Patrick McNamara & Reka Szent-Imrey. Miracles: God, Science, and Psychology in the Paranormal. Editor: J Harold Ellens. Volume 2: Medical and Therapeutic Events. Westport, CT: Praeger, 2008.

While theologians have long debated what could be learned about God from the study of miracles, we consider in this chapter what might be learned about human health from a close study of miracle cures. We think the traditional scientific approach to reports of miracles has all too often been concerned merely with debunking these reports and events rather than with learning from them. The assumption seems to be that if the events can be debunked then nothing can be learned from them. Or rather, given that miracles cannot occur, it follows that the only thing to be learned from them is that people are gullible and easily fooled. There apparently is no end to the boundless credulity of human beings.

We believe this debunking approach to reports of miracles is unfortunate because it neglects real study of these events. While debunking may have a constructive role to play when it urges ill and vulnerable people to not neglect consultation with medical experts, it all too often is merely a destructive and triumphalist enterprise that leaves these ill and vulnerable people feeling tricked and demoralized rather than empowered and focused. In the standard debunking scenario the hero-scientist runs to the side of the individual whose cancerous lesions have suddenly receded and informs him that there really is no cure and no chance that he will escape death;. that instead he is gullible, stupid, and still has the cancer and that therefore he is just buying into an illusion;. and that finally our hero the scientist should be thanked for providing this information to the unfortunate man.

In the zeal to debunk all miracle cures, there is a tendency to eschew careful study of the facts. We believe that extraordinary healings do occur and that they indicate normally unrealized healing resources within persons. Weil (1996) points out that an elaborate healing system exists in the body, a system that repairs wounds, renews bone and, most important, corrects mistakes that creep into our DNA blueprint and, if uncorrected, could result in cancer or other disease.

Relevant Data

Our biology, apparently, can promote remarkable cures, given the right circumstances. This is the stark and extraordinary lesson to be learned from miraculous healings, yet it clearly has not been learned by the scientific community. There is no concerted effort by the biomedical community to investigate reports of miraculous healings, spontaneous remission, or to investigate potential physiologic correlates of these healings. Yet reports of spontaneous healings and spontaneous remissions of chronic diseases, like the cancers, regularly appear in the medical literature.

Unfortunately very little is known about these spontaneous healings. We could find no reviews of the literature and no controlled epidemiologic studies of incidence of spontaneous remission in any of the major diseases. According to the Institute of Noetic Sciences (www.noetic.org), the number of spontaneous remissions from chronic disease may be 10- to 20-fold greater than previous and poorly documented estimates of one in 60,000 to 100,000 cases.

Aside from the well-known but poorly documented phenomenon of spontaneous remission and healing there is the well-documented but poorly understood phenomenon of the placebo response. With respect to the placebo response there is a better, more intensive research effort, but once again, this research effort is not strongly supported by the larger biomedical community nor are there many laboratories dedicated to exploring and understanding the placebo response.

Benedetti, Mayberg, Wager, Stohler, and Zubieta (2005) suggest that the placebo response is a psychobiological phenomenon that can be attributed to the patient’s subjective expectation of clinical improvement on the one hand and to classical mechanisms of Pavlovian conditioning on the other. The best-documented placebo effects have been in the field of pain and analgesia, but there are recent indications of strong placebo effects in the immune system, in motor disorders like Parkinson’s Disease, and in depression. Benedetti’s review of neuroimaging studies of placebo effects revealed increased activation of a large set of frontal regions with concomitant decreased activation in the amygdala.

The frontal cortical networks are known to inhibit subcortical limbic sites that mediate emotion and impulses and further that the amygdala is known to mediate aversive emotional states. Benedetti, therefore, suggested that one facet of the placebo responses involved a powerful suppression of negative emotions. While this suggestion is undoubtedly true it can only be a partial explanation of the placebo effect. A huge part of the placebo response of course involves the expectation that relief is on the way as well as faith and belief in the efficacy of the cure. In order to adequately understand the placebo response therefore we will need a full account of the role of emotion, expectancy effects, belief, and finally of faith. Certainly faith and hope are the major psychological factors involved in miracle cures.

