THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 10, Number 5, 2004, pp. 751–756 © Mary Ann Liebert, Inc.
ORIGINAL PAPERS
The Healing Presence: Can It be Reliably Measured? WAYNE B. JONAS, M.D., and CINDY C. CRAWFORD, B.A.
ABSTRACT Religious and spiritual traditions from all cultures and times describe a spiritual or loving presence as a contributor to healing. In addition, there is a common belief that a special “presence” can exude from certain practitioners. Is it possible to measure a healing presence in an objective and reliable way? Most research on healing has focused on trying to prove spiritual and “energy” healing in comparative tests. However, if a measure of healing presence is to be sensitive and reliable, objective and real-time indicators of such a presence will be needed rather than comparative and statistical outcomes. This paper discusses what healers from various traditions have felt are the primary components of a healing presence, summarizes various attempts to measure healing, and describes two recently published approaches that have potential to provide such an objective and realtime indicator of a healing presence.
INTRODUCTION
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eligious and spiritual traditions from all cultures and all times describe the spiritual or loving presence of the faithful as a major contributor of healing. In addition, the common belief that some individuals are highly effective healers, independent of whether they use a ritual, prayer, needle, pill or knife, perpetuates the common belief that a special “presence” can exude from certain practitioners. This presence is capable of inducing an experience of recovery, wholeness, peace or well-being in people who suffer. Given all of this to be so, the question is: “Can science objectively investigate this phenomenon?” Science has, for the most part, either ignored the claims of a “healing presence” or explained its effects psychologically; that is, the person responds as the result of belief, expectation, and placebo. Such effects are assumed to occur only through known psychophysiologic pathways within an individual after that person cognitively interprets or reacts to the context and meaning of social or therapeutic behavior. This “meaning” response is described as the mechanism underlying the “placebo” effect (Moerman and Jonas, 2002).
Meaning responses can be profound, varying in intensity from 0% to 100% and capable of altering both psychologic and physical illness (Moerman 2000; Roberts et al., 1993). While the effects induced by a healing presence may be largely attributed by the context and meaning of interpersonal interactions, and so be consistent with a “placebo” explanation, such an explanation is not consonant with the assumptions of most spiritual traditions or with most healers themselves. Healing traditions usually assume a transpersonal, spiritual, or energetic component that operates directly to affect the person independent of the social and psychologic interpretation or context of the healer’s behavior. In other words, these traditions assume that there is a special quality to the “presence” of a healer that operates outside the bounds of conventional psychosocial dynamics. In addition, a consistent, objective and reliable measure of the healing presence would go a long way toward understanding and effectively using this ancient concept in practice. In this paper, we (1) present results from a Delphi process exploring what healers from various traditions claim are the common components of healing; (2) summarize research that has attempted to measure the effects of a healing in ex-
Samueli Institute for Information Biology, Alexandria, VA.
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perimental comparative clinical and biologic studies; and (3) explore two measurement techniques that have potential to measure robustly the healing presence, using objective and real-time techniques.
WHAT ARE THE ESSENTIAL COMPONENTS OF A HEALING PRESENCE? Between 1993 and 1995, the New Creek Foundation, a nonprofit organization with an interest in healing, held a series of meetings involving healers from a dozen different traditions around the world and scientists from several different disciplines. These meetings focused on exploring the question, “What are the common components of noninstrumental healing across these traditions?” Table 1 lists the twelve healing traditions that were involved in the meetings. The focus was on healing traditions that used spiritual or energetic “presence” rather than treatment rituals or specific techniques. After describing the background, assumptions and approach to healing by each tradition, a Delphi process was used to distill and name what were considered by most to be the essential components of a healing presence. Table 2 lists the results of that process. The two components of a healing presence agreed upon by almost all participants were “love” and “good intentions.” Both were felt to be necessary for an effective healing presence. Love was generally described as a deep emotional connection with the spiritual or divine aspect of another person. It was considered a state deeply rooted in the “now” and the eternal aspects of existence. Thus, love was considered to be a state that connected the personal and profane with the eternal and “sacred” dimensions (in other words, the point of unity between “I, thou, and other”). An equally important component for healing was to hold a positive and altruistic intention for the other. While “love” was seen as providing the “depth and force” of a healing presence, good intentions were viewed as providing the “direction” and benevolent nature of the outcome according to these traditions. Other components of the healing presence were not agreed on by all to be necessary, although most participants agreed that these components were important. The spiritual nature of the healing presence was reflected in the third component, “spiritual grace.” In addition, the important contributions of belief, openness, listening, focused awareness, the direction of “energy,” and attention to connectivity, reconciliation, and forgiveness were acknowledged to facilitate healing when in the presence of another person cultivating these qualities.
