The Faith Factor

Not only does the mind influence our physical
well-being, but new research shows that spiritual belief helps
us heal, says physician and author Herbert Benson.

BY Beth Baker

Common Boundary
(July/August 1997)

Herbert Benson, M.D., has spent his career walking a tightrope, balancing his scientific credibility with a desire to explore humanity's spiritual side. A pioneer in the field of mind-body medicine, he has increasingly focused on the healing benefits of faith and religion.

As a student at Harvard Medical School in the late 1950s, Benson was frustrated by what he describes as a "spiritual crisis in medicine." Too much emphasis was put on the mechanics of medicine -- medication, technology, and surgery -- with virtually no attention given to the individual patient's own potential for healing. Moreover, his professors told him that all he was learning would likely be obsolete in a few years as medicine made rapid advancements. "I wanted to identify some timeless source of healing, the merits of which could never be denied," he writes in his latest book, Timeless Healing: The Power and Biology of Belief (Scribner).

After 25 years of research, Benson is convinced that humans have an inborn capacity for self-healing, one that can be triggered by faith and spirituality. "We're wired for God," he says. "There is something that makes us believers. It's something that transcends all and that will heal you."

His search took him from his Harvard lab, where he first worked with monkeys experiencing stress, to the surgical wards of Boston's hospitals to the peaks of the Himalayas, where he measured the physiological effects of the meditation practices of Tibetan Buddhist monks. "Pay attention to the three main components of Tibetan medicine -- the belief of the doctor, the belief of the patient, and the karma between the two," the Dalai Lama advised Benson, as he relates in his book Beyond the Relaxation Response.

Benson did pay attention, and developed his own theory about the healing power of belief. He concluded that the potential of the human mind to effect physiological change was immense. Perhaps the most dramatic example he witnessed was in Ladakh, on the edge of the Tibetan plateau, where monks practice the sacred rite of "fierce woman" (gTum-mo) yoga. He recounts that the monks were able to generate enough heat within their own bodies to spend the night comfortably outside in sub-zero temperatures, dressed only in thin woolen shawls with sandals on their feet.

While such research may seem esoteric, Benson drew on it to develop accessible therapies combining faith and relaxation. His best-known contribution is the "relaxation response," a simple meditation technique that can greatly reduce the damaging effects of stress and that can help with conditions ranging from headache, back pain, and insomnia to infertility, hypertension, and depression. (See box, "The Relaxation Response"). Indeed, according to Benson, 60 to 90 percent of all physician office visits in the United States stem from stress-related conditions that can be helped through the relaxation response and similar techniques that are now widely accepted in medicine.

In 1975, Benson wrote The Relaxation Response, which jumped to the top of the New York Times bestseller list and stayed there for six months. The book is now in its 35th printing and has sold some 4 million copies. He went on to cowrite six other books, which offer practical advice on using mind and spirit to promote wellness.

Benson is perhaps his own best advertisement for his ideas: He appears relaxed, serene, and cheerful, exhibiting none of the stereotypical pomposity that is sometimes associated with physicians or Ivy League academics. He admits that for years he did not follow his own mind-body advice, fearing that it would somehow mar his objectivity. But now he regularly elicits the relaxation response. "It's improved my health, no doubt about it," he says.

Benson, 62, grew up in Yonkers, New York, where his father was a businessman in the produce industry. He was raised in the Jewish faith and says he was imbued with solid middle-class values of hard work and honesty. He also confesses to a strong stubborn streak as a child ("My mom didn't have any more kids after me, I can tell you that!") -- a trait that re-emerged later when his research was challenged by colleagues.

To overcome the skepticism he continually faced, he relied on the scientific method and was able to maintain enough credibility to earn a lifetime position at Harvard Medical School. In 1988 he founded Harvard's Mind/Body Medical Institute, housed at Beth Israel Deaconess Medical Center in Boston, and in 1992 Harvard honored him by creating a permanent chaired professorship on mind-body medicine that will be named for him upon his retirement.

Over the years, the role of spirituality in healing has become a dominant focus of Benson's work. The Mind/Body Medical Institute now hosts semiannual conferences on this theme, which allow leaders of major world religions to share ancient healing traditions with practitioners of modern medicine.

