Dr. Judit Gellérd
Short Biographical Note
Judit grew up in Transylvania, daughter of a Hungarian Unitarian theologian and martyr of communist persecutions. Judit first graduated from music conservatory (violin), then from medical school. She practiced medicine for sixteen years, specialized in Neurology and Psychiatry in Budapest, Hungary. In 1988 she married Californian professor George M. Williams and moved to the United States. For the past twelve years, as a volunteer, Judit organized and led the Unitarian Universalist Partner Church Program of 400 churches, the largest Unitarian Universalist grassroots movement of the century. She translated and published several theological scholarship. She was awarded with an Honorary Doctorate from Starr King School for the Ministry in Berkeley, CA and with a denominational award.
Judit has just graduated summa cum laude from Boston University School of Theology. Currently she is working on an oral history project under the direction of Prof. Elie Wiesel.
Having practiced neuro-psychiatry in communist East-Central Europe for sixteen years, and now studying theology/ethics at BU School of Theology, I argue for the necessity of an integrative thinking in medicine. I attempt to illustrate it with a cross-disciplinary (religion and medicine) and cross-cultural (drawing from lessons of communism in medical ethics) integrative model. While giving up the rigid ontological causal commitment in favor of empirical aspects and personal benefits of ultimacy experience in healing, a dilemma is inherent in the two radically different interpretative modes of our experiences: the cognitive scientific and the theological. But do I need to choose between them? I choose to live in the "in-between"--with both. God is not my brain’s creation, but it is my brain that makes God “accessible” for me. The scientist in me is fascinated to find answers to the how quest?
Religion and Bioethics-Medical Ethics
An Integration Paper
Judit Gellérd, M. D., BU School of Theology, MTS 02 graduate
“The search for intelligibility that characterizes science and the search for meaning that characterizes religion, are two necessary intertwined strands of the human enterprise... essential to each other, complementary yet distinct and strongly interacting--indeed, just like the two helical strands of DNA itself!”--these were the words of the winner of the 2001 Templeton Prize for Progress in Religion, The Rev. Dr. Arthur Peacocke of Oxford University. He is not only a renowned physical biochemist--researching and describing the double helix structure of the DNA--but also an Anglican priest and Doctor of Divinity. Dr. Peacocke is a proponent of “critical realism,” who recognizes that “both science and religion try to depict reality and must be subject to scrutiny,” while admitting their creative interaction. Hardly anything could have been more timely and more inspiring for me. The title of his new book could serve as the motto for my present paper, my past career, and my future orientation: Paths from Science Towards God: The End of All Our Exploring.
Having practiced medicine for sixteen years in communist Romania and Hungary--specializing in neuro-psychiatry--and a current graduate student of Boston University School of Theology, I enthusiastically embraced the BTI Science and Religion Certification program. My very interest in coming to Boston University has been a desire for a coherent synthesis of science and religion. My first endeavor was the Spirituality and Health Practicum under the guidance of Prof. Jensine Andresen, and supervised by Prof. Wesley Wildman and Prof. Patrick McNamara. It has not only resulted in a joint publication but has also shaped my decision to re-direct my future professional life toward an integration of the medical, theological and ethical fields.
In my medical experience, the correlation between religiosity/spirituality and the state of health of a person have always been an intuited reality. Under communist totalitarianism however, introducing religious dimensions into the healing process, was discouraged, if not banned. Research in such a topic was unthinkable then. My participating in the Spirituality and Health project has had a far deeper significance than its face value--it carried the overtone of liberation for me.
Attempt to Interdisciplinary Integration: The Spirituality and Health Practicum
The Spirituality/Health Practicum was a very enriching and joyful experience. My task within the project was recruitment and testing of participants around age sixty and older. A high percentage of surveys were returned. It involved many follow-up phone calls and correspondence. I had 60 surveys completed by the end of the semester.
