Thursday, June 14, 2012
"Do you believe that spirituality is a factor in health?" The question came from Dr. Greg Burke, who leads the Public Health Science Department of the Wake Forest University School of Medicine (one of my many new bosses). We had been talking over some Thai food about the "Memphis Model" of large scale congregational networks and especially the rich stream of data that shows significant effect over five years and thousands of individuals. I had shared that data with the Board of Directors the evening before, including the fact it held some inconvenient good news. The good news is that CHN delays the return to the hospital by 39% over all comparative diagnoses -- 426 days compared to 306 days for non-connected patients. That's what you'd want for your mother.The bad news is that hospital won't ever be paid for that good news. The reasons is that it is much better news than the payers are asking for, including the Center for Medicare and Medicaid services. They are focused on just 30 days and are about to start punishing hospitals when people fail to stay out of the hospital for that long. Ironically, CHN patients doesn't show a lot of difference in that short run. The effect is dramatic--but in the long run.
This all seems very hospital operational to Greg, which prompted the question about spirituality and the possibility of proving its effectiveness. It felt like a change of subject because most research into spirituality and health is focused on very small groups, even individuals.
The problem is that spirituality is a very sloppy construct intellectually. So if you mean the "things we think we think" about God, the ultimate, or nature, it has little demonstrable affect. This drives researchers crazy because it is obvious that something as ubiquitous as spirituality should be useful for something measurable. But it is simply too complex and nuanced. The initial problem is that much of what we think we think, we don't--especially under stress such as in a health related crisis.
I noted that most of the research in this area is still done by highly educated men, which is the same kind of researcher which tends to have a lot of challenges in researching....female sexual response. Those researchers' minds tend towards instrumental and repetitive process, partly in order to develop interventions to increase whatever. The phenomenon is, well, complicated as even men have begun to notice. Viagra works for men; not so much for women. Go figure. Spirituality has a profound affect on life and health, but in ways extremely difficult to map or stimulate.Go figure. (Mary Roach, my favorite science writer, wrote a book "Bonk!" that explores these themes in case my male readers need some catch-up.) Back to spirit.
The spirituality that is demonstrable is what we see in Memphis. It creates social assets mobilized at large scale expressed through a rich tapestry of relationships. This social spirituality creates relationship beyond blood and money and is a healing miracle. Here, too, it is easy to get very instrumental about something quite nuanced and subtle. Spirituality has its its affect through relationships of trust, respect, care, unpredictable giving; not just functional "social support." That sounds random to those who want to believe in repetitive, invasive, therapeutic interventions. But it is not random; there are patterns and practices that nurture, sustain, express and channel exactly that kind of social spirituality.
It is large enough in scale to look like a public health initiative. And the data is clean and smart, so it looks like research. The clinical affect is significant enough to look like a service line. But it is a spiritual movement (I almost gave away the argument by saying "intervention.") It is the Spirit that moves. That is what we want to spread to North Carolina and why I am going to see if it be done on purpose.
CHN is such a menagerie, blending the most wildly unpredictable people; Baptists, Church of God in Christ, Methodists and all sorts of those with more complicated identities. It has even brought healing to a Senior Vice Pharisee.
The full text of the sermon is at: