Als "Antwort" auf den Artikel von Harro Albrecht in der ZEIT (
http://www.zeit.de/2010/37/M-Alternativmedizin ) äußert sich einer der Drahtzieher der Viadrina: Harald Walach. Bevor er an der Viadrina war, fiel Walach unter anderem durch eine seltsame Studie auf, bei der bis heute einige Unklarheiten [1] nicht beseitigt sind. Aber Aussitzen wird ihm nicht helfen...
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Irrtum, Harro Albrecht! Warum die Medizin ihren Verstand schon lange verloren hat.
Von Prof. Dr. Dr. Harald Walach | 15.Oktober 2010
Lieber Herr Albrecht,
Sie meinen, die deutsche Medizin hätte Ihren Verstand verloren, weil an verschiedenen medizinischen Fakultäten Kurse mit naturheilkundlichen, alternativmedizinischen, ja sogar magischen Inhalten angeboten werden. Schlimmer noch, die Medizin ließe sich ihre Seele abkaufen, weil Stiftungsprofessuren für Komplementärmedizin eingerichtet worden sind.
Hat die Medizin nicht schon lange ihren Verstand verloren, spätestens seit den 50er Jahren? Seit sie sich von einer Heilkunde zu einer vermeintlichen Naturwissenschaft meinte zu entwickeln? Seit sie aus dem Blick verloren hat, dass kranke Menschen nicht an entgleisten Enzymsystemen, defizitären Transmittern oder falsch geschalteten Calciumkanälen leiden, sondern an komplexen Bedingungen, deren Begleiterscheinungen solche somatischen Zeichen sind, aber nicht deren Ursachen? Seit sie dem Glauben aufsitzt, in der Pharmakologie allein liege das Heil der Menschen und die Befreiung von allem Übel?
Nüchtern betrachtet muss man feststellen: Außer bei akuten Problemen und einigen wenigen chronischen Krankheiten wie Diabetes sind die Erfolge moderner pharmakologischer Interventionen, vor allem was die Behandlung der zunehmend problematischen chronischen Erkrankungen angeht, nicht sehr eindrucksvoll.
Pharmakologische Interventionen sind oft sehr nebenwirkungsbehaftet und von zweifelhafter Effizienz. In den USA stehen Nebenwirkungen von konventionellen Behandlungen an Platz 11 oder so aller Todesursachen. Gerade eben ist eine Reanalyse aller Antidepressiva-Meta-Analysen und der größten je durchgeführten Beobachtungsstudie, des STAR*D-Trials, mit 35 Mio $ die teuerste dieser Studien, erschienen (Pigott et al, Psychotherapy & Psychosomatics, 79:267-279). Mit niederschmetternden Ergebnissen: hohe Nebenwirkungen, relativ bescheidene Langzeitwirkung, höchstwahrscheinlich nachträgliche Schönung der Daten.
Die sog. biologische Theorie der Depression und die davon abgeleiteten pharmakologischen Therapien, mit die umsatzstärksten, stehen auf sehr tönernen Füßen. Und das bei einer Krankheit, die von der WHO als die zweitwichtigste, bald wichtigste Krankheit mit Langzeitinvalidität als Folge in den Industrieländern angesehen wird. Das ist nur ein Beispiel. Und genau weil das so ist, weil die moderne Medizin eben viel weniger an wirklich effektiven Therapiemöglichkeiten für chronisch kranke Patienten anzubieten hat, genau deswegen suchen sich diese Patienten Alternativen.
Patienten sind nämlich nicht dumm und lesen nicht nur Boulevardblätter. Sie sind auf ihre Art Wissenschaftler: sie probieren aus, sammeln Informationen, fragen andere Patienten, hören sich um und machen sich ein Bild. Auch wenn das Bild nicht immer vollständig ist und sicherlich nicht den Charakter einer wissenschaftlichen Tatsache hat, ist es ein Bild, das wir Ernst nehmen sollten, wir, die akademische Medizin, die öffentliche Hand, die Fakultäten. Patienten fragen Komplementärmedizin nach, nicht weil sie abergläubisch, ungebildet und durch Werbemillionen der komplementärmedizinischen Pharmaindustrie hypnotisiert worden sind, sondern weil sie von den konventionellen Methoden oft nicht immer profitieren und weil sie bei komplementärmedizinischen Ärzten oft Hilfe finden.