The study assumed a direct correlation between religious attitudes/practices and improved physical health. This direct relationship has been observed empirically and proven through scientific studies: prayer and other spiritual practices seem to maintain and even restore health. Some forms of religious practices and prayers are directly related to frontal lobe functions. Our general hypothesis was that prayer and other forms of religious practices that result in health improvement, do so partly by involving, activating the frontal lobes. Thus our task was to investigate the relationship between various religious practices and attitudes, the overall functions of the frontal lobes, and the state of overall health. We postulated that if our assumption about the frontal lobes’ responsibility in mediating, “translating” religiosity into health improvement was correct, then people with better frontal functions would have better health or a more positive perception of the state of illness--that is, they suffered in lesser extent. Also, people with more intense prayer life and religiosity/spirituality were expected to have better health and better frontal functions. Some further predictions could be added to this main hypothesis and we partially looked into those, such as religiosity protecting against depression which could be responsible for poor health. Another aspect of this study was to investigate the correlation between religiosity and certain forms of frontal functions--e.g. the orbitofrontal functions.
While the role and function of the temporal lobes in correlation with religiosity and better health have been thoroughly researched, the role of the frontal lobe has never been the focus of any major study. Thus ours can be considered as a pioneer one.
We collected a wide range of data. The questionnaire had the following main parts (318 questions): personal data; dimensions and role of religion; frontal lobe functions--verbal fluency test for the left frontal lobe functions, and design fluency test for the right ones; frontal inhibition or desinhibition--especially characteristic to orbito-frontal disfunctions. For differential diagnostical reasons, we tested temporal lobe functions, looking into patterns of attachments. Questions on health tried to assess the subject’s handling stress, his/her overall perception of health and handling illness, chronic and acute (diagnosed or not) illnesses, discomfort level, medication. We also tried to detect signs of depression and anxiety.
My responsibility was to recruit subjects in the older age category--around 60 or older--presuming that frontal functions generally decline with age. I paid special attention that the participating subjects would be recruited from among a wide variety of religious backgrounds--Unitarian Universalists, Roman Catholics, Southern Baptists, Calvinists, but also New Age spiritualists, atheists, secular humanists. I also “targeted” a few friends whose personality suggested frontal dysfunction or who suffered from epilepsy. Unitarian Universalists comprise the majority of the participants--due to my close ties and affiliation with them--which also guaranteed a wide range of spirituality and pluralistic religious practices and attitudes. I consider my sampling representative and relevant. Most of the participants were middle class, educated people.
We used non-standard format scoring. For our hypothesis of direct correlation between health, frontal functions, and religiosity--intrinsic and extrinsic--we scored frontal functions, religiosity, and health--that is, seven main variables.
In scoring religiosity, we used Prof. Don Batson’s scales, focusing on three categories: (1) religious orientation, (2) religious life--measuring the means, the end, and the quest of one’s religious dimensions, (3) doctrinal orthodoxy--designed to measure belief in traditional religious doctrines, important component of the intrinsic, that is, the “end” dimension. This scale, however, was designed mostly for Catholics, and seemed inappropriate for non Christians.
In scoring health, I personally was responsible to design and try out the best formula. My medical background and a felt sense of the subject’s personality and psychological profile, by virtue of knowing some of them for years, was extremely helpful. This study did not employ an impersonal statistical method, rather a careful analysis of personality beyond the sheer number of scores of the questionnaire. This principle manifested especially in scoring health issues. Some subjects would pay less attention than others to their reactions, thus frontal and health-related answers clinically seem not always to be in correlation with the subject’s perception. However, the multidimensional aspect of frontal testing and the statistical dimension of the study eventually self-corrected extreme subjectivity. In testing health, we used several variables: multiplicity of illnesses, duration, number of doctor’s visits, diagnosed or not, discomfort, etc.. We, however, focused on three basic factors: (1) severity, life threatening character of an illness, (2) perception of the subject of his/her impaired health based on discomfort level, and (3) diagnosed or not, chronic or acute illness categories.
We calculated the health index using the following formula: the sum of # of diagnosed chronic illnesses and total severity multiplied with means of discomfort / # illnesses, and added the # of acute illnesses. This reflects a reasonable profile of one’s objective and subjective state of health.
b. Neuroanatomic and physiological background
The arguments for the benefits of prayer and regular meditation are manifold. The principal factor, responsible for the positive effect, is hope, a highly positive emotional charge. It is also fear and stress reduction, a positive outlook to the future, an active planning and volitional strength.
