Science in Christian Perspective

The Scientific Basis of Whole Person Medicine
ELISABETH McSHERRY
Veterans Administration
National Cost-Effectiveness Center
17 Court Street
Boston, Massachusetts 02108

From: JASA 35 December 1983): 217-224.

The object of medical science's study, man, is somatic only in part. Two-thirds of his person is psychological and spiritual, abstract qualities not measurable by physical science tools but rather with social science methods. Social science design strives to capture an abstract concept with concrete instruments such as surveys and questionnaires. The three critical criteria of good social science design are: is the study (1) comprehensive, (2) inclusive and (3) balanced? Academic medical science suffers from lack of comprehensivity and balance in how it operationally defines the health of the whole man. New social scientific evidence supports the importance to full health of the spiritual side of man, and new psychoanalytic theory provides the theoretic base for many of the new practice paradigms of whole person medicine. The scientifically describable nature and effectiveness of several of these modern whole person medicine models is systematically scrutinized.

What is a comprehensive, balanced, inclusive view of man's nature? What are the fullest dimensions of whole man? Platonic theory considers man's nature in three discrete but interrelated units, pneuma, psyche and soma (spirit, mindemotions, and body) where spirit is the chief governor of The whole. Hebraic theory sees man as a gestalt, a whole, with all the individual parts critically interdependent on the rest; central to the Hebraic perspective, man's entire earthly being must be critically-centered in a metaphysical presence (or God).² "Shalom," the word that defines health, is the peace of God-centered human wholeness.

We consider the spiritual (pneuma) aspect of man for this paper generically, as that aspect of every man concerned with meaning, purpose and values.

What is the modern social science evidence that the spiritual side of man is important to health and well-being? Does the operational balance in the way modern medicine is practiced in the 1980's, reflect the magnitude of the scientifically observed importance of the spiritual side of man on health and health-promoting behavior? If not, why not?

Scientific Evidence For The Importance To Health Of The Spiritual Aspect Of Man

Sociology has abundantly demonstrated through the work of Moberg,³ Levine,⁴ Greeley,⁵ Jackson,⁶ and Garrett,⁷ that religion and spiritual values are one of the most critical factors in perception of "quality of life" at all ages and in motivating major health-promoting life-style changes. Caplow⁸ in the most recent evaluation of Middletown, USA has shown that religion is increasing, not decreasing, as one of the most important aspects of American life.

Social scientists, in other disciplines such as population science, social psychology and survey-research have recently affirmed this also. Their studies show that the majority of American people in the 1980's are religious, and polls such as Gallup and Harris show this religious element markedly affects health seeking behaviors and tendency toward healthpromoting lifestyles. Greeley and McCreadie⁵ at NORC, Chicago, in their survey of "the Ultimate Values of the American People," (1978) demonstrated the importance of religious affiliation to moral decision-making. Most recently Connecticut Mutual Life Insurance⁹ in their survey of the values of the American people in the 1980's showed the single most important variable in health promoting lifestyles was religious affiliation.

So the spiritual aspect of man, that aspect of man concerned with meaning, purpose and values, has been demonstrated recently by several social science disciplines to be key to thinking and motivation for health behavior and quality of life. Why has this aspect of man been ignored in explicit medical science in the last 50 years? Why if it is considered at all in medical schools, is it taught only in forms that are either anecdotal or a single case history, as part of the art of medicine, but not rigorously approached as a generic field in the science of medicine? If we evaluate ourselves objectively as medical scientists, that is scientists of man's whole health, we are immediately faced with the evidence of our imbalance and noncomprehensivity in considering the whole health of whole man. In medical schools, we have not undertaken major social science effort to measure the effects of the idealism, ultimate values, meaning and purpose in a man's life, on his specific health-seeking and bealth-promoting behaviors and on his responses to illness.

At least three factors can be cited for the development of the present imbalance in the way medical science approaches the whole health of man.

1. Modern Americans in general, including highly biomedically, technically competent physicians, are unskilled and underencouraged in philosophic thinking and confronting the larger meanings in life.

2. Only recently, in the last two decades, has social science technology attained the capacity to measure significant effects of the spiritual side of man on health behaviors and illness response.

