From the Editors’ Desk: Religion, Health and Cucumbers

For 2 days each July, there is an annual ceremony organized by the monks at the Gochizan Renge-ji Temple, located in the northwest hills of Kyoto, Japan. Known as the Cucumber Purification Ceremony, this odd and fascinating event has taken place, virtually unchanged, for hundreds of years. The monks at Gochizan Renge-ji Temple are followers of Shingon (“True Word”) Buddhism, one of the main schools of Japanese Buddhism, brought to Japan from China by the renowned Buddhist monk Kukai in the year 806 AD. Shingon is one of the Esoteric Buddhism lineages; its rituals have never been written down. Instead, its practices have been passed down by word of mouth for centuries. In the past, Shingon monks were called upon to perform mystical rituals such as summoning the rain, warding off invading armies and healing the sick. Which brings me back to the Cucumber Purification Ceremony. On a humid day in late July, my wife and I visited the Gochizan Renge-ji temple to take part in this ancient ceremony, the goal of which is to heal one’s body of whatever ailment is troubling it. We were instructed by a young, friendly monk to write our name, age and ailment on a thin sheet of paper. This paper, along with a cucumber that must be purchased at the temple for 1,000 yen (about $13 US dollars), was then brought to another monk performing ritual chanting inside the ornate temple (Figure 1). The now blessed cucumber was then returned to us along with instructions to rub it on the part of the body that hurt or was ill, two times daily (morning and evening) for 3 days. The belief is that the cucumber will absorb the pain or sickness and remove it from the body. The young monk instructed us to bury the cucumber in the ground at the end of three days. He assured us that our ailments would be buried along with it. Figure 1 Cucumbers awaiting purification at the Gochizan Renge-ji Temple, Kyoto, Japan. (Photograph by Jane Kramer). Why a cucumber? Nobody seemed to know the answer to this fundamental question, but on a typically hot summer day in Kyoto, the cool, smooth skin of a cucumber feels good on an aching back. And to the worshippers at Gochizan Renge-ji Temple, it is surely the belief that the cucumber will alleviate their suffering that imbues it with magical powers. Lest we believe that the Cucumber Purification Ceremony is simply a quaint holdover from an era prior to the advent of modern medicine, this issue of JGIM features two papers that deal with the ongoing nexus of religion, spirituality and health. Williams et al. report on a study that examined medical inpatients’ religious and spiritual concerns. They found that while many patients expressed a desire to have their religious or spiritual concerns addressed while in the hospital, only about half reported having had such a conversation. Patients experiencing pain were both more likely to want and more likely to have had these issues addressed. Interestingly, patients who reported that they had had religious/spiritual discussions were more satisfied with their care, even if they had not expressed much interest in religion or spirituality initially. To conduct research such as the study by Williams et al., validated instruments are needed to measure the presence and extent of spirituality and religiosity. Stefanie Monod of the University of Lausanne Medical Center and her US-based collaborators report on results of a systemic review of instruments used to measure spirituality in clinical research. They conclude that there is a paucity of good instruments and limited data on the psychometric properties of these instruments. In spite of these limitations, they point out that over the past 2 decades there has been a tremendous increase in research on the relationship between religion and spirituality in health, much of which has found that patients with low spiritual well-being often have worse outcomes. Clearly, more research is needed, both to develop new and better measures and to use these instruments to more clearly elucidate the connection between spiritual beliefs and health. In the Cucumber Purification Ceremony, we were asked to take it on faith that the ordinary-looking cucumber that moments before had been residing in a crate with dozens of others of almost identical shape and size could somehow cure whatever ailed us in 3 days. Respectfully, I asked the monk how could I know that it would help. He replied: “It has been helping people for 1,000 years. Just be sure to follow my instructions and bury the cucumber in your yard at the end of the 3 days.” He should have said: “If you have to ask, it probably won't.”