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International Journal of Transpersonal Studies24 Andreescu

and conditions that activate those pathways related tohealth-disease outcomes (Kiecolt-Glaser, 2009; Miller,Chen, & Cole, 2009; Walker et al., 2005). For example,in order to exceed the medical prognosis regarding onescancer survival expectations, that patient would need tochange by psycho-emotional means his or her currenthomeostatic equilibrium, equilibrium already corruptedby the advanced cancer which has by that time adaptedsuccessully to the internal milieu o its host (Cunning-ham, 1999). Tis complex but presumably achievable taskmight require some undamentally dierent approachesthan those employed by conventional psychotherapeuticinterventions. It should be taken into account that sel-preservation o humans as a species could be a majorreason or which in daily lie an individual cannotusually infuence, signicantly and with ease, his or herown physiology to the point o radically altering theexisting homeostatic equilibrium (as in that stance, evena short lasting inability rom ones part to consciouslycontrol this process would induce instantly severe healthproblems upon ones body).

Changing Magnifcation and Perspective

In order to nd relevant answers to key questionspertaining to cancer survival, it is necessary to takeinto consideration the degree o detail and complexityrequired by this particular topic o inquiry within thegeneral context o cancer research (Mukherjee, 2010), anoperation corresponding metaphorically to a signicantchange o a microscopes magnication actor. Changingmagnication and perspective could reveal a dierentlevel o detail that implicitly will ask or customizedapproaches and adequate research tools. Hypothetically,there might be some discrete and insucientlyunderstood actors that, within specic individual andsocial constraints, could interact synergically in order toactivate or accelerate some body healing processes.

o take a relevant analogy (Reich, 2009), thesituation o the person seeking healing rom cancermight be comparable to that o that o a proessional

basketball player, whose success depends on both natureand nurture: as much on natural endowment (e.g.,height, ecient use o oxygen) as on abilities developedduring years o training (e.g., speed o running, precisiono throws). Recovering rom such a serious illness is a eatthat requires maximizing all resources, and that tests thelimits o human capabilities, just as world-class sportsevents do. Research in this area thus needs to do more thansimply look or norms within health-care-as-usual. As

Abraham Maslow once stated, I we want to know howast a human being can run, then it is o no use to averageout the speed o the population; it is ar better to collectOlympic gold medal winners and see how well they cando (as cited in Homan, 1988, p. 185). Healing cancer isa matter o the extraordinary. I psychological and sociallie is viewed as a sort o game within a Bourdieusianramework o athletic competitions (Calhoun, 2003, p.275), then taking on the work o attempting to positivelyinfuence cancer survival expectations with the assistanceo certain psychological interventions implies anOlympic-level eort: putting onesel on the line, beingpassionately engaged in a struggle with ones own limits,and being aware o the larger picture while remainingdeeply committed to valuable personal goals.

I this sports parallel remains credible, somequestions will need to be debated in the academic orum.Among them:

Would it be possible to consider as a suitabletrial-participant any cancer patient that has beenimmersed most o his or her lie in a variety omundane activities, rarely related to systematicculture-bound rituals o healing?

Would it be ethical to provide specic and intensivetraining only to some cancer patients?

Would it be in any way acceptable to put implicitpressure on the trial participants, as improvements

in their long-term health status would dependpresumably on their personal implication in thetraining process (though such a supposition has notbeen previously clinically validated)?

Ater taking these aspects into consideration, apotential clinically signicant result that might emergeollowing a specic training program should deserveto be considered as comparable with the perormanceo breaking a world sports record, with the time andeort dedicated to achieving such a goal playing a

large contribution in the outcome. Such an approachto cancer survival research shares not only similaritieswith sports (e.g., it might be hard but not impossible toduplicate high levels o perormance) but also signicantdierences. For example, there is the challenge oassessing participants ability to ollow successullyan intensive training program within a very limitedtimerame (added to the general challenging contexto ones health status) and the problematic matter (not


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International Journal of Transpersonal Studies 25Rethinking Prayer and Health Research

detailed in this article) o designing and validating whatis adequate content or such training activity.

Hypothesis and erminology

In light o the perspective described above, I suggestthat it is improbable or current trials designed toexamine the eects o psychotherapeutic interventionson cancer survival to ully succeed or to go beyondstatistically signicant results. I recognize that any typeo intensive training might be a very challenging or evenan almost impossible task or those patients with a lowlevel o stamina due to the progression o cancer. Still,assuming that some patients would be willing to joinsuch a training program, I propose three key elementsthat should be relevant to the health progress o anyparticipant to psycho-oncology trials or possible evento other trials exploring mind-body connection: onesworldview, intentional normative dissociation (IND),and psychosomatic plasticity-proneness (PPP).

I hypothesize that these actors might signi-cantly impact the nal results o such a trial especiallyi they operate together in using Christian prayer as avehicle o the intervention. Although such an approachappears to be accessible only to patients acknowledgingtheir Christian belies, uture research could probablynd constructive ways to incorporate its core contentinto those trials designed to explore the potential healthbenets associated with a variety o spiritual paths (e.g.,Carlson & Speca, 2011; Didonna, 2009).

Te concepts detailed to some extent in thepresent paper will certainly have diminished relevancei they are not related to a larger theoretical ramework(e.g., Atkinson, 2010; Bottero, 2010; Burkitt, 2002;Dillon, 2001; Gerrans, 2005; Harvey, 2010; Hilgers,2009; Ignatow, 2009; Kontos & Naglie, 2009; Lizardo,2004; Lo & Stacey, 2008; Pickel, 2005; Vaisey, 2009)that explores rom dierent angles notions such ashabitus (i.e., the social world incarnated in individualsthrough a set o internalized structures or assumptions,oten taken or granted and engaged upon without any

great deal o prior refection) and tacit knowledge (i.e.,knowledge not consciously articulated by a person butwhich signicantly regulates ones activities).

