In the early 1970s nursing began focusing on total patient care, which included not just physical and mental care but also sociological and religious needs. It was in that decade that Elisabeth Kubler-Ross did her seminal research on death and dying, which looked at beliefs and the process of death and grief. Although including religious beliefs was a grand idea, it was not until the 1980s that true incorporation of religion and its benefits began to appear with the advent of holistic medicine and nursing, with its focus on alternative and complementary health care techniques. It was around this time that the journal Religion and Health made its appearance, along with numerous scholarly articles in professional publications about the benefits of certain religious practices. First, however, we must look at what health is.

The World Health Organization (1948) defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Health is powerfully influenced by cultural, social and philosophical factors, including the existence of meaning and purpose in life and the quality of intimate personal relationships.¹

Therefore, religion as one of these aspects plays an important role in health promotion, but how does it work? One theorist has expressed the link between religious practice and health as follows:

religious practice? finding positive meaning? positive emotions? broaden mind-sets? augmented personal resources ? improved health and well-being.²

Positive emotions of themselves are motivators, and people seek them out and try to re-create the situations in which they occur in order to feel good again.³

When we look at the effects of religion on health care, the physical aspects are the easiest to quantify, so they initially are the ones to gain recognition. When Maharishi Mahesh Yogi brought Transcendental Meditation to the West, with its adoption by the Beatles as its most famous early practitioners, hundreds of people began benefiting from the practice of meditation. Today the benefits of meditation in stress reduction and cardiovascular disease are well documented in many studies. Other religious practices incorporated into health care include yoga, which is even more popular today. Unfortunately, the full religious significance of the practice in most cases has been lost to Western culture.

There are also reports of the psychological benefits of religious practice and meditation. The effect of having a strong religious foundation positively correlates with the ability to cope with and heal serious illness. Religious practice makes passing away more peaceful and less frightening for those with terminal illness. It provides a spiritual anchor and meaning to their lives. Religious practice has also helped with emotional problems. It helps mitigate some of the negative feelings created by issues such as depression by providing a source of social and personal affirmation, resources outside the home, and personal validation. It offers a means for afflicted individuals to look beyond the self by providing venues for helping others that raise their self-esteem and bring meaning and purpose to their lives.

So how does Buddhism, and in particular the practices of Rissho Kosei-kai, assist in health restoration and maintenance? To understand, we must first turn to the work of Abraham Maslow, who in 1943 published his paper "A Theory of Human Motivation." In this paper, he outlined a hierarchy of needs consisting of five levels, from physiological to self-actualization.⁴

Lower-level needs must be met first. Once met, growth occurs and an individual moves upward from one level to the next. So physiological needs must be met before safety needs, safety needs before social needs, and social needs before esteem needs, until finally, when esteem needs are met, the individual can move on to self-actualization and the related development of morality, creativity, spontaneity, problem solving, lack of prejudice, and acceptance. As needs on one level are met, there is upward movement to the next level; however, if for some reason a need is no longer met, there is a reprioritization of those needs and a focus again on the lower level until that need is again satisfied. One of the present writers learned this theory as part of her basic nursing education. It was crucial to understanding the motivation of clients as they moved from illness to the optimum level of health they could attain. During any given illness, individuals would cycle through the levels of Maslow's hierarchy of needs as they recovered from their illness. How does this relate to Buddhist practice?

Buddhism particularly lends itself to holistic health care with its focus on body, mind, and spirit. Buddhism in general teaches the following:

? A personal relationship with the transcendent (our in-herent buddha-nature)
? Practice involving some type of meditation, prayer, or chanting (chanting the Lotus Sutra) and a physical practice to harmonize the body by diet, yoga, or other practice
? A social relationship with the community (membership in the sangha)⁵

Each of these plays an important role in health. To understand this, we must return to Maslow's hierarchy.

The lowest level of Maslow's hierarchy focuses on the physiological needs, for example, breathing, food, water, sleep, homeostasis, and excretion. A lack in this area means challenges on the most basic level of survival. A perceived or real deprivation of food or oxygen, or a disease that attacks the body's key organ systems associated with the maintenance of life, creates a threat to the well-being of the individual. Until this is resolved, the individual cannot move forward in any manner. For Buddhists, the use of meditation or chanting can lower the level of anxiety associated with this type of challenge. Chanting has known benefits in healing many diseases. It stimulates reflex points on the roof of the mouth that correspond to the various organ systems of the body. This can lead to a reduction in pain and blood pressure, increased circulation, and production of the body's own endorphins. With the reduction of stress, the body can heal, breathing becomes easier, and pain is reduced, and now opportunities can develop to find the means to meet the physiological needs, freeing blocked creative thought. This can end a sense of paralysis that comes with stress, allowing an individual to move forward. Buddhists believe that much of our suffering comes from our transmigration through the Six Realms of Existence. In Rissho Kosei-kai, we chant the Lotus Sutra. Among its benefits, it raises us out of this cycle and brings our focus back to the teachings that make our sufferings disappear.⁶ As our study of the Four Noble Truths (the truth of suffering, truth of cause, truth of extinction, and truth of the path) shows us,⁷ all of our suffering is brought upon us by our own ignorance. We also learn through the great truths that all things are impermanent; so, too, our physical suffering will change.