While Benson always emphasizes the scientific basis for his views, he is also willing to share his personal beliefs. At the conclusion of Timeless Healing, he writes his "disclosure of belief" as a way of revealing any biases that may have influenced his work: "I believe in a scientifically describable biology and evolution and in a world that is, nonetheless, divinely influenced. The veracity of the experience of God is undeniable to me."

Common Boundary: You took a very unusual turn as a physician with your mind-body-faith approach. What made you go in this direction?

Herbert Benson: First of all, in college I became interested in the basic question in a religion course: Does God exist? I read William James's Varieties of Religious Experience, and he pointed out there was a commonality of human experience in all religions. That was very important to me.

Then my dad died of heart disease, and that got me interested in cardiology. After I became a cardiologist, I found that people's blood pressure in my office would often be quite high. I'd medicate them, and they'd come back with symptoms of hypotension, low blood pressure. This then led to the concept that the stress and anxiety of having their blood pressure measured might be elevating it. It was beyond the pale in those days to say that the mind could be affecting blood pressure -- people were centered on the kidney being the source of high blood pressure. I was told that any investigations of this matter were going too far, because the mind and body were separated in the realm of medicine at that time.

CB: You were not a professor yet?

HB: No, I was a fellow of physiology and a fellow of medicine.

I decided after I finished my cardiology fellowship to go back to Harvard Medical School and work to create a model for stress-induced high blood pressure in animals. It was mind-body, but it was animal research, so that made it acceptable.

During those years, some people who practiced Transcendental Meditation came to me and said, "Why are you fooling around with monkeys? Why don't you study us? We think we can lower our blood pressure." I said no way. Because that, I knew, was going too far. They kept coming back, and I kept saying no. Finally, I reasoned, why not have a look at this? I did it in the evenings.

CB: Surreptitiously?

HB: Right. These were the days before human-studies committees, so I didn't have to check it out. I did these initial experiments, and I saw profound changes.

CB: You were surprised by the results?

HB: Surprised and scared.

CB: Why scared?

HB: Because the physiological changes -- lowering their blood pressure, slowing their metabolism -- were so dramatic that I knew I had a real problem. If I stayed with that, I would be bucking the medical system head on.

I then received a rather large grant to continue studies on meditation. Some people said, "Don't allow Benson to accept the grant -- that's not what Harvard Medical School is about." In my youthful arrogance, I said, "Either I'm allowed to take the grant or I'm going to leave." Somehow, it got to the dean [of the medical school], Robert Ebert. Ebert said something that changed my entire career. He said, "Look, if Harvard can't take a chance and make a mistake, who can? Let Benson take it." When he retired as dean, he became chairman of the board of the Mind/Body Medical Institute.

I was fortunate enough to become the head of all cardiovascular teaching at Harvard Medical School. I stayed quite within the mainstream as I did this research, which was "Benson's crazy thing." To this day, there are people saying this isn't scientific, but that number has markedly diminished. Now at Harvard there is the Mind/Body Institute Chaired Professorship, which I sit in as associate professor, and that will become the Benson Professorship upon my retirement.

CB: When you brought in religion and faith in a much stronger way, was the skepticism revived?

HB: There's a wonderful historical parallelism that happened. The laboratory in which I was working was previously the laboratory of Dr. Walter B. Cannon, the famous physiologist who had defined the "fight or flight" response. When he injected calves with adrenal glands, the calves' blood pressure, heart rate, muscle blood flow, and rate of breathing increased, preparing them for running, or for flight.

Now, as I worked in those same laboratories, the changes of meditation I saw were clearly the exact opposite of the fight-or-flight response. That struck me immediately. It made no sense to me that Transcendental Meditation would be the only way to bring about this opposite response. It would be like saying that there was one way to perspire or one way to increase one's heart rate. So I dissected Transcendental Meditation into what I felt were its two basic steps: One is a repetition; the other is that when thoughts come to mind, you passively disregard them and come back to repetition.