Anatomical structures support the theory. Recent studies, especially those by Patrick McNamara, show that the traditionally known role of limbic system in emotional processes, in fact, is regulated by orbitofrontal cortex. Thus the frontal lobes participate directly in emotional processes: the left frontal cortex mediates positive emotions, the right frontal cortex mediates negative ones. Consequently, left frontal (orbitofrontal) lesion is likely to cause depression, right frontal damage leads to uncontrolled maniaform behavior.
Besides emotions, the frontal cortex is also responsible for pro-social behavior, empathy, and moral insight. Lesions of these structures cause a typical personality structure of impulsivity, aggressivity, inappropriateness of the expression of sexuality, a “sociopathic” behavioral pattern.
Self-consciousness is a frontal lobe function and in close correlation with religious mode of life; most religious practices claim to increase self-awareness. Impairment of the self and an impossibility to reach for it is a characteristic symptom of serious frontal lobe lesion.
The right frontal cortex is intimately involved also in memory, thus bears crucial role in the sense of self identity. Processes of belief-fixation are also involve frontal lobe functions and are subject of neurophysiological studies. One aspect is one’s openness to foreign belief systems.
There is, however, another major supporting physiological explanation for the health-improving effect of prayer and meditation: relaxation and consequent improvement of brain circulation. Electrophysiological feedback studies showed evidence for this.
A statistical analysis of two variables in our study, frontal functions and state of health, seemed to demonstrate unambiguously our prediction: the better the frontal function, the better the health is. The next step was correlating these with the third variable, religiosity and its types. Our study found subjects belonging into two groups: high religiosity and low religiosity. We found a direct correlation between frequency and intensity of religious/spiritual practices and overall state of health (or perception of it), and the same correlation between frontal functions and health, since the frontal lobes are supposedly responsible for the correlation. Or, we can formulate it in this way: good frontal functions and high religiosity protect people from suffering.
The study of the correlation between spirituality/religiosity and health has definitely convinced me about the values of an interdisciplinary approach in medicine. As a trained classical musician, now I would also like to add the study of the therapeutic aspects of sacred music.
Integration Cross-Culturally: Lessons from Communism in Medical Ethics.
The Time Factor
Since my youth, Albert Schweitzer has been my ideal, because he embodied interdisciplinary excellence--a “renaissance person” ideal. I view my own career changes from music to medicine to theology in a “Schweitzerian” sense. I have never abandoned any profession, rather I have incorporated each profession into the next. I play my violin in churches as often as I preach, and if I ever practice medicine again, I will incorporate religious dimensions into my work.
To illustrate the benefit from the Spirituality and Health Project for my interdisciplinary orientation, I recall my experiences as a physician in communist Eastern Europe. There was nothing spiritually quite as fulfilling as being a physician in that part of the world, where medicine represented not only science and a healing art, but also the most complex form of service and ministry. We practiced the art of medicine, and a great part of it was ministry to the marginalized, the abused women, the alcoholics, the elderly. Hospital conditions were miserable, social problems unsolved, social care virtually absent. So, the attitude toward and relationship of the physician with the patient carried a greater weight. For six years in a cancer research neurology department, I stood at the bedside of young dying patients, praying with them in their last hour. In a communist country, religious service for the dying and the presence of clergy wouldn’t have been welcomed. And younger patients had no religious background. But in the hour of their death in a desolate, inhumane hospital, they needed someone to hold their hand, look into their frightened eyes and help them die in peace. In psychiatric wards I played my violin during many Christmases. The effect of music--even on Alzheimer patients--was stunning. Touched by music, these patients, in their fading personhood, came alive. “Is it Christmas?” some asked me, wakening from years of absence.
During my years of medical practice, my patients consistently commented in these words: “When you enter the ward, the sun is suddenly shining and I feel that I am healing.” In that time I hadn’t been aware of what this really meant; I dismissed the recurring statements as mere compliment. Only later I understood that the “sunshine” my patients perceived was the Spirit in me, manifested through my compassion and intense love for them in their suffering. Patients who grew up communist atheist were ever hungrier for “spirituality.” I used their language to guide them back to resources of their inner selves, to (re)connect them with the divine and their own souls. The secretly religious patients intensely needed the nurturing of that dimension. There is a great power in combining God’s gift of the Spirit with good medicine.
