Spirituality and Healing In Medicine: The Enhanced Importance of the Integration
of Mind/Body Practices and Prayer
On December 11th, 2004, approximately five
hundred people gathered at the Westin Hotel in Boston Massachusetts to learn
about and celebrate spirituality in the context of the medical world. The
seminar, “Spirituality and Healing In Medicine: The Enhanced Importance
of the Integration of Mind/Body Practices and Prayer,” attracted physicians,
nurses, clergy, social workers and others who work both within and outside
of the medical world. Attendees were from 38 states, 5 provinces of
Canada and places as distant as Iceland, Korea, Mexico and Guam.
The conference was sponsored by Harvard Medical
School, The Mind Body Institute,
and the George Washington Institute for Spirituality
and Health. The conference has been held annually for the past
14 years and has focused on some aspect of spirituality and healing.
This year’s conference came on the heels of an important and comprehensive
study by the NHIS which underlined the importance of prayer in healing
for many people across the U.S., hence the inclusion of prayer as the main
theme.
The purposes of the conference were to explore
and emphasize the need for recognition of spiritual beliefs and practices
amongst those receiving medical care and to provide ways to integrate mind/body
practices into everyday care. The speakers focused on scientific evidence
and the value of prayer, meditation and a variety of mind-body approaches
in healing. The first speaker was Herbert Benson, the director of the Mind
Body Institute who is famous for his work and his book, The Relaxation
Response, who presented this technique as a well researched and clinically
valid way to approach the mind body connection in healing. Much of the information
below is presented on the Mind
Body Institute website.
Dr. Herbert Benson - The Relaxation Response
There are three legs necessary to insure stability
in the healing process: pharmaceuticals, surgery, and self-care. Of the three
legs, the one that has been much overlooked but is now gaining recognition
is self care. Several recent studies have shown that most people practice
some form of spiritual or alternative medical practice for their healing.
Dr. Benson has been studying the connections between mind, body and spirituality
in health since the 1960’s. In the first portion of his talk, he detailed
his early research and his (and others) discovery of the “Relaxation Response.”
We will not go in to detail about the studies or the physiology, but generally,
according to Dr. Benson, this Relaxation Response (RR) has two steps in its
practice:
1. The repetition of a word, sound, prayer,
thought, phrase or muscular activity, and
2. The passive return to the repetition
when other thoughts intrude.
The effects of the process include:
lowering of oxygen consumption, breathing, metabolism and heart
rates, changes in breathing & brain wave patterns, lowering of blood
pressure and CO2 production.
As is widely known, the body has a fight
or flight mechanism which involves the autonomic nervoussystem and which
is evoked by any change that requires a behavioral adjustment, or stress.
Western society today is characterized by an epidemic of stress related illnesses.
But there is one important fact that is now accepted byt the medical community
and has been proven by numerous studies. The stress response, or fight or
flight mechanism is caused by a cascade of internal secretions, generally
hormones (catecholamines) which can be overridden by the cerebral cortex!
The cerebral cortex can override the fight or flight and generally this
is what the relaxation response does…it takes the body out of a stress response
mode and puts it in a different mode which is, in the end, healthier. In
fact, stress has been implicated in causing or aggravating heart disease,
diabetes, cerebral vascular disease, chronic pain, hypertension, sleep disorders
and many other conditions that are endemic to western society. Dr. Benson
cited correspondences of the relaxation response with ancient teachings and
practices. References to the benefits of the meditative state are found in
such sources as the Hindu Upanishads, the Christian prayers of the Desert
fathers, the practices of the Jewish mystic Kabbalists, Islamic Sufis and
others. In addition, the universality of the RR has been scientifically
verified in laboratory experiments. In one of these a group of healthy students
did either a short practice of an instruction from Zen Buddhism or a concentration
exercise, (number counting ), and had similar physiological changes. The
findings replicated those of a group of healthy individuals who practiced
transcendental meditation. When the experiment was repeated with different
groups - people who prayed regularly, with Rosary, Lord’s prayer, 23 rd psalm,
or Om Mani Padme Hum, the same changes (as mentioned above) occurred.
For an informal practice of the RR, instructions
might go something as follows:
“Choose a word, a sound, a prayer, or a phrase
in your own belief system to repeat. Even a simple word will do: “one,”
“peace,” “calm,” “ om,” “shalom,” any word will do, it’s your choice. Or
you can do a simple movement or exercise, such as tai chi. Always start
with quick relaxation of all muscles: feet, calves, knees, chest, back,
shrug shoulders, roll neck, relax face. Close your eyes. On the out breath
say your repetition...when you notice a different thought has come to mind,
don’t get angry or stressed about it but let it go and gently come back
to your repetition. Repeat for 3 to 5 minutes.”
Now let the person practice and follow up by
gently telling them that the time is up and ask for any follow up, ie:
“Do you feel more wide awake now?" or "Is there
within you a sense of well being?”
Emphasize the fact that the person who is practicing
need not feel deep relaxation every time he/she does the practice. Also note
that the RR should not be practiced within 2 hours after eating a meal. Ideally
it is practiced twice daily for 20 minutes. See http://www.mbmi.org/pages/mbb_rr2.asp
for complete instructions.
Decreased oxygen consumption, rate of breathing
and heart rate have led to the associated beneficial physiological changes.
A relative quietude in the brain opens the door to realization of other aspects
of selfcare and hence can carry forward to other possibilities of what the
person can do for him or herself.
Dr. Christina Pulchalski -Restoring the Heart and Humanity of
Medicine: Integrating Spirituality into Healthcare
Dr. Christina Pulchalski, a leader in the field
of spiritual care in medicine, provided several lectures that focused on
how and why all medical personnel should and can attend to the spiritual needs
of patients. In her first address, “Restoring the Heart and Humanity of Medicine:
Integrating Spirituality into Healthcare”, Dr. Pulchalski focused on those
aspects that can support anyone’s spiritual life, those of “service
and compassion”. Dr. Pulchalski spoke about how education and the delivery
of holistic approaches to medical care is possible indicating that The Association
of American Medical Colleges and The George Washington Institute for Spirituality
and Health have been working together to develop models addressing the spiritual
needs of patients, models that can be integrated into existing care situations.
“Spirituality”, she defines as, “how someone finds meaning and purpose in
their lives and it can be expressed in many ways- faith, religion, relationship
with a transcendent outside of a formal religion, nature, art, music, and
relationships.” The effects of coping via ones spiritual life thus can affect
a sense of hope, love and the ability to forgive.
