Abstract
Distant healing procedures consist of benevolent intentions, often taking the form of prayers for a patient. Despite inconclusive evidence regarding distant healing, prayers are a widespread health-related technique. We studied subjective concepts of distant healing in 17 patients suffering from chronic fatigue syndrome and multiple chemical sensitivity who were given distant healing during a randomized controlled trial. We applied reconstructive interview analysis when analyzing the results. The overall theme was the tension between mainstream medicine and the immaterial healing procedure. Several components highlighted this tension: (a) patterns of legitimizing the use of distant healing, (b) distant healing and the social setting, (c) integrating distant healing into their belief system, and (d) reconstruction of effects by means of hindsight. The interviews showed that patients felt the need to legitimize having tried distant healing. They had to bear the full ambiguity of biomedicine being in competition with distant healing, though also experiencing distant healing as giving support.
Keywords
Distant healing procedures consist of benevolent intentions, often in the shape of prayers said by someone else (a healer, a group of people, or a family relative of the patient) for a patient. Prayer classifies as a health practice, and is included and ranks highly in studies from the United States on complementary and alternative medicine (CAM; e.g. Barnes, Bloom, & Nahin, 2008; Rausch et al., 2011). However, distant faith healing differs from complementary and alternative medicine because it is provided from afar, and is thus not directly perceivable by the patient. In a four-armed randomized controlled trial preceding the qualitative work presented here, we studied the effects of being prayed for by several independent persons without personal contact between patients and healers (Walach et al., 2002; Walach et al., 2008).
To date, no framework exists which helps to describe and explain what patients experience when being treated using a distant healing procedure, especially in a situation in which chronic and very debilitating symptoms are present. In this article we present themes that emerged from the accounts of patients with chronic fatigue syndrome or multiple chemical sensitivity who were treated with distant healing during a four-armed clinical trial. The themes are contextualized at the end of the article.
Several studies of the effects of distant healing procedures have been conducted (Astin et al., 2006; Sicher, Targ, Moore, & Smith, 1998). A meta-analysis pooling the results of 14 studies on intercessory prayer (IP) published before 2005 showed that IP was not superior to control procedures (Masters, Spielmans, & Goodson, 2006), a result which was also confirmed in an updated meta-analysis (Masters & Spielmans, 2007). Since then, there has also been a Cochrane Review on the health effects of intercessory prayer. Whereas an earlier version showed that IP can have significant health advantages over control procedures (Roberts, Ahmed, & Hall, 2007), the conclusion in the latest was that IP cannot be recommended, but that patients should not be deterred from IP on the grounds of the available evidence (Roberts, Ahmed, Hall, & Davidson, 2009). This review was heavily criticized after its publication (Jørgensen, Hróbjartsson, & Gøtzsche, 2009).
Masters and Spielmans (2007) pointed out that there are several methodological and epistemological problems when researching IP, and called for a broader view of the phenomenon, including effect modifiers, while also outlining possible lines of rigid quantitative research. Apart from known effect modifiers in placebo research, such as expectancy, conditioning, and meaning response (Walach & Jonas, 2004), the conclusions drawn from research on spirituality and religion are that these might affect health via regulatory systems including the immune system, the central nervous system, and metabolic processes (Seeman, Dubin, Fagan, & Seeman, 2003). Evidence suggests that the strongest impact of religion and spirituality on health is its preventive effect in healthy people (Chida, Steptoe, & Powell, 2009; Powell, Shahabi, & Thoresen, 2003), but religion/spirituality had also been shown to be a coping resource in diseased patients (Powell et al.).
Levin (2009) proposed a theoretical typology of possible mechanisms to explain healing effects. He hypothesized that there were (a) behavioral/conative, (b) interpersonal, (c) cognitive, (d) affective, and (e) psychophysiological mechanisms. Whereas the behavioral and conative mechanism linked religious practices with appropriate health behavior, the second (interpersonal) mechanism referred to the social component of connecting with like-minded people. The cognitive mechanism referred to supernatural ideations which can give meaning to all phases of life. The affective mechanism can buffer negative emotions more directly, because it mitigates stress, and the psychophysiological mechanism can provide physiological pathways that enable the subject to tolerate pain and the burden of disease more easily, as has been described by other authors (e.g., Pacheco-López, Engler, Niemi, & Schedlowski, 2006, Tracey, 2007).