In the context o this article, while acknowledgingthat the denition o terms such as illness anddisease is rather fuid (e.g., Craert, 2011), illnessreers to the way in which people experience a diseaseor any biophysiological state that is an object o inquiryor the current medical science (e.g., Kleinman, 1988;

Vellenga, 2008). Also, curing (clinical recovery romdisease) is not considered a synonym or healing (howregained health is subjectively experienced by the ormerpatient). As objective measures alone oten cannot recordadequately the emotional and social costs o a disease, theruptured lives unable to cope with the pain and with thememories o a possibly orever lost health, healing shouldbe seen as a undamental aspect o human well-beingand a necessary part o an authentic state o health. So,healing is here preerred to curing because no curingis complete without healing, and healing might precedecuring.

It is also important to note that three termsrepeatedly mentioned in this paper (religion, spiritualityand transpersonal) have dierent meanings despite theirsignicant overlaps. Tough it would be acceptable toconceptualize religion at the level o an organized socio-cultural system and spirituality at the level o individualspersonal quests or meaning and ulllment (Koenig,McCullough, & Larson, 2001), the examination othese terms within a transpersonal ramework might berelevant (Hartelius, Caplan, & Rardin, 2007; Pappas &Friedman, 2007) i salient questions pertaining to thetranspersonal experiences in which the sense o identityextends beyond the individual to encompass wideraspects o lie and cosmos are to be addressed (e.g., howcan we bridge the divide between the consensual world oreligiosity and the uniquely private world o spiritualitythat relates to what might be viewed as the sacred?).While the analysis o these broader concepts and theirsubstantive and unctional distinctions is beyond thepurpose o this article, the extensive academic literatureprovided at reerences may oer readers various denitionsand details suitable or their particular interests (e.g.,psychology, sociology, anthropology, theology).

Worldview

Apatients worldview could be loosely dened as aset o belies and assumptions that describe realityand dene the boundaries o what possibly can be done

towards healing by the patient himsel or hersel withand without additional support (medical, spiritual, etc.).Underused until now as a construct within the mainstreampsychological literature (Johnson, Hill, & Cohen 2011;Koltko-Rivera, 2004), worldview encourages attentiontowards the way patients perceive disease and healing,according to their cultural and social rameworks(Good, 1994; Hughner & Kleine, 2004). aking intoconsideration the recent academic literature exploring


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rom dierent perspectives the placebo phenomena (e.g.,Ader et al., 2010; Benedetti, 2008; Benedetti, Carlino, &Pollo, 2011; Colloca & Miller, 2011a, 2011b; Enck et al.,2011; Finniss et al., 2010; Flaten et al., 2011; Harrington,2008, 2011; Hyland, 2011; Jonas, 2011; Kaptchuk,2011; Kihlstrom, 2008; Kirsch, 2008; Kohls et al., 2011;Linde, Fssler, & Meissner, 2011; Meissner, 2011; Miller& Brody, 2011; Moerman, 2002; Mora, Nestoriuc, &Rie, 2011; Myers, 2010; Price et al., 2008; Raz, 2008;Tompson et al., 2009; Vase et al., 2011; Vits et al., 2011;Walach, 2011), it appears that the culture-constructedlenses through which one learns how to interpret theworld oten infuences to various extents many medicalconditions otherwise rooted in objective reality.

Tough patients are ree-willed and autonomouspersons, their attribute as relational beings (Gergen,2000) could shape their personal convictions abouthealing to such a point that they essentially could beviewed as mere outgrowths o social processes. However,culture seems to be embodied by human beings in waysthat are distinct rom those encountered in everydayexperience as objectied cultural orms (Lizardo, inpress) and narrative remains the conventional orm oorganizing experience and dening identity through theinterpretation and reinterpretation o lie events (e.g.,Bruner, 1987, 2008; Hyvrinen et al., 2010; McAdams,Josselson & Lieblich, 2006; McLean, Pasupathi, & Pals,2007; Ochs, 2009; Sirota, 2010; Swinton et al., 2011;Whitsitt, 2010). It could be said that as humans, welive in and we are shaped by the stories o our cultureor, as one researcher noted, we lead our lives as stories,and our identity is constructed both by stories we tellourselves and others about ourselves and the masternarratives that consciously or unconsciously serve asmodels to us (Rimmon-Kenan, 2002, p. 11). Te storiesthat are told in being lived and lived in being told (Carr,1986) contribute to the way a person comes to dene thelimits and possibilities o the world as it is, includingones potential ability to infuence psychologically the

evolution o a disease such as cancer.Stories do not appear in a vacuum but withinthe ramework o a culture that is dynamic and neverstill, and that represents what we make o the world,materially, intellectually and spiritually (Gorringe,2004, p. 3). An interdisciplinary examination is thusrequired or an authentic understanding o the extent towhich meaning is shaped by the nature o our individualhuman bodies (e.g., Johnson, 2007), o the interaction

between personality traits and culture in shapinghuman lives (e.g., Hostede & McCrae, 2004), and othe processes through which the dominant cultural models have instilled to varying degrees in humans manyimplicit assumptions regarding healing and illness (e.g.,Achterberg, Dombrowe, & Krippner, 2007; Garro,2003; Koss-Chioino, 2006). As illness experience ismapped onto a symbolic space created by the modelsand metaphors o the medical system (Kirmayer,2004), the patients perceptions and representationsgive rise to multiple levels o interpretations that mayreinorce each other, giving experience proound depth,or may contradict each other, leading the patient intoambivalence (e.g., Watson-Gegeo & Gegeo, 2011),illuminating oten the workings o the everydaysymbolic violence (Bourdieu, 2002) embedded in themodes o action and structures o cognition belongingto dominant social agents.