3. The major popular USA educational media (TV, magazines and newspapers) selectively emphasize the somatic and emotional aspects of man. This imbalance in perspective on man by the popular media education was also supported in the past by the more vocal of professional psychological opinion. It appeared that some psychiatry and psychology in a rather glib way ally rejected the spiritual and values side of man's in their search to uncover his most authentic forgetting that values themselves are generative of man's most sublime feelings.

Faulty Psychological Premises Affected Past Perspectives

Because this third factor blocking our scientific comprehensivity in dealing with man's whole health originated with the medical profession, it is important that we look in depth at the faulty premise and assumption on which psychological neglect of the effect on human health of spiritual side of man was based. At the turn of the Freud, a man most interested in religion, ff 'red neurotic reasons why people might seek faith 0' G~e In blush of his new analytic understandings, with data, he conceptualized the possibility that man created himself and no God, external to man, necessarily needed exist. Freud firmly believed, however, that every man bad internal God-image as part of psychological develop But he then made the enormous philosophical assum that in adulthood, "The non-believer was ... normal." explanation was made for what the non-believer did with God-representation. Freud did not deal with the fact that non-believer needs an explanation for his lack of belief in God-representation as much as the believer does for belief About Freud's incomplete rigor in considering this aspect child to adult development, one modern analyst states,

a child whose parents forbid him to have a God may have to resort to a secret belief ... As long as men can follow their notion of causality to ib very end. . every human will have some precarious God representaton ... God will remain at least in the unconscious. We need our objects from beginning to end ... as Mahler says. It is the paradox of being bumaiL Freud's ideal of a man without illusions will have to await a new breed of human. ¹¹

Of course the metaphysical question as to the actual external existence, or not, of God, is beyond the discipline of psychoanalysis to answer; it has been a source of wonderment for the philosophic and theologic disciplines for millenia. Following in his analytic discipline, Freud's major dissentem including Jung, Adler, Putnam, Rank, and Biswanger¹² responded to his special emphasis that Freud's reductionist view of man was mechanistic, and did not take into account the capacity of man for transcendence. To man's transcendent dimension they gave several names: Adler called it "soul," Putnam called it "spirit" and the "imago dei," Rank describes it as "beyond psychology" and as "soul" or "spirit" Jung and Biswanger similarly refer to this dimension as "spirit." Unfortunately these analysts' views and statements on the spiritual dimension of man rarely, in the past, have been explicitly instructed in psychiatry departments at USA Medical Schools. Yet recently the spiritual side of man has become an increasing focus of modern analytic thinking.^10,12,13,14 William R. Rogers of Harvard, in his University of Louvain lecture series (1977)¹³ mirrored Freud's original list of seven neurotic causes for belief, with seven neurotic causes for modern man's unbelief. Recent analytic and object relations theorists in Boston,¹⁰ New Haven,¹⁵ and Durham¹⁴ accept as Freud did that every individual whether religiously affiliated or not has an "Imago dei," which is formed as a critical transitional object in human psychological development, but they further suggest that only when the individual can consciously examine and healthily bond with his unique fullest "Imago Dei," does he reach maximum human potential and wholeness. Giargos specifically expanded basic Freudian drive theory to state that every individual has a basic human-metaphysical drive (missed by Freud,) i.e., man not only has the drive for intra-human relationship (or human object bonding) but man also has an innate drive for metaphysical relationship (for bonding with the transcendent). Further, Rizzuto's analytic clinical research studies on 20 subjects¹⁰ offer strong empiric support to these recen advances in analytic thinking. So we see that superficial thinking and slurred development of premise, has contributed to the avoidance for nearly 50 years by the psychological medical sciences, of the importance of the spiritual side of man to his full health.