While taking up the methodological challenge (Targ & Walach, 2010) to check for placebo effects in a four-armed study on distant healing in patients with chronic fatigue syndrome or multiple chemical sensitivity (Walach et al., 2002; Walach et al., 2008, we additionally took a completely different approach and nested a qualitative study within the four-armed trial to investigate patients’ views when receiving distant healing. The results are presented here. As far as we are aware from the published data, this is the first study that provides an insight into the world of patients who seek distant healing.
Methods
The Four-Armed Randomized Controlled Study
A two-by-two factorial design was chosen to evaluate the effects of distant healing on a chronically and severely impaired sample of patients suffering either from chronic fatigue syndrome (CFS) or multiple chemical sensitivity (MCS), while simultaneously probing for a possible placebo effect. The four arms consisted of two arms that were treated immediately and two arms that received deferred treatment (after 6 months). In each of these conditions (immediacy vs. waiting), half of the patients knew whether the treatment had been applied or not applied within the first 6 months, and the other half was blinded, i.e., they were told they had a 50% chance of being treated. Table 1 depicts these conditions.
Two-by-Two Factorial Design: What Did Participants Know?
After 6 months all participants were told what condition they had been in. After that period, all patients were treated by distant healing, including the patients who had been in the waiting group. The outcomes were quality of life as measured by the SF-36 Mental Health Summary Scale (primary outcome) and the SF-36 Physical Health Summary Scale (secondary outcome; McHorney, Ware, & Raczek, 1993). The results showed that distant healing had no significant effect on either of the quality-of-life summary scales for the chronic fatigue patients. However, expectations of an enhanced outcome contributed markedly to a clinically significant improvement of one standard deviation (Walach et al., 2008). Ethical approval was granted for the whole study by the ethics committee of the Freiburg University Hospital.
The Distant Healing
Healers were either self-referred or recommended by national healing organizations. No financial compensation was provided. All of the healers had experience with distant healing and declared that they believed in its clinical effects. Each confirmed to the investigators that during their usual healing practice they did not interfere with conventional medical treatment, did not diagnose patients, and did not indulge in sexual relationships with them. They came from many different European countries and from different healing traditions. The distant healing was practiced individually or in groups via such means as prayer or by imagining the transmission of “healing energy,” “light,” or “healing power” to the patients. They were free to adopt any healing intensity and frequency provided it was in accordance with their usual practice. Each patient was assigned to three different healers to guarantee a minimal level of distant healing. Patients and treating physicians were free to use any concomitant treatment during the entire trial period. Healers were given the first name and a portrait photograph of the patient. To ensure that healers and patients did not get to know each other during the trial, healers living within 100 kilometers of the patient were replaced with another from the database before a picture was sent out.
Chronic Fatigue Syndrome and Multiple Chemical Sensitivity
Patients affected by chronic fatigue syndrome (CFS) report severely disabling long-lasting fatigue including subjective impairments to cognitive functioning, pain, and sleep disturbances. Patients also reported stigmatization during the course of their illness, and explained that coping with the stigmatization comprised both social withdrawal and actively approaching therapeutic options (Åsbring & Närvänen, 2002). Longitudinal studies have shown that most patients remain impaired for years (Wilson et al., 1994). There is no exact and easy way to administer diagnostic tests of CFS. Diagnostics include the subjective report of persistent or relapsing fatigue lasting 6 or more consecutive months in the absence of other fatigue-inducing conditions (such as sleep apnea, narcolepsy, cancer, unresolved hepatitis, and so forth; Fukuda et al., 1994). A meta-analysis has shown cognitive behavioral therapy and graded exercise to have some effect on CFS (Price, Mitchell, Tidy, & Hunot, 2008).