Sick people oten became patients with terriblesuddenness, so personal narratives o illness experienceare ways o linking body, sel, and society (e.g., Bury,2001; Feder-Alord, 2006; van de Berg & rujillo, 2009).It might be that these narratives represent ones eorts toregain the ability to respond eectively to given challengesgaining increased sel-ecacy (Bandura, 1994) byunderstanding and modiying some o the perceived toxicbelies. Still, due to the convergent pressure o externaland internal orces that can make the patient reluctantto engage condently with the outside world, questionsshould be raised on how these narratives are impactedby the cultural customs in oncology wards (e.g., Broom& Adams, 2010; Carr, 2010; Mulcahy, Parry, & Glover,2010; Speraw, 2009), by the religious unction o modernmedicine (Wardlaw, 2011), by the inadequate theorizingo health and illness (e.g., Conrad & Barker, 2010;Murray, 2004; Stam, 2000), by the moral dimensions ostigma (e.g., Jackson, 2005; Yang et al., 2007), or by theextent to which health proessionals consciously providenarrative care to their patients (e.g., Coulehan, 2003;

Frank, 2007; Henoch & Danielson, 2009; Kirmayer,2003; Lyttyniemi, 2005; Mattingly & Lawlor, 2001).As both literature and psychology involve not only aconception o language and what it does (Jones, 2007;Wear & Jones, 2010), but also adopt as one o theirgoals the better understanding o individual and socialbehavior (e.g., Contarello, 2008; Moghaddam, 2004,2006), realist ctional works about illness (e.g., Moore,1998) are oten able to provide imaginative access to


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lived events, deserving to be explored in depth within asuitable academic context (e.g., Ratekin, 2007; Scha &Shapiro, 2006).

Maintaining psychological well-being duringserious illness is both challenging and dicult or thepatient (Folkman & Greer, 2000; Lepore & Revenson,2007), so the illness narratives o cancer survivors shouldstimulate urther exploration o their worldview and othe related inner resources one could use to create orderand coherence in the ace o a threatening disease (e.g.,Broom, 2009; Cantrell & Conte, 2009; Coulehan, 2011;Drew, 2007; Frank, 1995, 2003; Killoran, Schlitz, &Lewis, 2002; Little et al., 1998; Radley, 2002; Richins,1994; Ring et al., 2009; Sarenmalm et al., 2009;Schilder et al., 2004; Willig, 2009). It would not beunreasonable to hypothesize that, most oten unspokenand taken or granted, ones worldview might be shapedby key actors such as subjectivity (e.g., Biehl, Good, &Kleinman, 2007; Crapanzano, 2006; Csordas, 2008;Jahn & Dunne, 1997; Layton, 2008; Ortner, 2005;Willig, 2000; Zahavi, 2005) and sel identity (e.g., Hall,2007; Manzi, Vignoles, & Regalia, 2010; Maslow, 1976;Quinn, 2006; Schwartz, Luyckx, & Vignoles, 2011; vanHuyssteen & Wiebe, 2011; Vignoles, Chryssochoou, &Breakwell, 2000; Zahavi, 2009), themselves embeddedin a silent web o social constraints and inter-subjectivecreation (e.g., Baerveldt & Voestermans, 2005; Cohen& Barrett, 2008; Csordas, 2004; Gillespie & Cornish,2009; Hollan, 2000; Jenkins, 2001; Kabele, 2010;Laughlin & Troop, 2009; Martin, 2000; Moore &Kosut, 2010; Nolan et al., 2008; Pachucki, Pendergrass,& Lamont, 2007; Slocum-Bradley, 2009; Strauss, 2006;Vaisey & Lizardo, 2010).

Intentional Normative Dissociation

Asecond possible actor in healing is what I will reerto as intentional normative disociation (IND).As dissociation theorists have noted (Bernstein &Putnam, 1986; Ludwig, 1983; Putnam, 1989), disso-ciative experiences all along a continuum ranging rom

everyday events involving absorptionespecially in dailyrecreational activities (e.g., listening to music, readingnovels, watching movies, daydreaming)to the extremeand relatively rare conditions belonging to pathology(e.g., disorders o memory and identity). Currentacademic literature (e.g., Butler, 2004) considers thatnon-pathological dissociation known also as normativedissociation (both terms indicating the presence onormal dissociative processes) implies a change in the

state o consciousness that is not induced organically,does not occur as part o a psychiatric disorder, andinvolves the alteration or separation o what are usuallyexperienced as integrated mental processes lasting alimited amount o time. Most dissociative experiencesare not pathological and allow the individual todisengage rom the tension o their present situation, thekey ingredient being absorption (ellengen & Atkinson,1974); this construct is seen as involving a state o totalattention, o complete engagement in experiencing andmodeling the attentional object. Considered as positivedissociative experiences (Pica & Beere, 1995), theyoccur during a non-traumatic event when perceptiono an individual narrows during an intense situation opersonal relevance and blocks out the background.