Die Medizin hat ihren Verstand schon lange verloren, weil sie dieses Symptom öffentlich wirksamer Empirie nicht erkannt und so getan hat, als könne sie Wissenschaft an den Nutznießern der Ergebnisse vorbei betreiben.
Hätte die Medizin noch ihren Verstand beisammen, dann hätte sich spätestens in den 90er Jahren die eine oder andere weitsichtige Fakultät sagen müssen: wir sollten da genauer hinsehen, lasst uns eine Professur einrichten. Stattdessen wurde gemauert und ignoriert, bis nun eben über Stiftungen das Öffentlichkeitsinteresse laut geworden ist.
Der Hinweis auf mangelnde wissenschaftliche Fundierung ist ein Schuss in den Ofen. So manche komplementärmedizinische Methode hat mehr solide Wissenschaft hinter sich, als vieles, was in der Praxis an konventioneller Medizin betrieben wird. Wo, bitte, sind die Langzeitstudien, die belegen, dass jahrzehntelange Einnahme von Antirheumatika, oder Antidepressiva, oder anderer Anti…a, nicht nur wirksam, sondern auch nötig und nebenwirkungsfrei sind?
Die meisten Wirksamkeitsstudien sind von sehr kurzer Dauer. Die meisten Studien sind an ausgewählten Patientengruppen durchgeführt und die wahre Forderung der evidence based medicine, diejenigen Patienten zu untersuchen, die in der Praxis vorbeikommen, ist selten erfüllt. Wenn man den Standard, den Sie, Herr Albrecht, der Komplementärmedizin verschreiben wollen, an die konventionelle Medizin anlegt, müsste man mindestens die Hälfte aller Verfahren, wenn nicht mehr, abschaffen oder verbieten, davon einen Großteil der Chirurgie.
Wie, bitteschön, sollte man die Ergebnisse der großen deutschen Akupunkturstudien bewerten, die zeigen, dass Akupunktur und Scheinakupunktur doppelt so wirksam sind wie das beste, was die deutsche Medizin bei Rückenschmerzen und Kniearthrose aufzufahren hat? Sollen wir nun alle Orthopäden und Schmerzmediziner zu Flachnadlern ausbilden und ihnen verbieten, Schmerzmedikation zu verschreiben?
Vieles liegt im Argen. Die Komplementärmedizin weist auf die Lücken und Paradoxa des momentan herrschenden Denk- und Therapiemodells hin. Statt Zeter und Mordio zu schreiben wäre es, glaube ich, an der Zeit, kühl und profund nachzudenken. Wer profitiert von einer Ausgrenzung der Komplementärmedizin? Warum hat sie sich den Weg in die akademische Welt erobert, entgegen erbitterten Widerstand meistenteils? Warum verlangen Patienten danach? Was bewegt gut ausgebildete Ärzte, Geld, Zeit und Aufwand zu investieren, um komplett neue Verfahren zu lernen, wo sie doch alle die Segnungen der modernen Pharmakologie zur Verfügung haben? Warum widmen ich und meine Kollegen, die auf ähnlichen – zeitlich befristeten – Stiftungslehrstühlen arbeiten, die wir alle gut ausgebildet sind, wertvolle Lebenszeit, opfern andere Karrieremöglichkeiten, um Komplementärmedizin zu beforschen? Weil wir zu blöd sind, um was anderes zu machen? Weil wir Millionen damit verdienen?
Herr Albrecht, wenn Sie diese Fragen einmal durchdacht haben und eine schlüssige Antwort gefunden haben, dann schreiben Sie wieder einen Artikel. Einen, der der Sache näher kommt.
.
Prof. Dr. Dr.phil. Harald Walach, Dipl. Psych.