Dr. Pulchaski suggests that if healthcare providers
can honor their patients’ spiritual lives, as well as their own, in the context
of coping and healing with illness. The medical system of care can itself
be restored to an entity of care and compassion for those that it serves.
Dr. Puchalski outlined how compassionate care focuses on all dimensions
of suffering: physical, psycho social, emotional, existential, spiritual.
The caregiver’s role will change depending on the area of the greatest need
for the patient. Listening is important. The root of suffering is a sense
that “ what ought to be whole is being split apart.” Healing is integration
of self, people moving from a sense of being broken to a sense of wholeness.
Spiritual Issues are: meaninglessness, hopelessness, despair, lack of
forgiveness, anger, abandonment, feeling unloved and unconnected. Our encounters
are an opportunity for us to connect with our patients – to feel loved and
heal the unconnectedness.
Dr.Puchalski went on to outline
the findings of the Ethics Consensus Conference 2003:
Obligation to respond to suffering and provide compassionate
care.
Spiritual needs are important to patients.
Respond to suffering and provide spiritual care.
Spiritual care is interdisciplinary.
Not intended to replace Chaplains.
Care should be non-coercive/ patient centered.
Professional boundaries are important
The importance of being present and compassionate.
The definition of spirituality is very broad
and not limited to religion.Spirituality contributes to health. Patients
are looking to their spiritual beliefs to help them cope with illness and
in this way they are empowered to care for themselves. The concept of spirituality
is found in all cultures and societies. It is expressed in an individuals
search for ultimate meaning through participation in religion and / or belief
in God, family, naturalism, rationalism, humanism and the arts. Spirituality
helps those who are ill in the following ways:
Gives hope – for a cure, for healing, goals or a peaceful death
Gives a sense of control
Allows the forgiveness of self and acceptance of the situation
Gives strength and purpose
The root of our work is spiritual. Illness and
stress are triggers for spiritual quest – what gives meaning and life. 40%
of patients say their life is better after their illness. This makes
one look at life a lot differently. Many come to more fully appreciate their
lives because of their illness. “ By looking at these questions I
could look at my life deeply.” Conversely, attachment to a hurt arising
from a past event can block the flow of hope into ones life.
When including spirituality and healthcare important questions are: How
do we find meaning in changes through our life? How do we interact with
our patients and with ourselves?
Topics of Research in Spirituality and
Health include:
Coping
Health outcomes
Quality of Life
Mind-Body
Surveys on patient need, healthcare
Professional talking with patient/integrating spirituality into care.
What do patients think? It does it make
a difference in care.
In the workshop portion of the day, Dr. Pulchalski
spoke more specifically about models of taking spiritual histories (FICA)
and assessing spiritual needs through case studies and exploration of a variety
of interventions.
The FICA model of taking a spiritual history,
according to Dr. Pulchaski, involves; “F”- “Faith and Belief”, I - “Importance”,
C - “Community” and A - “Address/Action in Care.”
The Doctor asked us all as participants to pair
up and work with the accompanying questions to this model such as “Do you
have spiritual beliefs that help you cope with stress?” and “What role do
your beliefs play in regaining your health?” Personally the questions came
easily and it was nice to be asked about my personal beliefs, things that
matter to me most. This FICA model runs fairly smoothly, it seems, in application
although the obvious potential problem is that it will require more time,
something many people asked about. One gentlemen in the crowd who works as
a chaplain in a hospital asked about the private nature of asking such questions,
inquiring if we are acting intrusively by pursuing this line of questioning
with spiritual care. Dr. Pulchalski responded by saying that “we take histories
related to people’s practices of physical exercise” indicating that we are
finding out how individuals care for themselves, physically, spiritually
and emotionally, one aspect being no less intrusive than another.
Dr. Pulchaski did clarify that these are spiritual
histories and assessments that healthcare providers are seeking, and that
clergy, chaplains and spiritual leaders should be called upon as experts
when spiritual distress is identified. She emphasized that “proselytizing
is not acceptable in professional settings” and that praying with patients
should be considered with the utmost respect for the patients needs and requests
based on a trusting relationship between the healthcare provider and the
patient.
Overall Dr. Pulchalski encouraged and modeled
(in her own behavior) with the audience how compassionate presence and an
openness to dialogue about interfaith challenges can create medical systems
that offer a place for healing, alongside of technology. She honored all
questions and worked with the audience participants in ways of service. The
experience of this encounter seemed to have participants feeling valued, supported
and ready to offer the same to their patients.
Dr. Richard L. Nahin, PhD - Who Uses Mind/Body Therapies, Including
Prayer for Health Reasons, and Why?
As part of the first days events, Dr. Richard
L. Nahin, PhD, MPH led a discussion entitled, “Who Uses Mind/Body Therapies,
Including Prayer for Health Reasons, and Why? Data From the 2002 National
Health Interview Survey”. Dr. Nahin was equipped with many statistics
that NIH is accumulating in relationship to the power and influence of mind/body
practices on ones health status. Dr Nahin represents the National Center
for Complementary and Alternative Medicine (NCCAM), a component of NIH, created
in 1999. The NHIS report reviewed in this lecture was about how
the public is using certain mind/body practices, “concentrating on the who,
what, when, where and how.” Dr. Nahin reviewed comparisons in statistics
related to the use of “prayer for health reasons” versus the use of “complementary
and alternative medicines (CAM)”. Specifically, income, age,
gender, race/ethnicity, culture/geographic location and education were measured
with some outcome generalizations that seemed interesting and relevant. For
instance, prayer for health reasons was used more often that CAM in the southern
part of the US. The west utilized CAM more often, “1.5 times more often”,
than any other region and all regions used prayer for health much less than
the south as a whole. As far as income, the more people made, the more
they used CAM and the less they use prayer for health, which is a similar
trend with education re; the higher the education level, the more use of CAM.
Blacks and Native Americans were found to use more prayer for health than
whites. Prayer for health went up with rising age, and women use more interventions
both with prayer for health and CAM, than men. Overall this talk by Dr. Nahin
provided the necessary data and justification for healthcare providers to
incorporate such services into the healthcare system. For information
see: http://nccam.nih.gov and for the
NHIS survey see: http://www.cdc.gov/nchs/nhis
Dr. Benson The Power of Belief and the Role of the Relaxation
Response in Healthcare
Dr. Benson expanded on his morning lecture, “The Power
of Belief and the Role of the Relaxation Response in Healthcare”, during
an afternoon workshop. Again he reviewed the physiological benefits of using
the Relaxation Response and how one’s health could quickly benefit. However
more emphasis was place during this discussion on the power of belief. Dr.
