important etiological and exacerbational factors in pathogenesis.
This community tend[s] to devalue or even demean the significance of these
factors in treatment." Spirituality
is important to patients. King and Bushwick found that 77% of patients wanted
their physicians to consider their spiritual needs, 48% wanted their physicians
to pray with them, and 37% wanted their physician to engage them in a
discussion of their religious beliefs. Bearon and Koenig found that 79% of
people believed that spiritual faith could help people recover from illness,
injury, or disease, and that 64% thought that physicians should join their
patients in prayer if the patient requested it. There
is also evidence from the depression literature to support the conclusion of
this study -- that an intensive, spiritually-based treatment can reverse a
progressively deteriorating trend among patients who select it, when these
patients have been previously treated with non-intensive, non-spiritual methods
. Among
a group of Christian clients with depression, Propst studied the effects of
adding an emphasis on religious themes to a cognitive-behavior therapy program.
The religiously oriented program "gave Christian rationales for the
procedures, used religious articles to counter irrational thoughts, and used
religious imagery procedures." Two comparison groups consisted of (1)
standard cognitive-behavior therapy and (2) client-centered pastoral counseling
with incorporated Biblical themes. The largest absolute reductions in
depression were produced by religiously oriented cognitive-behavioral therapy.
Whether or not the therapist was personally religious made no difference to the
outcome. When no religious imagery was used, the largest reductions in
depression were made by those therapists who were personally religious. Simply
incorporating syntonic religious imagery into treatment enhanced outcome.
Alcoholics anonymous is another religously oriented treatment with which the
approach of this paper can be compared. Simply attending AA, for instance, does
not improve treatment outcome. The extent to which clients actively used the
program did predict outcome. Passive attendence was not possible in our
program. Walker
studied the effects of intercessionary prayer on recovery from alcoholism.
Patients who believed that someone else was already praying for them (prior to
the treatment) showed less improvement in treatment than those who believed
that no one had been praying for them. Intercessory prayer by random assignment
was not found to be helpful. Again, apparently, an active personal praying, as
patients did in this study, is necessary for healing. Table 1. Problems leading clients to
seek Intensive Therapy
Table 2. Age spread of clients seeking
Intensive Therapy
Table 3. Results of Intensive Therapy
Table 4. Comparisons of Intensive
Treatment. There are 106 treated patients and 1200
comparison patients (100 for each disease). Comparisons were made with
log-likelihood methods and chi-squares.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