While the ubiquity o non-pathologicaldissociation in the lie o human beings seems to bean accepted act (e.g., Alvarado, 2005; Budden, 2003;Butler, 2004; de Ruiter, Elzinga, & Pha, 2006; Hunt etal., 2002; Krippner, 1999; Seligman & Kirmayer, 2008;Somer, 2006), the mechanisms and unctions hiddenbehind the surace o this phenomenon are not clearlyidentied. Keeping in mind normative dissociationscomplexity and its underestimated importance or onesdaily lieeven when it is just about the pursuit orecreational enjoyment (Butler, 2006), it seems possibleto suggest (without clinical evidence) the existence o anormative dissociative experience that is intentionally, ioten unconsciously, cultivated: IND.

I ordinary, normative dissociative events thatmost people experience could be dened as brie, usuallyuncontrolled, and supercial (in terms o the depth andstability o attention ocus), the participants in searcho deeper personal transormation deliberately trainthemselves to partake in IND activities that eventuallylead to signicant identity transormations, refected alsointo ones experience o the external world. Although Iam aware o the Singlestate Fallacy, briefy dened asthe erroneous assumption that all worthwhile abilities

reside in our normal, awake mindbody state (Roberts,2006, p. 105), IND may be relatively unrelated to theknown spectrum o altered states o consciousness. TeIND process shares similarities with the institutionalizedorms o trance (Bartocci & Dein, 2005; Castillo, 1995;Krippner, 2009; Vaitl et al., 2005) only to the extent thatit requires a conscious practice o controlling attention inorder to disengage onesel to the desired degree rom thesurrounding environment.


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As here dened, IND is usually accompanied byan increase in the cognitive and emotional unctioning,inducing positive consequences on ones consensusconsciousnessa general label or the state in whichone spends most o the time, an active, semi-arbitraryconstruction shaped undamentally by the cultureone is raised in (art, 2001). Ones habitual state oconsciousness might be consistently infuenced by thecollective assumptions and cultural values o the societyones lives in, thus allowing the dissociation to becomea central element in some types o healing processesperormed mostly in certain areas o the world (Cardea& Cousins, 2010; Cardea & Krippner, 2010; Chapin,2008; Schumaker, 1995; Seligman, 2010; Winkelman,2004). Such a concept, i empirically veriable, might beo help in clariying the relation between dissociation,cultural variability, and religion (e.g., Dorahy & Lewis,2001).

Psychosomatic Plasticity Proneness

Athird dimension related to healing process,psychosomatic plasticity proneness (PPP),is proposed here as a way to conceptualize thepsychosomatic potential possessed to various degreesby each human being and used, oten in an implicitmanner, to turn personal psycho-emotional contentinto a bodily reality. Psychosomatic is, o course, a termwidely accepted as reerring to the inseparability andinterdependence o psychosocial and biologic aspectso human beings (Engel, 1977; Lipowski, 1984). I thisproposed construct is in some measure valid, it wouldthen ollow that without the discrete mediation o PPP,psychosocial actors cannot contribute signicantlyto the progression o a disease or to the regaining ohealth.

I PPPs existence as a catalyst can be validatedempirically, uture research may well show that it hasa strong connection with transliminality, a perceptual-personality construct reerring to a hypersensitivity topsychological material originating in the unconscious,

and/or the external environment (Talbourne & Maltby,2008). As with dissociation, PPP alls presumably alonga continuum, its impact ranging rom discrete subjectiveand physiological changes (visible as the mild orms oplacebo and nocebo eects) to extreme physiologicalmaniestations (e.g., Jawer, 2006; Seligman, 2005). Isuggest that PPP can perhaps be stimulated or inhibitedto a large extent by the complex and multi-layeredinteraction between ones identity and social orces,

thus playing a signicant role in the incorporation othe social body into the physical body (Kleinman &Kleinman, 1994).

Prayer Brings ogether

Worldview, IND, and PPP in Promoting Health

he act o prayer is usually understood as ones way ocommunicating with a divine power and, while the

activities involved in it vary widely, it can be considered asperhaps one o the most remarkable culturally-mediatedorms o normative dissociation and a ubiquitousreligious phenomenon. Due to its intentional dimensionand its large acceptance in various cultures as part osocial narratives across an extended period o time(Crook, 2007; Geertz, 2008; Janssen & Bnziger, 2003;Levine, 2008; McCullough & Larson, 1999; Neyrey,2001), the sustained practice o prayer might be able topiece into a single whole the three previously discussedelements pertaining to healing: worldview, IND,and PPP. Oten used by Christians as a way to builda personal relationship with God (Luhrmann, 2005),investigating prayers place within the process throughwhich supernatural order is known and experienced bybelievers could oer a glimpse into the trained absorptionskills shared by those lay people maniesting signicantspiritual and transpersonal experiences (Luhrmann,2004). A recent hypothesis (Luhrmann, Nusbaum,& Tisted, 2010, p. 67) proposed that learning toexperience God depends on interpretation (the sociallytaught and culturally variable cognitive categories thatidentiy the presence o God), practice (the subjectiveand psychological consequences o the specic trainingspecied by the religion: e.g., prayer), and proclivity (atalent or and willingness to respond to practice).