TABLE 2. COMMON COMPONENTS
OF A
HEALING PRESENCE
Number of traditions identifying the component • • • • • • •
Love (11) Spiritual grace (6) Focused awareness (5) Openness to healing (4) Creativity (3) Imagination (2) Connectedness (3) or relationship (3)
• • • • •
Good intention (11) Belief (5) Direction of energy Listening (3) Reconciliation (3)
MODELS OF HEALING PRESENCE Healing traditions have a diversity of explanations for how presence facilitates healing (Cooperstein, 2003). Most explanations take one of four forms. These are: (1) “alignment with God,” usually through prayer, as the primary mechanism of healing; (2) “immersion into a universal consciousness,” through meditation and other spiritual and personal “deepening” experiences (a second model); (3) transmission of “spiritual energy” through the healer (a third description either by using exercises or spontaneously); and (4) interaction with spiritual “forces or entities” (a fourth, less-common explanation) (O’Laoire et al., 2003). Most traditions assume that human beings have physical, mental, and spiritual dimensions. Healing presence is facilitated when we place our attention toward the “deeper” or more subtle dimensions of our existence than the body, that is, the spiritual, emotional, and mental aspects of self. Figure 1 illustrates these dimensions. Notice that, according to this model, the more central aspects of our being are closer together and more unified on a transpersonal level; that is, they are nonlocal. Notice also that there are some parallel modern concepts that sometimes serve as metaphors for these same dimensions. These are “matter” that makes up the body, “energy” required for our psychologic or mental function, and “information” that, while not the same as our spiritual nature, does have nonlocal characteristics. From the perspective of this model, the development of a healing presence involves experiencing and placing awareness on these
TABLE 1. HEALING TRADITIONS SAMPLED • • • • • •
Ayurvedia Qigong Greek orthodox Kabalistic Sufi Native American Medicine
• • • • • •
Christian evangelical African shamanism Psychotherapy Christian science Spiritual healing Brazilian psychic surgery
FIG. 1.
A model of nonlocal being: A visual model.
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HEALING PRESENCE more central, nonlocal dimensions in which humanity is closer and more universally connected with each other and the divine.
IS THERE QUALITY RESEARCH ON HEALING PRESENCE? Recently, we completed a 3-year project aimed at reviewing the literature on noninstrumental healing approaches that may conform to the nonlocal assumptions of these traditions (Jonas and Crawford 2003). In order to determine research quality, we established quality rating criteria for assessing the literature and asked experts in several fields to apply those criteria to current studies. We then rated the level of evidence for this literature according to standards currently accepted for conventional biomedical research. These six levels of evidence ranged from A for high quality independently replicated experiments to F for an opinion without quality data. We applied these standards in six categories of spiritual, intentional or energy healing, and mind–matter research. These categories were: (1) religion and spiritual practices; (2) prayer and distant healing; (3) laying-on-of-hands; (4) qigong (Chinese energy healing) in both laboratory research and in clinical studies on hypertension; (5) intentional influences on physical phenomena (primarily random event generators); and (6) intentional influences on biologic phenomena (primarily cellular and laboratory experiments and experiments measuring electrodermal changes in humans). Each of us independently assessed the quality of study design, measurement and analysis issues, randomization, TABLE 3. SUMMARY
Topic Religion and spirituality Intercessory prayer “Energy” healing Qigong (laboratory) Qigong (clinical) DMILS (EDA) DMILS (RS) MMI (Individual) MMI (Group)
OF
EVIDENCE
blinding, objectivity and validity of outcome measurement, lost data handling, statistical analysis, and whether studies had been independently replicated. These summaries were discussed and critiqued at two conferences held in the Fall of 2000 and 2001. The resulting papers were then sent for peer-review and modification. Results of this analysis are presented in Table 3 and have been published in a book and summarized in several journal papers (Crawford et al., 2003; Jonas and Crawford, 2003a,b). We were surprised to find more than 2500 references to nonlocal types of healing in the English literature alone and more than 200 controlled clinical studies or experiments from the laboratory that were investigating whether noninstrumental healing was effective. The laboratory studies presumably were not subject to placebo effects and some might have provided a measurement tool for measurement of the healing presence. The results of this survey and analysis are summarized in Table 3 (Jonas and Crawford, 2003c). Almost all of these studies, whether clinical or laboratory, were attempting to prove that healing exists. Thus they used two group research designs in which experimental and comparison groups were measured looking for statistical differences between these two groups. There are very few “realtime” measurement studies that could be used to both detect and monitor the healing presence. The most statistically robust and replicable studies are those that use measurement tools allowing repeated assessment with continuous and objective rather than categorical measures. The most promising approaches from this literature that appear to have this potential are measures such as enzyme metabolic rates, random-event machines, electrodermal responses, and ion flux across cell membranes. FOR