Benson relayed personal stories of both family and patients that exhibited
seemingly miraculous responses in healing when a persons spiritual beliefs
and practices were incorporated during times of illness related stress.
He spoke of a study done in South Central LA where the students were taught
the relaxation response and encouraged to practice this daily. The outcomes,
according to Dr. Benson, showed the students gained improved concentration
and ability to focus and learn. Dr. Benson reviewed a bit of history in
the development of the medical system related people’s beliefs as a culture.
He reported that about 150 years ago “all medicine really had was beliefs”,
until the 1850's when Pasteur discovered “that certain diseases were caused
by certain bacteria” and then in the 1920's when insulin was discovered.
This, the Dr. reported, affected the general populations beliefs in medicine,
recognizing that some illnesses could be cured by medication alone. This
altered beliefs in healing from within until the “Placebo Effect” came back
in the 1950's. Dr. Benson outlined “Three Components of Remembered Wellness”
that have to do with the “Placebo Effect; 1- Belief and experience on the
part of the patient, 2- Belief and expectancy on the part of the care giver
and 3- Belief and expectancies generated by a relationship between the patient
and the care giver”. These beliefs are important to explore given their value
on the patients ability to heal, thus “placebo=belief”. Dr. Benson
advocates that the scientific focus of the effects of these beliefs on one’s
health can help sustain the use and value of such practices in treating disease.
“If you believe in the therapy, the therapy will be enhanced”, says Dr. Benson.
So I asked Dr. Benson about the apparent problem we have culturally in addressing
the needs of the dying, specifically in initiating someone onto hospice care.
As a hospice worker I often see the effects of a person coming onto the hospice
service one to two days prior to their death- often in physical pain with
a family and patient feeling shocked and unprepared to experience the dying
process of a loved one. I asked about beliefs about dying, wondering if earlier
referrals are possible so as to have the time to assist the patient and family
in addressing all issues of pain, physical, psychological, spiritual and
emotional. Dr. Benson concurred that my current approach of validating with
a patient how hospice care can engender their well-being in the midst of
their dying, is in fact the main approach. He advocated further the need
to continue to educate as possible that dying does not necessarily equate
to the belief that there is “nothing more that we can do” when curative efforts
are no longer in sight.
Skills to Build a Meditation Practice: Deeper is Better – Margaret
Baim
In this interesting afternoon workshop, Ms. Baim
talked about her work at the Mind Body Institute. She described three
reactions to stress: intellectualizing, feeling overwhelmed and feeling numb.
She talked about using the relaxation response in conjunction with positive
psychology to promote better mental and physical health. She described how
people that she sees at the Mind Body Institute are encouraged to
find their own way and to build a meditation approach. She showed how simple
concentration exercises lead to contemplation. As one is building a meditation
practice they should not look for immediate results, but measure their progress
decade by decade. In using positive emotion combined with the relaxation
response and meditation, one can focus (meditate) on an inspirational figure,
something beautiful, someone or something they are deeply devoted to or
deeply appreciate. This inner work can effectively turn around illness and
negative emotion.
Greg Fricchione -The Potential for Illness Prevention via Spirit-Mind-Body
Approaches
The second day of the conference brought continued enthusiasm
and information from leading scholars in this field of Spirituality and
Health. Greg Fricchione, a psychiatrist at Mass General Hospital, spoke
about the potential for illness prevention in spirit- mind body approaches.
This talk was packed with information - an outline of it is presented
below:
Objectives:
To review present state of knowledge regarding pathogenic effects of stress
and allostatic loading.
To review present state of knowledge regarding stress buffering and health
strengthening effects of relaxation response, cognitive behavioral therapy,
social support, belief and conscious expectation.
To define resiliency.
To review some potentially instructive prevention studies.
To summarize with an evolutionary perspective.
Implications for modern medicine.
Talk:
We hope to prevent several illnesses with mind
body approach. Stress is a challenge, hyper arousal, with implications for
the organism. There is cascade of effects- thalamus sends info to amygdala,
which mediates fear responses, when aroused, send messages to hypothalamus
and outpouring of catecholamine, adrenaline, noradrenaline. There is another
hypothalamic, pituitary, adrenal and thyroid mutually interactive cycle.Hans
Selye investigated this thoroughly– when stress becomes overwhelming it’s
dis-tress.
At the end of the stress response, when the organism
can handle no more stress, is conservation withdrawal, curling up in a ball
and giving up. Allostasis is maintaining stability or homeostasis thru change,
investigated by Bruce Mckewen. Allostasis is the ability to change, adapt.
This is orchestrated by higher mechanisms, they predict and overrule with
the cerebral cortex as a maestro over the body system, controlling blood
pressure etc. There is a price to pay for having continual stress or allostatic
loading and measures of AL are cortisol, norepinephrine, epinephrine etc.
Anxiety and depression can be seen as allostatic
load disorders. Anxiety is related to the separation that we feel and connected
to Coronary Artery Disease.Depression, affecting 6-17% of adults, is a
big disabler
Depression and CAD, ischemic heart disease, related,
1.5 times the risk
HTN, atherosclerosis, cardiomyopathy, metabolic syndrome.
There is research coming out: rat pups that have
nurturing mother will actually have different genetics than those who are
not nurtured. Then following through to adult hood the adult children
of the nurturing mothers are much better able to deal with stress.
Relaxation Response – self induced stimulus, break
train of everyday thought, repetitive mental or physical activity causes
decreased O2 consumption, HR, arterial BP, resp rate with decreased metabolism.
Cognitive behavioral therapy: substitute positive
thoughts for habitual anxiety and depression provoking ones. Best in 6-12
weekly sessions, recording of automatic thoughts and resultant feelings
in a homework diary along with testing of behaviors and cognition that relieve
anxiety and also role playing situations
Social support – helps reinforce positive behaviors,
can change neuro biology and physical status. Stress involves appraisal
of demands and adaptive capacities which are affected by perceived availability
of social support.
Social stressors can be life changes. Stress lowers
the threshold for a disease that you may be vulnerable to. This should be
on the mind of every physician who is evaluating someone.