I then spent two years reviewing the religious and secular literatures of the world, and it leapt out: Every single culture that had a written history had these two steps, normally in the sense of prayer. Whether it's "Om," or "Shalom," or "Hail Mary, full of grace," or "Sh'ma Yisroel," or "Insha'allah," every culture had it. And that's when I really became concerned. Because if I was beyond the pale with mind-body, bringing in religious thought was really going too far. I was told, "You've blown it." But many people at Harvard, many years my senior, came to me and said, "You're on to something extraordinarily important -- so important, you don't even recognize how big it is. Stay with it."

CB: Were you publishing your results during this time, or was it still a quiet effort?

HB: From the very outset, I published. The initial publication was in '69, as a letter to the editor of the New England Journal of Medicine, pointing out that people who practiced Transcendental Meditation gave up their drug habits. I went on to the best places I could publish.

To this day, practitioners of Transcendental Meditation feel that I'm wrong. They feel they have a uniqueness to their words and sounds, and I'm saying it's universal. But I owe them a tremendous debt, because none of this would have occurred without their coming to me. I have profound respect for what they have done.

That was a very long response to your first question about my course into the spiritual. It was there from the beginning. But then I found secular ways to achieve the same results, and I wrote The Relaxation Response, which became a bestseller.

CB: Were you shocked at that?

HB: Yes. And not only that -- it caused me further problems because at the time, in '75, academic people in medicine did not publish in the lay press.

CB: You were a "popularizer."

HB: Yes -- even though everything I have done is based on initial publication in the peer-reviewed literature. It's been a pattern I've followed throughout. The relaxation response was science -- if you thought in a certain way with a repetitive focus and disregarded everyday thoughts, measurable, predictable, reproducible physiological changes occurred. That was science. It was akin to taking a pill or doing surgery.

CB: Why can't you just read a good book and get the same effect?

HB: Because the book in itself is arousing. You need a neutral stimulus. Even music might be a problem.

CB: So you tried to measure these physiological changes when people just read.

HB: Yes, that was the control.

CB: Do you know if the relaxation response is widely used now?

HB: We know that about 50 percent of medical schools teach the relaxation response. And a recent Gallup poll we've done shows that over 30 percent of adults elicit the relaxation response. That would include a lot of different ways of getting that response.

CB: Are there some physical problems where this approach won't help you?

HB: Yes, there is a long list. There's no mind-body effect that could work the way immunizations work, anesthesia for surgery, antibiotics, cataract removal, hip replacements, drugs for congestive heart failure, cancer -- on and on.

CB: However, wouldn't you argue that if you had some of those conditions, you would still benefit from doing the relaxation response?

HB: Without question. Let's assume you need cardiac surgery. We've done studies that show that if you elicit the relaxation response just before surgery, you have fewer arrhythmias afterwards.

From the very beginning, people were saying the relaxation response was nothing but the placebo effect -- which then got me started on the placebo effect and that whole range of studies, beginning to point to the importance of belief. At the same time, I was finding that people who elicited the relaxation response regularly claimed to be more spiritual.

CB: They just volunteered that it made them feel more spiritual, or closer to God, when they used the relaxation response?

HB: Yes. I said, "What are you talking about?" So we got together and for five years investigated what they meant by "spiritual." Finally, it registered that two things occurred in our people when they said they were more spiritual: One was the feeling of the presence of a power, a force, an energy -- God. Secondarily, that presence was close to them. When those two things occurred, that was spirituality. Then we found that those people had fewer medical symptoms than others.

We then decided to bring together these scientifically proven healing practices we'd been doing with the healing practices of the first religions. So we brought representatives of Hinduism, Buddhism, Judaism, Christianity, and Islam all together in a conference -- so they would review their healing traditions and we would review what we were finding -- to look for commonality.

When I presented this idea for a course to Harvard's Department of Continuing Education for approval -- this is an example of how far things have changed -- it was unanimous that it be accepted. At the meeting, at least three people and subsequently many others, physicians, came up to me and said, "Herb, what took you so long?"

You see, we as physicians often come into medicine to help people because of these [spiritual] beliefs, and we're not allowed to exercise them unless there is a scientific basis. So bringing the two together gave physicians permission to do something they already wanted to do. We carried out a poll among family practitioners, a Yankelovitch poll, wherein 99 percent of family practitioners said that belief and religious faith were important in healing.