Miracle cures go way beyond mere placebo effects. While placebo effects can temporarily relieve distress, a miracle cure is a cure or a reversal of a severe illness or impairment. In contradistinction to placebo effects, the psychology of expectation and the effects of expectation on health seem much more promising avenues for understanding miraculous healings—yet funding for this research is hard to get and journals only rarely accept papers on expectation effects. Even expectation effects, however, are not rich and powerful enough to capture the phenomenon of miracles. Indeed we know of no models that have yet been able to capture the complexity of miraculous healings. That is because there are no detailed scientific models of faith. What is faith? Who has it? How does one acquire it? While there are theological answers to these questions, scientists routinely ignore the theological accounts of faith and hope. At a minimum, however, faith is a religious trait and hope is a spiritual virtue. Yes, it is true we speak of faith in doctors and scientists, and the like, but when we speak of the active ingredient in miraculous healings we speak of religious faith.

Faith, of course, is connected to and dependent upon religion or at least a religious or spiritual context. The context for most miraculous healings is typically religious. Religion and religious belief, in turn, is extraordinarily complex. Religious belief at a minimum involves a history of acquisition or education in the belief system; current emotional and personality makeup, participation in public rituals, practice of private rituals of devotion, and the like. There is something about religious belief and practice that facilitates miraculous healings in certain individuals. That apparently involves faith. Thus a rational approach to the study of miraculous healings should include both a study of the impact of religious practices on healing, the biology of the healing itself, and the wild card factor: faith.

One recent theoretical approach to the relationships between religion and healing is McClenon’s ritual healing theory (McClenon 2002). McClenon argues that the development of human religious rituals functioned in part to facilitate healing and it was their efficacy in doing so that promoted the evolutionary rise of religion among human beings. According to McClenon, early hominids practiced repetitive, therapeutic rituals based on dissociative processes. These rituals, practiced over many millennia, provided survival advantages to those with genes promoting dissociative psychological processes and the ability to go into hypnotic and trance like states. Rituals facilitated biologically based forms of unusual experience: trance, apparitions, paranormal dreams, and out-of-body experiences. These episodes created recurring patterns within folk religion, generating beliefs in spirits, souls, life after death, and magical abilities. These beliefs are the foundations for shamanism, humankind’s first religious form. The ritual healing theory argues that ritual healing practices shaped genotypes governing the human capacity for dissociation and hypnosis, allowing modern forms of religiosity.

While clinical studies indicate that hypnosis and trance is particularly effective in alleviating pain, asthma, warts, headache, burns, bleeding, gastrointestinal disorders, skin disorders, insomnia, allergies, psychosomatic disorders, and minor psychological problems (Bowers and LeBaron 1986), there is no evidence that suggests that the placebo response depends on the ability to go into dissociative psychological states like trance. Nor is it clear why dissociation should facilitate any kind of healing. Certainly manipulation of attention can distract a person for a little while from the feeling of pain, but the placebo response as described above is related to expectancy and belief and faith, not merely to distraction.

Because the ritual healing theory of religion and religious healings depends so decisively on the ability to go into dissociative states it cannot explain miraculous healings. That is because most reports of miraculous healings have not involved reports of dissociative or ecstatic states of any kind. Instead what seems to be the most important factor is this thing called faith and its accompanying virtue, hope.

Let us look at concrete examples (Leuret and Bon 1957, 94-98).

Cure of Pierre Bouriette (1858) (Traumatic Blindness)

Pierre Bouriette was a quarry worker on de Pic du Jer. It was his job to set off the blasting charges, which produced stones for the quarry men. Twenty years before the apparitions of Mary at Lourdes, in 1838, his right eye had been injured by an explosion. For twenty years this organ had been a blind, red, oozing sore. One day he came to a Dr. Dozous and asked whether he should go to Lourdes, stating that he understood that “Bernadette’s water cured people.”

