Lewis Mehl-Madrona: Traditional Native American Medicine - Treatment of Chronic Illness
traditional native american medicine Traditional (Native American) Indian Medicine
Treatment of Chronic Illness:

Development of an Integrated Program with Conventional American Medicine and Evaluation of Effectiveness

By   Lewis Mehl-Madrona, M.D., Ph.D.

Lewis E. Mehl-Madrona, M.D., Ph.D.
Native American Medicine
Associate Professor of Family Medicine and Psychiatry
Department of Family Medicine
University of Saskatchewan College of Medicine
3311 Fairmont Drive
Saskatoon, SK S7M 3Y5
Dr. Lewis Mehl-Madrona
Phone: 306-655-4249
Fax: 306-655-4894
Email: moc . loa ta anordamlhem

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Summary :

Increasingly, traditional Native American healing practices are being requested by Native Americans and non-Natives alike. A series of meetings among traditional Native American healers and the author resulted in a dialogue between the Native American world view and that of biomedicine. Recommendations arose for how treatment should proceed in the modern world and how best to introduce interested non-Natives to Native American healing practices. An approach was developed for bridging cultures to facilitate the interaction of non-Natives with traditional healers.

One hundred sixteen patients were treated in this manner by the author in conjunction with traditional Native American healers. More than 80% of patients showed significant, persisting benefits of a time-intensive treatment program. A comparison group of patients derived from the author's emergency room patients showed significantly lower rates of improvement. The author suggests that an intensive treatment experience (inspired by Native American Medicine practices) over 7-10 days for treating chronic physical illness achieves both health benefits and improved cost utility.

The treatment philosophy underlying this approach and communicated by the traditional healers is best described as general systems theory, or that of dynamic energy systems. Within this theoretical framework, physical illness can be treated by counseling and ceremony, since illness is viewed as simultaneously spiritual, mental, and physical. Because of the interaction and hierarchical embeddedness of these levels, intervention at any one level should affect any other.

Introduction :

Recent years have shown a surge of interest in the therapies of traditional cultures, in patients' use of alternative medicine, and in the desire for mind-body therapies and for spiritual treatment, as well as for behavioral medicine treatments for chronic medical illness. Some hospitals have included traditional Native American healers as part of their staff. Harvard University has created a Center to study alternative medicine. Dossey has documented the healing power of prayer. Religious practices and beliefs appear, for the most part, to be good for one's health. The medical effect of prayer and healing seems to be more related to the intensity of one's own practices and belief system, than to the particular denomination or religious tradition with which one is affiliated. Devout people of various religions appear to have similar medical effects.

Americans frequently participate in religiously based healing activities.2 In a 1985 study of 200 elderly women, participants were asked to indicate what resources they called upon when they become sick. Ninety-one percent of the women reported praying when in trouble, and 86% reported thinking of God or their religious beliefs. Ninety-six percent of patients undergoing heart surgery reported praying with most reporting positive benefits from their prayers. One of seven persons reported experiencing a divine healing in a 1986 random telephone survey. The most common problems healed were viral, but some respondents did report healing of cancer, back problems, and emotional problems.8

Gallup found that 95% of the American population believes in God, more than 50% of people pray daily, and 40% attend church weekly. Nearly 75% of Americans claim that their entire approach to life is grounded in their religious beliefs. There is a large gap between what patients would like regarding spiritual involvement in medicine and what health professionals are providing at this time. Many patients want their religious beliefs and practices respected and their spiritual needs acknowledged as part of their medical care. They would like to incorporate their spiritual beliefs into their medical care. This integration is not generally occurring at the present time.3

One of the spiritual practices which patients may request (especially in the American Southwest) is Native American Healing (NAH) to complement their conventional medical treatment. Some patients even voice a preference for exclusive NAH. On reservation settings, tension may exist between Native American healers and conventional physicians supplied by the Indian Health Service (IHS). Native American medicine has been practiced on the North American continent for at least 10,000 years, depending upon one's theory of origin or arrival. When Europeans arrived in North America, the native population were a healthy lot. Plagues and epidemics from Europe soon changed that, but do not mitigate against the effectiveness of Native American methods for attaining long-term survival and the treatment of chronic disease.