Chastised for imbalance in the way the medical profession has operationally viewed and described the health of modern man, and collectively remorseful for the faulty premise and slurred understanding of the limits of the psychological disciplines to answer eternal metaphysical questions, while simultaneously neglecting their responsibility to observe the effect of the spiritual side of man on health, we can now correct our error by inspecting some modern definitions of health for the whole man that explicitly address his fullest possible dimensions. To find these definitions, we turn to the theologic, philosophic and behavioral science disciplines. Systematic definitional analyses of three great thinkers of mento-spiritual health are reviewed by Sandborn in his book Models of Mento-Spiritual Health: an analysis of Hiltner, Boisen and Clinebell: 1978. ¹⁶ Tillich ¹⁷ as well as Gordon Allport¹⁸ and Roberts¹⁹ have also offered excellent theses. All suggest that mental health is critically dependent on spiritual health and conversely fullest spiritual health is not obtained without sound and robust mental health; a balanced interdependency between mental and spiritual health is critical for the health of the Whole man. Their theses urge full, balanced implementation of the World Health Organization's definition of health care: the three processes of healing of disease, prevention of sickness and promoting fullest health, in the three dimensions of man: body, psyche and spirit.²⁰

So where do we go from these more explicitly inclusive definitions of whole person health? in federal Washington, four indicators test the possibilities of new programs: It is (1) acceptable to the powers? (2) appealing to the people? (3) actualizable by the Congress? (and most critically) (4) after all that, truly implementable? The fullest definition of man's health (cited above) is philosophically acceptable. Whole person medical care, adding respect and concern for man's spiritual dignity to the best in traditional medical care of his body and emotions, is highly appealing to the 1980's consumer. This leaves the question: Is a Whole Person medical scientific approach to man's spiritual health care actualizable and implementable?

What are the practice and professional paradigms for integrating mental and spiritual health care? In the past two decades, concern for the clinical implementation of integrated mental-spiritual care has escalated in all levels of mental health professionals, best conceptualized by John Hoffman's book, "Importance of Ethical Confrontation in Counseling" (1978),²¹ and that of Peck (Connecticut psychiatrist), in which actualized spiritual growth is considered a sine qua non of full mental health.¹⁵ Analysts; MD-psychiatrists; Family, Marriage and Child Counselors; and MSW-all levels of mental health credentialed practitioners-have subgroups that practice spiritually-integrated counseling, known as Judaeo-or Christian-or combined Judaeo-Christian Psychotherapy.

Over the last three decades a new special health professional with theological credentials as an ordained pastor (rabbi or minister) and a Ph.D. in clinical psychological counseling, generally known as a Pastoral Psychotherapist, has burgeoned: they have a credentialing board, and in their professional society, The American Pastoral Counselors Association alone, are now listed 1500 certified Ph.D. members. The CAPS, an ASP sub-organization of Christian Counselors, has more than 4000 members. Additionally, the hospital chaplain, who in the early part of this century performed virtually only as sacrament administrator, now in the last two

Elisabeth McSherry, MD, formerly Associate Professor of Clinical Pediatrics at the University of California, San Francisco, is currently with the National VA Cost-Effectiveness Center, Boston, a satellite affiliate of the Harvard Center for the Analysis of Health Practices. A MPH-Candidate in the Economics of Health Promotion, Dr. McSherry finds this a needed discipline to document the effectiveness of spiritually-integrated healthcare and wellness programs. Recently one of her papers won as a finalist in USA HHS Secretary Margaret Heckler's First National Contest for Innovations in Health Promotion. Dr. McSherry lives with her two children, ages 14 and 16 years old in Concord, Massachusetts.

Clinical Models

What are some of the new clinical settings where we can scientifically observe the effectiveness of the clinically integrated mento-spiritual health care?

1. Hospices, the whole person health care centers for the nation's 400,000 dying of cancer each year, are mainly modeled after St. Christopher's in London, where the medical chaplain is the major health deliverer. Since the first USA Hospice at Yale, in eight years over 800 hospices have started in the USA.²⁴

2. As stated in the Pellegrino 1982 National Endowment for the Humanities report, in the last five years 126 of the nation's 128 medical schools have started medical ethics or humanistic medicine divisions; the quality and refinement of how ethics is conceived and taught in these programs has increased with longevity. There is still room for further refinement in this discipline of the theological sciences, as the British, who have experienced similar burgeonings of such departments in the last five years, so clearly report.²⁵

