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Extract from: Magazine of the Brazilian Association of Medicine; Sao Paulo, July/September of 2000

Psychic Surgery: an investigation
The summary of a Scientific Research by A.M. de Almeida, T.M. de Almeida, A.M. Gollner

Psychiatry Institute of Hospital das Clinicas, Sao Paulo's University School of Medicine; Department of Pathology of the School of Medicine of Federal University of Juiz de Fora, Minas Gerais

Summary - Objective: A very popular modality of treatment that captures a lot of the attention of Brazilian media is psychic surgery. To date it has received little scientific evaluation. Such phenomena raise issues about their authenticity, although research in this field is scarce.

Methods: This study presents the results of an investigation made with one of the most famous psychic surgeons in Brazil, Mr. João Teixeira de Farias. Thirty surgical interventions with cutting were observed, and among those, six patients undergoing surgery had their histories taken, plus the physical examination and examination of the tissues supposedly extracted from them.

Results: What was striking was the fact that the surgeon in fact incises the skin or the ocular tissue, besides making ocular scrapings without the use of any identifiable anaesthetic or antiseptics. Yet only one of the patients reported moderate pain when having her breast incised. The patients were examined for three days after the surgery and none of them showed any signs of infection. Longer follow ups of patients show no trace of infection at all on the surgical sites. The Histopathology examination of the specimens showed them to be compatible with the sites of origin, and except for a 210 grams lipoma, they were healthy tissues without any discernable pathology. A revision of the literature and discussion regarding to the placebo effect has been made in this study.

Conclusions: The surgical procedures are real, but it hasn't been possible to evaluate the efficacy of them. It did not appear to have any specific effect on the healing of patients. Our findings are undoubtely more of an exploratory nature rather than conclusive ones. Further studies are clearly necessary in order to further evaluate this unorthodox form of treatment.

Keywords: Psychic surgery, spiritual healing, alternative therapy, complementary therapy.

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Introduction
There is a vast record of psychic healing all over the world dating from remote ancient times. Records have been found in Egypt and Greece, and among indigenous populations elsewhere. Christian history has innumerable records of such cases.

Although having originated in such ancient times, the psychic healing that persists today is almost ignored by scientists. Nevertheless, there has been an increasing interest from millions of people in search for the relief from various diseases both in developed and developing countries.

People understand the difference between allopathic and psychic healing, considering both efficacious. Therefore, psychic healing is used as complementary to allopathic medicine. Often, psychic healing is the last "hope" for many patients, but at the same time they do not divulge the use of this alternative therapy to their allopathic doctors. In recent years there has been a growing interest from the allopathic doctors on this field, in an attempt to "domesticate" this knowledge that in the past has been considered to be too "anarchic" to be incorporated.

One of the most interesting and controversial types of psychic healing is spiritual surgery, which is very popular in Brazil and Phillipines, where millions of people seek help daily. As in all complementary therapies, the subject is polemic and provokes divergent opinions amongst the general population, the media and research scientist, who may often focus on records that will reflect their own opinions on the subject, choosing to ignore contrary results. It is possible to identify that the majority of the results of research come from preconceived ideas, shaped according to one's individual beliefs.

Doubtless, there are cases of deceit, charlatanism, and mere tricks, but it is important to identify if all the phenomena are in fact fraudulent, or if there is something that is real and worthy of further study and recognition. The evaluation has been made difficult due to the fact that many of the "healers" would not allow the tissues removed from patients to be examined. In some cases when this examination was possible it has been verified that some of the tissues were fraudulent.

With regard to the efficacy of psychic healing, some researchers consider that only the patients with somatic disturbances benefit from such treatment, while other researchers have found that organic conditions have also been healed. There are records of actual diagnoses by psychic means that have even preceded conventional diagnoses.

Another obscure aspect of psychic healing is the role of Faith in the process of healing. It is a predominant view that it is necessary, but some authors affirm that the healing happens regardless to one's faith.