CB: I'm trying to picture how practitioners weave that into their medical practices.

HB: View health and well-being as a three-legged stool where one leg is pharmaceuticals, the second is surgery, and the third is self-care. In that self-care leg, we have nutrition, exercise, relaxation response, stress management, but also a belief system. You do your routine stuff -- your penicillin, your surgeries, whatever's necessary -- but engage the person in performing an exercise to elicit the relaxation response on a regular basis. There you give the person a choice of a word, sound, prayer, or phrase. You're not telling the person to pray; you're telling the person to choose a technique that conforms to what they already believe in.

It's very easy to do. And that's what we're doing here at the Mind/Body Medical Institute, teaching and training people across the nation to carry out these approaches.

CB: I have a friend who had cancer and was put off by the mind-body approach. She said it made her feel terribly guilty.

HB: One of the dangers is that you can attribute too much power to the mind affecting the body. You can feel hope from learning that your anxiety, your depression, your anger might be causing your particular problem, and if that's the case, perhaps you could turn it around by using these same mind-body approaches. But you take a disease like cancer, and there's a very strong likelihood that [the disease] could progress. If it does, and you've ascribed so much power to the mind-body effect, you've got double guilt. Guilt up front that you caused it and guilt that you were so weak that you couldn't make it go away.

Go back to the three-legged stool. You got the cancer -- it might have been influenced somewhat by mind-body, but there are lots of other things: genetics, environmental exposures. In taking care of the disease, you want not only to use your mind-body approaches but also to use the radiation, the chemotherapy, the surgery. Then rather than feeling guilty if it does progress, you should feel at ease that you've done everything possible, of which mind-body is one. But to give exclusivity to that sets you up for this guilt, which has no place whatsoever.

CB: What are your thoughts about alternative medicine, such as acupuncture?

HB: What we're talking about has nothing to do with alternative medicine. Alternative medicine, conceptually, belongs more to the first two legs of the stool: Herbs and homeopathy are like pharmaceuticals; massage and acupuncture are akin to procedures. They're things done to you; they are not self-care.

Secondarily, from my point of view, these other approaches are scientifically unproven. Ours are proven. To my way of thinking, it's your belief in the homeopathy that's working, rather than the homeopathy itself.

The approaches that we're talking about with self-care -- belief, relaxation response, nutrition, exercise -- are money in the bank. But alternative medicine is cost-additive. In other words, people continue the regular system; they just add the homeopathy to it.

CB: Do you have any way of measuring how much we could reduce costs with more emphasis on mind-body medicine?

HB: If we approached medicine in this way, calculating the costs of reduced office visits, it comes to over $54 billion a year.

CB: What are the implications of managed care for your approach?

HB: First of all, there's a tremendous opportunity to recognize that training people in this work will help because it decreases visits.

CB: It seems, though, there's more and more pressure on doctors to spend less and less time with patients.

HB: These data will help counter the odious spread of shorter and shorter visits, which do not allow a relationship to develop between the physician and patient, which is counterproductive to health. If you spend more time up front, it will be taken care of down the line.

CB: Do you feel that HMOs are listening to you?

HB: They are now, from the number of people coming to our center for our trainings. It's just a matter of time, because it's in their own interest.

CB: Could you talk more about the role of faith and belief in all this? There are some who are very skeptical about the notion of faith healing. What do you say to them?

HB: What I'm saying is not that faith heals but that belief heals, and the belief may or may not be religious. The belief can be belief in the physician, belief in your medication, belief in your relationships. But the fact is that 95 percent of Americans believe in God. For them, the most important belief is a religious belief, and we have to honor that.

CB: Even though you say it could be belief in the caregiver, it seems like you are saying there are extra benefits if the belief is of a religious nature.

HB: There is something that makes us believers -- not everybody, but certainly the vast majority of people, around the world, at all times. From the earliest writings of humans -- Gilgamesh, third millennium B.C. -- we have always invoked things beyond us: powers, forces, energies, an afterworld. That is very comforting to us. I am not saying that God exists or not -- I don't know. But what I am saying, from a medical point of view, from a healing point of view, is that we're in a win-win situation.