Europa Universität Viadrina
Institut für Transkulturelle Gesundheitswissenschaften (InTraG)
Frankfurt (Oder)
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[*/quote]
Warum die Viadrina ihren Verstand verloren hat, weiß ich nicht.
Daß sie ihn verloren hat, ist nicht zu leugnen.
Man sollte aber auch die anderen Universitäten, so Freiburg und Northampton, fragen, wie es um ihre geistigen Fähigkeiten bestellt ist. Wer Geistheilerei betreibt, bei dem kann man bei der Suche nach Geist garantiert keinen finden. Nicht mal einen toten.
Banken sind inzwischen zur Einsicht gelangt "Mit Geld spielt man nicht."
Auf die elementarste Erkenntnis, daß man mit dem Leben von Kranken nicht spielt, ist man an der Viadrina noch weit entfernt.
Selbstverständlich steht es Jedem frei, bei Kopfschmerzen von der Brücke zu springen oder Bungeespringen mit dem längsten Seil Europas zu machen. Es aber zu wagen Kranken Religion oder anderen Krimskrams leistungsreduzierter Hirne zu empfehlen, gehört unter Strafe gestellt.
http://www.rcpsych.ac.uk/pdf/Niko%20Kohls%20and%20Harald%20Walach%20Lack%20of%20Spiritual%20Practice.x.pdf[*quote]
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Lack of Spiritual Practice -
an important risk factor for suffering from distressDr. Niko Kohls and
Professor Harald WalachIntroduction
In recent years, the relationship between spirituality and health has become a
new topic of interest within clinical and health sciences alike (Culliford, 2002;
Miller & Thoresen, 2003). Empirical findings have identified both religiosity and
spirituality in the generic sense as a potential health resource (Koenig,
McCullough, & Larson, 2001; Larson, Swyers, & McCullough, 1998;
McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000; Seeman, Dubin, &
Seeman, 2003). There is, however, still considerable ambiguity in research
findings and correspondingly uncertainty about the mechanisms that drive the
spirituality–health connection and research in this area is beset with specific
conceptual and methodological problems.
1. There is first and foremost considerable uncertainty about basic definitions.
Not only do clear and universally accepted criteria for defining spirituality
not as yet exist, there is also lack of clarity with regard to differentiating
spirituality from other related constructs such as religion, religiosity, sense
of coherence, purpose or meaningfulness, to name but a few. In particular,
the terms ‘spirituality’ and ‘religion’ have been used interchangeably in a
rather naïve way in past research endeavours. Although the two categories
certainly have some common ground, there are important differences on
closer inspection. For example, an individual may develop spiritual faith in
a higher being, ultimate power or transcendental principle whilst not
necessarily being aligned to any form of orthodox religion. On the other
hand, an individual may also develop a deep-rooted spiritual conviction
that tenets of an established creed are true, but personally never have
experienced any sense of a divine or transcendental component. Thus,
identifying precise criteria that are suitable for demarcating spirituality from
religion is far from easy, as both are complex and multi-dimensional
constructs that are not only difficult to grasp but also non-exclusively
related to each other. However, there is an aspect that might give at least a
heuristic basis for their differentiation: whereas spirituality points to the
subjective, experiential and private dimensions of transcendence, religion
refers to objective and social dimensions, which offer a cultural framework
for the interpretation of spirituality. In other words, religious traditions may
be interpreted as cultural venues that help codify, structure and interpret
spiritual experiences by means of providing explanatory models that are
culturally accepted.
2. Thus, as spirituality is a complex, interconnected and also culture-
dependent phenomenon with many facets, it may not only be understood
in many ways but also on many levels. Although the holistic nature of
spirituality has to be taken into account in order to do justice to the fragile
phenomenon in question, for a proper scientific analysis of distinct
pathways pointing from spirituality to health, different aspects – such as
1
spiritual practices, attitudes and experiences - have to be differentiated.