Social support: ION report 2001, reports on doctors
style, need for charity and caring, if you add an empathic warm emotional
ingredient to the cognitive element then you get a better outcome.
Studies were cited that illustrate importance of social support in women
with Lupus and also with people with irritable bowel, ischemic heart disease
and depression.
Woloshin etc studies per social support and recovery from
heart disease
Belief and conscious expectation
History of the placebo in medicine
Placebo effects stem from patient belief in the
doctor’s ability to heal them. Positive conscious expectation of a return
to wellness is important as it stimulates the brain to produce sense of pleasing
security with a decrease of allostatic loading.
Top down control of stress response systems - belief
and positive expectation diminish dis-ease.
Recommendation of a book entitled Health Wars
Placebo response : belief can be in everything or anything,
learned optimism and placebo - top down neuroanatomy, placebo is an
active approach to healing. Parkinsons patients and pet scans – just by giving
a placebo to PD pts there was improvement of PD (elegant study with receptors)
in Science magazine.
Another experiment looked at mothers with healthy children
vs chronically ill child, the mothers with chron ill children who had high
perceived stress showed shortening of telemeres, aging markers, that was
10x that of mothers without perceived stress.Telemeres – oxidative stress
related, related to resiliency of neural mechanisms...affected by reward
and motivation, fear conditioning, social behaviors.Some people cannot differentiate
stimuli and lump them together, need to be able to quickly extinguish
a learned fear. Secure attachment is important.
Brain evolution – earliest organisms have sensory apparatus
and effector apparatus/ motor apparatus – approach and avoid -
the history of the brain shows that the human mechanism works best
when the human is in environment of secure based attachment and social support.
Evolutionary movement is to social support.Deep down in limbic brain you
know that separation is the deepest threat. Unicells move according
to chemotaxis, the drive of human beings is toward spiritual connection or
spiritotaxis. We have ability - have downstream spiritotaxis – upstream spiritotaxis
is more important – when buffeted by illness has effect of solace, you
can have successful end of life if you are gifted with the ability to do
spiritotaxis up stream.
Implications for the system – managed care takes no
heed of what organism is all about. That is a problem, it is in scientific
interest not to ignore what goes on in the brain. The topic of mind body
medicine brings you back to what the human being is all about – the person
is not a gearbox. Keep working to advance this study and never let the perfect
be the enemy of the good.
The Power of Community in Health and Healing - Rev. Natalia (Tanya)
Vonnegut Beck
The Rev. Tanya Beck spoke about “The Power of Community
in Health and Healing” emphasizing the need for social support, awareness
of one’s essence or spirit, and a model for building community. Dr. Beck
defined community here as “a group of people unified by a common trait”. So
in her community building model she spoke of the need to “focus on
the issue, not the personality that is there”. The guidelines of this community
building were outlined as 1- Purpose for being, 2- Rules to live by (No Gossip,
No questions, Listening, Doing the Job Well without judgment of how others
are doing their job) and 3- Responsibilities to Fulfill (recognizing that
people come together for a reason and to affirm one another in that goal).
Rev. Beck spoke further about the needs for communities and faith traditions
to act with caring, and compassion, functioning with an open and inclusive
set of rules of belonging. She also placed her attention on our needs
as an audience, our needs for self-care hich was refreshing. Rev. Beck
spoke of “serving ourselves” and being rooted in the present, recognizing
our own essence and it’s wisdom and intuition. She noted the importance of
looking at reality as clearly as possible for that is where actual healing
can begin. Upon reflection of what is important in developing groups and
communities, Rev. Beck outlined what she calls “The Covenant” which incorporates
“honoring all that is said”, noting that one “always has a right to
pass” in discussion and to avoid “interruptions, this takes power away from
the person speaking”. In this community development model important aspects
identified were; ability of the community to cope well with difficulties by
acting creatively to solve problems and inspiring one another. The most important
factor in this kind of environment is trust, the feeling of safety.
A more detailed outline of her talk appears below:
Changing times, what is our role in these changing
times? Most important issue is that of social support.
Everything said here is relevant to your patients but also to you (conference
attendees). Topic of this discussion is - where does the spirit become essential
- she will present a simple model to build community.
We are living in a time of change, we are a people
in ransition, we want people to know what our thoughts are. We have more
information at our fingertips and responding is imperative. Yet we experience
isolation in everyday lives, wanting more connection. We lose who we are,
want to connect with other people and connect with greater essence.
This gives power to go with the ebb and flow of life, cry for
empowerment, sanction our insights. The community is a group of people unified
by a common trait
Post 911 story of the Trinity Church in NYC, feeding,
music, massage therapist, podiatrist, all volunteers working at the site
to give relief to rescue workers - the volunteers changed everyday. Everyone
was given a job – the place was ready to go. Chaos supreme, but it worked.
There was a focus, a reason for being which is a main aspect of a good community.
City inspectors said food couldn’t come from all hotels – but the police
made a circle around St. Paul’s and just stood there until the inspectors
left. The reason the project worked is because they had a commitment...
1. Purpose for being,
2. Rules to live by,
3. Responsibilities to fulfill – a mandate to answer the work that was
being done. Come together for a reason and we know what we want to do about
it. We know in the reality of this moment we know that changes are
desperately needed.
4. Affirmed one another all the time. Police and fireman and EMT were
always thanking them for what we were doing. She did mass – for the
Catholics. This is a real church, “that essence of caring and compassion
and really listening, and being absorbed with others.”
When there is this transformation – there is hope.
A state of mind – not a state of the world. Hope is an orientation
of the spirit. Vaclav Hagel – pres. of Czechoslovakia. Hope is not
the same as joy when things are going well, but rather for something to
succeed. This hope gives us the strength to try new things. Important
in these times to have the spirit alive. What was alive in the chapel in
Trinity – during and after 911. The horror of the world trade center
added a sense of urgency and to the search for spirituality.
In this moment learn how to serve yourself so you will
be available to serve others. There are so many others crying
out to us to be served. We need to see that what physicians and others see
as dis–ease is a struggle of the spirit. We cannot solve the pain of those
coming to us but we can listen well and empower. This is a tremendous
task for us which causes higher expectations on ourselves. When we
face reality rooted in the present moment we can start talking about healing.
When we face the reality of the moment. People become empowered when they
affect all of themselves. With a community this can happen. Mountain-top
highs, an outside expert comes in but then we come back to our roots, what
now? How do we develop a sense of community? Knowing how to facilitate
this - it needs to begin with us. We need to experience this in ourselves
also in order to offer it to others.