In Christian scripture, the intentional practiceo dissociation as a learned behavior is stated explicitly:Tereore I tell you, whatever you ask or in prayer,believe that you have received it, and it will be yours(Mark 11:24). Framing this verse in relation to thepreviously presented psychological elements might

mean, or example, that or a meaningul prayer, oneshould dissociate onesel rom the present conditiono illness by seeing it as ragile and volatile against thegeneral cultural conditioning and oten against objectivemedical proos. Simultaneously, one should live in thegrateul habitual assumption o the wish ullled untilrelie is elt and a deep conviction in an active healingprocess is installed, as one cannot longer yearn orsomething that has been already granted. It thus appears


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that prayer, in order to be eective to a greater degree,requires a devoted believer. In this context, religiousdevotion might be understood as representing a believerwho is psychologically endowed with a high ability tobecome absorbed, to reach a fow state o energized andhabitual ocus, being able to direct with ease its streamo attention towards internal, mental stimuli (makingmore lively and natural the representation o ulllment)while simultaneously disconnecting themselves romthose palpable evidences that at least temporarily denythe possibility o ones predictable healing.

As one acts everyday according to a complexsystem o reerences and justications, each humanbeing could be considered, psychologically speaking, abeliever in his or her own worldview. Within a culturalperspective (Ward, 2005), what might separate a devotedbeliever rom an individual without a strong religiousand spiritual credo is whether his or her worldview isundamentally shaped and reinorced both by a religioustradition and personal spiritual experience. In the caseo Christianity, this might require a amiliarity withrelevant Christian scripture and the conviction that Godis permanently present in his or her lie, thus providinga sense o existential security. I a devoted Christianbeliever accepts as truth the above mentioned scripturalverse and decides to act according to it, then it mightentail embodying the desired wellness by assumption,suspending disbelie to such extent that he or she is ableto imagine his or her own health or, according to thiswords Latin roots, to conceive it within, to becomepregnant with it. At a cognitive and emotional level,this embodiment might happen through a sequenceo epiphanies (McDonald, 2008) culminating with aradical ontological shit towards a spiritual identity. Assuch identity is oten dened by how the individual egorelates to and incorporates spirituality into its personalsense o sel (MacDonald, 2009, p. 90), in the devotedbelievers case a spiritual identity should undamentallyrewrite ones illness narrative and oer a release rom

psycho-emotional, internalized constraints that are non-conducive to healing.Te psychological act o conceiving the desired

state o health is neither supercial nor easily duplicated.Still, it is an act as essential to a prayer or health asphysical conception is or giving birth to a child. Toughlocus o control is external in a God-centered worldview,ollowing the metaphor o the sailboat aligning itselwith the wind (Ellens, 2010), such alignment may

involve a great deal o activity by the sailor; the task ohabitual dissociation rom ones illness while grateullyassuming the sensory vividness o the desired healthstate is a challenging task that may require an extensiveadjustment o ones identity and liestyle. According tothis perspective, God is not actored out o the healing,nor is God manipulated to do ones will (e.g., Pretorius,2007; Pretorius, 2009). While it is not the purpose othis paper to engage in theological debates regardingthe relationship between human beings and a ChristianGod, or any kind o divine power, it must be statedthat a prayer-based approach is necessarily based on thepresumption that God, however understood, will alwaysgrant some orm o healing to any believer who expressesin his or her identity and spiritual practice a stableconstellation o elements (some o which are tentativelyexplored in this article).

Various hypothesis involving God are orobvious reasons oten impossible to test empirically;however, or experimental purposes it could be suggestedthat a devoted believer is better at praying than a non-devoted believer, to the extent that one deliberatelyuses the available personal reedom in order to choosenot just to believe in a Divine Power but to transormthat decision into a starting point or a proound andlong-term engagement in the delicate construction oa healing-prone spiritual identity. Following this path,one might be more likely to benet rom whatever as-yet scientically unknown healing mechanism thatmay have given rise to traditional belies in divinehealing (e.g., Breslin & Lewis, 2008; Levin, 1996).Anchored in the general assumptionwith signicantmoral ramicationsthat health is a desirable state obeing or any individual, prayer or health might havea higher level o congruence with ones worldview andwith the general support that a amily or a communitycould provide to a patient, in contrast with prayers orattaining other goals that might be more or less ethicallyand socially acceptable.

All Prayers Are Not Equal in Faith

Beyond understanding prayer as a way o osteringconnectivity with the sel, with others, and with theDivine (e.g., Ladd et al., 2007), at its very core it remainsa petition (Capps, 1982) structured according to onesworldview (Cadge & Daglian, 2008; Levine et al., 2009;Ridge et al., 2008). From a psychological perspective,or the devoted believer, prayer might be a meaningulpath that will help reincorporate health into ones lie.


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Still, to various degrees, prior to actually perorming theembodiment o health, the inner transormations relatedto the healing outcome could be cognitively processed byany believer as an alien, inaccessible experience o radicalotherness.

Te Christian Bible can be seen as the mostimportant religious book or a Christian believer, abook whose words are intended presumably to ormand shape that persons lie. A Christian re-appropriatesthe biblical text by engaging its testimony and probablyby including those passages that they nd relevant andresonant with prior lie experience into a very personaland proound psychological drama, eventually changingtheir identity to various extents in the pursuit o healingand ulllment. Its statements and transormation storiesrepeatedly underline the idea that prayer is meaninglessand ineective without aith (e.g., Mark 11:24, TereoreI tell you, all things whatever you pray and ask or,believe that you have received them, and you shall havethem; Mark 9:23, Jesus said to him, I you can believe,all things are possible to him who believes.). Besidesthe various interpretations that one might give to theseverses, aith could psychologically be assimilated with avividly-experienced, healing-conducive worldview.