Native Americans stressed development of the inner life which was seen reflected in the outer world. The events of the outer world spoke to inner processes for the person. A fire is burning on the mountain. The person is in agony. An awareness comes which dissipates the agony. Rain comes to quench the fire. The events are seen as related. The fire and the rain were messages about the internal processes of the person. Such ideas are more consistent with a dynamic energy systems (DES) approach in which systems interact in complex ways, actually communicating and creating shared memory through their reciprocal effects upon each other during that communication. While preposterous to the conventional psychotherapist that a human being can communicate agony to nature, modern DES theory parallels the traditional belief that the mountain could have responded with fire and then the sky with rain, both in response to the human and now also the burning mountain.

Conventional psychotherapies have ignored the potential utility of ceremony and ritual as treatment. Through the reifying effect of action, fears and internal emotional processes are re-presented as dolls, shields, objects, or paintings and participate "object-ively" in a process of implied transformation during a ceremony. Ceremonies couple the patient's intention to heal with the power of belief and faith in the ceremonial process.

Conventional psychotherapeutic approaches are not necessarily helpful for helping to alleviate symptoms of psychobiosocial illnesses. Insight-oriented psychotherapy, for example, is not generally effective with physical symptoms. Some early psychoanalysts, including Alexander, even recommended against insight-oriented therapies in the presence of physical illness, finding that the therapy sometimes worsened the condition.

Additionally, religious practices may be a potentially valuable form of treatment for particular health problems.3 Further research is needed to indicate which clinical situations will be most responsive to spiritual intervention.3 This paper reports the results of a series of meetings between the author and traditional Native American healers in which a proposal arose for a method of treating any patient with the principles of the healers. A goal was also to bridge cultures and to discover how to prepare non-Natives to interact with the healers. While some Native American people and healers reject all contact of their spirituality and healing techniques with the non-Native world, the healers involved in this study had resolved that the wisdom of their ancestors should be shared freely, both for its power to prevent the coming potential apocalypse predicted by tribal prophecy, and for its capacity to relieve suffering of needy individuals. As one medicine man humorously remarked, "Once I only helped other Indians, but then I realized there weren't enough Indian babies being born for all the old-time Indians to get back onto the Earth, so that they had to take any body that they could, and therefore, I started treating everyone."

Methods :

A series of meetings were held with Native American healers and the author, along with selected colleagues, the purpose of which was to explore how the healers conceptualized their work, to determine how mind-body medicine and psychotherapy would have to be modified if it were to accept inspiration from these healers, and to develop a means of working together on patients, both Native and non-Native. The meetings were, by nature, informal, and were organized around the author's questions for the healers, who, thankfully, tolerated his inquiries and ignorance.

Recommendations arose for a method of treatment that was then applied to 116 patients who called the author requesting therapeutic work. These patients all traveled to the author from out-of-state, and no patient was excluded from this study. No adequate comparison group could be found for these unique patients. A "rough-estimate" comparison group against which to view the results of this treatment method was developed from patients enrolled in the author's computer modeling for prediction of health outcomes research project. These comparison patients had not requested NAH, but had enrolled in a study in which a dynamic systems computer simulation model was being used to predict the course of their health and disease, including the time at which they would develop a myocardial infarction. A bias toward the study population consisted of their strong motivation to seek alternative treatment for their health problem to what was being offered by their conventional physicians. A bias against the study population was noted from the observation that all patients in the study population were worsening despite conventional treatment, this being a major impetus for them to seek additional help. The comparison group of patients had similar illnesses but were more stable and not necessarily progressively worsening as were the study patients

A subset of patients' treatment was financed by research grant funds; the remainder paid for their treatment. The determining factor was economic need. Grant funds were not used to finance care when other means were available to the prospective patient. For purposes of this study, we defined healing as the restoration of health, strength, and vitality to a person who has lost this through illness. A healer is someone recognized by the person or his/her community as someone who is capable of helping a sick person restore his wellness. Sickness was defined in the conventional biomedical manner of having a diagnosable illness as listed in the International Classification of Diseases Annal (ICDA).

