COMMENTARY

Readers' and Author's Responses to "The Meaning of Life in Medicine"

Swaati Dhawan, BHMS, PGDHHM, Diploma in Yoga; Shaheen E. Lakhan, MS, MEd, AFACB, PhD, MD (c.); H. Steven Moffic, MD

Disclosures

August 29, 2008

To the Editor:

This question has been very well tackled in the Eastern cultures and a lot of cultures and historical civilizations on earth.[1] Spirituality has been an inseparable part of human existence, which answers the deepest and the most crucial questions of life on "Spaceship Earth."

In my personal experience, connecting with patients on these subjects not only deepens the bond that the physician shares with them and their families, but it also enhances the process of healing and reduces the average length of stay in the hospital or of sickness remarkably. It adds both quality and quantity to life as patients and their families derive more happiness -- the source of which is from within the patient and not in external objects or circumstances. Hence, it also improves the morbidity and mortality quotient.

Dr. Swaati Dhawan, BHMS, PGDHHM, Diploma in Yoga
swatid_16@hotmail.com

Reference

  1. Moffic HS. The meaning of life in medicine. Medscape J Med. 2008;10:133. Available at: http://www.medscape.com/viewarticle/574838 Accessed August 15, 2008.

Author's Response:

To the Editor:

Thanks so much for your response. The necessary brevity of the piece precluded discussion of specific specialties of medicine or unique cultures, so I appreciate Dr. Dhawan bringing up the "Eastern" cultures, especially because I have had a long-standing special interest in cultural psychiatry and published much in that area.

H. Steven Moffic, MD
Professor of Psychiatry
Medical College of Wisconsin
Milwaukee, Wisconsin
smoffic@mcw.edu

 


To the Editor:

Dr. Moffic is of the opinion that doctors should ask patients what gives meaning to their lives.[1] It is true that in Western medicine we are ignorant of the benefits of asking our patients such a question. However, in Eastern philosophies the importance of this question has been long recognized. We can use these Eastern practices as a model to provide spiritual aspects of care to our patients.

In Tibetan Buddhism finding meaning in life is an integral part of spiritual and personal development. Reflecting on positive accomplishment throughout life, accepting self and others, and performing loving acts support Tibetan Buddhists to find meaning in their lives. An early approach to spiritual development is necessary, to be able to use it when it is needed.[2] This Eastern point of view is more and more adapted in Western society and Western medicine.

Mindfulness-based stress reduction (MBSR) derives from Buddhist meditation and has recently found growing acceptance among Western health professionals.[3] Several studies this year have illustrated improvement in psychological distress and medical symptoms through MBSR.[4] The practice of mindfulness meditation leads to increased mindfulness, which in turn leads to symptom reduction and improved well-being.[5,6] A low-dose MBSR can benefit healthy, working adults in reducing stress and increasing mindfulness.[7]

A study at the Alberta Cancer Board examined 59 patients with breast cancer and 10 with prostate cancer. They were enrolled in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. It was found that MBSR program enrollment was associated with enhanced quality of life and reduced stress symptoms and resulted in possibly beneficial changes in hypothalamic-pituitary-adrenal axis functioning.[8]

In a more recent study, the same team of researchers investigated the ongoing effects of participation in an MBSR program on quality of life; symptoms of stress; mood; and endocrine, immune, and autonomic parameters in early-stage breast and prostate cancer patients. It showed significant improvements in overall symptoms of stress that were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (proinflammatory) cytokines. Systolic blood pressure decreased from pre- to post intervention, and heart rate was positively associated with self-reported symptoms of stress.[9]

Doctors are trained to provide physical and sometimes social care to patients. Psychological and spiritual aspects of patients are often not cared for. However, patients are searching for the meaning of their lives, especially terminally ill patients or patients in life-changing situations.[10,11,12,13]

This may be the result of time restrictions, a lack of education, or perceived parameters of care.

It has been shown that some patients consider emotional components of physician behavior to be significant for their coping with cancer.[14] Health professionals, including doctors, need education and guidance to provide holistic care.[15] Training packages should be made available to achieve this.[16]

Being unprepared to face illness and death is common in Western society. Reflecting on meaningful things in life has simply been neglected. We have to value these fundamental realizations in life to improve the quality of our lives and therefore our and our patients' health.

Shaheen E. Lakhan, MS, MEd, AFACB, PhD, MD (c.)
Executive Director
Global Neuroscience Initiative Foundation (GNIF)
Los Angeles, California
slakhan@gnif.org
http://slakhan.gnif.org

References

  1. Moffic HS. The meaning of life in medicine. Medscape J Med. 2008;10:133. Available at: http://www.medscape.com/viewarticle/574838 Accessed August 15, 2008.

  2. Smith-Stoner M. End-of-life needs of patients who practice Tibetan Buddhism. J Hosp Palliat Nurs. 2005;7:228-233. Available at: http://www.medscape.com/viewarticle/508915 Accessed August 15, 2008.