Patients affected by multiple chemical sensitivity (MCS) report a multitude of different physical and mental health complaints such as headaches, dizziness, impaired cognitive functioning, pain, sleep disturbances, fatigue, and so forth when exposed to extremely low doses of airborne chemicals such as odors from paints or perfumes, which are normally considered to be well tolerated below toxic concentrations. People usually start avoiding social contacts because these are associated with possible exposure. Textbooks on treating MCS recommend avoiding any physiological or biochemical explanation of the syndrome, which leads to patients feeling they are not being taken seriously (Busse et al., 2008). Eighty-six percent of general practitioners reported recommending avoidance of offending substances, possibly leading to negative consequences such as work absenteeism and the loss of social contacts. All in all, MCS presents a major challenge to the health care system because there is no accepted diagnosis and effective treatment strategies are lacking (Skovbjerg, Johansen, Rasmussen, Thorsen, & Elberling, 2009).
The Qualitative Study
The aim of the qualitative study was to gain insight into patients’ perceptions of the distant healing procedure itself, its perceived benefits, and its shortcomings; therefore, a purposive sample of patients was recruited, but it was mainly patients who had improved under distant healing that were available for interview. Interviews were carried out via telephone using a semistructured interview guide. In this nested qualitative study we used a thematic analysis informed by the general grounded theory approach, ensuring an open inductive process in which the results were grounded in the available data and thus reflected them (Kruse, 2009b; Strauss & Corbin, 1996).
Participants
We sampled 40 patients (10% of the total) from the study. Twenty-seven of the chosen patients provided us with legible addresses and agreed—along with providing their initial informed consent—to participate in a phone interview after the study. In this first attempt we purposively sampled patients who showed exceptionally high decreases or increases in quality of life after the study (10 points = 1 standard deviation above or below their baseline values on the SF-36 physical or mental health scales). Only 17 patients were interviewed, because we could not reach all 27 patients despite making several attempts to do so. Out of these 17 patients, 14 had improved during the study. Although it was never intended to recruit only patients who had improved, those patients who could be contacted were mainly the ones who had. We interviewed 13 women and 4 men between the ages of 31 and 66 years, with the onset of disease ranging from age 2 to age 30. All of the participants were diagnosed with CFS; 15 of them had an additional diagnosis of MCS.
The Interviews
The interviews took place approximately 1 year after the study, when a trained interviewer (second author Andreas Anton) was available. We compiled a semistructured interview guide (see Table 2) and Anton telephoned the patients. Semistructured phone interviews were employed because these assured subjective accounts while also being feasible for a study in which patients were recruited from all over the country. The interviews were taped and transcribed such that micropauses and intonation were available for analysis (Deppermann, 2008; Kruse, 2009b). The interviews lasted between 7 and 24 minutes, with a mean duration of 13.4 minutes.
Semistructured Interview Guide
Data Analysis
The basic approach to data analysis was reconstructive interview analysis, a technique devised by Helfferich & Kruse (2007; Kruse, 2009a). Third author Jan Kruse was also part of the team that conducted the analysis. In this approach, basic ideas of ethnomethodological conversation analysis (Bergmann, 1994) and Karl Mannheim’s documentary method (Mannheim, 1980) are picked up on and further developed. Its strength is the focus on the participant’s actual wording and language, enabling researchers to reconstruct meaning. The process of the analysis itself resembles the coding process used in grounded theory (Kruse, 2009a), which includes the following steps: open coding, axial coding, and selective coding. After openly coding 13 interviews, we extracted a number of initial sensitizing concepts (Hoonaard, 2008; Kelle, 1996) and condensed them into categories using all of the interviews, while allowing new categories to be added. In a final step, the interviews were structured using these categories, leading to the interpretation and identification of the final themes that are considered most important. During the first step of open coding in particular (but also during more advanced iterations), the analysis is based on emerging language patterns, rules of addressing subjects, patterns of interpretation, leading themes, and central motives given by the participants. A team-based approach to the analysis was chosen. Five groups, each consisting of four sociology students supervised by a sociologist (Kruse) and a psychologist (Güthlin), analyzed the transcripts and prepared summaries and codes which were constantly and repeatedly discussed within the team.