Three days after his interview with Dr. Dozous, Bouriette washed his blind eye in the still muddy spring water. He did not really have much faith in the water’s powers; curiosity rather than hope was the driving force behind his action. He was quite taken aback when he realized that, when he had washed his eye, he could see with both of his eyes. It might be thought that his immediate reaction would have been to thank the Lady of the Apparitions, or Bernadette, who happened to be there at the time. He actually did what not a few still do, he rushed to the physician, to have his cure properly verified.

Dr. Dozous did in fact verify the cure, the first such medically verified cure at Lourdes. Bouriette evidenced no signs of going into a dissociative or trance-like state. Instead he simply had faith in the curative quality of Bernadette’s waters. But is faith really the curative factor? What about cases of healings in children or people without any religious faith at all? Perhaps the most difficult case for the view that religious faith is the key ingredient in miraculous healings is the phenomenon of healings of sick infants. The second historically recorded cure at Lourdes involved an infant and was medically verified by Dr Dozous. This is the case of Louis-Justin Bouhohorts.

Cure of Louis Bouhohorts (1858) (Osteomalacia and Febrile Wasting)

Louis Bouhohorts was 18 months old. He lay quite still in his cot, for he had not moved since birth. He suffered from a syndrome characterized by fragility of his bones—then given the name of osteomalacia. He never had moved, nor sat, nor stood up—nor, obviously, had he ever walked.

In addition to this he suffered from a febrile wasting disorder which had at that time brought him to death’s door. As he lay in extremis in his cot, his father remarked to his mother, still stubbornly nursing him, “Let him be; it’s obvious he’s nearly dead.” At which he left to fetch a neighbor to sew his shroud—who soon arrived with the necessary material. But his mother snatched the child from his cot and wrapped him hurriedly in the first thing that came to hand—a kitchen cloth. Running to the grotto, she covered the last fifty yards on her knees. This part was then rough and stony, unlike the smooth modern pathways. Making her way through about 40 curious people standing at the foot of the grotto she arrived to find Bernadette praying and Dr. Dozous awaiting events.

There was a small pool, roughly five feet by two, dug by quarry workers of the Pic du Jer in thanksgiving for their fellow worker Bouriette’s cure. Into this icy water (48°F) she plunged young Louis-Justin to his neck. She kept him there for fifteen and a half minutes (timed by a concerned Dr. Dozous). When she took him out, he was stiff and blue, which was hardly to be wondered at.

His mother, rather ashamed of what she had been doing, wrapped him, still stiff, in his kitchen cloth, took him into her arms, returned home and put him in his cot. When his father saw him in this condition, he felt no anger but simply said to his wife, “Well, you should be happy anyway, you’ve managed to kill him off.” He turned away with tears in his eyes while the child’s mother remained in prayer beside the cot. After some moments she tugged at her husband’s coat. “Look—he’s breathing.” Which in fact, he was. He fell asleep now and spent a quiet night. He woke gurgling next morning and took his breakfast—this, despite his age, at his mother’s breast. According to her he had a good meal. She put him back into his cot and went into the next room to do her household chores. Leaving him alone did not worry her—he had never moved. A little later she heard behind her the patter of feet. On looking around there was Louis-Justin—cured of all his suffering, the osteomalacia, the wasting illness, which had almost carried him off. Furthermore, he could walk—without having learned to walk.

While Bouriette’s cure might be ascribed to a simple faith or to some extraordinarily potent placebo effect or more likely some sort of expectation effect, surely the infant’s cure cannot be accounted for in these terms. Given that the child was only 18 months old it seems unlikely that the cure could be ascribed to faith, trance, or belief effects. A child of that age does not believe in anything. Thus, neither our emphasis on faith nor science’s emphasis on the placebo effect nor the ritual healing theory described above can explain the cure.

In short we have no explanation for the miraculous healing of an infant. At most the current state of science might help to explain miraculous healings in adults. For the rest of this essay we will therefore focus on healings in adults and ask what might science and medicine learn from these extraordinary healings.

For a religious person no special explanation is needed for these miraculous cures, but for the scientist some sort of explanation must be attempted, not in order to debunk the religious explanation but in order to learn from the cures. What sort of naturalistic explanation might help?