SPIRITUAL
AND
ENERGY HEALING Quality of studies
Number of studies
No. positive # (%)
Average effect size
130 13 19 130 33 (of 76) hypertension 24 13 216 80
100 (78) 6 (46) 11 (58) All 32 (97)
ND 0.300 0.600 ND ND
Good Fair Fair Poor Poor
D B B C F
0.160 0.310 0.007 ND
Good Good Excellent Unknown
B B A E
9 (37.5) 7 (60) ND ND
Evidence level
DMILS, Distant mental interaction with living systems; EDA, electrodermal activity; RS, remote staring; MMI, mind–matter interactions (individual and group studies); ND, no data. Quality Categories Poor: 0–30% of studies meeting more than 60% of maximum quality criteria Fair: 30–50% of studies meeting more than 60% of maximum quality criteria Good: 50–70% of studies meeting more than 60% of maximum quality criteria Excellent: More than 70% of studies meeting more than 60% of maximum quality criteria Note: Table taken from: Jonas W, Crawford C. Science and spiritual healing: A critical review of spiritual healing, “energy” medicine, and intentionality. Altern Ther Health Med 2003;9(2):60; with permission.
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ARE THERE METHODS TO MEASURE THE HEALING PRESENCE OBJECTIVELY? Cogent questions are: “How can one determine whether a healing presence exists? Can one objectively determine when a practitioner is deep into a state of healing presence?” Most claims of healing are accompanied by anecdotal stories or myths of magical powers, information that is not helpful for scientific investigation. The development of simple, real-time, and objective techniques to measure the healing presence is the single most crucial obstacle to conducting high quality research in this area. Most studies on nonlocal mechanisms of healing used subjective measures that were difficult to apply, had other design flaws, or were not replicated. Sets of studies that reached the top (A) level of evidence and used simple, objective, real-time methods to measure outcomes were few. We have done preliminary studies on two measures that may serve as possible detectors of the healing presence. These are the random-event generator (REG) and real-time monitoring of calcium flux in a cellular model. The electronic REG is the development of a program pioneered by Robert Jahn, Ph.D., director of the Princeton Engineering Anomalies Research (PEAR) at Princeton University, NJ. An REG is an electronic device that produces a stream of random bits of information (either 0 or 1 in random sequence) and captures that information on a computer. Normal operations of a REG produce on average equal numbers of 0s and 1s in any given stream of data. Jahn and many others have demonstrated that mental intention to increase or decrease the number of 0s or 1s generated by a REG results in significant deviation from that seen by chance (Radin and Nelson, 2003). The deviation is small, but statistically significant and seems to correlate with coherent intention efforts by individuals and groups similar to those described
JONAS AND CRAWFORD by healers (Nelson and Radin, 2003). Thus, the REG provides a stream of continuous outcome data that might serve as a detector of intention and healing presence. Is the REG a useful device for the measurement of a healing presence? Most studies with REGs have not examined healing or healers. Figure 2 illustrates a REG tracing captured during a Shonshoni healing ceremony at Devil’s Tower, AZ. Note the marked deviation from chance expectation. We have recently attempted to see if a REG placed in a healer’s office performed differently than a similar device in a medical-school library. We ran a REG during healing sessions in the office of a bioenergy practitioner that heals through the development of a healing presence. This practitioner describes spiritual energy as flowing through him to a client, which is Model Three of the four primary models of healing described in our Delphi process. Figure 3 shows the results of three separate month-long experiments examining the behavior of the REG in these two settings. The REG deviated from chance levels at least once on approximately half of the days in which it was placed in the library. In the healer’s office, the REG deviated at least once almost every day during healing presence sessions and also deviated more frequently per day in the healers office (data not shown). We are now examining whether the REG behaves differently in other settings where healing is occurring such as a postoperative recovery room. The REG may provide a possible method of detecting the healing presence. Studies on healing indicate that the effects of healing presence are larger in biologic and clinical settings than on mechanical or electronic measurement devices. Because of this, we have been exploring the use of cellular calcium flux as a possible method for detecting the healing presence. Imaging calcium flux across the membrane of immune cells is a common and objective measurement approach in bio-
FIG. 2. Cumulative deviation of field random-event generator (REG) data during a 20-minute healing ceremony performed by a Shoshone Shaman at Devils Tower, AZ. Taken from: Nelson R, Radin D. Research on mind–matter interactions (MMI): Group attention. In: Jonas W, Crawford C, eds. Healing, Intention and Energy Medicine: Science, Research Methods and Clinical Implications. London: Churchill Livingstone; 2003:54, with permission.