o a certain extent, aith is hermeneutical(Brmmer, 2010; Schutte, 2011) and could be viewed as aspecic adjusted lter, perorming a radical interpretationo ones human experience. Tis means much more thanjust accepting at the cognitive level some type o religiousconvictions while at a closer look signicant emotionalambivalences might await to surace. Religious aithappears to be or Fowler (1981) an orientation o thetotal person involving an alignment o the will anda resting o the heart compatible with a vision otranscendent value and power, one s ultimate concern,aith serving to give purpose and goal to one s hopesand strivings, thoughts and actions (p. 14). Toughsuch process o interpretation takes place according to aheritage o religious metaphors and oten activates even

some desirable role-taking conduct (e.g., Capps, 1982;Kuchan, 2011), ones personal way o responding totranscendent value and power as perceived and graspedthrough the orms o the cumulative tradition (Fowler,1981, p. 9) could go deeper into the cultural reality osome specic state o consciousness resonant with biblicalphenomena (Pilch, 2004; Craert, 2010; Bowie, 2011).

Te power o ones prayer-ritual language needsto reverberate and evoke ones aith, thus granting an

essential perormative dimension to any prayer act, butespecially to ones prayers or health. Praying implies arelationship o trust and dependency with a Divine power(Levin, 2009), a relationship maniested through theabsence o anxiety, so that aith seen as worldview shouldbe a deeply inhabited aspect o ones lie. I this verydicult step that requires a trained ability to habituallydissociate in a normative way rom the sensorial aspectso a disease is successully accomplished, then rom thepsychological point o view it will make redundant anyexpectation o gratication; in the assumed identityo the devoted believer, emotionally saturated withdevotion and gratitude, health has already been restoredat a subjective level and with persistent condence willgrow objectively visible according to the strength o onesaith and the discretion o divine grace.

It might not be an exaggeration to claim that anyparadigmatic worldview o the 21st century is, globallyspeaking, a scientic-prone one, the hegemonic infuenceo the media shaping even the ambiguities o onesnarrative. Implicitly, or research purposes, aith cannotbe conceived as being a standardized and identicallyshared component o most believers lie. Beneath theseemingly naturalness o any type o worldview, be itreligious, spiritual, or secular, lies an intricate web oconstructed meanings, individual-specic elementsblending fuidly with those that are socially-enorcedand perpetuated (Csordas & Lewton, 1998). While therationalization o suering has radically increased inthe last decades (Davies, 2011; Youll & Meekosha, inpress), the threat o a disease such as cancer could stillrestructure ones worldview in a short period o time andto a signicant extent, or better or or worse. For thisreason, some consideration should be given to the idea(Cavanagh, 1994) that the cancer counterpart to thedictum there are no atheists in oxholes might be, thereare no atheists in oncology and bone-marrow transplantunits. In this context, i suitable help is given to patientswho are open to new therapeutic approaches, the radical

inner transormations required or health embodimentmight be achieved in cases where worldview, IND, andPPP are blended adequately.

Te Production o Healing Requires Capital

In the last decade, a large number o researchers (e.g.,Berry, 2005; Chiu et al., 2004; de Jager Meezenbroeket al., in press; King & Koenig, 2009; Zwingmann,Klein, & Bssing, 2011; see also the eld analysis onwww.metanexus.net/tarp) advocated that a sustained


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interdisciplinary eort must be made in order toidentiy and clariy the ambiguity o denitions andthe inadequacy o measurements that make problematicmany discussions on spirituality. For example, accordingto a general sociological perspective on spirituality (e.g.,Flanagan, 2008; Knoblauch, 2008), this concept isrelated to spiritual capital, a type o capital embodied inthe knowledge, abilities, and dispositions an individualhas amassed in the eld o spirituality (Verter, 2003;Guest, 2007). Within this ramework, it could be saidthat in the childhood period, the complex acquisitiono spiritual capital is probably infuenced by the child-rearing process through which culture gets internalized(Bloom, 2004; Quinn, 2005, 2010; Seymour, 2010;Sirota, 2010) and implicitly by the availability oemotional capital, a resource essential or the adequatepsycho-social development o any individual (e.g., Reay,2004; urner, 2010).

Later in lie, depending on the developmenttaking place in adolescence and emerging adulthood(Barry et al., 2010; Dean, 2010; King & Roeser, 2009),the initial stock o tacit knowledge one possesses couldsuer a complex process o cultural disempowerment(Bssing et al., 2010), reducing ones capacities to copemeaningully with illness, suering, and death (Oman& Toresen, 2003). Such depreciation, related probablyto individual secularization (Spickard, 2007; Wood,2009) and to the hidden expressions o the secularbody (Asad, 2011; Hirschkind, 2011), is a consequenceo various complex processes, a highly signicant onebeing the extent to which postmodern subjectivity isshaped by media consumption (e.g., Marsh, 2006, 2007;Meyer, 2009; Milord, 2010; Scharen, 2006; urner,2008) more visibly through the particular relationshipdeveloped in recent times between the viewer and theV (e.g., Winston, 2009; Ott, 2007a, 2007b). Toughreligious involvement appears to be the product o bothgenetic and social-environmental infuences (Bradshaw& Ellison, 2008), it may be that transliminality is more

related to genetic actors while, especially in secularsocieties, a child inherits religious and spiritual capitalmainly rom amily.