Results :

    A. Meeting results :

Besides important camaraderie and the opportunity to laugh (the healers were incredibly funny people), a number of important concepts about healing emerged from the meetings. These concepts are worthy of further study and empirical research. The shared metaphor that arose was the comparison of healing to a chemical reaction or to baking a good cake. The healers seemed intrigued with the ideas of biochemistry, as much as the author was with their unique viewpoint of nature. They created elaborate metaphors of the sexual exploits of molecules, trying to couple with other molecules and produce offspring, only to end up with too many waste products. The metaphor survived the frivolity, however, to emerge with the following important concepts.

1. Healing takes time and time is healing. The healers recognized that one should not start the job of treating a sick person unless he or she had sufficient time to give that person to get well. Hours of contact were required, unlike the Hollywood stereotype in which a short ceremony with a few shakes of the rattle brings the person back to full strength and wellness. They also recognized that the act of giving time to another person is healing in and of itself.

Cake baking and chemical reactions also require time to unfold. Too little time in the oven and the cake is still mush. Too much time, and the cake is burned. The healers believed that even the act of baking a cake imparted an intention and a power from the baker to the cake which would be passed on to the person who ate the cake. This sense of "contained intent or information," is similar to a story quoted by Schwartz and Russek6 of Claire Sylvia, a former dancer who received the first successful heart-lung transplant in New England. Six weeks after her transplant, when she was allowed to drive again, she drove straight to a Kentucky Fried Chicken, a place she had never been before, and ordered chicken nuggets, not something she had eaten in her past as a fit and thin dancer. Later she learned that the 18 year old male whose heart and lungs now lived inside her had had a fondness for fried chicken nuggets. At the time of his death, uneaten chicken nuggets had been found stuffed inside the pocket of his leather jacket. Similarly, the healers believed that one's thoughts were contained in every object he or she touched, made stronger by the more focused intention of that touch.

2. Healing takes place within the context of a relationship. The healers recognized that the quality of their relationship with the sick person was important in helping that person to find wellness. The better the relationship, the more likely was success. They recognized the relationship as a kind of container or vessel for the baking of the cake. "You wouldn't put cake mix in the oven by just pouring it over the bottom," one said. "You have to put it in something. Some kind of a bowl." The relationship was the bowl in which the cake baked.

3. Acheiving an energy of activation is necessary. While the traditionals believed that healing takes time, they also believed that the time should be intensive. Water doesn't boil until it's very hot, they said. The medical practitioners likened this concept to catalysis and the energy of activation.

In both organic and biological chemistry, an energy of activation is required to initiate a reaction. Once initiated that reaction may proceed irreversibly to completion. Without sufficient energy of activation, the reaction never occurs. A minimal level of energy (usually heat) is needed to transform the internal arrangements of molecules. Traditional healers said that weekly or even daily hour-long sessions with a patient would not be sufficient to iniitate healing (change on a physical level or, in the biochemical metaphor, to "rearrange the molecules"). The question of "how many hours over what period of time are necessary to produce change?" is rarely addressed in psychotherapy practice. The weekly visit has become normative. Even in intensive psychotherapy when patients are seen once daily, the question of "what would happen if we 'raised the heat?'" is rarely addressed.

The Native American healers told us that they typically worked with the client until the job was done. They typically treated one client at a time, and some clients traveled great distances to see them. Sometimes they traveled far to see a patient, and needed to put in maximum effort over a short period of time. Partly because of long distances travelled, they would concentrate their work over a number of days with multiple hours being spent each day. When they felt progress had been made, the client would be sent home with instructions to return at a later date for further treatment, and often with specific instructions for tasks to complete during the interval between treatment.