  3. Rejeski WJ. Mindfulness: reconnecting the body and mind in geriatric medicine and gerontology. Gerontologist. 2008;48:135-141. Abstract

  4. Carmody J, Reed G, Kristeller J, Merriam P. Mindfulness, spirituality and health related symptoms. J Psychosom Res. 2008;64:393-403. Abstract

  5. Carmody J, Baer RA. Relationship between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31:23-33. Abstract

  6. Nyklicek I, Kujipers KF. Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism. Ann Behav Med. 2008 Jun 6; [Epub ahead of print].

  7. Klatt MD, Buckworth J, Malarkey WB. Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Educ Behav. 2008 May 9; [Epub ahead of print].

  8. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29:448-474. Abstract

  9. Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007;21:1038-1049. Abstract

  10. Mehnert A. Meaning and spirituality in patients with chronic somatic illness [in German]. Bundesgesundheitblatt Gesundheitsforschung Gesundheitsschutz. 2006;49:780-787.

  11. Breitbart W, Gibson C, Poppito SR, Berg A. Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry. 2004;49:366-372. Abstract

  12. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: a review of manualized interventions. Clin Psychol Rev. 2008;28:472-493. Abstract

  13. Harding R, Molloy T. Positive futures? The impact of HIV infection on achieving health, wealth and future planning. AIDS Care. 2008;20:565-570. Abstract

  14. Finset A, Smedstad LM, Ogar B. Physician-patient interaction and coping with cancer: the doctor as informer or supporter. J Cancer Educ. 1997;12:174-178. Abstract

  15. Hawks SR, Hull ML, Thalman RL, Richins PM. Review of spiritual health: definition, role, and intervention strategies in health promotion. Am J Health Promot. 1995;9:371-378. Abstract

  16. Walters P, Tylee A, Fisher J, Goldberg D. Teaching junior doctors to manage patients who somatise: is it possible in an afternoon. Med Educ. 2007;41:995-1001. Abstract

Author's Response:

To the Editor:

I most appreciate the response of Dr. Lakhan. As may be apparent, the brief nature of my editorial precluded elaboration of my points, including incorporation of differing cross-cultural approaches to the meaning of life.

Depending on one's cultural background and values, so-called "Eastern" (Eastern actually encompasses many different countries and traditions) practices are certainly relevant to a person, patient, physician, or healthcare system. There is always a danger that "minority" or less prominent cultures will be undervalued or ignored by the dominant values of any healthcare system, hence the call for cultural competence in medicine.[1]

Mindfulness and meditation could be one of the strategies for understanding and processing "meaning-of-life" questions. It behooves all clinicians to have some familiarity with it, and Dr. Lakhan provides an excellent summary and references for MBSR [mindfulness-based stress reduction]. However, like virtually all treatments, MBSR may not fit all or most patients, and conceivably could even be used to avoid grappling with meaning-of-life questions. Countries with Eastern philosophies have also not been immune to devaluing spiritual development and life, as we've witnessed not long ago in Cambodia and more recently in Myanmar (formerly Burma).

The key here is not a specific technique, a specific value system, or a specific way of life. There are various meanings of life. We can learn from one another, as I just learned some from Dr. Lakhan, how to make this topic more meaningfully present in our lives, illnesses, and deaths.

H. Steven Moffic, MD
Professor of Psychiatry
Medical College of Wisconsin
Milwaukee, Wisconsin
smoffic@mcw.edu

Reference

  1. Moffic HS. 7 Ways to improve cultural competence. Curr Psychiatry. 2003;2:78.

 


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To the Editor:

Dr. Moffic is of the opinion that doctors should ask patients what gives meaning to their lives.[1] It is true that in Western medicine we are ignorant of the benefits of asking our patients such a question. However, in Eastern philosophies the importance of this question has been long recognized. We can use these Eastern practices as a model to provide spiritual aspects of care to our patients.

In Tibetan Buddhism finding meaning in life is an integral part of spiritual and personal development. Reflecting on positive accomplishment throughout life, accepting self and others, and performing loving acts support Tibetan Buddhists to find meaning in their lives. An early approach to spiritual development is necessary, to be able to use it when it is needed.[2] This Eastern point of view is more and more adapted in Western society and Western medicine.

Mindfulness-based stress reduction (MBSR) derives from Buddhist meditation and has recently found growing acceptance among Western health professionals.[3] Several studies this year have illustrated improvement in psychological distress and medical symptoms through MBSR.[4] The practice of mindfulness meditation leads to increased mindfulness, which in turn leads to symptom reduction and improved well-being.[5,6] A low-dose MBSR can benefit healthy, working adults in reducing stress and increasing mindfulness.[7]

A study at the Alberta Cancer Board examined 59 patients with breast cancer and 10 with prostate cancer. They were enrolled in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. It was found that MBSR program enrollment was associated with enhanced quality of life and reduced stress symptoms and resulted in possibly beneficial changes in hypothalamic-pituitary-adrenal axis functioning.[8]

In a more recent study, the same team of researchers investigated the ongoing effects of participation in an MBSR program on quality of life; symptoms of stress; mood; and endocrine, immune, and autonomic parameters in early-stage breast and prostate cancer patients. It showed significant improvements in overall symptoms of stress that were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (proinflammatory) cytokines. Systolic blood pressure decreased from pre- to post intervention, and heart rate was positively associated with self-reported symptoms of stress.[9]

Doctors are trained to provide physical and sometimes social care to patients. Psychological and spiritual aspects of patients are often not cared for. However, patients are searching for the meaning of their lives, especially terminally ill patients or patients in life-changing situations.[10,11,12,13]

This may be the result of time restrictions, a lack of education, or perceived parameters of care.