3. Pastoral Psychotherapy Counseling Centers and Christian (or Jewish) Mental Health Service Centers have burgeoned, at a time psychiatry divisions in general hospitals (and even at the Boston medical schools) are contracting or dissipating because of lack of clientele and sufficient support. "Life Enrichment," "Family health promotion," and "Marriage Enrichment" courses are often taught as group health education from such centers. Using the local churches, as well as the families, of their clients as extra therapeutic-hour support groups, these mental-spiritual health specialists often appear to have faster, more lasting improvements in their clientele's problems than those of other mental health approaches (Gordon report: USA Mental Health Commission, 1978.²⁶

4. Finally, perhaps the most interesting to a group of sophisticated internists, is the whole person medical practice model, known as Wholistic, (spelled with a W,) Health Clinics, Inc. Generally these clinics offer care to the physical, emotional and spiritual parts of man through a health team composed of a family practitioner or somatic psychologist, a pastoral psychotherapist or counselor, and a h educator nurse. Presently these clinics are based in general sites.

(a) The first site is in churches. The 12-year old Granger Westberg Wholistic Health Clinics, Inc. management group based in the Chicago area and supported by the Kellogg Foundation, has affiliated fifteen such clinics across the USA. and founded or consulted on at least 100 others. The church building, used Monday through Friday, is desirable because of its low overhead and easy accessibility and because of the 1; symbol it provides to the patient that his spiritual side will be cared for also. These clinics, in addition to a standard medical checkup, evaluate with a short written instrument, a (10 minutes) Holmes' stress events scale with a five spiritual question addendum. At the second visit, they provide the client with their unique health planning conference. At this conference, chaired by the Pastoral Counselor, all three health professionals and the client agree on a plan of action to promote the client's fullest health, which is based on needs identified in his Holmes' scale profile and his checkup. (For example, the health promotion plan might include a stop smoking group, a diet-exercise group, pastoral counseling to enrich marriage and teen communications, and to consider the developmental possibilities in spiritual prioritizing that may improve and facilitate former perceptions and responses to stress-provoking events.) Such conferences have reduced hospitalization days in these clients to 30-50% that of matched controls according to a 1978 University of Illinois evaluation study. In 1981, a repeat study of 3 WHC clinics showed 200-500 hospital days per 1000 people versus 500700 for HMO's and 1200-1400 for National Health statistics. Aetna with WHC, Inc. started a Wholistic Health Center Board in Hartford for the New England region two years ago.^27-30

(b) A second site for Whole Person Clinics is in a general building in a special-need community. Examples of this kind are the Klingberg Family Clinics, Connecticut, the Life Enhancement Clinics in North Carolina, Total Life Clinics in West Virginia, and the South Central Mississippi Health Board-Voice of Calvary Health Center chain of John Perkins, which is now a national model of self-help whole person medical care by the poor that has demonstrated itself to be remarkably cost-effective. This Mississippi product is now replicated in Boston, in the 100 churches membering "the Christians for Urban justice Wholistic Health project," and in other programs in Charlotte, North Carolina and Santa Ana, California.

(c) The third site for Whole Person Medicine Clinics is as a triage clinic in the Community Medicine-Family Practice section of State university medical schools. Granger Westberg has recently cloned his three person health teams in state medical school family practice teaching units at the Universities of Arizona (Tucson) and Washington (Seattle).

Beyond the clinical research and program evaluation research possibilities offered by these new clinical models offering explicit health care to the spiritual side of man, greater depth of theoretical research, scholarship and clinical research in the philosophic, theological science and pastoral psychotherapy-behavioral science disciplines are being brought to the tertiary care centers and to academic medicine. Four national Whole Person Medicine Research Institutes have started in the last year. They include, in Jackson, Mississippi, the Ford Foundation International Studies Unit of the John Perkins' Health Centers, funded to do survey evaluation studies on the effectiveness of this self-help, .1 affirm man's dignity" model of whole person health care to the urban poor. The Claremont Theology School in Pasadena under the direction of Howard Clinebell has started a Whole Person Medicine Institute for Basic Theoretical Research and a library of 130,000 references on the subject. The Granger Wesiberg Whole Person Research Institute with

The spiritual aspect Of man, that aspect of man concerned with meaning, purpose and values, has been demonstrated recently by several social science disciplines to be key to thinking and motivation for health behavior and quality of life.