My keen interest in comparative approaches toward bio- and medical ethics stems from my experiences in two radically different societies. Having been witness to the abuses and manipulations of scientific data (particularly concerning AIDS) and medical practice (especially in areas of psychiatry and gynecology) for political gains in a communist society, I want to raise awareness of risks of possible manipulations--although for different reasons and in more subtle ways--in our affluent US society. The ubiquitous presence of special interests and prominence of profit-making necessitate an ever greater ethical vigilance and moral imagination from scientists and religious professionals alike. Although people’s moral sense of good or bad, virtuous or evil, ethical or unethical are basically similar cross-culturally, unprecedented technological developments have made bioethical and medical decision-making more complex and complicated than ever before. We truly need to stretch our moral imagination. Science and its applications, divorced from ethical considerations, could be disastrous, therefore should be unthinkable today. Communism offers valuable experiences which, unless we learn from, rather than dismiss them, might prevent us from repeating some of the mistakes.
Medical ethics in general continues to be ruled by the Hippocratic Oath as its basic guiding principle. Yet the difference between the ways in which we live out our moral values as physicians are vastly different in poor and wealthy societies, and in different political systems. I am often puzzled when I read idealized high-minded ethical treaties, yet watch actual practice under the pressure of the profit-making “industrial” mentality which forces doctors to occasionally compromise their ethical integrity.
In my experience, one of the most evident compromises lies in the view of time as money. In the accelerated pace of Western life, where the greatest achievements of science and technology are available for medical diagnosis and treatment, the precious commodity of time is curtailed, often denied to both the doctor and the patient. Time is crucial in building trust and a nurturing psychological environment, essential for decision-making and healing. The hostile, legalistic mentality of the courtroom often and sadly replaces the failed trust-building process in the medical office. Take the example of how the principle of informed consent is typically implemented when a patient suddenly faces the diagnosis of cancer, and needs to make decisions about life and death issues. The extreme pressure of time in the few-minute-long medical visits and the perhaps monotonous, almost automated recital of options and consequences--often seasoned with unnecessarily frightening possibilities of side-effects and worst scenarios--will only aggravate the patient’s stress, and, consequently his or her decision-making will likely be affected. In such circumstances the patient might reject an effective treatment, and, the doctor, respecting the autonomy of the patient, will ultimately fail the patient. This is all in the name of medical ethical principles, but inhumanely applied.
Now, through my attempt to present some contrasting features of medical practice in a communist environment, where time is abundantly available and ministering to the patient is part of the practice, I wish to illustrate my main point: the importance of bringing out the spirit of the ethical law, not only following its letters.
In communism, medical training was free, subsidized by the state, and so was health care. The physician had no financial interest invested in practicing (good or bad) medicine. His/her salary was the standard minimum of any other member of the society. There were no insurance companies, no HMOs, and definitely no law suits (frivolous or otherwise) against doctors. Paradoxically, in a society lacking freedom totally, freedom was granted to doctors to practice according to their own conscience. Cost, either of time or of treatment, was never a consideration within the limits of available resources. Physicians had as much time as they needed for the patient. In the above-mentioned case of terminal illness, the fluidity of the doctor-patient relationship--pejoratively called more of a “patronizing” model--would allow the doctor to take more responsibility in the decision-making, as a counselor/minister, as a compassionate fellow human. The patient’s stress because of the illness is already overwhelming. There is no lonelier space in the universe than that of a person who has just become a cancer patient and is expected to make crucial decisions in five minutes. A practice can be perfectly ethical, yet inhumane. Compassion has to be added to the rigid letters of rules. The need for strengthening and deepening our ethical culture and moral imagination only increases with the advancement of biotechnology.
One might ask how Eastern European doctors were controlled, if not by legal means. I attempt an answer based on my personal experience. First of all, high social status was a true reward for the doctor’s conscientious work and self-dedication. Negatively put, social pressure prevented the physician from abusing the trust of society. A genuine trusting relationship between the physician and patient has always been a key to successful practice. Trust having been established, there was no need to practice a defensive type of medicine. The limited resources were used for the benefit of the patients, not wasted on the doctor’s self-defense. Medical practice was based on the assumption that the Hippocratic Oath is ultimately binding, and that doctors have the moral and professional integrity to follow its spirit and do their best in the given situation and technological circumstances. Although medical ethics was not formally taught at medical universities, it was woven into the texture of each discipline.