One major factor for the lack of knowledge about psychic surgeries is the lack of research by scientists resulting from pure skepticism. The subject that has been so under-researched is a rich source of possibilities for study to determine which procedures have efficacy and which are useless or even harmful.

Since the issue is a search for relief and healing, what in fact is proved useful should be incorporated by the medical practice, especially because these procedures have no recorded side effects and are of insignificant cost. Those that are useless and harmful should be dispensed with. Controlled researches would enable to identify the charlatans and expose them.

It is essential to try to avoid the conflict between allopathic and non-allopathic medicine, as they should be seen as complementary rather than antagonistic. The phenomena that have been so far considered paranormal are mere facts that have not yet been satisfactory explained by existing scientific knowledge.

There is a real need for further studies on psychic healing, because of it's potential value having regard to its methods and ability to cure. A significant need is for a scientific methodology that could control the placebo effect on the spiritual cure. The existence of objective results that would overcome the psychological effects of psychic healing have not been enough to convince the majority of the scientists to encourage further serious research on this field. Nevertheless, there are records of: the increase of the enzymatic activity in vitro; reduction of bacterial growth; acceleration of the growth of plants; development of scar formation in rats; the increase of human hemoglobin; the reduction of blood pressure levels in cases of hypertension; the reduction of pain in patients suffering from idiopathic chronic pain. Orthodox medicine has often required from complementary forms of treatment more rigid standards to prove themselves than the ones applied to itself. In historical terms, the application of the scientific methodology to allopathic medicine is recent, and many of it's procedures do not have a firm scientific base. Doubtless, the scientific foundations for complementary therapies are even more rare.

In the search for further understanding of psychic healing, we have decided to study the controversial psychic surgeries. The main objective was to evaluate the authenticity of such procedures.

Methods
In order to achieve the objective of this research, the following steps were taken:

1. The medium João teixeira de Farias, who was chosen as the object of this study, works in Abadiania, in the state of Goias, in the central-west part of Brazil, about 115 k. from the capital. He was chosen because he sees dayly hundreds of people, and has drawn the attention of the media and researchers from Brazil, Peru, Germany and the United States. He receives groups of sick people who come from all over Brazil, and also United States, Portugal, Italy and other European and Asian countries.

2. The institution where he sees his patients, "Casa de Dom Inacio", was previously contacted by phone, and the controlling board authorized the research.

3. Between the 16th and the 18th. August 1995, the activities at Casa de Dom Inacio, the eccumenical temple where the healing works take place, were observed by researchers.

4. The research subjects have signed an agreement to participate in the studies.

5. All the patients subject to the study were examined and their histories taken. There was an effort to identify their religion, how they got to know about the medium, their level of education, their faith in the cure, the existence of medical diagnosis and complementary physical examinations. From all 30 surgeries observed, only six fitted the criteria of this specific investigation.

6. Antiseptic procedures and any posterior infectious complications were investigated.

7. The anesthetic procedure, together with the report of patients sensation of pain during the surgery, were evaluated to identify the presence or absence of pain.

8. The surgeries were video taped and photographed, observing the instruments used to make the incisions.

9. In each case, tissues removed in surgery were taken to further histo-pathologic exams to verify it's authenticity.

10. Examination of the surgical scars and sutures was undertaken.

11. An attempt to keep touch with the patients was made, trying to follow up with complementary examinations and the evolution of illnesses after the operations, but this phase has not been successfully completed due to the lack of response by the patients which were the subject of this study.

12. Verification of the existence of some sort of commercial exploitation such as the charge of fees was evaluated.

13. Observation of any suggestion for the patient to abandon medical treatment.

14. Evaluation of the site where the surgeries take place: the site itself, the cleanness, lights, number of people watching and their emotional response.