Costly Signaling Theory (CST)

We situate our approach to understanding illness phenomenology and illness recovery within an evolutionary theoretical framework concerned with communication between people or between animals or organisms of any kind. This communications theory is known as Costly Signaling Theory (CST; Bliege-Bird, and Smith 2005; Bradbury and Vehrencamp 1998; Grafen 1990; Maynard-Smith and Harper 2003; Zahavi 1975; Zahavi & Zahavi 1997). CST is concerned primarily with understanding animal signaling behaviors. The basic idea is simple: for signals between two parties to be workable or believable by both parties they must be reliably unfakeable. Only signals that cannot be faked can be trusted to carry honest information. Unfakeable signals are those signals that are metabolically motorically, or behaviorally difficult to produce (costly). Their production costs or costliness is their certification of honesty.

Costly signals are preferred by animals under conditions in which the animals are capable of deception but require reliable and honest signaling between the parties, for example, between the two sexes during mating season. Many of these costly signals have come to be known as handicaps. For a signal to classify as a handicap the net benefits for displaying the signal (illness in our case) must be higher for a high-quality individual than for a low-quality individual (or the costs of an illness must be higher for low-quality individuals). Thus a low-quality signaler must be able to send a signal suggesting high quality; must be able to fake high quality. The signal must be costly to fake but not impossible to fake. The handicap principle asserts that low-quality signalers generally do not send false signals because it simply does not pay; the net costs are too high.

We suggest that in some cases an illness, after it has passed the acute phase, can function as a signal. That is because illnesses carry information about the genetic qualities of the ill individual. At a minimum if the illness is severe and the individual survives the illness, then the individual displays resilience and good genes. This is the kind of information that CST claims is crucial for development of cooperation between two parties. In the human context people want to partner, in a marriage or a business or for a hunt, with reliable, resilient, intelligent, robust, trustworthy individuals. To identify such individuals they need to find reliable, unfakeable sources of information. Surviving an illness is one such source of reliable information. It is not the only source but it is one source and thus illness behaviors are scrutinized by others whether we like it or not.

So the questions we need to ask ourselves when considering illness as a signal bearing important information about an individual’s genetic quality are the following: (1) Do people use illness to signal others? and (2) Is illness correlated with genetic quality? We answer each of these questions in turn and then turn to a summary about how CST might treat miraculous healings in religious adults.

Do People Use Illness to Signal Others?

Humans, of course, engage in a range of signaling behaviors, but can illness plausibly be considered one of them? Human signaling behaviors include everything from speech and language exchanges to emotional displays; body language such as clothes, postures, tattoos, and gestures; and other nonverbal behaviors. Our basic claim in this paper is that illnesses can function as signals. Illnesses, for example, can function to facilitate signaling when they produce some effect such as an emotion or a mood or a bodily posture or a behavior that communicates a message to an observer. An ill person typically behaves differently than a healthy individual. Many illnesses create background moods and behavioral dispositions that linger long after the illness has passed. Showing an illness to another gives the other a direct window onto recent brain/mind activity, and thus a direct window into the quality of the individual sharing the illness.

Like many other costly signals, illnesses are considered to be involuntary physiologic, cognitive and emotional experiences and thus less fakeable than voluntary signals. We contend that many of the signals produced by a person who is ill can be and should be construed as costly signals, emotions or behaviors that are costly to the individual. The informational and affective content of the illness creates a mental set in the individual that signals other people concerning the qualities of the individual who is ill. For example, an ill or impaired person is very obviously handicapped.

People use information concerning the health of an individual when considering interactions with that individual. Among other things an illness is interpreted as a signal to remove the acutely ill individual from social circulation. During acute phases of an illness the person is removed from daily interactions and obligations and allowed to rest. After the acute phase of the illness has run its course however, the individual is treated differently. Depending on the strength and vitality of the recovered individual, he or she may be treated with greater respect and deference, even if the illness becomes chronic. As long as he or she survives the illness he or she will attain to greater prestige and status. If on the other hand the illness becomes chronic and increases in severity he or she may be shunned and stigmatized.

