A brief literature review of cancer survival trials is employed by the author to raise questions on their design and to bring speculatively into discussion concepts such as “worldview”, “intentional normative dissociation”, and “psychosomatic plasticity-proneness”. Using prayer’s psychological dimension as a way to unite such elements opens new fertile perspectives on the academic study of prayer and health. In this context, it is suggested that a consistent interdisciplinary research agenda is required in order to understand those biopsychosocial factors interconnected within the process and outcome of prayer before attempting to decipher the big answers laying dormant probably within the transpersonal and spiritual layers of human experience.
The last 20 years have been challenging for those researchers asking the question, “Can psychological interventions promote survival in cancer?” Starting with two promising experiments (Fawzy et al., 1993; Spiegel et al., 1989) interpreted widely as encouraging the possibility that psychological intervention might promote cancer survival, today the academic literature presents a different picture. A collection of recent studies failed to replicate earlier positive results (Cunningham et al., 1998; Edelman et al., 1999; Goodwin et al., 2001, Kissane et al., 2007), while meta-analyses and associated commentaries (e.g., Chida et al., 2008; Coyne, Stefanek, & Palmer, 2007; Coyne et al., 2009; Kraemer, Kuchler, & Spiegel, 2009) signaled the need for more rigorous methodological standards in this research area. Though some published papers outline promising avenues of research (e.g., Andersen et al., 2008; Cunningham et al., 2000; Cunningham & Watson, 2004; Kissane, 2009; Lengacher et al., 2008; Lutgendorf, Sood & Antoni, 2010), from a physiological standpoint, Greer (1999) has drawn attention to the claim that it is highly improbable for psychological processes to play a significant role in the course of most cancers. Still, psychological interventions might contribute theoretically to homeostatic control in those cancers where hormonal and immunological factors may be important (e.g., in breast, gynecological, and prostate, renal cell, melanoma, and similar cancers). Due to the complexity of processes and cascading events that take place in the lives of cancer patients, it is currently very difficult to attribute causal influence in medical outcomes to any specific psychological intervention when so many variables are implicated. Until consistent progress will be made in this regard (e.g., Gorin, 2010), some of the claims linking psychological states and health outcomes might be critically labeled as “Unproven Medicine” (Coyne & Tennen, 2010; Coyne, Tennen, & Ranchor, 2010).
The above-mentioned situation encourages attention to the methods used to investigate such an intricate subject (Cunningham, 2005; Stephen et al., 2007), especially the reasons why psychological therapies have not robustly addressed the potential “psychogenicity” of some cancer types; this notion refers to the ability of a psychological intervention to elicit significant and permanent changes on key psychosocial factors that are demonstrably linked with biological variables known to determine favorable biomedical outcomes (Temoshok, 2002). Assuming that one’s psycho-emotional life could often play a consistent role in the regulation of many hormonal and neurological events in the body, a major difficulty—one that particularly concerns psychoneuroimmunology researchers—is the identification of the key ingredients and conditions that activate those pathways related to health-disease outcomes (Kiecolt-Glaser, 2009; Miller, Chen, & Cole, 2009; Walker et al., 2005). For example, in order to exceed the medical prognosis regarding one’s cancer survival expectations, that patient would need to change by psycho-emotional means his or her current homeostatic equilibrium, equilibrium already corrupted by the advanced cancer which has by that time adapted successfully to the internal milieu of its host (Cunningham, 1999). This complex but presumably achievable task might require some fundamentally different approaches than those employed by conventional psychotherapeutic interventions. It should be taken into account that selfpreservation of humans as a species could be a major reason for which in daily life an individual cannot usually influence, significantly and with ease, his or her own physiology to the point of radically altering the existing homeostatic equilibrium (as in that stance, even a short lasting inability from one’s part to consciously control this process would induce instantly severe health problems upon one’s body).
Changing Magnification and Perspective
In order to find relevant answers to key questions pertaining to cancer survival, it is necessary to take into consideration the degree of detail and complexity required by this particular topic of inquiry within the general context of cancer research (Mukherjee, 2010), an operation corresponding metaphorically to a significant change of a microscope’s magnification factor. Changing magnification and perspective could reveal a different level of detail that implicitly will ask for customized approaches and adequate research tools. Hypothetically, there might be some discrete and insufficiently understood factors that, within specific individual and social constraints, could interact synergically in order to activate or accelerate some body healing processes.To take a relevant analogy (Reich, 2009), the situation of the person seeking healing from cancer might be comparable to that of that of a professional basketball player, whose success depends on both “nature and nurture”: as much on natural endowment (e.g., height, efficient use of oxygen) as on abilities developed during years of training (e.g., speed of running, precision of throws). Recovering from such a serious illness is a feat that requires maximizing all resources, and that tests the limits of human capabilities, just as world-class sports events do. Research in this area thus needs to do more than simply look for norms within health-care-as-usual. As Abraham Maslow once stated, “If we want to know how fast a human being can run, then it is of no use to average out the speed of the population; it is far better to collect Olympic gold medal winners and see how well they can do” (as cited in Hoffman, 1988, p. 185). Healing cancer is a matter of the extraordinary. If psychological and social life is viewed as a sort of “game” within a Bourdieusian framework of athletic competitions (Calhoun, 2003, p. 275), then taking on the work of attempting to positively influence cancer survival expectations with the assistance of certain psychological interventions implies an Olympic-level effort: putting oneself on the line, being passionately engaged in a struggle with one’s own limits, and being aware of the larger picture while remaining deeply committed to valuable personal goals.If this sports parallel remains credible, some questions will need to be debated in the academic forum. Among them:
Would it be possible to consider as a suitable trial-participant any cancer patient that has been immersed most of his or her life in a variety of mundane activities, rarely related to systematic culture-bound rituals of healing?
Would it be ethical to provide specific and intensive training only to some cancer patients?
Would it be in any way acceptable to put implicit pressure on the trial participants, as improvements in their long-term health status would depend presumably on their personal implication in the training process (though such a supposition has not been previously clinically validated)?
After taking these aspects into consideration, a potential clinically significant result that might emerge following a specific training program should deserve to be considered as comparable with the performance of breaking a world sports record, with the time and effort dedicated to achieving such a goal playing a large contribution in the outcome. Such an approach to cancer survival research shares not only similarities with sports (e.g., it might be hard but not impossible to duplicate high levels of performance) but also significant differences. For example, there is the challenge of assessing participants’ ability to follow successfully an intensive training program within a very limited timeframe (added to the general challenging context of one’s health status) and the problematic matter (no detailed in this article) of designing and validating what is “adequate” content for such training activity.
The rest of Adrian’s article may be found on TranspersonalStudies.org.