Kellogg, Aetna and Blue Cross funding opened in Chicago May 8, 1982 to fund survey and delivery evaluation research for Whole Person health clinics serving the middle and upper class in stress reduction and health promotion. Martin Marty, the University of Chicago Theological School, Rush Presbyterian Hospital, and the University of Illinois Medical School are cooperating in Project Ten, a basic whole person medicine research institute, housed at Lutheran General Hospital with an anticipated library of 150,000 volumes. Other theology schools such as Gordon-Conwell, part of the nine school Boston Theological Institute, and Union Theological Seminary in New York City are moving into their communities by offering theoretic and theological scholarship to Whole Person Medicine Delivery models, thus providing for the substance and spiritual accountability of such models.

So far in this discusion, we have surveyed the modern theory and clinical models of Whole Person Medicine. We have seen that this acceptable and appealing medical concept is, in fact, implementable, thus fulfilling the four USA government criteria to start a new program. But now, not just as policy-setters, but as scientists, we must consider a fifth criterion: Is such a program effective for improving the health and well-being of the consumer?

Is Whole Person Medicine Effective?

Of major current interest to the USA government, Whole Person Health Care is highly cost-effective. The University of Illinois surveys (1978/1981) demonstrated that the health planning conference approach used in the Granger Westburg Wholistic Health Clinics, Inc., reduced hospital days to 35-50% those of matched controls (1978).' The John Perkins' South Central Mississippi Health Board Wholistic Clinics have delivered health care to the urban poor so effectively that they were cited by the Regional Atlanta Public Health Service Office (Dr. Reich) as a national model and compete favorably with other care models in primary care delivery to the poor federal grants. Addressing disease prevention and health promotion cost-effectiveness aspects only, the major USA public health problems in the 1980's are not physical disease as seen in underdeveloped countries but spiritually and stress-related illnesses predominate in many age-specific categories. In USA teenagers, and in young adults, the greatest morbidities are drug-abuse and unwanted pregnancv; the highest mortalities, in order of frequency, alcohol-related auto accidents, suicide and homicide. Among middle year groups, cardiovascular disease related to hypertension and arteriosclerotic disease (both of which have been shown to be related in part to stress response and lifestyles) is the major killer. Among the elderly, depression, loss of lifemeaning and interest, severely affects full functional health, And across all age categories ambulatory mental health disorders have been increasing annually and now newly affect 6-12% of the USA population per year with an ongoing prevalence of 20% of the USA suffering symptomatic mental distress annually.³¹ The great bulk (>75%) of these ambulatory mental disorders are cared for in primary care medical facilities; only a quarter (25%) by mental health specialists.³¹ Much of this non-psychotic mental distress is related to life priorities, meanings and values, i.e., the spiritual side of the individual has a major affect both on illness and for the health of the emotional side. Studies of Kaiser HM0^32,34,35 show that 60-80% of first visits to the internal medicine outpatient clinics are not primarily physical or psychiatric, but rather problems of meaning, purpose and value, and existential ennui, all sometimes described under the umbrella term "Anxiety of Wellness" or "the Worried Well."³² Kaiser refers out these clients to local Whole Person mentospiritual integrated counseling centers for specific care (e.g., Church of the Highland's San Bruno Counseling Center). Health promotion programs in the pilot Santa Teresa Kaiser model, that utilize specific referrals for spiritual counseling, have reduced annual outpatient visits for illness-care to 40% the Kaiser HMO control average.³³