4. Biological systems behave similarly across hierarchical levels. There is isomorphism of principles. The traditional medicine people told us that nature is the same at every level. The same principles that guides the movement of the stars and the sun work within the body. As a group we returned to the biochemical metaphor. The traditional healers quickly agreed that psychotherapeutic or psychophysiological change should behave just like change biochemical systems. We found ourselves discussing reaction kinetics, which asks basic questions about the amount of materials that must be present for a reaction to occur, the amount of energy that is required to start and to maintain a reaction (and sometimes to reverse it), what catalysts are required to facilitate the reaction, what enzymes are necessary, etc. For example, outside the human body considerable heat (thousands of degrees) is necessary to melt iron. Inside the body the process takes place at 37 degrees. Because of catalysts within the body, a minimum level of energy is needed to begin the change process which is then maintained with less energy. They idea emerged for the biomedical practitioners to try an intensive week of 6 contact hours per day to start a change process.

5. The distractions of modern life "inactivate" catalysts for change. Most traditional therapies stress the need for self-contemplation. With adequate time, skills, and emphasis upon self-exploration and discovery much of modern psychophysiological therapy might be unnecessary. The traditionals believed that the modern world complicated and vitiated our ability to heal ourselves by distracting us from our study of ourselves. Television wastes vital hours which can be used for healing. Reading can both enlighten and deaden. (The great novel brings us face to face with the human condition and our own similarities with the protagonists about which we must reflect; popular novels may repeat trite plots with minimum character development.) Newspapers fill the mind with only slightly relevant information. The more tabloid, the more useless. Running to friends, relatives, or movies can fill waking hours with activity as avoidance. The quest to avoid boredom provides the raw material for many advertising campaigns. This quest also avoids self-discovery. Without external distractions, consciousness turns inward for it must direct itself somewhere. Therapy is harder in proportion to the number of competing distractions. Weekly outpatient therapy is particular difficult since the therapist must compete with so many more pleasurable or obsessional distractions to the process of self-discovery. Our traditionals believed in removing their patients from the distractions of modern life and working with them in an environment of peace and quiet. This was usually done within the client's home or within the medicine person's home. Nevertheless, they advocated an intentional avoidance of newspapers, radios, televisions, magazines, telephones, computer games, and the myriad of other distractions available to modern people.

Our traditionals believed that catalysts on the organismic level corresponding to biochemical catalysts on the molecular level arose from self-exploration and developing an awareness of emotional states. Knowledge of personal misery fosters an inclination to do something about it. Excessive business or exhaustion can prevent reaching a level of emotional awareness from which change can occur.

6. Modern culture systematically teaches us to ignore emotions and to maintain a low level of emotional awareness. The traditionals pointed to television commercials as the best examples of this principle. Whatever discomfort we may feel, we are encouraged to stop at our corner drug store to obtain a medicine to eliminate it. This attitude of intolerance for discomfort sells products, which relates to every entity's goal in an economic society (one operating on money) -- to make money. Self-reflection does not sell products. Nor is successful psychotherapy self-maintaining, for those whom we help no longer need us. No other product sits on the shelf which we can sell them. (Unless we are only marginally effective and can maintain a client in counseling for years.)

Traditionals pointed out that children are taught in school to ignore their body needs for elimination until it is convenient for the teacher. They are taught to ignore their wish to play until scheduled recess. Civilization, as it is now constructed, requires a level of emotional unawareness for smooth functioning that the traditionals found sad. They pointed out how strange it was for a secretary to be unable to take time off if overcome by sadness from a case history being typed. Emotions are expected to be secondary to efficiency. They pointed out that theirs used to be a less-hurried society, but that hurry has become the watchword of modern society; the faster we go, the more money we make.

Traditionals pointed out that hunting and gathering societies were more realistic about expenditures of human energy, for the preparation of the hunter was known and addressed on many levels. Lowered alertness from mental or physical exhaustion of any member of the group could endanger the hunt and the tribe. Periods of prescribed inactivity were common. Men rested or fasted before an anticipated period of great physical activity, purifying themselves on several levels. Women retired to the menstrual hut to take a deserved monthly rest. Today television commercials and drug advertisements teach modern society's members that a product is always available to get a person up and out the door to work or to play golf or to whatever scheduled activity is next. There are no natural breaks or allowances for the vicissitudes of the body's own rhythms.