Many spiritual and not so spiritual retreats turn into sounding boards
of frustration.
1 – Sense of isolation
2 – Disappointment in the careers we chose. We wanted to touch, love and
share. And we don’t have the time to do that. Only 5 – 6 minutes with each
patient. I can’t be who I wanted to be.
3 – There is a lack of trust with the people and institutions we serve.
No more loyalty . People move from one institution to another. Move
people all the time. Not a sense of trust.
4 – Self worth is dissipated because we don’t seem to offer what people
need.
We keep our masks on, our true self deeply submerged.
Not to reveal our weakness to anyone. Risking sharing with anyone is thought
to be potentially disastrous.
Story of massage work, laying on of hands in Florida
6 years ago. An operating room nurse came in – she couldn’t go to
work one more day…it was too stressful. The group could help. On Tuesday
night, helped and on Thursday night the OR nurse returned with 3 more nurses.
About 2 weeks later they came in with a doctor. He is open to the fact
that things are very turbulent in the surgery room and wishes he could help
with that. Now those nurses and that doctor get together at 5 in the
morning. They do some relaxation response, share what it is happening, frustrations
etc, - and then go out and do their day. Takes only 5 minutes. Doesn’t take
a lot of time, only intention.
If we don’t have a community – we need to create one
for ourselves. Last night 149 people were at the creative dialogue.
14 tables with 6 to 12 at each table. Went thru steps of forming a community.
We started out by doing a covenant – and sharing, began to list the issues
that we heard about in the conference. All the things we had been hearing.
Choose one of those things at your table to discuss. Pick a scribe to take
the notes, give some reasons why it is, give some resolves, and then where
you might fit into the resolution of the issue. At the end – these
are the main words that you think are the questions we have to deal with.
Empowerment
Integration – into the setting. The spiritual life and the whole staff.
Starting with the housekeepers so that everyone knows what everyone else
is concerned about.
Reform – institutional reform. – Maybe our grandchildren will be
able to do something about this.
Self Care.
A Broader View.
Just Love People – to be a loving presence.
Dialog.
Spirituality.
Gratitude.
All came out of 1.5 hours together. It was a community. There was a sense
and energy in that room. Good ideas. Focus on what do we need to do.
Knowledge is in people. Information is in ideas and in paper.
When the individual spirit is connected to the group, people become connected
to something deeper. The group process allows parties to speak.
To facilitate a community we have to ask:
Integrity – do I really want to empower all these people to find
the road to health… to realize they have within themselves the power to find
their own health?
Intention: Can I offer my undivided attention to that person
for a particular period of time, intentionally listening to what they are
saying? It is the basis of trust.
Risk: Am I able to risk a process that does not promise success?
Lao Tzu asked: Do you have the patience to wait until the mind is clear?
Are we able to take the risks and sit and trust the process.
A covenant must do this.
Start the group every time by repeating the covenant. The only way
trust can be built over long period of time. Live in reality of the moment,
don’t block whatever comes up.
Handout:
Levels of Living
1 – Survival Area - We are not God , we can’t be at the top all the time.
It makes no difference what your credentials are – what your sense of worth
is. Must make a list for someone in the Surviving Area. Someone
provide the support system for the person. Recognize that fact and give up
the expectations that they are in some other arena.
2-Coping – we work from outer structure. Life as a struggle.
3-Creating Level – constant challenge of yourself.
4-Collaborative Level – people share with one another. Ideas and people
get together, form a team, be a community and see if we can make some change.
The Levels of Living can be a real tool when you are
working with staff or teams to see where they are and talk about how to
bring someone up the level, and support folks. Wonderful for marriage
relationships and significant others. Communication.
In every group team, there needs to be a time to do
an affirmation process. Ask your team members to write down 10 life
successes – everything from graduating high school to living thru terminal
illness of parent. As the person speaks to their life success
--- words that show the strength list all of those and then one by one
and go up and look at the person, look them straight in the eye and tell them
those 10 words. We’re not used to hearing good things about ourselves that
came from us. It is from the person and reflecting back to themselves.
Put it on the refridge door and remind themselves. Powerful tool.
Example from last week: 20 terminally or chronically
ill people came together. Did affirmations. In the introduction part a woman
said “I don’t know why I am here. I don’t talk to people, I came out
of a childhood abusive situation and now faced with another situation tumor
on ovary and need it removed immediately, I don’t think I can do this.” We
began talking about the positives. We saw as she began to realize inside
her was all the power she needed to make the decisions and deal with them.
She said she quilted whenever she got into one of these situations.
Never showed them to anyone. Sunday morning , she came back. Tucked under
her arm was a quilt.
“I want people to know that I am alive. And this is how I am alive.”
She got a blessing on the quilt – that is the power that is available.
All of this is about community that we have to build
trust. People are able to say what they think and to disagree with
one another.
To raise the trust level – be consistent on the focus
on the unifying issues, not the personalities, honor the covenant, allow
for chaos to occur in the best sense of the word. Use silence – don’t
be afraid if it gets very quiet. Be very faithful in the attendance
to the meeting with your people.
GB Shaw – The true joy of life – being used up for
a purpose recognized by yourself as a mighty one, and to be of service and
use to others
Panel discussion - The Use of Prayer and Mindfulness in
Healthcare
The Panel of professionals who addressed “The Use of
Prayer and Mindfulness in Healthcare” each spoke from their faith traditions
and practices and how their work has manifested in their individual paths.
The talk is presented below in outline form. Representatives were
as follows:
Buddhist – Kusala Bhikshu, BA
Catholic – The Rev. Joseph J. Driscoll, MDIV
Christian Scientist – Giulia N. Plum, CSM
Jewish – Rabbi Simkha Y. Weintraub, CSW
Muslim – Imam Yahya Hendi, MS
Native American – Terry Tafoya, PhD
Protestant – The Rev. Dr. Teresa Snorton, DMin
The Rev. Natalia Vonnegut Beck, MA - facilitator
Terry Tafoya, of the Native American tradition spoke
of how prayer is part of his tradition and that of his community. “Taking
a sip of water is prayer,” according to the North American Native Tradition.
Giulia N. Plum, a Christian Scientist spoke of prayer
as “a purpose to connect with God, shift our way of thinking, and see our
self, our oneness with God”. She says further, “Prayer moves and changes
us, helping us be who we are”.