How effective is Whole Person Health Concern on a major USA physical disease such as hypertension /coronary artery disease? Workers have demonstrated the importance of the ways in which we allow ourselves to perceive apparentlynegative events. If we are insecure spiritually, we may respond to such events with stressful reactions and the chemistry which, in the long term, impairs both mental and physical health [LeShan,³⁶ Lazarus,³⁷ Freidman,³⁸ Simonton,³⁹ Eisenberg,⁴⁰ Catlin ⁴¹ and Herbert Benson⁴² Other workers have demonstrated the importance of social environment (Nerem et al)⁴³ and physical affection in the prevention of artherosclerosis.⁴⁴ Two major national studies, Comstock's at Johns Hopkins⁴⁴ and in Alameda County⁴⁵ show weekly church attendance (and we assume the lifestyles frequently attendant thereto in such communities) is associated with a reduction in the incidence of hypertension, increased longevity and increased host resistance to infection. Recent articles since December 1981 in the American Journal of Public Health describe decrease in hypertension and increased longevity (beyond that attributable to non-smoking) in both Seventh Day Adventists⁴⁶ and members of the Missouri synod offshoot of the Mormon Church .⁴⁷ Further, in low income areas of Baltimore, Johns Hopkins reports churches have been very successfully used as high-blood pressure detection centers.⁴⁸ More experimentally-designed studies are needed that evaluate the effectiveness of spiritual counseling for effecting lifestyle changes that favorably affect the incidence of hypertension and coronary artery disease; the data so far, from the University of Illinois surveys of wholistic health clinics are extremely positive.

On the major teenage USA Public Health morbidity, adolescent pregnancy, a whole person values-oriented sexuality curriculum experimentally-administered to poor urban Baltimore blacks by the Joseph P. Kennedy Foundation working with Jewish, Muslim, Catholic and Protestant theologians and the Johns Hopkins Pediatrics Department, show an 80% drop in teen pregnancies as a result of the transdenominational generic values instruction in human relations between the sexes, taught by the curriculum."' Several Transdenominational Whole Person drug and alcohol-abuse centers for teens such as "Valley of Hope" in Kansas and "Touch" in San Antonio have shown higher rates of effectiveness than non-whole person programs.

Among the dying, the Hospice and Whole Person Care delivery has been shown to increase "Spiritual Well-being" defined at the 1971 White House Conference on Aging as .1 the ability to deal with negative reality with hope and competence" and facilitate the best response of the dying to their new realities.^3,6,50-52 

Among the elderly, Moberg,³ Jackson,^6,53 and Rosow⁵⁷ have shown that spiritual counseling and support produce measurable positive effects on health and health promoting behavior, as well as a sense of well-being.

Among many disorders seen characteristically in specific medical specialties, when research has been done, the effectiveness of the systematically-administered whole person approach, which includes values concern and spiritual counseling, has been demonstrated.^55-57 For example, in a University of Virginia study,' in age- and type of injury-matched orthopedic patients, the random assignment of a medical chaplain to visit daily was the independent variable associated with a decrease in days of hospitalization, amount of pain medicine ordered (to one-third the matched control group) and of unnecessary use of ward-based professional personnel time.

Obviously, the medical science of spiritual health care im the medical schools must continue to broaden its scientific base and increase its depth of experimental scientific studies to more adequately inform the medical community. In 197,& the 3rd National Conference on Classification of Nursijg Diagnosis adopted a spiritual disorder classification for the RN taxonomy. In 1982 at Duke University, the first national symposium for a medical taxonomy of patient spiritual disorders and resources completed an initial proposed medical spiritual disorders taxonomy that has been published under Duke University Press.⁵⁸ Modern social science measures of the spiritual profile and well-being of clients from such well-regarded social scientists as Moberg,⁵⁹ Ellison,⁶⁰ Spilka,⁶¹ Allport,⁶² Kohlberg,⁶³ Rest,⁶⁴ Fowler, ⁶⁵ and Holrnes⁶⁶ are available to augment the new clinical diagnostic assessments with those of objective instrumentation.

Clinical research experimental designs on the effect of the spiritual component of health are ongoing at many schools and general hospitals. At UCSF, one of the leading research medical schools in the country, this year a generic spiritual component was added to the six core curricula already integrated with the George Engel Bio-Psycho-Social Model.⁶⁷ Faculty participating with the students in the UCSF course design included psychiatrists, psychologists from levels of consciousness and developmental disciplines, a Rabbi-Ph.D, psychotherapist, chaplains and somatic medicine specialists with a deep background or credentials in theological sciences or social science research on the spiritual side of man.^68-75 Theology schools are now providing adjunct and full-time faculty to medical schools for in-depth scholarship strength in theological sciences, pastoral psychotherapy and behavioral sciences to offer a more accountable medical science in the
area of spiritual health care to the practicing medical world. Conversely, medical and public health schools, such as that at Loma Linda, are offering behavioral science and health education MPH degrees to ordained pastors to return them to their pastorate as more effective whole person health educators in helping to promote stress-reducing lifestyles in their groups.