Let's assume you have this profound belief that appears to be wired in us. If you believe in God and God doesn't exist, that belief can heal you. It's something that's good for you because it's playing maximally on your power of belief. Let's assume you believe in God and God does exist. Isn't that wonderful? So we can't lose.

CB: What about atheists -- are they missing out on this?

HB: No, not at all, because atheists can believe in science, in what we've proven about the power of their own bodies to heal.

CB: What are some of the health benefits that seem to come from churchgoing?

HB: It appears that those who partake in communal activities do better than others. It just so happens that many of our communal activities are built around churches. It's very hard to separate. But the people who do participate in such communal activities are much healthier than those who do not, across the board. Things like ritual, music, prayer, altruism, fellowship can be very soothing and therapeutic.

CB: Does the research separate out the fact that churchgoers tend to smoke and drink less?

HB: Yes, it was controlled for that.

CB: What does the research say about intercessory prayer, praying on someone else's behalf?

HB: Intercessory prayer is a tradition that is beyond anything we've been discussing. With every condition I've been discussing, the person knows they're being prayed for, or they're praying for themselves, and hence their belief can be working. In intercessory prayer, in the studies done, people prayed for someone, and the person didn't know about it. Those studies are highly flawed from a scientific point of view. They have to be replicated. I've recently done some studies with alcoholics who didn't know they were being prayed for. Those who were prayed for did worse.

CB: In your book you say that most of us are uncomfortable linking God and genes, spirituality and nerve cells. Have you had much negative feedback from people who are deeply religious, who say you're reducing their beliefs to something biological?

HB: I was fearful of that, but it's been just the opposite. People are saying, "Isn't it wonderful that science is reaffirming what we're doing?" I make it very clear that I'm talking about only one dimension of spirituality -- that is, healing. But there are other components that transcend this. I've been so pleased with the religious community pointing to this work as an asset, that finally science and medicine are coming together with religion and spirituality.

CB: It was interesting in your book how you managed to satisfy everybody. If readers think that we evolved with this inner power because it was good for us as a species, they can accept your ideas, and if they believe God put us on this earth and gave us this self-healing power, they can also accept your views.

HB: Yes, that's what makes me so comfortable with it.

CB: Your approach seems very hopeful, and also very simple. It requires no great sacrifice. I look at my mother, who hates to exercise -- she's not going run a marathon, but something like this she might do.

HB: Exactly. Because we all have beliefs.

CB: But it's not enough just to have this belief. Doesn't it have to be activated, in a way, for the healthy things to happen?

HB: It's very subtle. It has to be quiet belief: "It's okay, I'm there, I'm being taken care of, I can help myself," rather than "Do it, do it, do it." Just let it become a part of you, and get on with your life.

CB: But don't people have to make the conscious link between their faith and their health for this to happen?

HB: Yes. "I'm in God's hands, and God will take care of me. God will help my doctors take care of me." That's what I'm talking about.

CB: Which is primary -- the person's belief system or the relaxation response?

HB: It's a formula. Relaxation response plus belief equals the faith factor. In other words, either one will work alone, but the two together are one heck of a combination.

I want to add that, throughout my career, I really don't think I've discovered anything new. All I have done is go back to age-old practices and measure them. And that's what we're finding: A number of things that had been there forever just hadn't been culled out. But it isn't as if a new molecule were discovered. It's a reaffirmation.

Contributing editor Beth Baker is a writer in Takoma Park, Maryland.

The Relaxation Response

To elicit the relaxation response, sit in a comfortable position in a quiet place. Close your eyes and relax your muscles. Repeat a phrase or word with each exhalation of your breath. Choose a phrase that has meaning for you, such as a prayer, or a word such as "love" or "peace." As thoughts intrude, passively disregard them and return to your repetition. Continue for about 15 minutes, once or twice a day, on a regular basis.

The resulting slow-down of your metabolism -- including lowered pulse, respiration, brain-wave activity, and blood pressure -- helps counter the damaging effects of stress on health.

There are many other ways to produce the relaxation response. Examples include meditation, some types of prayer, yoga, t'ai chi chuan, jogging, and swimming.

-- B.B.

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