Results
The overarching theme of the interviews was the field of tension between mainstream medicine and immaterial healing procedures such as distant healing. It was clear from the interviews that all patients accepted the biomedical prerogative of interpretation, and this led to particular central motives and language patterns, e.g., when the interview crossed the boundaries of the scientific world and experiences were presented which could not be explained in straightforward scientific terms. It is important to note that few people spelled out this field of tension, but several prominent components pointed to it, and these emerged repeatedly; they were (a) patterns of legitimizing the use of distant healing, (b) distant healing and the social setting, (c) integrating distant healing into their own belief system, and (d) reconstruction of effects by means of hindsight.
Patterns of Legitimizing
Despite not being asked why they decided to take part in the study, patients seemed to feel inclined to legitimize their decision to try distant healing right from the outset of the interview. They used “hard facts” to describe the state of their illness, as well as the improvement during the healing procedure, talked about their despair on the grounds of not being helped by whatever previous treatment they had tried, and relied on “authorities” when legitimizing their use of distant healing.
“Hard facts”
One respondent referred repeatedly to his “blood and hormone counts” to undermine the necessity to be helped; another told us exactly how much he had weighed before and after the study to describe the improvement when undergoing distant healing. He explained his illness as, “We’ve clarified everything from a medical perspective. I’ve been negatively affected by poisons, by a wood preservative, and by amalgam. That’s been proven. These facts have been clarified, and now I’ve got chronic Lyme disease.” One patient referred to the effects of distant healing, saying,
Yes, and now it is even the case that my blood count has improved [laughs], which I am very pleased about and, err, mm [medication?] or something, well, the iron levels are rising, without my taking any iron, yes, and I feel more stable in general and notice, mmm, yes, my strength is coming back, little by little.
Despair
Despair was one of the most prominent reasons for “trying” distant healing. In terms of language, people mainly used set phrases when linking their despair with the decision to take part in the study. The phrases used were “cling to every straw”; “There is nothing left to lose. At best I will get better”; “It can’t do any harm”; or “You have to try everything you can.” Despair resulted from experiences within the health care system: “I’ve dealt with a hundred thousand doctors, specialists, university hospitals, and I don’t know what else, and nothing worked and everything just got worse.” Another example was
Distant treatments exist and, err, I think you can influence things differently from conventional ways, by means of energy. And I just kind of thought, that can’t do any harm, and I want to try everything and the doctors implied that they couldn’t do anything else. Or couldn’t do any more than they were doing, and my doctor, the one that did something for me, he’s a CFS specialist, and he said he didn’t really believe in healing. He didn’t say it directly. I just understood that from what he was saying, but I believe in healing. I just hoped it could contribute something toward helping me to get better, and it has.
Distant healing even seems to have bridged the gap left by the missing diagnosis because it provided the means of “getting closer to it”:
Err, I tried everything I possibly could, and I didn’t really have great expectations or any specific expectations. I just gave everything a try. And then something new came on the scene and because no one knew what exactly I had, and I didn’t either. No one had a clue, and I just thought, there is this other way and I didn’t know if it was all psychosomatic or whatever. It could have been anything at all. No one wanted to commit themselves and no one really knew anything. So I went to see a healer and things, and the doctors didn’t know anything . . . just to try to get closer to it. Otherwise, yes, I thought there are no real disadvantages for me, and in your desperation you try everything, cling to every straw, don’t you?
It was clear that distant healing occurred at a particular point during the course of the disease: “I’d really reached the lowest point of my being. I thought things would never get better, and then I read about the study.”
Relying on authorities
Another feature of the pattern that emerged to legitimize distant healing was reliance on authorities when explaining either the incurability of the illness or when defending the use of distant healing. One participant felt that the whole procedure was respectable enough to take part in. She said,
I found it all very trustworthy because it all came via the university hospital, and I had a discussion with the doctor close to [name of the city] and the whole thing was very, very, help me now. [Interviewer: respectable.] Yes, exactly.