So we see that the specialized scholarship and trained health professional manpower needed to broadly initiate Whole Person Medical Clinics and teaching is already imaginatively deploying itself to medical schools. Fortuitously the extra-medical graduate schools for the behavioral science of the spiritual side of man have been preparing specialist research scholars for over 20 years, and this talent can be moved, en block, to medical schools, to rapidly fill the specific health manpower need that such an imbalance in the operational definition of health has represented. Thus although as medical scientists we in the 1980's USA have been seriously incomplete and imbalanced in how we viewed the health of the whole man, we are uniquely fortunate in such a major health care deficiency to have an extra-medical bank of faculty level health professional behavioral scientists to move into medical schools, to rapidly build up specialty departments for the teaching, clinical care and research of the health effects of the spiritual side of man,

Whole Person Medicine is a scientifically, conceptually sound way to view the full nature of man, the object of medical science's study. From a sufficiently broad definition of the domains of man's health, we are able to appreciate that the integration of care for man's spirit as well as his psyche is now being described and measured explicitly by the social and pastoral sciences. This moves spiritual health care, from a previous assignment in the realm of the intuitive art of medicine, to an accountable, describable, scientifically disciplined practice of medicine for this specific aspect of the human personality. Mento-spiritual integrated health practice models are burgeoning in USA medical schools and elsewhere in the last decade, employing health deliverers specially-trained to explicitly care for this dimension of human health. Discovering that most of the major Public Health morbidities and mortalities in the USA in the 1980's (in youth and early and mid-adult age-specific categories) are not primarily of physical origin, as in underdeveloped nations, but rather have their roots in psycbospiritual and values-developmental problems, we saw how spiritual interventions on individual and collective levels can enhance health and increase both longevity and life quality. Finally' addressing the future of Whole Person medical teaching as . scientific, (not just an art), discipline in medical schools, we saw bow (a) faculty from theology and pastoral psychotherapy graduate schools could enrich the theoretical depth of departments in medical schools and (b) how modern social science instruments that describe and measure the outcome functions of various types of spiritual development in man, can be used now in experimental (randomly-assigned) clinical research in academic medical settings. it appears that for health promotional, as well as disease preventive reasons, and, in general, for the overall good of American Public Health, serious medical science consideration of the effect of health of the spiritual side of man, is a most fruitful area for future scientific research.

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⁴Levine, Sol. Personal communication.

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⁷Garrett, W.R. "Reference Groups and Role Strains related to Spiritual Well-Being" Sociological Analysis 40:43-58,1979.⁸Caplow, Theodore (Sociology, U. of Va) "The Future of Religion in Middletown," presented to the Society for the Scientific Study of Religion and Religious Research Assoc. Meetings, 10/30/1981, Baltimore, Md.

⁹Connecticut Mutual Life Report on American Values in the 1980s, Connecticut Mutual Life, 110 E. 59th Street, New York, New York 10022.

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____ A Critical Assessment of the Psychoanalytic Theories of Religion and the Crisis of Faith."

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___Behavioral Science, Religion and Mental Health," Ibid. #2, pp. 83-95.

¹⁹Roberts, Catherine. "Biology and the New Age: an evolutionary and ethical assessment," Perspectives in Biology and Medicine, 25 (2), pp. 176-193, University of Chicago, Winter 1982.

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²⁹Reidel, John et al. 2nd Univ. of Illinois Survey of Wholistic Health Clinics, Inc., 9/1981.

³⁰Westberg, Granger. "Multiplying Wholistic Health Centers," Chapter 9, Increasing the Impact, Battle Creek, ME Kellogg Foundation, 123-141, 1979.

³¹Regier, D. "Mental Health and distribution of care facilities: The defacto US Mental Health Services System," Arch. Gen. Psychiatry, 35, pp. 685-693, 1978.