Results
João Teixeira de Faria is a farmer who finished school after the 8th grade and works as a psychic healer three days a week. Every day he attends hundreds of people who cue to see him. One by one, without the need of any explanation of their illnesses, he prescribes herbs in a nearly illegible handwriting, decodifyable only by the people who are responsible for the sale of the preparations of herbs and roots. If necessary, there will be a directive for a psychic surgery. Although he does not appear to be in trance, the medium maintains that during the procedures he remains unconscious to allow the manifestation of one of the dozens of spirits of a "spiritual team".

The patients to whom surgery is indicated may choose between the visible (in which an incision is made, and therefore the object of this research) and the invisible surgery, that takes place in the spiritual body, while patients rest on a bed or a seat in a room reserved for its purpose. The medium affirms that there is no need for the visible surgery. It is only recommended for who do not believe in the invisible and feel the need of proof through visible surgery.

The surgeries called visible last no longer than a few minutes and take place with the patient standing or sitting in a room full of spectators, who are there to be treated. The observation of such surgeries and the "power" demonstration by the "surgeon" provoke a big emotional response and confusion in some of those present in the room.

There is no charge of any fee and contributions are not asked for. Furthermore there is the free distribution of soup for everyone who wishes (hundreds in general). On the other hand, each of the bottles with the prescribed medicine costs R$ 3,00. While each patient may be prescribed many bottles, the ones who are very poor do not pay. There are also sales of rosaries, video-tapes and t-shirts.

Although many of the people who search for psychic healing have already been disappointed by the allopathic treatments, the abandonment of such is never encouraged.

João Teixeira is sought for the healing of various diseases such as sclerosis, cerebral palsy, cancer, breast nodules, gastric illnesses, headaches, vertigo, abdominal pain, back pain, eye disorders, and so forth. A cure is not promised, as it depends on the "will of God".

In total, tissues from ten surgeries have been taken for examination, but only six patients were up to an extensive clinical examination.

Characteristics of the study group:
- They were all Catholic and believed in the cure;
- Three of them had heard about the medium from neighbors; one from his parents, one through a friend and one through the press;
- Four were there for the first time, one was there for the second time and another was there for the fourth time;
- The surgeries were made without antiseptic procedures: the medium did not wash his hands between surgeries, nor did wear gloves and there was no special cleaning on the surgical area. The instruments vary from sterilized surgical appliance to kitchen knives. Nevertheless, there were no case of infection.
- There was no identified anaesthetic used, but from the six examined patients, only one had referred pain, whilst all of them claimed to be lucid during the procedures.
- The surgical wounds are real and the most common procedures are nasal scrapping (obtained through the insertion of a type of forceps with cotton wool up the nose), eye scrapping and the removal of fragments of the bulbar conjunctive.

It has not been possible to undertake a meticulous follow up of the patients after the surgery, although of the four statements obtained after six months, two showed significant improvement, while the two who suffered from retinal hemorrhage and chronic sinusitis affirmed they received no benefit at all. One of the patients who reported improvement suffered from alcoholic liver disease, hypermetropy and incapacitating back pain for five years. The other had a macular cyst and abdominal pain which had been examined through ultrasound and laparoscopy, and an exploratory laparotomy had been recommended.

The first patient reported that the back pain has disappeared, finally allowing the practice of sports, and that the eye disorder had improved (as the medium said it would happen). A month after the surgery, having stopped drinking alcohol and with the use of the prescribed herbs, the GMA GT fell from 221 to 113 U/L, and the activity of enzime Protrombine grew from 44% to 68%.

The second patient was incised in the lower gastric area, from where fatty tissue was removed, together with scrapping for the removal of fragments at the bulbar conjunctive. He reported a significant reduction of pain and improvement of the visual capacity. It was not possible to get a medical report from either of these patients, and the information here registered is the patient's own statements.