Another said, “Err, before I took part in the study I really felt awful. That means I couldn’t—I don’t know how literally I meant that—even get up. The doctors had given up on me.” These quotes clearly show that giving reasons for taking part in a study using distant healing was a prominent theme for the participants. It should be borne in mind that the interviewer did not explicitly ask for reasons, but they were presented throughout the interviews. Legitimizing distant healing can, however, take various forms: using “hard facts,” explaining the despair resulting from the disease, and relying on medical or spiritual authorities.
Distant Healing in the Social Setting
Besides legitimizing distant healing to the interviewer, patients also reported, noticed, or rather assumed certain reactions from significant others, and behaved accordingly. Reactions were quite hostile (or it was suspected they would be hostile) or, on the contrary, rather encouraging, depending on the social setting one was in. One participant described the reaction of her husband, and her reaction to his reaction:
And to be quite honest my husband has never believed in such things, and I said to him—because he noticed it, although I kept it secret—and then he saw it and just sort of waved it aside. Then I said it was my problem and he shouldn’t say anything about it. I really took drastic action and said it was completely and utterly my business, and he didn’t say a word about it, and now he says, “Well, maybe there’s something in it. Maybe there is.”
There was a reluctance to talk about the study and the distant healing given throughout it, as can be seen in the following quote. This was more of a precautionary measure, and did not result from bad experiences.
I went to see my physician a year later and he did a blood test. I didn’t say anything about the study. I had told virtually no one about the study. Only my husband and my son knew anything, no one else, yes? And he didn’t either, because I don’t know what he thinks about such things. Perhaps he would have said, “Well, you’ve got nothing to lose. You can do almost anything.” But I just didn’t want him to know. And then I went to his practice six weeks later and he said, “Well, I don’t know how you did it, but your blood count has improved.”
Later in this same interview the participant rang off (hung up the phone) suddenly because her parents had obviously come into the room, and they had not been informed about her participation in the study. Another participant told us that his improvement was regarded as a miracle:
The priest came every week and gave me Holy Communion and, well, there wasn’t much else he could do. And that there had been a complete turnaround, well that was enough of a miracle. Well, then the doctors also said, like my vicar, “A miracle has taken place.” That things could develop in a completely different direction really is a miracle. But as I said, the fact that I can now say, “It’s not that you can see it black and white, but it happened at exactly the same time that things started developing in a different direction.”
This shows that another recurrent theme was the social setting patients were in during the time of the study and afterwards. They had either experienced reactions from others which could range from being derogative to encouraging, or assumed (negative) views from significant others.
Placing Distant Healing Within One’s Own Belief System
Patients felt inclined to place their beliefs within the material and the immaterial world, thus demonstrating their ambiguity; one explained,
I always had a positive view of it, but I had never had any experience, and so I just said that if I could find a good healer, I think that something could be done. I also have patients that oriented themselves in that direction and some of them were successful. And you can’t always say it has to do with one’s faith and say if you believe in it you’ll become healthy. A bit, maybe—the psyche has an influence on lots of things. I believe that some people have certain capabilities and have more energy than others.
This man thanked his healer in a letter after the study, and wrote, “Mind over matter. I have been cured!” He continued in the interview,
I just saw. When you actually see something in your own body, that something can work to such a degree, something that others aren’t able to believe. Then it strengthens faith immensely, if one sees that such inexplicable changes actually occur.
Another patient relied more on scientific facts and had to downplay distant healing to ensure consistency with her belief system:
Nowadays I also think it is important that you know what your problem is and get a really good diagnosis, and I think that is the be-all and end-all of it. If you get a bit of distant healing or similar on top. Even if you just have diabetes it’s important to know that and then to do these things. I mean, the corresponding things, to get the medication. And then I think in most cases distant healing is probably the one thing that won’t help at all. Maybe as a supplementary thing, or perhaps it really helps for other things but I basically think that it all stands and falls with the real test, with examinations and with the ability of the doctors, with whatever, err, what do I know?
