title: Neural and cognitive basis of spiritual experience: biopsychosocial and ethical implications for clinical medicine.
abstract: The role of patient spirituality and spiritual/liminal experience(s; SE) in the clinical setting has generated considerable equivocality within the medical community. Spiritual experience(s), characterized by circumstance, manifestation, and interpretation, reflect patients' explanatory models. We seek to demonstrate the importance of SE to clinical medicine by illustrating biological, cognitive, and psychosocial domains of effect. Specifically, we address where in the brain these events are processed and what types of neural events may be occurring. We posit that existing evidence suggests that SE can induce both intermediate level processing (ILP) to generate attentional awareness (ie, "consciousness of") effects and perhaps nonintermediate level processing to generate nonattentive, subliminal (ie, "state of") consciousness effects. Recognition of neural and cognitive mechanisms is important to clinicians' understanding of the biological basis of noetic, salutogenic, and putative physiologic effects. We posit that neurocognitive mechanisms, fortified by anthropologic and social contexts, led to the incorporation of SE-evoked behaviors into health-based ritual(s) and religious practice(s). Thus, these experiences not only exert biological effects but may provide important means for enhancing patients' locus of control. By recognizing these variables, we advocate clinicians to act within an ethical scope of practice as therapeutic and moral agents to afford patients resources to accommodate their specific desire(s) and/or need(s) for spiritual experiences, in acknowledgement of the underlying mechanisms and potential outcomes that may be health promotional.
authors.affiliation: Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA. jgiordano@neurobioethics.org
authors.forename: James
authors.initials: J
authors.lastname: Giordano
authors.forename: Joan
authors.initials: J
authors.lastname: Engebretson
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015510:Clinical Medicine / Q000458:organization & administration*; D003071:Cognition; D026690:Ethics, Clinical; D006694:Holistic Health; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D010819:Physician's Role; D010817:Physician-Patient Relations; D029181:Spirituality