7. Physiological change often requires a break in usual daily rhythms. While we are in an activated state of running our daily lives, necessary resources are not always available for the work of change, said our healers. The body needs rest and quiet to promote cellular repair. Sleep, for instance, is a crucial ingredient of life. Without sleep, illness ensues. Often, the most important therapy we can give a client is to put them to bed.

In the days before modern pharmaceuticals, healers did just that. Rest was a key ingredient of any therapy. Even in conventional medicine examples abound of the usefulness of rest. Just ten years ago I watched an older cardiologist manage a patient dying of heart failure by putting him to bed. Rather than encourage his undergoing a heart transplant (which is of limited utility for long-term survival), she put him to bed. Six weeks later his heart failure had disappeared. To this date she receives yearly cards of gratitude from this man for saving his life, yet all she did was to put him to bed.

Traditionals felt that these same principles were applicable to counseling. Healing may best begin by putting the client to bed. This disturbs daily routines and breaks old habits. Hypnotherapist Milton Erickson believed that the effective therapist confused the patient sufficiently that his old habits began to look strange. Perhaps this is all effective counseling need to do.

8. Traditionals mentioned the importance of ceremony as a means of accessing help from the spiritual dimension for healing. Traditionals mentioned the importance of a number of ceremonial procedures, including the Vision Quest in which the seeker prepares through fasting and other methods of purification to journey to the top of a mountain and sit alone for 1-4 days in prayer and meditation, waiting for a vision to be revealed. Vision concerns the self (even when it contains social prescriptions) but also guides personal development and facilitates healing.

Traditionals described purification ceremonies which are also important for the inner life. During the sweat lodge ceremony, for example, the person fasts and then enters a lodge -- a low structure covered with skins (nowadays blankets) to retain the heat. Into this lightless world are brought hot rocks. Dippers of water are placed upon the rocks. While sweating away toxins and illnesses, participants are guided to look within and confront fears. As a fear is discovered and released the inner experience of heat diminishes. Within the lodge participants receive information and visions about personal lives and inner processes. Participants learn how to live in balance and harmony with nature and each other. A communal experience of participation increases social support.

    B. Treatment Process :

The Treatment Process that emerged from the meetings and discussions of traditionals and non-traditionals (including the author) resulted in a 7 to 28 day intensive healing experience. This treatment process (to be described below) was offered to patients who called the author for help with health problems and who lived outside of the state. A minimum duration of 7 days was encouraged for all callers, but, occasionally people would come for less time to sample the program or for less severe problems. The first seven days consisted of bedrest away from distractions.

There was no access to televisions, radios, books, newspapers, telephones, computers, other people with whom to talk, or other distractions. Participants were to rest face-to-face with themselves. They were fed appropriate food based upon their personal biochemistry, food allergies, preferences, and nutritional needs. During the treatment period, they received 2 to 7 hours per day of therapeutic attention, which could include reading their journal and commenting upon what had been written, reviewing art they may have produced on assignment, general discussion and integration of their experiences and what they were learning; hypnosis and/or imagery; body therapy; projective techniques including the use of native American images, shields, or animal images; and ceremony.

Participants were to be introduced to the use of ceremony in therapy and for their own personal growth. Night sessions often took place outside in the medicine circle around a fire. The setting was rural desert without other visible dwellings or structures. Participants were helped to prepare for a sweat lodge ceremony on the fifth or sixth evening. If they were sufficiently strong and prepared, they would be taken to the top of a nearby mountain to sit for the night and perhaps receive a vision, on the night after the sweat lodge.

If they stayed for a second week, clients would perform tasks to beautify the property and participate in a simple caring for and service to the earth alongside their continued treatment. They also helped clean up the nearby National Forest, take hikes, walks, or otherwise engage in physical activity. Intense education was begun in this time along with continued individual therapy (using what had proven helpful and useful during the first week). The first week stressed self-discovery through contemplation; the second week, self-discovery through service.