The opposite social effects, enhanced prestige versus stigmatization, that follow the opposite outcomes of an illness demonstrate the capacity of an illness to be interpreted as a signal bearing enormously consequential information. An individual who has recently been ill may find either that he is shunned and left to die or that his social prestige is considerably enhanced. An illness is therefore treated as if it bears reliable unfakeable information about the quality of an individual. Illnesses thus satisfy the primary condition to function as a costly signal within the framework of CST.

What information regarding quality will an individual send with an illness? First it may be information concerning resilience. If I have survived an illness I may be able to survive another illness and therefore I will be a valuable member of the tribe. Another signal or piece of information that an illness might carry concerns an individual’s character. Let us back up a step to explain how the issue of character fits in with CST.

For cooperation to evolve, the problem of the free-rider, the faking ill person, must be overcome. A free-rider is someone who takes the benefits of cooperation without paying any of the costs associated with cooperation. They are cheats and exploiters. One way to handle this problem of the free-rider is to impose stringent membership conditions for participation in the cooperative group. These membership requirements can serve as hard-to-fake tests and ultimately signals, when the individual adopts them, a person’s willingness and ability to cooperate with others. What kinds of signals could serve such a role? CST theorists (Irons, 1996, 2001; Sosis, 2003, 2004) have pointed out that a number of religious behaviors, like restrictive diets, participation in rituals and rites, ascetical practices, and altruistic giving might be such signals as these behaviors are both costly and hard-to-fake. It is precisely the costliness of these behaviors or traits that render them effective since individuals incapable of bearing such costs could not maintain the behavior or trait. Free-riders would find it too expensive to consistently pay the costs of religious behavior and thus could be winnowed out of the cooperative group. Most people, even free-riders, can sustain a restrictive diet or attendance at ritual services for a short period of time, but few free-riders would be willing to engage in such costly behaviors over long periods of time.

Since group members cannot measure directly a person’s willingness to inhibit free-rider behavioral strategies, they will need a different measure of willingness to inhibit free-rider tendencies. Willingness to perform costly religious behaviors for relatively long periods of time can function as reliable signals of willingness to inhibit free-rider strategies and ability to commit to cooperation within the group. Included in such costly religious behavioral patterns are the hard-to-fakevirtues and character strengths, as free-riders would not be willing to incur the costs in developing and practicing such virtues. Sustaining virtuous behavior is, to say the least, difficult. That is why character and virtue cannot be faked, at least over the long term. Character therefore can serve as a signal of quality (Steen 2003). Just as ritual and religious practices, when practiced consistently over time, help winnow out free-riders from the group, so too will development of hard-to-fake character strengths. To act generously and altruistically consistently over time is a convincing indicator of character as it requires the ability to consistently inhibit short-term gratification of selfish impulses. We suggest that coping with a long illness over time can be a particularly potent revealer of a person’s character. Given that is the case it follows that individuals who potentially interact with that individual will use the illness as a way to study that person’s character.

It is extremely important to remember that we are dealing with the so-called environment of evolutionary adaptation in which people lived in relatively small groups of no more than 200 people. The average life span was 40 years with sickness and illness a frequent event. While reputation and prestige certainly were used in estimations of a person’s character, it is reasonable to suggest that a person’s behavior during an illness was used as well. If tribal members observed a person’s behaviors during an illness then it follows that the ill person would use the opportunity to signal concerning his quality and his social intentions (willingness to cooperate) to these others.

Though there is no guarantee that an illness will be used by an individual to signal information concerning social intention, illness certainly functions that way. An illness can allow the person to advertise quality and thus honesty in communicative interchanges, and so the long-term results of a strategic illness are improved social interactions for the individual and thus increased fitness. It may seem odd to us that the way Mother Nature defeats free-riders and achieves cooperative interchanges among her creatures is to have them develop and display handicaps, or to have them use an illness and its associated negative emotions to signal willingness to cooperate. After all, negative emotionality and illness is, on the face of it, not too attractive, and many handicaps, like the paradigmatic peacock’s tail, works precisely because it is attractive to peahens. So how can illnesses serve a handicapping strategy if most of what they produce is content containing a lot of negative emotionality?