It has been shown that some patients consider emotional components of physician behavior to be significant for their coping with cancer.[14] Health professionals, including doctors, need education and guidance to provide holistic care.[15] Training packages should be made available to achieve this.[16]

Being unprepared to face illness and death is common in Western society. Reflecting on meaningful things in life has simply been neglected. We have to value these fundamental realizations in life to improve the quality of our lives and therefore our and our patients' health.

Shaheen E. Lakhan, MS, MEd, AFACB, PhD, MD (c.)
Executive Director
Global Neuroscience Initiative Foundation (GNIF)
Los Angeles, California
slakhan@gnif.org
http://slakhan.gnif.org

References

  1. Moffic HS. The meaning of life in medicine. Medscape J Med. 2008;10:133. Available at: http://www.medscape.com/viewarticle/574838 Accessed August 15, 2008.

  2. Smith-Stoner M. End-of-life needs of patients who practice Tibetan Buddhism. J Hosp Palliat Nurs. 2005;7:228-233. Available at: http://www.medscape.com/viewarticle/508915 Accessed August 15, 2008.

  3. Rejeski WJ. Mindfulness: reconnecting the body and mind in geriatric medicine and gerontology. Gerontologist. 2008;48:135-141. Abstract

  4. Carmody J, Reed G, Kristeller J, Merriam P. Mindfulness, spirituality and health related symptoms. J Psychosom Res. 2008;64:393-403. Abstract

  5. Carmody J, Baer RA. Relationship between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31:23-33. Abstract

  6. Nyklicek I, Kujipers KF. Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism. Ann Behav Med. 2008 Jun 6; [Epub ahead of print].

  7. Klatt MD, Buckworth J, Malarkey WB. Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Educ Behav. 2008 May 9; [Epub ahead of print].

  8. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29:448-474. Abstract

  9. Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007;21:1038-1049. Abstract

  10. Mehnert A. Meaning and spirituality in patients with chronic somatic illness [in German]. Bundesgesundheitblatt Gesundheitsforschung Gesundheitsschutz. 2006;49:780-787.

  11. Breitbart W, Gibson C, Poppito SR, Berg A. Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry. 2004;49:366-372. Abstract

  12. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: a review of manualized interventions. Clin Psychol Rev. 2008;28:472-493. Abstract

  13. Harding R, Molloy T. Positive futures? The impact of HIV infection on achieving health, wealth and future planning. AIDS Care. 2008;20:565-570. Abstract

  14. Finset A, Smedstad LM, Ogar B. Physician-patient interaction and coping with cancer: the doctor as informer or supporter. J Cancer Educ. 1997;12:174-178. Abstract

  15. Hawks SR, Hull ML, Thalman RL, Richins PM. Review of spiritual health: definition, role, and intervention strategies in health promotion. Am J Health Promot. 1995;9:371-378. Abstract

  16. Walters P, Tylee A, Fisher J, Goldberg D. Teaching junior doctors to manage patients who somatise: is it possible in an afternoon. Med Educ. 2007;41:995-1001. Abstract

Author's Response:

To the Editor:

I most appreciate the response of Dr. Lakhan. As may be apparent, the brief nature of my editorial precluded elaboration of my points, including incorporation of differing cross-cultural approaches to the meaning of life.

Depending on one's cultural background and values, so-called "Eastern" (Eastern actually encompasses many different countries and traditions) practices are certainly relevant to a person, patient, physician, or healthcare system. There is always a danger that "minority" or less prominent cultures will be undervalued or ignored by the dominant values of any healthcare system, hence the call for cultural competence in medicine.[1]

Mindfulness and meditation could be one of the strategies for understanding and processing "meaning-of-life" questions. It behooves all clinicians to have some familiarity with it, and Dr. Lakhan provides an excellent summary and references for MBSR [mindfulness-based stress reduction]. However, like virtually all treatments, MBSR may not fit all or most patients, and conceivably could even be used to avoid grappling with meaning-of-life questions. Countries with Eastern philosophies have also not been immune to devaluing spiritual development and life, as we've witnessed not long ago in Cambodia and more recently in Myanmar (formerly Burma).

The key here is not a specific technique, a specific value system, or a specific way of life. There are various meanings of life. We can learn from one another, as I just learned some from Dr. Lakhan, how to make this topic more meaningfully present in our lives, illnesses, and deaths.

H. Steven Moffic, MD
Professor of Psychiatry
Medical College of Wisconsin
Milwaukee, Wisconsin
smoffic@mcw.edu

Reference

  1. Moffic HS. 7 Ways to improve cultural competence. Curr Psychiatry. 2003;2:78.

 

 

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