A third week was designed to help clients prepare to re-enter their world through learning problem-solving techniques and learning how to apply Native American philosophy to their lives. Relapse prevention strategies would be taught, with a continuing emphasis on self-reflection and discovery and worship in the manner most appealing to each person. Naturally, we expected that most participants would be drawn toward Native American or similarly oriented nature religions. Nevertheless, we planned for the experience to be relevent to Christians and Jews as well. More information on the actual experience of an Intensive, along with development of themes encountered, and techniques utilized is available elsewhere.

A fourth week was designed to consist of a specialized course in Native American philosophy, desert survival, and other specialized spiritual pursuits (tracking, stalking, climbing, etc.).

Implicit within the program were the values and beliefs of Native American culture. It was expected that participants would implicitly learn to use spiritual practice as support and to rely on larger entities for help with problems and with healing. All practitioners involved in the program were expected to hold a deep respect for the participant's individual beliefs and an acceptance of whatever belief system the participant would bring. The shared value was the belief that no one path was correct for all people. Spirituality can choke people when it requires adherence to one conceptual scheme or dogma.

    C. Evaluation :

For such an innovate treatment program such as this, and for a first report, it was felt that simple was best. Therefore, five years after completion of treatment, patients were asked through telephone follow-up call by a research assistant (so that they would not feel that they had to please the author and tell him they were better when they weren't) if they were free of symptom or disease, improved, no better than when they came for treatment, or worse than when they came for treatment. Death was a final possibility that a family member might report. There were 21 patients who were treated but lost to five-year follow-up.

To give a benchmark for a typical population, the same question was asked of 100 randomly selected emergency room patients (for each of the diseases listed in Table 2) who had carried that diagnosis at least once during the past five years. (The disease did not have to be active at the time of their emergency room visit.) Patients were asked them to look back over the past 5 years and make an estimate as to whether or not they were cured of that particular condition, improved, the same, or worse. Patients who came in dead or dying from that particular condition were rated, obviously, as dead.

This procedure gave a rough estimate for what would happen to 100 randomly selected patients in terms of our simple, 5 point rating scale. Twelve hundred patients were interviewed to obtain our comparison population -- one hundred for each disease.

Statistical comparisons were made with the log-likelihood measure and the chi-square statistic. Rounding was widely made to call attention to the crudeness of the measurements and their nature as more of a benchmarking than an experimental design which would have invited more rigorous numerical calculations.

Final Results :

Five year minimum follow-up was available for 107 people who participated in intensive experiences. They learned of the program through word of mouth and through lectures given by the author in various cities and at conferences. The author was the primary therapist, involving local medicine people and traditional healers whenever appropriate and possible. All clients who came graded their problem as at least moderately severe ("5" on a 10 point scale), and had received a minimum of one year of outpatient treatment, including forms of counseling, which were ineffective. All reported that they had gotten worse during the preceding year. A wide variety of problems were present (Table 1), including angina, asthma, back pain, cancer, chronic fatigue syndrome, diabetes, depression, hypertension, infertility, gynecological disorders, obsessive-compulsive disorder, and pregnancy-related complications.

The age spread was from 20 to 79, with the mode lying within the fourth decade of life. No statistically significant differences in age were found between the intensive population and the comparison group. The treatment group was biased toward higher socioeconomic status than the comparison group (as judged by type of insurance; p < 0.05). there were no differences in the number in each group reporting religious affiliation.

The breakdown of client's improvement was judged simply in the sense that the problem completely disappeared, was improved, was unchanged, worsened, or led to death. Patients generally improved more following a healing intensive than did randomly selected patients in the emergency department, our crude benchmark (Table 3). Statistically significant differences in outcome included all illness. Statistical testing was rounded widely, given the crude nature of the outcomes being compared and the benchmarking nature of the comparisons (different from the rigor expected had this been an experimental design).

The longest available follow-up was 10 years, although clients may have had their diseases longer than this. In general the more severe or the longer the problem, the more difficult it is to change. The costs of care ranged from free for selected patients to $10,000 (U.S.). the typical patient spends $2100 to $3600 (1990 dollars) for 7-10 days, plus some food and lodging costs (approx. $60/day at present). The average expenditure was $2825. The least amount of time utilized was three days, the maximum 21. On average, clients stayed 7.8 days.