Another “controlling” factor was a healthy team spirit among physicians, who felt responsible for each other and looked into each other’s work, even critically when malpractice threatened. Mistakes on the physician’s part were considered honest mistakes, and doctors were genuinely trusted. On the one hand, close team-work among doctors assured reasonable ethical decisions; on the other, the expectations of patients and relatives from physicians were also reasonable, and almost never created ethical-legal crises. Physicians were not attributed, nor expected to have god-like powers. End-of-life issues, for example, were not regulated by written rules, but a deep sense of reverence for life, and also a recognition of the right of a person to die in dignity. Certain aspects of passive euthanasia were a socially accepted part of such respect. Of course, this had to do also with the limited therapeutical resources. Because of the limited availability of medical technology, a common-sense ethical culture could handle the complexities of an artful practice. Ethical dilemmas were mostly around a just allocation of the existing resources. Communitarian principles were applied here also. No child was ever precluded from immunization. Hospitalization lasted until the patient recovered. Patients were never sent away from emergency rooms, or any medical office, unexamined and untreated. Although doctors were free to ask for any lab tests and had access to specialists, it was embarrassing to practice defensive medicine, asking for “umbrella” paraclinical tests. In fact, during the worst years of the dictatorship, doctors were punished if they asked for unnecessary tests--the cost was deducted from their salaries.
I have attempted to draw some valuable lessons offered by the kind of medicine I had practiced during communism. At the same timeframe, however, stand their tragic counterpoints, the most brutal manipulations especially of medical-statistical data, of practice of psychiatry, and of gynecology.
Abortion and birth control issues are increasingly politicized in many parts of the world. But I doubt that it had ever been as brutally controlled and manipulated by the political system as in Romania. The madness of Ceausescu’s “Abortion Decree” turned clinics of gynecology and obstetrics into “mother-killing-fields.” The law forced all women to give birth to a minimum of four children before age 45, and doctors were forbidden to intervene in cases of illegal abortion. Birth control methods were punishable by imprisonment. All women were subject to periodic and compulsory gynecological screening to detect pregnancy. Ceausescu’s motivation for this coercion was his plan to “rejuvenate” the nation. He had no moral reservation against abortion as such. With increasing poverty and well-known disastrous food and energy shortages, criminal abortion cases were ever increasing. Secret police officers were on duty in the operation rooms of gynecological clinics, watching over the shoulders of the doctors and often preventing them from life-saving intervention in fatal hemorrhages after self-inflicted abortions. The woman, treated as “criminal case,” had two “choices”: either plead guilty and her life saved--then arrested for inflicting abortion--or, be left to perish on the operation table. This policy furnished an endless supply of orphans for state orphanages, where brainwashing, abuse, and AIDS epidemics were considered a state secret. Women had never experienced such terror--nor doctors.
Conclusion: Integrative Thinking
At a crossroads in my life and career, grounded in two different cultures, having lived in two extremes of political systems, I have tried to use their lessons comparatively and integratively. Now I turn from issues of applied bio- and medical ethics, toward a more general mindset of integrative thinking. In my view, integration of science and religion also means a transformed thinking about and interpreting our very experiences. Dr. Peacocke’s remarks are indeed guiding principles in this area. “The search for intelligibility that characterizes science and the search for meaning that characterizes religion, are two necessary intertwined strands of the human enterprise.”
Having made an attempt to sketch an integrative model cross-disciplinarily and cross-culturally, I now conclude with the dilemma, inherent in such integrative approach. Applying the principles of integration on the findings of the Spirituality/Health project, I have two radically different interpretative modes of my experiences: the cognitive scientific and the theological. The dilemma is, Do I need to choose between them in order to properly appreciate the effect of my prayer upon my health? Which is the source of my sense of blessedness, zest for life, the overwhelming love for suffering people--God or my brain chemicals, neurobiological processes?
When cognitive science has provided convincing scientific evidence through neurobiology and neuropsychology for a plausible explanation of my experiences of ultimacy, I cannot afford to ignore this evidence. Yet it feels threatening that these explanations will eventually explain away my precious experiences of the transcendent. It seems “dangerous” to ask what “the truth” is. Can two opposing and equally convincing and powerful truths coexist and be reconciled? Will--in the newly enlightened understanding of embodied religiosity--prayer become utilitarian, a mere means to activate my frontal lobes in order to evoke emotions of bliss and serenity, which then improve my health? “Activate your frontal lobes first, then God will honor your effort.” Is this our spiritual future?