Nevertheless, as the very essence of spirituality is, strictly speaking, a
subjective phenomenon that must be embedded in an individual life
context, methodological problems are naturally entailed in this reductionist
approach. To put it bluntly, spirituality as an essentially subjective
phenomenon defies experimental manipulation and objectification. This
may be the reason why there are problems associated with researching
spirituality by means of experimental approaches such as randomized
controlled trials and may explain why research has predominantly focused
on observational studies so far. It is hardly surprising that investigations of
the relationship between spirituality and health have been repeatedly
criticized for failure to control for important confounders and lack of
longitudinal studies (Miller & Thoresen, 2003; Powell, Shahabi, &
Thoresen, 2003).
Pathways from Spirituality to Health
Although in the past it has frequently been hypothesized that it is mainly the
element of social coherence associated with religious practice that conveys
the health benefits (Levin, Chatters, Ellison, & Taylor, 1996; Powell et al.,
2003), new conceptualizations suggest that it is spiritual experience and its
intrapersonal effects as moderated by regular spiritual practice rather than
belief sets, attitudes or behaviour alone that may be pivotal to understanding
the pathways from spirituality (George, Larson, Koenig, & McCullough, 2000).
1. Spiritual or mystical experiences as they are reported in the mystical
traditions are presumably at the roots of most forms of religions.
2. As indicated by the plethora of conversion phenomena reported in the
course of human history, spiritual experiences seem to be able to
exhibit major impact on human beings.
3. Spiritual practices like prayer, meditation or different forms of
contemplation may be seen as intended and designed to elicit spiritual
experiences (Meraviglia, 1999). It has additionally been shown that
regular spiritual and meditative practice entails not only a characteristic
change in the way the self is perceived and organized but also alters
physiological parameters (Davidson et al., 2003). For example, a recent
FMRI-study has found evidence that individuals practicing some form of
mindfulness meditation seem to be able to alter their personal
psychological model so they can dissociate their self awareness of the
present from their long term ‘self image’ (Farb et al., 2007). Thus, there
is good reason to assume that the effects cannot be merely explained
as consequences of interpersonal or social factors and that to
completely elucidate them one has also to take intrapersonal factors
into account.
2
The phenomenology of spiritual experiences
It should be noted that the phenomenology of spiritual experiences do not
necessarily support the popular assumption that the relationship between
spirituality and health is mainly positive. To begin with, spiritual experiences
are not always positive in nature, but often associated with crises (Wardell &
Engebretson, 2006) and, further, the phenomenological similarity of
transcendent and psychotic states is well known (Lukoff, 1988; Thalbourne,
1991). This may be why, for example, spiritual experiences have been
interpreted as acts of ego regression, borderline psychosis or psychotic
episode and have been associated with temporal lobe dysfunction (Lukoff, Lu,
& Turner, 1992).
The authors’ research
We started from the assumption, first declared within academic psychology by
William James a century ago, that spiritual experiences can be a major
pathway from spirituality to health (James, 1904). In his important treatise that
comprised his edited Gifford Lectures on ‘Natural Theology’, James
distinguished two types of spiritual health, the healthy minded and the sick
soul. Whereas the spirituality of healthy-minded individuals leads to a positive
outlook on life, sick souls tend to be depressed and have an anxious outlook
on life; according to James, the only remedy for them is a powerful mystical
experience.
We would agree with James that there may be both positive and
negative influences of the spiritual domain on health, because stabilizing
spiritual experiences may foster health while, in a parallel manner,
destabilizing spiritual experiences may enhance distress. The interpretation of
spiritual experiences as potentially stabilizing or destabilizing may be
associated with the individual belief system. For example, the spiritual
experience of universal connectedness can be experienced both as utter
dread of ego dissolution or as gratifying experience of ego expansion,
depending on the individual’s system of reference. Here, the question
immediately arises as to how a negative spiritual experience might be
differentiated from a psychopathological experience?
In order to be able to investigate the prevalence and cognitive
evaluation of positive and negative spiritual experiences, we have developed,
pilot-tested, cross-validated and revised a 25-item instrument called
Exceptional Experiences Questionnaire (EEQ) (Kohls, 2004; Kohls, Hack, &
Walach, 2008, in print; Kohls & Walach, 2006).