Prayer in Christian Science – helps us get answers to the question Who
Am I?
Christian Science is a universal practical prayer based system. Discovered
by Mary Baker Eddy. Founded the First Church of Christ Scientist. Always
free to choose any method of healthcare. Church membership is not pre-requisite
for practice of Christian Science. Mary Baker Eddy lived a deeply
prayerful life, love for the teachings of Jesus and for all humanity. She
realized there was a science behind the way that Jesus healed, provable scientific
laws that could be practiced any time. This was the core of her work
as spiritual healer. Cancer, paralysis, blindness, pneumonia, broken bones,
heart disease, broken homes have all been cured with Christian Science. Proved
in her book – Key to Health with Science and Health. Purpose of prayer is
to connect us with God and shift the basis of our thinking from material
to spiritual nature. Fundamental to the spiritual perspective is God’s
nature and power as good and only good.
This is a practical loving presence. And we are God’s image in likeness.
Everything is in us – inseparable spiritual relationship with God. Examples:
patient, forgiving, or unlimited. Can show all the qualities that are
in Deity. Prayer comes in to help this. It is heartfelt devotion that
strengthens us. Prayer lifts and redeems us and frees us. Examine our
motives for prayer. Not a pleading for something or a repetition of words.
The effect of prayer is the fulfillment of its purpose.
It aligns our thinking with the all good spiritual power that is God and
relieves us from fear, guilt, etc. and other negative states that underpin
disease.
Prayer is not an activity of the human mind. Effective healing prayer
demands that we live our prayers day by day.
Prayer (Chapter in Science & Health)
Imam Yahya Hendi, of the Muslim tradition, spoke of
the “Five daily prayers” which he defined as; “Focus on God, to God we belong
and God we return, Glory be to God, God is the greatest and Praise and Thanks”.
He says, “a Muslim patient believes in the power of the prayer.” In Muslim
“Imam” comes from the same root as “dust.” The Imam claims that
his nationality is “dustian.”
ISLAM sounds/ comes from Shalom, meaning peace, the building of peace.
Islam teaches that peace has to be established on different levels.
1.– with God
2.– with others – fellow human beings, nature, environment
3.- with one’s self.
Flesh, Mind, Soul, Heart – 4 elements make the human being.
Vutra. Translated as the thing that makes the human being - the relationship
between those 4 elements. Does go thru disorder – called sickness or disease.
One has to serve, or deal with the mechanical disorder of the body, mind
or the way they function and deal with the inner intangible side – the mind,
soul, heart, that is called prayer. Sometimes referred to every
good act of the human. Act of prayer is eating, sleeping, intimate relation
ship with spouse.
And also the focus of person on God who knows how this works and ask for
guidance on how to bring about order
5 daily
Started by focus on God. Can eat, cannot be chewing gum, not drinking
water, not talking focus absolutely on God and bring order to that organ.
Make Zhikr – focus on God, say different things. “To God we belong
and to him return. “ “Glory be to God.”
“God is the greatest,, praise and thanks be to God.”
Help us with our relationship, recharge, rethink, and step aside to see
if we did something to bring about something to create that disorder.
To bring about comfort the Doctor is to use Islamic terminology – Inhallah
– god willing. Salaam -Peace be with you. Praise be to God. Patience.
Helpful advice or doctors to interact with Muslim patients:
Even if you don’t believe in power of prayer, the Muslim patient does.
A man was finding his way swimming to a shore of a sea. Noticed the current
of water running over him. Looked behind and saw a shark.
Looked up and said, “God help me -I thought you don’t acknowledge me."
God said, “Yes, I don’t...but the Shark does.”
The shark continued to swim to the man and opened its mouth, but just
then as it was getting close it froze. The man said, “Thank you, God!”
Then the shark closed it’s eyes and said “God, thank you for the food
I am about to receive.”
Rev. Dr. Teresa Snorton says this about her Protestant
faith and belief in prayer, “Prayer articulates that which is most ultimate.”
Theresa Snorton, - CPE – pastoral care. Ordained Methodist
minister. Been a pastor, chaplain in psychiatric facility, in hospital,
and university medical setting
Presbyterian Seminary, Baptist Grad School, and attends Afro Centrist
Church.
Christian faith encompasses a lot of faiths. Make a distinction
between patient’s religion and their spirituality.
Basic spirituality – 4 components:
Awareness of the Transcendent
Sense of Belonging
Sense of meaning and purpose
Sense of Creativity
Grandmother baked apple pies – she sang and she prayed. She delivered
pies to sick, family of death, loss of job, or someone who needed cheering
up. She was a religious woman but her spirituality represented itself
in a different way.
Relevant questions are: What is your religion?
What are your private spiritual practices?
How do you have your sense of community, to God and the rest of the world?
Prayer in the Protestant tradition. Martin Luther in protest determined
there was another way to worship God and to live with God.
Faith is payer and nothing but prayer. For prayer is at the very
heart of religion. Prayer is articulating that which is most ultimate. To
a God that is faithful, response.
PUSH – Pray until something happens.
ASAP – Always say a Prayer
FROG --- Fully reliant on God.
Reliance on prayer is a central demonstration of faith. Lord’s prayer
in New Testament is a model of how to pray.
Answer to prayer is sometimes immediate, sometimes delayed, sometimes
no, and sometimes yes.
Prayer is a part of our responsibility and the appropriate way to expect
God’s healing and to ask for God’s healing. There was a story of a woman
who was very faithful churchgoer.
On the day he died, she said “ I have done what I was supposed to do.
Believing in a miracle and God has answered. So now, you’ll pray for me.”
Wide variety of prayer – written, spoken, memorized.
Other – responsive – evangelistic – spontaneous - all at the same time.
Ask about the tradition and the religion, but be aware of the person who
lives within those traditions, then you will be equipped to care for the
person for whom you are serving.
Rabbi Simkha Y. Weintraub outlined two aspects of Jewish
prayer, “prayer itself” and “the ability to pray” . He says “Pray in order
to be able to pray”, identifying five prayers of importance; “ Prayer to
the service of the heart, for petition, thankful acknowledgment, praise, to
develop self to better relate to God”
Jewish – Behold how good and pleasant it is for siblings to sit together
as one.
4 Precepts:
1. Upon 3 things does the world stand – on Torah, on
Avuda – service of god – prayer,
deeds of loving kindness.