Negative emotions can be powerful signals when used as leverage in social interactions (eliciting sympathy/empathy from conspecifics; Frank 1988; Hagen 2003; Sally 2005). When used in this way they enhance social ties or alliances. In any case at least 30-50% of the population exhibit and report a chronic experience of negative emotionality (Kessler et al. 2005; Riolo, Nguyen, Greden, and King 2005; Watson and Clark 1984). Negative emotionality treated as a trait evidences moderate to high levels of heritability (Bouchard 2004). Evidently people who exhibit high negative emotionality are considered attractive enough to at least a portion of the general population as they marry mates and produce offspring who inherit the disposition for negative emotionality.

Current evolutionary approaches to negative emotionality, and game theory simulations of the evolution of cooperation in human groups, predict that some portion of the population will exhibit high levels of negative emotionality as negative emotionality performs several different signaling and social functions. These include indicating the presence of cheats or free-riders in the population; indicating withdrawal or voluntary abstention from social bargaining processes; indicating resilience against adversity, that is, character strength; and eliciting sympathy or empathy from conspecifics. These enhance social ties and alliances (Fessler and Haley 2002; Hagen 2003; Neese 1998; Sally 2005). It is not for us to solve the problem of the existence and widespread prevalence of negative emotionality. The available evidence however indicates that it is widespread and it can function as a signal and be attractive to others.

Can Illness Signal Genetic Quality?

The short answer to this question is no: illness does not signal inferior genetic quality. Surviving an illness, however, can signal genetic quality as it suggests resilience. It will be recalled that the conditions for the evolutionary or game-theoretical stability of costly signaling (Grafen 1990), in the realm of illness effects, were that individual differences or variation in illness effects must be correlated with some value or quality, such as genetic quality, of the individual who uses illness to send signals to some observer. Or more precisely, the cost or benefit to the signaler of illnessing must be quality dependent, namely, the marginal cost or marginal benefit of illnessing is correlated with the signaler’s quality.

Illness is a perfect medium for the signaling of quality. Depending on previous mental and physical health, individuals differ in their abilities to bear the cost associated with a new illness. Some individuals experience little or no long-term effects of illness, while others suffer severe mood and cognitive changes including psychotic hallucinations. Many illnesses leave scars and sometimes these scars are worn as badges of honor. An individual who carries scars from these illnesses reveals something of his history and quality. The scars reveal that he is a survivor.

How Then Might CST Account for Miraculous Healings in Religious Adults?

First recall that we are agnostic on the supernatural origins of miracles. Our task here is the more modest one of trying to present one naturalistic approach to these phenomena so that medicine may learn from them. If illness can signal crucial information about genetic quality and social intention in individuals who unconsciously use illness that way, then once the signal is sent and verifiably received by the intended receivers the information-bearing function of the illness is completed. At that point our version of the CST approach to miraculous healing would predict a miraculous healing. The scenario is roughly this: an individual gets sick. He goes through the acute phase. He survives the acute phase and now the illness begins to be a candidate for taking on a signaling capacity. If the individual finds himself in a social situation where he needs to signal convincingly that he is a quality individual and is not a free-rider; that he is truly interested in cooperating and that he is trustworthy and resilient; he will begin to use the chronic phase of the illness to signal this information to significant others. The greater the need to convince others that the signal is unfakeable and trustworthy the more dramatic the illness symptoms will be. Once the individual is convinced that the message has been received and believed, then the purpose of the signaling behavior has been fulfilled and there is no further need for the illness. At that point conditions for a miracle cure are present and that is when CST predicts they will occur.

If we are correct, miracles can teach medicine a great deal. First and foremost miracles tell us that an innate biology exists that can reverse an illness and that this innate healing system can be accessed and activated under social, communicative, and contextual conditions described and captured by costly signaling theory.