The next level of Maslow's hierarchy is safety. This corresponds to the individual's desire for an orderly world. It relates to security of body, employment, resources, morality of the family, health, and property. No matter how much we try to impose order in our world, it is an elusive state. Religion, and in particular the practice of Buddhism, helps us to establish internal order through the Eightfold Path (right view, right thinking, right speech, right action, right living, right endeavor, right memory, and right meditation),⁸ which leads to a feeling of safety. This guideline for living and our understanding through the threefold truth that we are connected to all of humanity, nothing is permanent, and our suffering in the moment will end brings us an internal peace that enables us to weather any challenge we face.

When our world turns upside down, chaos erupts, we lose our job, or we experience a traumatic event, the basic teachings provide a solid framework that helps us regain stability and deal with our world. We create internal safety through our Rissho Kosei-kai practice, which is not disturbed by external forces. This internal structure reduces stress and helps us focus on meeting the challenges of this world of suffering. In return we do not suffer from the ill effects of the chaos, which otherwise might overwhelm us.

The third level of Maslow's hierarchy deals with love/ belonging (social needs). Buddhist practice brings us membership in the sangha, the community of support and love. This membership connects all participants through the opportunity to practice the Six Perfections (donation, keeping the precepts, perseverance, assiduity, meditation, and wisdom)⁹ within our community and to attend hoza, which helps us to practice the Six Perfections within our daily life. In hoza, sangha members sit together as a group to discuss problems they are experiencing in their daily lives and talk about the teachings. It provides the opportunity to share the implementation of our practice, ask for guidance from other sangha members, and learn how to use the basic teachings in situations we will experience in the future. Sangha membership brings a very close connection to others in the sangha, which in turn provides physical, emotional, and psychological support, particularly in times of trouble. This can influence the course of events in our lives. Those who feel supported do not feel alone, nor do they feel helpless, because there is the sangha to turn to for help.

Self-esteem is the fourth level of Maslow's hierarchy. Focusing on self-esteem, confidence, achievement, and respect from others, it speaks to the inner sense of happiness. Buddhist practice generates a sense of well-being though chanting, providing a framework for dealing with life, and through acceptance by the sangha. Those with a positive outlook are affected less by stress and will be happy and healthy. They in turn pass this positive attitude on to those around them by their presence and practice of the path in daily life. If illness does occur because of karma or practice-associated problems, people are willing to look at their actions in light of the teachings to find the key to their suffering. They know this is temporary and that with the help of the teachings they will move beyond their suffering. Therefore, patients with strong religious or spiritual practice tend to have a far better prognosis compared with others having little religious or spiritual support in their lives. A peaceful mind facilitates healing and acceptance of outcomes and is open to possibilities, which are the foundations of hope and grace.

Maslow's last level is that of self-actualization, where one reaches a level of morality, creativity, and problem solving. Here, also, there is a lack of prejudice, and there is acceptance of facts. This equates with the stage of Buddhist practice we sometimes refer to as wisdom, among the Six Perfections. In this stage, an individual can accept a diagnosis of terminal illness with calm. There is no fear, stress, or anguish. People move through the process of passing peacefully rather than struggling against death. They live life until it is gone because they have moved beyond the illusions that bring suffering.

Our health is a direct reflection of our ability to maintain our practice. As with all experiences, our health is a reflection of our practice, and our practice reflects on our health. As mentioned earlier, a strong, peaceful mind can overcome adversity and radiates out into the community. The laws of physics relating to harmonics state that when something vibrating at a certain rate is brought into the proximity of an object that is at rest, the resting object begins to vibrate at the same rate. This happens with chanting too; it brings up the vibration and enlivens the spirit, which in turn affects the vibration of all who connect directly or indirectly with this person. Masaru Emoto's study of water-crystal research documents this vibratory effect.¹⁰ This effort supports the belief that only 1 percent of a population moving in a positive direction, emanating a new vibration, can shift any paradigm. This results in change on the microcosmic level, which in turn results in changes on the macrocosmic levels. We saw this happen constructively in the aftermath of the terrorist attacks of September 11, 2001 in the United States. The focus on help and support was enormous. While many would argue that the effects were temporary, the impact still resonates today. Our practice benefits not only our own health but also that of the world around us.

Notes

Taye VanMerlin has a master's degree in nursing with a minor in human physiology. She is a retired nurse and former co-owner of The Uncommon Herb, an alternative health provider and herb store in Oklahoma City, Oklahoma. Kazzrie Neval is a hereditary herbalist and also former co-owner of The Uncommon Herb, where she trained health professionals and the general public in the safe use of herbs and in other alternative therapies.

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