Researching transpersonal and spiritual aspectso human existence involves not just abstract theoreticalendeavors but practical matters also, some o them relatedto health issues (e.g., Ellens, 2009; Elmer, MacDonald,& Friedman, 2003; Louchakova & Warner, 2003). Tespeculative perspectives on prayer or health proposed in

this article sometimes share similarities with mysticalpractices (e.g., Hunt, 2006; Daniels, 2003; Ellens, 2009),making challenging the process o testing them withina secular setting. In this fuid context, what could beseen as a production o healing through the mediationo prayer may be undamentally dependent upon andenhanced by ones ability to transcend the dense rationaland emotional ceiling derived rom and enorced by thenormative cultural patterns o secular societies.

Tough the concept o transpersonal capital isnot novel within the academic literature and it relatesto the connection between the corporeal and the social(Kleinman & Kleinman, 1994), I choose to looselyredene it in a dierent manner and within a specicpsychological ramework, hoping to make more clearthe speculative network o arguments presented inthe paper. Assuming that ones spiritual worldviewis constructed with the help o brie but prooundtranspersonal experiences which provide penetrating,transorming insights into ones identity, I suggest thatacquiring transpersonal capital requires at a primarylevel a conscious individual eort to inhabit andmaintain a credible spiritual worldview, ound to belargely congruent with the persons own mediated andunmediated lie experiences.

Building such congruence while living mostly ina secular environment could be compared to some extentwith the acquisition o a muscular physique (whichcannot be done at second-hand, but entailing personalcosts and lie choices). Te ormative transpersonalexperiences resulting rom daily spiritual practiceare dicult to generate at will and although in manycases such lie events are rare and eventually turn intobackground memories, it might not be unusual orthe people who have them to consider themselves asbelonging to a so-called cognitive minority, denedas a group o people whose view o the world dierssignicantly rom the one generally taken or granted intheir society a group ormed around a body o deviant

knowledge. (Berger, 1963, p. 18). Te upgrading obrie transpersonal insights and peak experiences intoenduring understandings and stable plateau experiences(Walsh, 2011, p. 121) is probably mediated to a largeextent by IND and it represents a undamental part othe embodiment process through which transpersonalcapital is gained.

Such a challenging endeavor o sel-ashioningleading to a robust spiritual worldview oers a new


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relevance to ones level o committed implication inits own governance through the selection and usage oappropriate technologies o the sel, technologies seenas orms o knowledge and strategies that make possiblethe construction o ones identity (e.g., Nielsen, in press),allowing individuals to eect by their own means orwith the help o others a certain number o operations ontheir own bodies and souls, thoughts, conduct, and wayo being, so as to transorm themselves in order to attaina certain state o happiness, purity, wisdom, perection,or immortality (Foucault, 1988, p. 18).

As contemporary miraculous healings seem toimply enormously accelerated natural healing processes(Nichols, 2002), a spiritual worldview might stimulatenot just existential and psychological wellbeing (Ellison,1983; Ry, 1995) but also those practices dependent ospecic states o consciousness (art, 2001) and probablyinvolved in gaining access to exceptional inner resources.Deepening the supposition, these resources mightbecome physiologically active ollowing transormationsin the mechanisms o human plasticity, recent researchon epigenesis suggesting that sustained experiencescould be able to aect both brain structure and unction(e.g., Belsky & Pluess, 2009; Cole, 2009; Kitayama &Uskul, 2011; van IJzendoorn, Bakermans-Kranenburg,& Ebstein, 2011; Masterpasqua, 2009; Park & Huang,2010; Roberts & Jackson, 2008; Wessel, 2009).

Conclusion

his speculative article should be viewed more likea minoritarian maniesto calling or increased

communication within and across diverse researchelds, a gentle provocation or a conceptual boldnessderived rom cross ertilization o ideas and sources oempirical evidence with the aim o nurturing theoreticalintegration and tangible applications. As such, exploringthe psychological dimension o prayer in health researchis not an attempt to nd support or some kind oreligious ideological agenda. Tough prayer shouldnot be crippled by the daunting task o exploring the

ineable in a positivistic manner (Ellens, 2009), it alsoshould not be conceptualized a priori as just a one-waytransmission (a orm o monologue with onesel) or asa communication without a veriable closure (missingsome sort o evidence that God heard ones prayer).

In order to gain a more elaborate understandingo the prayer phenomenon, exploring in depth its rolein ones healing process requires constructive scholarlyconversations particularly within the boundaries o social

science. A coordinated academic eort to identiy andconceptualize the key psychosocial actors involved inthe human healing process might provide in a decade arened perspective and even some encouraging empiricalresults (Ellens, 2009). Te designs used in the variousempirical experiments o the last decades on prayer andhealth (most recently reviewed in ap Sin & Francis,2009) might need substantial renement, at least withregard to the prayer and aith concepts. Keepingin mind that prayer practices might dier signicantlywithin Christian communities, researchers involvedin the academic study o such complex subject shouldcreate new interdisciplinary methodologies, sensitive tothe intricate acets that prayer entails beore claiming adenitive answer regarding its impact on health and well-being. As dierent orms o religious praying are denedalso by diverse cognitive eatures (e.g., Schjoedt et al.,2009), a more accurate conceptual understanding o whatprayer is and how it might work within a biopsychosocialramework should be developed. Renewed sociologicalinterest in prayer research (Mason, 2011; Giordan, 2011)suggests that prayer might be re-theorized as the mostundamental religious act and conceived as a prooundlysocial activity (even the so-called private prayer).