2. There are 2 aspects to prayer. The prayer itself
and the ability to pray.
3. It is the duty of the Jew to cry out to God in times
of trouble.
4. He who prays, speaks to God, but he who studies Torah,
God speaks to him.
7 points about prayer in Judaism:
1. Prayer is extremely important – but not the whole
story. Jewish tradition would take Torah – besides prayer and ritual
practice – study and moral living. Don’t serve master to receive a reward.
Piety cannot exist in ritual acts only. Man’s
2. Judaism understands prayer as the service of the
heart: petition, thankful acknowledgment, and to develop ourselves
so we can better relate. We pray in order to be able to pray.
One prayer and its relationship to the spine.
3. The Hebrew word – le hip palel – trans. To
judge oneself to examine one’s life in relation to god. 613 obligations
that touch every aspect of god. 3 times daily life review. Prayer is impossible
and also to omit or avoid.
4. Creative tension in prayer life of the jew. Fixed
and spontaneous. Between what is on the page and what is in the heart.
5. Fixed and spontaneous prayer – Prayer and the Community.
Any human being can come before God, but there is a different dimension if
pray as the community of People of Israel. Extraordinary emphasis on
communal worship. One prayer – Misha Verhav prayer – quorum of 10 together.
Someone called up to the Torah is read now.
6. Hebrew as the language of prayer. Permissible to
pray in any language, it is critical for people to understand what they
are expressing. The language of Jewish prayer is Hebrew. The vocab. Idioms
and spiritual life cannot be conveyed in foreign tongues. And with ancient
tradition.
7. Music and chant always a part of Jewish worship.
Add quality and actual meaning to add to the prayers. Some prayers prescribed
to be said in certain ways. Part of the Jewish trad. Is penetrating thru
the prayers. Words can be an impediment to prayers --- wordless melody
– chant – help us penetrate. Doubtless elicit the relaxation response.
Prayer is not meant to be spectator sport
The Buddhist representative Kusala Bhikshu clarified
that in the Buddhist tradition “there is no divine to pray to” and that their
focus is on “how to end suffering”. He says further about prayer, “ We don’t
pray, we practice.”
Buddhist: Buddhism is about doing something. The Buddha was polytheist.
When he petitioned the gods to end human suffering they stayed silent. He
learned as enlightenment. Called Nirvana. Died at 80. At his death – 18 different
schools. 3 major branches of Buddhism existed. The teachings are based on
4 universal truths.
Life is Unsatisfactory. We are born, get sick, get old and die.
Everything that we love cherish and hold on to will be taken away from
us. Impermanence and Change.
We will aways encounter people we don’t like and places we don’t want
to be.
2nd Truth – We Suffer because we are all selfish.Try to cling and hold
on to good stuff, because born with original ignorance, it is impossible
to get it right.
3rd Truth – There can be an End to the Suffering. Buddha – The Great
Physician.
4th truth - The way to end suffereing is to follow the Noble 8 Fold Path
– Right: view, intention, speech, action, livelihood, effort, mindfulness,
concentration.
3 Categories – personal disipline, mental purification, and wisdom.
Personal Discipline: Speech action livelihood
Mental purification: Effort, mindfulness, concentration
Wisdom: View and intention
Buddhists do not have a Divine Deity to pray to. A non-theist religion.
We don’t know. Do not have a 1st cause. Consider it like a circle. Can believe
God as Creator, or big Bang theory. Buddhism's niche, our focus – how to
end suffering. At weddings have little to say, but at funeral, prisons hospitals
– people are suffering I have something to say. I don’t tell them to pray.
I tell them to practice.
Precept practice is morality, and Meditation is for transformation of
consciousness.
Precepts are for mouth and body - not to kill, steal, indulge sex misconduct,
lie, consume intoxicating substances
Unskillful speech and action creates suffering. Unconscious thoughts lead
into unskillful action
Meditation is for the mind. Allows the Buddhist patient or practitioner
into a perfect human being, replacing lower manifestations with higher ones:
Not lust – would have love
Greed – would have generosity
Anger and hatred – would have loving kindness and compassion
Delusion and ignorance – wisdom.
2 Wings of Buddhism are compassion and wisdom.
I am cheerleader and coach. Encourage the practice. The Buddha,
and the dharma is their salvation.
Practice expresses and aspiration - - new energy and purifying energy
Inspires our hearts to wisdom and rousing our hearths to awakening.
Med. Professionals . & Buddhist work together
Acceptance, focus on mind and body, and transcend pain and suffering.
Please see Kusala's website for
more details on Buddhist Practice
Referring to morality and meditation. The Rev. Joseph J. Driscoll
says that “the experience of prayer is what surges the heart” for the Catholic.
He refers to prayer as “a relationship with an outer reality, God, which is
the heart of Christian prayer”
The session then moved in to a question and answer session:
Q: In the face of Evil – sitting in front of you, or evil that has
befallen one in your community – what practices for evil doer and those
who have befallen evil?
Buddhist: -- No ultimate evil. We lack concept of ultimate
evil because we lack ultimate good. Call it unskillful. People who need to
learn new skills. Certain behaviors create suffering. Need to learn new behaviours.
Q: Importance of Stress and Emotional Support – Psalm 133 – What are
your traditions doing for a group of homosexual people who are being asked
to pass as heterosexuals?
Native American people: Never been an issue. Only an issue
when influenced by Christianity.
Protestant: -- A burning issue. A lot of judgement that evolves
out of doctrine. Some Prot. Traditions have a lot of openness-
find a place that affirms them, or get hung up on loyalties, so not to be
affirming discussion. Responsibility to find places in midst
of suffering to find a place to be affirmed.
Christian Science: -- Meeting re AIDS – on one’s identity – a view
of ourselves that goes beyond gender and sexual orientation in image and
likeness of god. Being essential spiritual beings.
Catholic: -- Schizoid on this issue. No problem with that.
Looked at evil – when not an answer. US Bishops Letter – not to discriminate.
Need to respond out of love. In our moral tradition we get caught. In Biology
with 13th Century. There is a tension between what we are trying to do.
Jewish: Many different concerns: In the more liberal
part of the spectrum can have same sex marriages, and a lot of struggling
with it. Homosexuality is an Orthodox issue. Graduate From Rabbinical
School started a lobby group meaning – in our image. Let us make men in
our image. For full inclusion of lesbians & gays.
Islam: Tho homosexual does not to be accepted across the board.