Patients also mentioned religion and believing in God when relating distant healing to their own belief system:
I have, back then, yes, I somehow got connected to the heavens. I started praying, I would say. Lots happened during that time, if all that . . . it all came together. And it, it has, someh . . . much has since then, yes, changed for the better. I still am, still as well [incomprehensible] health problems, but I, I am, I can deal with it a lot better emotionally. I am, after all, when I compare it to like five years ago or four years ago, much, much better. Yes, yes and if it was exactly, I think several good things came together [laughs]. Yes and I do think, that also, your [“thing”? background noise] contributed a pretty good deal.
Integrating experiences within their own belief system proved to be important for participants. Depending on their belief system patients had to accept more or less ambiguity, and expressed either that the experiences resulting from the study had strengthened their belief or had had minimal effects.
Reconstruction of Effects by Hindsight
The fourth repeatedly and clearly emerging theme was the reconstruction of effects deduced with hindsight: “And, in retrospect, when I had survived it all a year later and found out, well, distant healing was being done at that time, then I thought, well, maybe it did help.” Another man said,
I, it just happened to be at exactly the same time that, I mean, you didn’t even know when you were being treated, so to speak, undergoing distant healing. But in retrospect it was exactly the same time I started to feel better. Yes, that’s how it was. I found it out and then, when I looked back to when the turnaround occurred, it was at exactly that time.
Other patient comments included:
But all in all, and in retrospect, I can say that it stabilized things somewhat. I should add that at that period I didn’t know when a therapy was taking place, or at what time I was in therapy; no one told me that at the time and then I, in retrospect, when I was asked, I remembered that at that time I felt much stronger, somehow more assertive.
The participant comments all clearly show the pattern of constructing what happened throughout the study, and thus during distant healing, by looking for evidence in retrospect.
Discussion
This qualitative study, which was nested into a larger quantitative trial on distant healing in CFS and MCS patients, highlighted a significant but tacit field of tension between mainstream medicine and the immaterial healing procedure. However, the study has some limitations, which are presented first. For practical reasons, guideline-based telephone interviews were selected. These are sometimes suspected of not adequately ensuring that the principle of openness is adhered to. The problematic aspect of being guideline based was countered by choosing a partially narrative version of the guideline interview. We thus ensured that within a specific selection of topics, openness and the immanent flexibility to react to the dynamics of the discussion were guaranteed. The interviews lasted for approximately 15 minutes and were thus relatively short. This brevity was planned, because we knew from practitioners treating CFS and MCS patients who were part of the study planning team that these patients might have problems with their concentration span, and we took care not to exhaust them. However, for future studies, we suggest expanding the interview time so that brevity does not compromise data depth and quality.
From a methodological perspective it is necessary for the interviewer to remain in the background, and every effort was made to train the interviewer accordingly (Helfferich, 2005; Kruse, 2009b). Because the interviews touched on rather sensitive topics such as disease and distant healing, we assumed that the fact that interviews were conducted over the phone helped to ensure the necessary distance and thus contributed to openness.
Another limitation was the selection of patients. Although we tried to assure maximum variation in accordance with Kleining (1982) and Merkens (2003) by purposively sampling patients who had improved and deteriorated, the interviewed participants, i.e., the interviewees we were able to contact represented only a sample who had improved. There is no obvious reason for this besides the hypotheses that either patients whose health had deteriorated felt too ill to answer the phone or that patients who did not improve were even more distressed by the fact that they tried a rather “dubious” procedure (by the standards of their peers) which, again, provided false hope.
It should be borne in mind, however, that the aim of qualitative studies is not to yield results from which generalizations for the entire population can be made. Despite the brevity of the phone interviews and the small and skewed sample, the results might well represent matters of particular relevance to patients who had improved following distant healing, and touch on subjects that were easy to communicate to a researcher associated with the study group. Hence, in practice this might mean that the field of tension was more pronounced because we interviewed patients whose symptoms improved during the phase when healing was applied.