Tough the research on the ormation oidentity and subjectivity in relation to health (e.g.,Whyte, 2009) should be integrated into the largerramework o individual and collective worldviews,the researchers should not chase or an ever-increasingcomplexity that will inevitably lead to the entrapmentwithin specication, in a utile eort to record thefuid territory o human experience. Te parallel withsports intensive training suggested in the cancer survivalsection o this article should be considered as useulalso in the empirical research on prayer and health. Ashumans, we enculture ourselves through the ormativeaspect o training and this deliberate and perormativepractice will not only recontextualize implicitly priorexperiences but it might also oer in time an accurate

eedback on how to design suitable trial experiments. Ata time when secular societies are diving into a new age oacute anxiety and ecstasy deprivation (Bourguignon,2003), inner authenticity appears to become an essentialpart o a postsecular spirituality (van Aarde, 2009). Fora potentially successul health embodiment, aith asworldviewthat sharp and habitual awareness o thenearness which empowerswould denitely require alot o intense and persistent preparation, probably close


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to the extent o those rites o passage explored usually inethnographies on spirituality (e.g., urner, 2006).

It is beyond the purpose o this paper to correlatein detail its content to related areas o inquiry such as:

religion, spirituality and health (e.g., Heti, 2011; Hillet al., 2000; Koenig, 2010; Koenig, McCullough, &

Larson, 2001; Levin, 2010; Levin, Chatters, & aylor,2011; McCullough & Willoughby, 2009; Miller &Toresen, 2003; Lee & Newberg, 2005; Oman &Toresen, 2002; Park, 2007; Steanek, McDonald &Hess, 2005; Toresen & Harris, 2002)

gratitude (e.g., Emmons & McCullough, 2003;Lambert et al., 2009; McCullough, Kilpatrick,Emmons, & Larson, 2001; McCullough, Kimeldor,& Cohen, 2008; Sheldon & Lyubomirsky,2007; Wood, Joseph, & Maltby, 2008; Polak &McCullough, 2006)

intercessory prayer (e.g., Cadge, 2009; Dossey &Huord, 2005; Hodge, 2007; Masters & Spielmans,2007; Schjoedt et al., 2011; Schlitz & Radin, 2007).

o minimize such limitations, the reerencesprovided by this article may help interested readers graspthe current state o research in these promising areas.

While the psychological process o praying orones health considered here lacks detailed explanationsbased on experimental data and thus might becontroversial in the larger communities, I hope thatthe present article will at least increase awareness notonly o the immense potential that lies ahead, as yetunexplored, but also to the diculties implied by arigorous interdisciplinary research on human natureand experience (e.g., Ammerman, 2006; Belzen, 2009;Belzen & Hood, 2006; Bender, 2010; Cadge, Levitt, &Smilde, 2011; Chamberlain, 2000; Chibeni & Moreira-Almeida, 2007; Cromby, 2011; Crammer et al., 2011;Cunningham, 2007; Davis, 2003; Edgell, in press;Gergen, 2010; Goertzen, 2008; Henrich, Heine, &

Norenzayan, 2010; Hickey, 2010; Horneber et al., in press;Jones et al., 2009; Lengacher et al., 2003; Louchakova &Lucas, 2007; Newberg & Lee, 2005; Notterman, 2004;Ray, 2004; Salsman et al., in press; Schroll, 2010; Slie& Richardson, 2008; Stenner et al., 2011; aves, 2009;Walach, 2007a, 2007b; Walach & Reich, 2005; Walsh& Vaughan, 1993; Valsiner, 2009).

It should be generally recognized that pastand present endeavors in the eld o prayer and health

have only marginally explored the complex aspectsinvolved in those intensely intricate phenomenaassociated with the eld, so it will take some time tocrawl beore walking. From such perspective, moresubstantial attention should be given to understandingthose biopsychosocial actors interconnected withinthe process and outcome o prayer beore attemptingto decipher the big questions lying dormant withintranspersonal and spiritual layers o human experience.In other words, extending the sailing metaphor, socialscience researchers should pay special attention to theway lived socio-cultural meanings are shaping the sailorshuman development. Under the pressure o a persistentand implicit enculturation process, previously learnedand oten unchallenged meanings are binding thesailor rmly to the collectively sedimented assumptionsabout the sailing experience. Inevitably, these meaningswill end up shrinking the sailors independent choices,leading to a predictable but possibly unsatisactorychance o reaching the desired spiritual horizon and/orhealth outcome (Ellens, 2010).

Past medical and social science research hasailed to oer to the academic community the clinicallysignicant results that would have supported beyonddoubt the idea that prayer can improve to a large extent, ina relatively predictable manner, ones physical and mentalhealth. In such context, concluding that urther trials othis type o intervention should not be undertaken (usingthe resources available or the investigation o otherquestions pertaining to health care) might seem like areasonable idea to many researchers. Contrary to thisline o thought, the present article claims that stoppingthe research on prayer and health or even continuing itwhile using conceptually unsuitable designs could delayvaluable academic progress.

Pursuing emergent paths to new knowledgeon prayer and health issues should imply trying rst todescribe accurately ones individual experiences connedwithin the margins o an apparently mundane consensual

trance and latter careully identiying the possiblehealing-prone patterns. Such a complex task wouldprobably require a persistent, stimulating and unsettlingsearch or new orms o theorizing about lived experience(Good, 2010), but in time some o the laws that governthe ineable will eventually become clearer and arguablyeasier to integrate into the mainstream paradigms o theuture academic endeavors (as they might be currentlybeyond scientic understanding not by denition, but by


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virtue o remaining at the rontier o that understanding).In the end, the study o prayer-mediated healing shouldbecome an opportunity towards a deeper refection onwhat it means to be human, a chance or the academiccommunity to explore respectully but inquisitively thedeep Inner Space, the ultimate Final Frontier.

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