Potential Negative Effects :

Every client save two reported major psychological breakthroughs. One was a client with obsessive-compulsive disorder. The problem for which he came disappeared, but his personality did not appreciably change nor did he experience epiphanal awakening of any kind. His obsessive urination along with other compulsive activities and his accompanying record keeping kept him fully distracted despite our best efforts. Another patient with angina did not improve, and returned home with anger at the cost of his intensive and at the waste of his time. He was invited to submit a request for refund to the Board (which would have been honored), but did not. His wife, forty years his junior, was also angry. She felt "ripped off," though they received more time than they were billed for, and more time than they had agreed to spend for less money than expected. They did report a very interesting experience in the week following their return to California. An earthquake occurred during the third day after their return home. The street was blocked and their propane gas tank was in danger of catching fire. The wife described screaming for help from anyone to move the gas tank from the path of a fire. A strong man appeared and moved the tank and then disappeared. He was not from the neighborhood and was never seen again. The roads were closed for several miles into their mountainous area home. The wife concluded that the man was an angel. An infection in the vicinity of her husband's pacemaker came to the surface of the skin and drained during this week, also. The pacemaker was therefore replaced.

There were no other negative results described by clients. Most reported the experience as one of the more positive events of their lives.

Most clients reported spiritual experiences and a significant deepening of their faith, regardless of the type. The other two most difficult clients were a brain-damaged manic-depressive who had trouble following instructions, and a very depressed man with severe back pain who has been in therapy for the past 26 years. Because of his strong atheistic views he was limited in what he could partake from the treatment, but nevertheless was doing marginally better in his home environment with monthly phone calls from the author.

Stages of the Intensive Process :

The general stages of the therapeutic process consisted of:
  1. Restlessness and anxiety, alternating with sleep — 2-3 days.
  2. Acceptance and yielding with relaxation — 3rd to 4th day.
  3. Stage of rapid insight — 4th or 5th day.
  4. Stage of spiritual connection — 5th to 7th day.
  5. Integration into life routine — 6th to 8th day.
The first stage could almost be seen as a detoxification from the lifestyle in which the person had been living or the hectic pace most have been maintaining. An unusual insistence on promptness was seen in the patients from the large urban areas, which led to frustration when it was explained that part of the treatment process was that they would not know when to expect the therapist. "It would just happen." Even though there was essentially nowhere to go and nothing to do, these clients used their watches to mark their day and insisted on structure. As they passed through the lack of structure, then a heightened level of relaxation ensued. Interestingly, my obsessive-compulsive client beat me at the "no-structure" game and was able to generate times from me that I would appear under threat of grave anxiety if I was even five minutes late.

The majority of clients had powerful experiences as did the author, forming lasting bonds which still generate cards and letters from time to time, and left happy that their problem was well on the road to solution.

Discussion :

The study demonstrates that a Native American inspired, intensive treatment approach can be implemented for patients of non-Native cultural backgrounds with positive effects. The comparison group is crude. A better comparison group might be attenders of holistic health clinics. Nevertheless, the comparison group showed a trend toward improvement in their health problems over a five year course, as did the treatment group. The treatment group's improvement was more marked. Was this because of the type of person who was willing to carry out such an intensive treatment program or related to the treatment itself or both? Other further prospective research can answer this question.

The relative success of this program even with crude measurements of outcome point toward the value of further investigation into this treatment process. If it could improve outcome through intensive treatment, perhaps long-term costs of care would be reduced. This is also an area for further study. The short-term costs of care were clearly higher than a business of usual approach, though no measurements were made for long-term costs of care which should be part of a future study.

"...[T]he oldest mind-body effect [is] the relationship between spirituality and medicine." Unfortunately, "[t]he scientifically oriented biomedical community tend[s] to discount the importance of psychological and behavioral variables as important etiological and exacerbational factors in pathogenesis. This community tend[s] to devalue or even demean the significance of these factors in treatment."

Spirituality is important to patients. King and Bushwick found that 77% of patients wanted their physicians to consider their spiritual needs, 48% wanted their physicians to pray with them, and 37% wanted their physician to engage them in a discussion of their religious beliefs. Bearon and Koenig found that 79% of people believed that spiritual faith could help people recover from illness, injury, or disease, and that 64% thought that physicians should join their patients in prayer if the patient requested it.