It is worth pointing out that for a methodologically fully satisfying study, a symmetrical sample of patients who had not been helped or who had deteriorated would have been necessary. Although we tried to motivate such patients, unfortunately none of them volunteered to participate in additional interviews. This can be seen from several perspectives: Patients with chronic fatigue syndrome are generally weary and tired. Being interviewed about a study participation that did not bring them any help might have been of little interest to them. Furthermore, the interviews took place some time after the study. It can be assumed that participation in the interview process was of interest only to patients who experienced significant changes. Thus, by default, patients with a lack of therapeutic success would not be motivated to expend energy being interviewed about the study. Finally, for patients with chronic fatigue syndrome, not getting better is the normal everyday experience they have discussed with many doctors and therapists, friends and relatives. To discuss this once more in the context of a study that did not help might not make any sense to them.
So as not to provide false hope, make unwarranted promises, or promote overly optimistic expectations, the study information material was written in a dry and factual style, reducing expected nonspecific therapeutic effects. In the face of this situation we think that the outcome is comparatively good overall, and the study brought at least a shadow of a therapeutic option to patients who considered themselves impossible to treat and who had long given up hope of improvement. The study took place at least one year after the distant healing was given. Thus, it was sometimes difficult for the participants to reconstruct exactly what had happened during the study. The interviews showed, however, that the subjective and individual reconstructions of benefits, limitations, and experiences were still present at the time of the interview, and probably represented a selection of subjective reconstructions that had remained in the patient’s memory.
The overall reasoning patients presented during the interviews followed the principles of biomedicine, such as using hard facts (e.g., cell counts) as proof of having the disease, as well as of any deterioration or improvement. Patients also relied on authorities, both when talking about medicine and about religion. This might have been reinforced by the fact that the distant healing procedure was part of a scientific study, and it was clear that the interviewer was associated with a trial group located at an academic center. Another possible influence of the interviewer being associated with the study group is that participants might have assumed that the interviewer took a favorable stance toward distant healing, and were thus more positive about their experiences. However, accounts reflecting ambiguity were also presented; thus, the results do not only describe positive experiences.
Another pattern used to legitimize the decision to participate was the emphasis that because there was “nothing left to lose,” patients were prepared to embark on distant healing. They reported significant despair and helplessness because of the long-lasting and draining nature of the illness, and also suggested that despair is a very good reason for trying unusual treatments. Despair and helplessness are certainly not specific to the patients we interviewed, but are known to be problematic both in CFS and MCS (White & Schweitzer, 2000). Both diagnoses are confirmed by excluding biomedically “significant” causes of complaints such as cancer or toxic damage (Eis et al., 2008, Fukuda et al., 1994), because being diagnosed as having no medical problem often leaves the patient with the feeling of being denied feeling ill. Patients feel they are not being taken seriously by the health care system and often begin an extensive search for a meaningful (new) self-identity (Clarke & James, 2003). People feel severely ill despite being diagnosed to the contrary, and spiritual healing is perceived as running contrary to biomedicine. In this healing situation the concept of the “three bodies” developed by Benjamin Myers (2010) to explain placebo effects becomes palpable for patients: They have to integrate the “individual body,” which bears all the consequences of the chronic disease; the “social body,” which feels the cultural meaning of the healing ritual; and the “political body,” which relates to (political) power and control, and thus to external opinions. The experiences gathered during the journey through the biomedical system leave the patients in uncertainty, and call for rituals to fill the perceived gaps (Broom & Tovey, 2008). In practice, not only distant or faith healing procedures fill this gap, but also complementary and alternative approaches to medicine, which are known to be explicitly sought when people are dissatisfied with the (mostly biomedical) therapy they are undergoing (Boon, Brown, Gravin, Kennard, & Stewart, 1999).
Besides the (probably subconscious) need to legitimize distant healing, other themes emerged that pointed to the conflicts the patients might have had, either consciously or subconsciously. Among the conscious conflicts, hostile reactions from significant others played a role, as did the fear that people might denounce their efforts as quackery, with unknown consequences for their health care. Patients often kept the fact that they were trying distant healing to themselves, which is also known to be true for the use of complementary and alternative approaches to medicine (Robinson & McGrail, 2004). One man reported that his improvement was acknowledged as a miracle by a priest. He was thus able to “transcend” the border between biomedicine and faith (healing) with the help of an authority unconnected with biomedicine. The need to legitimize distant healing procedures might be reinforced by the notion that health is still defined as the absence of illness, and that cure refers solely to fixing pathogenic mechanisms (Levin & Browner, 2005).