Yes and no. I personally need both the bliss of experiencing the non-embodied One, but I also need and want the blessings of the intellectual enlightenment. In this rich double-rootedness, what I propose is to avoid physical reductionism of the ultimate.
My typical reaction initially was a sense of threat to “my” God posed by scientific revelations of the biological mechanisms underlying my ultimacy experience. But after passing the threshold which seemingly separated the “world of God” and the “world of science,” I discovered the vast richness of life, and I gained an ever deepening sense of appreciation for it. The threat is no longer. God is not my brain’s creation, but my brain makes God “accessible” for me. The scientist in me is fascinated to find the answer to the how quest? We are part of nature. If we admire a butterfly or the lilies of the fields, how much more the awe and sense of blessedness awakens in us when we see the marvelous microcosm of our own brain! My knowledge is divine gift rather than a threat to my faith. It enriches the awareness of life’s extended dimensions rather than takes away from it. If one feels threatened by the illumination of science, it is perhaps because of one’s insecurity in one’s faith.
There is no incompatibility between my God experience and my self-understanding of it. Communism brainwashed us scientists: it was an “either-or,” a commitment to religion or to science. Reconciling the two in an ideologically manipulated world was unthinkable. Now freedom’s precious gift is also an intellectual freedom: one can research scientifically, in reverence for life, awe toward God. “We are not forced to choose between a blunt realism about ultimacy and a hermeneutical disengagement from reality” And the more we penetrate through our knowledge the veil of the microcosm of our nervous system in its miraculous complexity, the more grounded we become in our relationship with the ground of Being.
By virtue of having a marvelously sophisticated nervous system, I am able to have the richest, the most complex experience--that of the ultimate. Through my “free radicals” of longing for the transcendent dimension of life, I connect, I tap into a “God consciousness,” I become aware of the indescribable, unnamable, unimaginable divinity, the eternal--Tillich’s “ground of Being”-- yet experienced as “present” in me, “loving” me, changing me. Not as an intentional “Being” but as a reflection of It in my being--thus making me a “drop” of the divine. My experience is that reflection of the One who is beyond existence, and who has no other way to reveal Godself to me, a creature in time and space and part of nature, than through my own biological makeup, through my wondrous neuropsyche.
Will the awareness of, the insight into, the mechanisms of the experience diminish the experience? I think they rather enhance it. It is impossible to glimpse the depth of creation and the wonder of the neurobiological processes--which ultimately enable us to glimpse--without a deep sense of awe and admiration for creation. Knowing and naming the vehicle, the triggerer, the enhancer of the experience won’t discredit it, because my quest is no longer focused on the cause of the experience, but rather on its transformative effect on my reality.
I no longer particularly worry about what exactly was the cause of my experiences--an intentional God or neurobiological circumstances. What helped me was my giving up viewing my experience in an ontologically direct cause-effect manner. What matters is the value of the experience in my life, which has been changed dramatically by those experiences. Giving up the rigid causal commitment in favor of the empirical aspect of the experience, “delegitimates the debates about whether or not real contact with some sort of Ultimate occurs in religious experiences.”
My experiences are relevant in the extent they are meaningful to me in a semiotic sense. I am she who reads my meaning into them. This allows both a relative neutrality and a subjective engagement that grants the benefit from my experiences to the fullest, toward my spiritual health and growth. This world view mandates the integration of medicine as science and art with religion. The way of the future is indeed “science towards God: the end of all our exploring.”
Patrick McNamara, Jensine Andresen, Judit Gellérd, "Religiosity and Health in Community Dwelling Elderly: Possible Role of the Frontal Lobes in Mediating Effects of Religiosity on Health." (under publication in Journal of Gerontology).
Wesley J. Wildman & Leslie A. Brothers, "A Neuropsychological-Semiotic Model of Religious Experiences" in Neuroscience and the Person. Scientific Perspective on Divine Action. Ed. by Robert John Russell, Nancey Murphy, Theo C. Meyering, Michael A. Arbib. (Vatican City State and Berkeley, CA: Vatican Observatory Publications and Center for Theology and the Natural Sciences, 1999) 350.