³²Jackson, Jeffrey 0., and Greenlick, Mervyn R., "The Worried-Well Revisited," Medical Care 12(8):659-67, 1974.

³³Sobel, David. Santa Teresa Kaiser Pilot Health Promotion Progratn, San Jose, CA.

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³⁷Lazarus, R.S., and Launier, R. "Stress-Related Transactions Between Person and Environment," in L.A. Pervin & M. Lewis (Eds.), Perspectives in Interactional Psychology,

³⁸Friedman, M. and Rosenman, R.H. Type A Behavior and Your Heart. Greenwich, Conn., Fawcett Publ., 1974. Also: AMA 1/25/80.

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⁴³Nerem, R.M. Levesque, M.J., and Gambill, J.F. "Social Environment as a Factor in Diet-Induced Atherosclerosis. " Science 208:1475-1476, June 27, 1980.

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⁴⁶Harris, R.B., et al. "Child-adolescent blood pressure in Seventh Day Adventists (SDA) and non-SDA Children." AJPH, Dec. 1981, Vol. 71, No. 12, 1342-1349. Ibid. "Increased longevity among Missouri members of the Church of Latter Day Saints," (beyond projections related to nonSmoking), pp. 1350 ff.

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⁵³Jackson, J.J. "Marital Life Among Aging Blacks," Family Coordinator 21:21-27, Jan., 1972. Satin, David Ed. Religion and Autonomy in the Aged: A seminar published from the Eric Lindemann Community Mental Health Service and Psychiatric Medicine and Health Statistics Department, the Aging Division of Harvard Medical School and Mass. General Hospital, 10/26/1981.

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⁵⁶Pattison, Mansell, et al. "Religious Experience alone and complete reversal of homosexuality," J. Am. Psychiatric Assoc., December, 1980.

⁵⁷ Florell, J.L., "Crisis Intervention in Orthopedic Surgery-Empirical Evidence of the Effectiveness of a Chaplain Working with Surgery Patients" in Bull. of Amer. Protest. Hosp. Assoc., 29-36, March 1973, University of Virginia.

⁵⁸McSherry, E., Manganello, J. et al. "10 & 20 Spiritual Health Disorders at a Mental Health Clinic and Whole Person Medicine Facility; Health Integration Services, Inc., Peabody, MA," Duke University Seminar January 7-10, 1982, Duke Univ. Press, Wilson, W.P. Ed., June 1982.

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⁶⁵Fowler, James, Stages of Spiritual Development, in Perkins journal, Fal 1979 and Stages of Faith, Harper & Row, 1981.

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⁶⁹Dunscombe, D.C., Gershkoff, A.M., Nelson, R.M., "Medical Students in CPE,- J. of Pastoral Care, XXXII (3):179-183, 1978.

⁷⁰MeElhinney, T.K., (Ed.), Human Values Teaching Programs for Health Professionals, Institute on Human Values in Medicine, Soc. Health and Human Values, 3rd Edt., Philadelphia, PA.

⁷¹Dunscombe, D.C. (Ed.), Ministers in Medical Education, 5th Edt., Society for Health and Human Values, Philadelphia, PA, 1979.

⁷²Shriver, Donald, W.J. Chapter I -"Introduction to Post-Flexnerian Medical Education" in Medicine and Religion, Edt. by D.W. Shriver, pp. 4-5, #3 Community Health Series Society for Health and Human Values, Univ. of Pittsburg Press, PA, 1980.

⁷³Kohlberg, Lawrence. "A Cognitive-(Moral) Development Approach to Moral Education," The Humanist, Nov/Dec., 1972. Ellison, Craig. Modifying Man: Implications and Ethics, Univ. Press of America, 1978, Washington, D.C.

⁷⁴Vitz, Paul C. "Moral Education: A Comparison of Secular and Religious Models," in Moral Education, St. Paul Press, Boston, MA, 1982.

⁷⁵Vanderpool, Harold Y. "Religion and Medicine, a Theoretical Overview," J. of Relig. and Health, 19 (1):8-17, Spring, 1980.