Qualitative research shows that longstanding illness poses a subjective threat to a sense of security and identity (Aujoulat, Marcolongo, Bonadiman, & Deccache, 2008), and thus leads to feelings of insecurity. It is known that chronically ill patients seek to restore equilibrium, constantly comparing and integrating external and internal factors (Sharpe & Curran, 2006). Clearly, this also refers to biomedically accepted cures, as well as to spiritual healing.
Another clear theme was the need to incorporate the distant healing procedure within one’s own belief system. The positions taken by patients were by no means clear, but marked by ambiguity. Whereas “connectedness” is a recurrent theme in other research on spiritual care (Burkhart & Hogan, 2008), in this study concepts that sounded closer to biomedical science were often presented. Terms like a good healer were used, implying that there is some kind of quality assurance in distant healing. Despite implicitly calling for quality checks for healers, one man concluded that in his case, “his mind now reigns over the body,” thus expressing the opinion that some kind of war had to be fought. Another participant concluded that in the end only hard scientific facts like diagnostic tests matter, and felt that distant healing provided a “little bit extra,” which surely could not have contributed significantly to the improvement in the disease.
Last but not least, many patients made an effort to reconstruct the effects by using the term in retrospect, and attaching well-being or support to the time the healing was performed. Because this was a distant healing procedure, every perceived effect was a construction made by the patient using individual clues in the absence of any physical contact or clear biomedical outcome. Levin (2009) proposed a theoretical typology of possible mechanisms to describe a salutogenic effect. He hypothesized that there are (a) behavioral/conative, (b) interpersonal, (c) cognitive, (d) affective, and (e) psychophysiological mechanisms. Whereas the behavioral and conative mechanism linked religious practices with healthy behavior, the second (interpersonal) type pointed to the social component of connecting with like-minded people. The cognitive mechanism referred to supernatural ideations which can give meaning to all phases of life, and the affective mechanism can buffer negative emotions more directly because it mitigates stress. The psychophysiological mechanism might provide physiological pathways which enable the subject to tolerate pain and the burden of disease.
To sum up: Regarding the theoretical typology of mechanisms of faith healing in accordance with Levin (2009), the hypothesized mechanisms for integrating salutogenesis into one’s life when ill, such as the behavioral/conative, the interpersonal, the cognitive, the affective, and the psychophysiological mechanisms, also provide a comprehensive framework for our results. The interpersonal mechanism is touched upon when patients rely on authorities like a priest, the cognitive mechanism when patients start talking about biomedical markers such as cell counts, and the affective component when people integrate the healing procedures into their belief system.
A study comparing religious healing with biomedical practice provided in an oncology center (Vallenga, 2008) underscores the patterns we found in our study. The author found similarities in both healing practices, with both eliciting a tendency to objectify the underlying framework (both healing rituals were presented as representing the “truth”) and a very instrumental way of working (in the sense of “restoring” health). Furthermore, healers were ascribed the status of experts in the sense of either having a God-given gift or being cancer specialists, and efficacy was attributed to the indirect route of symbolic healing through emotional support, together with the act of “restoring” health, and a comparable way of dealing with unknown and uncontrolled factors (suggesting that something is missing, either enough faith or insufficient biomedical means to save everyone).
Our results support data that imply the existence of a psychophysical pathway in healing through spiritual rituals, and gave subjective insight into the perspective of patients. In our study patients felt—despite or because of existing empirical data—the need to legitimize having tried distant healing. They bore the full ambiguity of biomedicine being in competition with spiritual practices, having to cope with reactions from others, having to integrate their beliefs, and the slippery feeling that distant healing has contributed “something.”
Footnotes
Acknowledgements
We thank Phillip Elliott, who translated the quotations from German into English, particularly ensuring that quotations were kept vivid.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors disclosed receipt of the following financial support for the research and/or authorship of this article: The original study was funded by the European Commission FP 5 Programme Quality of Life and Living Resources. The qualitative element of the study was partially supported by the Samueli Institute.