There is also evidence from the depression literature to support the conclusion of this study -- that an intensive, spiritually-based treatment can reverse a progressively deteriorating trend among patients who select it, when these patients have been previously treated with non-intensive, non-spiritual methods .

Among a group of Christian clients with depression, Propst studied the effects of adding an emphasis on religious themes to a cognitive-behavior therapy program. The religiously oriented program "gave Christian rationales for the procedures, used religious articles to counter irrational thoughts, and used religious imagery procedures." Two comparison groups consisted of (1) standard cognitive-behavior therapy and (2) client-centered pastoral counseling with incorporated Biblical themes. The largest absolute reductions in depression were produced by religiously oriented cognitive-behavioral therapy. Whether or not the therapist was personally religious made no difference to the outcome. When no religious imagery was used, the largest reductions in depression were made by those therapists who were personally religious. Simply incorporating syntonic religious imagery into treatment enhanced outcome. Alcoholics anonymous is another religiously oriented treatment with which the approach of this paper can be compared. Simply attending AA, for instance, does not improve treatment outcome. The extent to which clients actively used the program did predict outcome. Passive attendance was not possible in our program.

Walker studied the effects of intercessionary prayer on recovery from alcoholism. Patients who believed that someone else was already praying for them (prior to the treatment) showed less improvement in treatment than those who believed that no one had been praying for them. Intercessory prayer by random assignment was not found to be helpful. Again, apparently, an active personal praying, as patients did in this study, is necessary for healing.

Table 1. Problems leading clients to seek Intensive Therapy

Angina 1
Asthma 9
Back pain (severe) 1
Cancer 11
Chronic Fatigue Syndrome 11
Diabetes 9
Depression and Manic-depression 11
Hypertension 13
Infertility 13
Non-malignant gynecological 10
Severe Obsessive-Compulsive Disorder 1
Pregnancy-related complications 7
Total 107

Table 2. Age spread of clients seeking Intensive Therapy

Ages of Clients Number of Clients
20 - 29 21
30 - 39 38
40 - 49 32
50 - 59 11
60 - 69 2
70 - 79 3

Table 3. Results of Intensive Therapy

Status of Improvement 5 Years after Treatment
Disease "Cure" Better NC3 Worse Death
Angina 0 0 0 1 0
Asthma 3 4 1 1 0
Back Pain (severe) 0 1 0 0 0
Cancer 3 4 14 1 2
Chronic Fatigue Syndrome 2 7 1 1 0
Diabetes 0 8 1 0 0
Depression & Manic-depression 7 3 1 0 0
Hypertension 7 6 0 0 0
Infertility5 9 NA 4 NA NA
Non-malignant gynecological 6 2 1 1 0
Obsessive-Compulsive Disorder 0 0 0 1 0
Pregnancy-related Complications 12 5 0 0 0
Totals 50 41 9 5 2

Table 4. Comparisons of Intensive Treatment.

There are 106 treated patients and 1200 comparison patients (100 for each disease). Comparisons were made with log-likelihood methods and chi-squares.

Treatment Index for Treated and Comparison Patients
Disease Treatment
Angina -1 -1.00 -0.19 p<0.01
Asthma 9 1.00 0.09 p<0.01
Back Pain (severe) 1 1.00 0.07 p<0.01
Cancer 5 0.45 0.20 p<0.05
Chronic Fatigue Syndrome 10 0.91 0.10 p<0.01
Diabetes 8 0.89 -0.40 p<0.01
Depression & Manic-depression 17 1.55 1.19 p<0.05
Hypertension 20 1.54 0.50 p<0.01
Infertility5 18 1.38 0.19 p<0.001
Non-malignant gynecological 13 1.3 0.90 p<0.05
Obsessive-Compulsive Disorder 1 1.00 0.11 p<0.01
Pregnancy-related Complications 29 1.71 0.95 p<0.01
Totals 107 1.48 0.371 p<0.001

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