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FIG. 3.
Differences between library versus healer in random-event generator deviations. Reg, random-event generator.
logic sciences and can be monitored in real-time with fluorescent detection methods. In addition, intracellular calcium modulates many vital cell functions and would be expected to change when healing is taking place. We have recently begun exploring florescent calcium imaging as a method for detecting the healing presence. Initial studies have shown that when a healer is creating a healing presence in the laboratory, intracellular calcium consistently rises by 10%–20%. This does not occur when the healer is not practicing and does not occur when untrained individuals sit in the same room with the cells (Kiang et al., 2002). Figure 4 is a sample tracing, illustrating how these approaches might be used to detect the healing presence. The figure shows a calcium rise after 15 minutes of a healing presence compared to 15 minutes in front of someone not attempting to generate such a presence. The consistency of this measure and its objective, continuous output make it an ideal candidate for evaluation of the healing presence. We have been using this measure to explore a variety of parameters of healing such as various control conditions, the influence of distance and time, and the cellular mechanisms affected by the healer (Kiang et al., 2003). Unlike the REG in which deviations occur more frequently but inconsistently during a day in the healer’s office, calcium flux occurs consistently during healing practice even over short periods. Thus, calcium imaging may be a more sensitive method for detection of a healing presence than REG measures. What is of interest is that the increases in calcium flux seen with a healing presence seem to linger for several hours in the laboratory after the healer has gone. This “linger” effect implies that the “presence of healing influence” in a space may occur separate from the healer’s physical presence. Therefore, careful design issues including caution when conducting any crossover or alternating “on” and “off” tests is required. Of course, a wider variety of healers need to be tested with definitive thresholds and cutoff points and under blinded conditions before such a measure can be considered reliable and valid for clinical use. We are also exploring the use of electroencephalogram (EEG)
A
B
FIG. 4. External bioenergy alters intracellular calcium. (A) External bioenergy treated Jurkat cells (B) Sham operated control Jurkat cells. Taken from: Kiang J, Marotta D, Wirkus M, Wirkus M, Jonas W. External bioenergy increases intracellular free calcium concentration and reduces cellular response to heat stress. Kiang J, Marotta D, Wirkus M, Jonas W. External biology increases intracellular free calcium concentration and reduces cellular response to heat stress. J Invest Med 2002;50(1):41. Used with permission.
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and brain-imaging technology for detection of the healing presence state. Characteristic brain-imaging patterns are said to occur during meditation (Newberg et al., 2001). In addition, there have been reports of EEG correlation between a healer and healee during healing presence sessions (Fahrion et al., 1992). For the most part, these studies have not been confirmed independently and possible artifacts of EEG autocorrelation have not been ruled out. More fundamental research on nonlocal EEG correlation is needed that examines the role of variables such as bonding, deep personal engagement, and healing practices (Wackermann et al., 2003).
CONCLUSIONS While the idea of the healing presence is both ancient and universal in human culture, its scientific investigation is in its infancy. The influence of the doctor–patient relationship, the context and meaning in which treatment occurs, and the expectation and belief on both practitioner and patient are all widely accepted in both conventional and complementary medicine. The assumption that such effects can occur only through individual cognitive psychosocial processes is not consistent with assumptions of many healing traditions nor does it explain effects from nonlocal healing found in the laboratory. In these traditions, the healing presence is said to have spiritual, transpersonal and nonlocal characteristics. Only a handful of studies have examined claims that love and good intentions can nonlocally influence reality and suffering. These studies, while preliminary, indicate that alternative mechanisms to conventional psychodynamics may also be involved in medicine and healing. Experimental, two-group tests that use categorical outcomes may be too inflexible to serve as detectors of the healing presence. Continuous, objective measures, such as REG, electrodermal activity, EEG or biologic functions, such as calcium flux and enzyme metabolism, are more likely measures to be useful as real-time detectors. Further development of rigorous, objective methods for measuring the healing presence will help us investigate and so understand better the multidimensional nature of healing.
ACKNOWLEDGMENTS This study was supported by the New Creek Foundation and the Samueli Institute for Information Biology. We are grateful for the helpful review and editing by Ronald A. Chez, M.D., Samueli Institute, Corona del Mar, CA.
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