Summary of Research
The Exceptional Experiences Questionnaire (EEQ)
Detailed information on development and validity of the EEQ has been
published elsewhere (Kohls, 2004; Kohls et al., 2008, in print; Kohls & Walach,
2006). In short, the EEQ was developed because existing instruments
embracing spiritual experiences such as the Daily Spiritual Experiences Scale
3
(Underwood, 2006; Underwood & Teresi, 2002) have been designed as
unidimensional constructs, which only assess positive spiritual experiences. In
contrast, the EEQ captures diverse positive and negative spiritual, exceptional
and psychopathological experiences by asking about the frequency of those
experiences as well as their current evaluation as additional information. The
EEQ shows adequate discriminant validity with sense of coherence, social
support and mental distress and convergent validity with transpersonal trust.
Specifically employing a principal component factor analysis, we were able to
show that exceptional experiences are phenomenologically distinct: examples
included ‘I am illumined by divine light and divine strength’ and ‘a higher being
protects or helps me’ (factor 1 ‘positive spiritual experiences’); ‘my world-view
is falling apart’ and ‘a feeling of ignorance or not knowing overwhelms me
(factor 2 ‘experiences of ego loss and deconstruction’); ‘I clearly hear voices,
which scold me and make fun of me, without any physical causation’ and ‘I am
controlled by strange and alien forces (factor 3 ‘psychopathological
experiences and delusions’) and ‘I dream so vividly that my dreams
reverberate while I am awake’ (factor 4 ‘visionary dream experiences’). There
exists a 57-item long version, which mainly serves as a phenomenological
research tool and a 25-item short form, which shows good psychometric
properties (Cronbach’s alpha: r = .89, test – retest reliability after 6 months r =
.85). It is noteworthy that we have cross-validated the EEQ with post-
questionnaire interview data in order to test for the reactivity of the instrument
(Kohls et al., 2008, in print).
Summary of Research Findings
We have investigated the EEQ in non-clinical and clinical populations alike
(Kohls, 2004; Kohls & Walach, 2006, 2007; Kohls, Walach, & Wirtz, 2008,
accepted for publication). Particularly, intersample differences between
spiritually practicing and non-practicing individuals have been compared. In
short, the five most important results for clinical practice were as follows:
1. With regard to the prevalence of exceptional experiences, we have
been able to show that individuals with regular spiritual practice report
both more positive spiritual experiences, experiences of ego loss as
well as visionary dream experiences. In contrast, no differences were
found for psychopathological experiences.
2. With regard to the cognitive assessment of exceptional experiences, we
have shown that spiritually-practicing individuals evaluate both
experiences of ego loss and visionary dream experiences more
positively. In a parallel manner to the prevalence data, no differences
between the cognitive evaluations of psychopathological experiences
were found.
3. A comparison of the impact of exceptional experiences of spiritually
practicing and non-practicing individuals by means of a linear
regression analysis revealed different pathways from experiences of
ego loss to psychological distress (Kohls & Walach, 2007). Although
spiritually practicing individuals reported more exceptional and spiritual
4
experiences, they accounted only for 7% of psychological distress (as
measured with the Brief-Symptom-Inventory (BSI)) in the spiritually-
practicing sample, but for 36% of distress in individuals with lack of
spiritual practice. Further analysis revealed that experiences of ego loss
had no effect on psychological distress in the group of spiritually
practicing individuals, while they exhibited significant impact on distress
in individuals with lack of spiritual practice. In contrast, positive spiritual
experiences had no large buffering impact on distress. Based on these
findings, we have suggested that spiritual practice could be considered
to be a specific coping strategy for the distress caused by experiences
of ego loss. It is noteworthy that a more sophisticated re-analysis of the
data by means of structural equation modelling has corroborated this
finding (Kohls et al., 2008, accepted for publication).
4. We have replicated the differences in pathways from exceptional
experiences to distress in a sample of N = 111 patients with chronic
illness (chronic fatigue, migraine, irritable bowel) that were treated in a
single integrated medical practice (Kohls, Walach, & Lewith, 2008,
submitted). Employing linear regression analysis, we were able to show
that mindfulness acted not only as a generic buffer against distress, but
particularly as a buffer against distress derived from experiences of ego
loss. We have therefore proposed that lack of mindfulness may be
regarded as a distinct risk factor for populations that are prone to
experiencing experiences of ego loss, such as chronically ill patients.