But the strongest teaching is that no one can judge but god, at the end
of the day. Not up to you to deal with it. God will deal with it.
Buddhist: A certain equanimity. A monastic tradition sees that
everyone suffers. Its difficult not to be in relationship no matter who
you are, and all relationships cause suffering.
Q: Insight -A Dance going on as you were changing seats. (referring
to the panelists). Seeing a lot of similarities that exist. At the same time
each of you were doing such a good job distinguishing yourselves. How is
it that you foster – a biologically driven adaptive survival skill, love –
how do you deal with the compassion and extending that very expansive connective
experience...or how does compassion impact like on a daily basis when there
is a conflict between religions?
Catholic: Bottom line question. What would Jesus do in this situation.
Comes down to really respecting the other person. With that patient how do
I support what gives them life?
Muslim: Come from Palestine – could have a lot to hate. Come
to study Judaism on my own. Life is so short, as to bring tears to our faces.
To find those difference to celebrate. Find ways to find commonalities.
Christian Science: My mother is catholic, lives at
Jewish home in Ct. and I am CS. Thought she would die during the night
in the nursing home. What we did - I started to pray immediately. Striving
to see the spiritual essence of her life intact. My brothers and I had a
priest come and visit her. And a Rabbi showed up and he prayed from his tradition.
I stayed with her for a week and read for her aloud, she came conscious and
roused.
Protestant: Jehovah’s Witness patient – had some form of cancer and danger
of bleeding out. They don’t believe in blood transfusions. Doctor was concerned
about that. Wife was so upset couldn’t participate in the decision making.
2 Adults children: one adult child Methodist, and brother was Baptist preacher.
Creates a lot of work when there is this kind of conflict. Give everyone
a chance to say what was important to them. Then emphasize the need to think
about the patient and what they would want. Then everyone felt honored in
that process. Not resolve it, and hang in there. Family able to talk together
about how they could honor the patient.
Q. Some patients have told them they are supposed to suffer. My training
is to decrease suffering. How should I address this?
Catholic: All tied in with punishment. Wise action,
contact a catholic chaplain, and give that person the help to understand
the tradition and reform that so person can use the tradition.
Bahai faith – Good and the absence of good. Think this is an inherently
noble person. Often wanted to ask by patients – we are counting on
you, or please save my baby. Wanted to say – no, you please pray for
me. Instructed – beseech the mercy of God. Have wanted to do that.
So that God will guide me appropriately. Is it crossing a line. Or reassuring
to the patient, have to be appropriate.
Catholic: - Wouldn’t use those words. I would say,
I will do my best, and know that God's power will be there.
Muslim: - Patients are closer to God. And have some
kind of power. And you do ask him to pray for you and to pray for guidance.
Q. What role does music play at bedside of the dying?
Native America – song is a prayer. Healing prayer and song for
joy. Secular songs that are pall songs. When people are in pain want
to go back to childhood memories. What song would be remembered. Sufi people
-- Some songs would comfort them. Children reared in non
Indian home, may not no them. Treat all as individual.
Buddhist: Being sick or coming close to death, music may
be a distraction. Closest would be chanting. Generally the words of the
Buddha – reminding how to practice. Silence would be most conducive
to Buddhist practice.
Patients of Jewish original had a lot of grief and anxiety. Didn’t have
a view of the afterlife.
Jewish: A great anthology Jewish views of the afterlife.
Actually 3 times a day we speak of the resurrection of the dead. And other
notions related to the afterlife. There isn’t one very specific dogma or
belief system about the afterlife. The normative Jewish notions is that
this life is not the whole story, but we main not know. Reincarnation. In
medieval Judaism. Explore what they themselves are feeling. The whole
issue of dying in Judaisim. Letting go is an issue with the survival
imperative in the Jewish community. A shortage of the Jewish. A great belief
in medical technology.
Q. What do you recommend for a person who has no religious
practice.
Catholics: Chaplains are trained to be multi faith. Administer
to anyone spiritual needs.
What is important to you? Spirituality meaning and values. Communicating
with them, touching, being with them.
Dr. Benson commented on how he was struck by the universality of the diverse
kinds. We hope these conferences will continue for health and well
being for all of us.
This panel agreed that one must ask, inquire about the specific practices
of a persons faith tradition and avoid assumptions based on the category
of a specific religion or philosophy. Because, they clarify, no two
Jews, Christians, Muslims, Buddhist or Native Americans may practice and believe
in the same way.
“Prayer and the Catholic Tradition” -Rev. Driscoll
In attending Rev. Driscoll’s afternoon workshop on “Prayer and the Catholic
Tradition” I was provided with an in depth view of the Catholic faith and
it’s traditions and beliefs around prayer. He spoke of the various experiences
of prayer defining such terms as spirit, energy, and spirituality. He delved
into the Theological foundations of Christian prayer and referred to such
classical writers on prayer as Ignatius of Loyola, Teresa of Avila,
John the Cross, and Catherine of Sienna to mention a few. Rev. Driscoll outlined
the “Catholic Content of Christian Prayer” as “Creed, Liturgy, Moral life,
Prayer”. And lastly Rev. Driscoll clarified “The Experience of Prayer at
the Bedside” speaking specifically about the sacraments and prayers for the
dying as outlined by the Catechism of the Catholic Church. He reminds us
to be respectful of the patient and families wishes regarding prayer, seeking
out what they need specifically during the time of their dying.
Summary
In summary this conference on Spirituality and Healing and medicine seems
to be about restoration, discovering and recovering a medical communities
spiritual life, and thus the spiritual lives of those served by it. The recognition
that this work must be done does not lessen the struggle of this task. As
people and their medical communities have become less and less personal,
more confidential and technology based, one’s emotional and spiritual life
is often not addressed at all, until there is crisis, chaos, or perhaps,
death. The wonderful speakers and sponsors of this conference have worked
hard and with strong intentions to teach the students at this conference
how to better work with their own spiritual life as well as those of their
patients. It may be true that what we believe is our reality. And given the
ultimate reality of death and suffering in everyday existence it seems we
must continue to swim upstream in our fight to restore a spiritual life to
healthcare. At least these were the messages that seemed to capture my attention
in this gathering. Lastly, recognizing the wealth of knowledge, care,
and compassion within the walls of this conference reminded me of what already
exists in most people and places, a desire to be cared for, listened to and
respected. These are spiritual principles that we all can honor and practice.