5. We have also compared the test-retest reliability after 6 months for
psychological distress as measured with the Brief Symptom Inventory
(a 53 item short form of the Symptom-Check-List-90) between two
subsamples of spiritually practicing and non-practicing individuals,
which were post-hoc matched for important sociodemographic
parameters (Kohls & Walach, 2008, accepted for publication). The test-
retest reliability after sixth month was r =.62 for the spiritually practicing
individuals and r = .78 for the sample with lack of spiritual practice,
indicating a statistically significant difference Thus, individuals engaged
in spiritual practice(s) seem to perceive distress as temporary states
rather than permanent traits.
Conclusions
In summary, our research findings point to the fact that spiritual experiences
are of major importance to health. In the light of our findings, the following
points seem to be important from a clinical perspective:
1. Regular spiritual practice seems to be able to endow an individual
with an important resource for resilience against destabilizing
experiences. Thus, from a clinical perspective, instead of promoting
positive spiritual experiences as a venue for promoting health, one
should rather focus on the potential for augmented distress in
individuals with lack of spiritual practice stemming from experiences
of ego loss. To put it bluntly, lack of spiritual practice may potentially
5
be regarded as a distinct risk factor, particularly for individuals that
are prone to experiencing experiences of ego loss.
2. Spiritual experiences and particularly destabilizing experiences
should by no means be lumped together with psychopathological
experiences by the clinical practitioner and the diagnostician alike.
We believe that pathological interpretations of (temporarily)
destabilizing spiritual experiences are frequently erroneously made
due to the fact that spiritual and psychopathological experiences
have not been yet disentangled in a satisfying manner. It follows
that finding suitable criteria for differentiating spiritual experiences
from psychopathological symptoms is an important topic for the
advancement of the psychiatric profession.
3. Based on our findings, one might be inclined to recommend regular
spiritual training as a preventive method for buffering distress. While
we would in principle agree with this statement, we would like to
address some caveats here. It is important to recall that spiritual
practice apparently increases both the frequency of positive and
negative spiritual experiences. Thus, establishing a routine of
spiritual training may at first potentially induce distress, which could
potentially add to the extant distress. Additionally, spiritual
competences cannot be established in a short period of time but are
rather long-term goals. Thus, in order to benefit from distress-
annihilating effects of regular spiritual practice, it needs strictly
speaking to be understood as a preventive rather than curative
intervention.
4. As regular spiritual practice may exhibit major impact on stress
perception and coping alike, it seems to be important to gather
information about the spiritual history of a patient, thereby
particularly paying attention to regular introspective, contemplative
and meditative training. Moreover, as we have found significant
differences between the time stability of distress between spiritually
practicing and non-practicing individuals, this is a strong argument
against the employment of distress scales as single criterion for
assessing the effects of pain in spiritually practicing individuals.
To sum up, we believe that our findings point to a blind spot within psychiatric
lore that needs to be closed. With the rise of modern medicine, spiritual
approaches to coping with and understanding distress have been largely
abandoned, perhaps with the exception of psycho-oncology and the nursing of
terminally ill patients (Georgesen & Dungan, 1996; Smucker, 1996). Instead,
distress has been defined by mainstream conceptualisations as a negative
phenomenon, consisting of a physical and a psychological component only. It
is our firm belief that psychiatry and clinical psychology would make greater
progress if mental health professionals dared to widen their concepts to
include spiritual aspects.
6
Further Research
We are currently trying to collect data from clinical and non-clinical populations
in Hungary, Germany, Great Britain and the United States. Should you be
interested in collaborating with us, please feel free to contact either Professor
Dr. Dr. Harald Walach (harald.walach@northampton.ac.uk) or Dr. Niko Kohls
(kohls@grp.hwz.uni-muenchen.de).
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© Niko Kohls and Harald Walach 2008
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