Discussion
Psychic surgeries are a phenomena of the Twentieth Century, and although in the Phillipines they are most common in the rural areas, in Brazil they are concentrated in the urban areas. The spiritual surgeons aren't like traditional healers, they are products of the modernization of our society, as it is reflected by the fact that they are sought by the people from the most elevated levels of society. This kind of therapy in Brazil is not opposed to the allopathic medicine, but it endeavours to work as a complementary therapy. This fact has been observed on this study is that.

The process of electing surgeries and the surgeries themselves deserve more consideration, as the metaphorical and symbolic meaning of the performance of the healer or the doctor may affect their efficacy directly. The fact that a psychic surgeon has presented himself as available has already been described, as well as the lack of need of any description of what needs to be healed. The emotional involvement of all the people present may have a strong therapeutic effect. The atmosphere in which the surgery is perfomed and the extroverted behavior of a surgeon may contribute to a beneficial outcome beyond the surgery itself. It is known that when patients are involved in the choice of the surgical procedure it is a strong incentive for them to talk about the benefit they get from it.

The predominance of superficial ocular surgeries has been previously observed in the performance of spiritual surgeons both in Brazil and Phillipines. Although there have been records of the extraction of malignant neoplasies, our observation showed that the extracted tissues would not justify a hypothetical cure of such patients (except for the lipoma). Like other spiritual surgeons, João Teixeira da Silva affirms that the surgeries are dispensable, as the spirits may invisibly work directly with patients. But there are those who need to see the cure being done in the physical body, in order to believe the efficacy of the procedure. It may be therefore that visible surgeries are in fact an instrument to facilitate the so called cure occurring for the patient who watches the surgery, via an unknown mechanism that it not yet understood. Perhaps the surgery serves as a placebo. The magnitude of the placebo effect on surgeries is approximately the same as other placebo responses (around 35%). In many studies using drugs, the placebo effect reduces after 3 months, but the apparent effect of more invasive procedures seem to last longer. For ethical and technical reasons it is very difficult to evaluate the placebo effect of the surgeries.

The definition of what would be the placebo effect is controvertial. Goetzche (1994) affirmed that according to current conceptions, it is not possible to describe placebo in a logical way without contradictions. The label placebo may yet be found to be transitory, or it may be later shown to have specific effects. How does one distinguish an active intervention that uses an unknown method, from a placebo effect? It is frequently said that non scientific practices have a placebo effect to a certain degree, as there are not scientific proofs to explain its actions. Nevertheless, there have not yet been developed empirically verified theories that would explain the active mechanism of placebo effects. Based on these considerations, the same author concludes that the focus of interest has to be separated from the insoluble problem of determining if such intervention is or is not a placebo in order to evaluate the magnitude of the effect of such intervention. In general, it is better to compare the effect with the results of no treatment at all to establish how useful a procedure is, whatever its nature. The history of medicine shows that there has been more harm to patients resulting from the conducts of theoretically based procedures than those based on empirical tests. A change of posture may help overcome the schism between scientific and non -scientific medicine.

There is not enough knowledge about psychic healing yet. The hypothesis raised is that the result arises from either psychological suggestion or the transmission of an energy not yet detected. The fact is that sceptical explanations for the spiritual healing do not reach beyond the sphere of the psychosomatic treatments. Such as in previous studies, the spiritual treatment has been proved not to cause side effects.

Summary of the studied cases
Case 1: Male, 36 years old, economist, rail worker; *M.C: Abdominal pain for seven years; Procedure: nasal scrapping;Pain: no; Histology: epthelial cells, multicilliate secretory cells, leukocytes, bacterial colonies;

Case 2: Female, 56 years old, housewife;*M.C: Benign breast nodules, goiter, arthralgic condition; Procedure: Breast incision, the removal of fragments and stitching; Pain: yes; Histology: adipose lobulus mature tissue with hemorrage;

Case 3: male, 53 years old, Pharmacist technician;*M.C.: alcoholic hepatic disease, incapacitant low back pain for 5 years, hyperopia; Procedure: Corneal scrapping and needle introduction on the carpal; Pain: no; Citology: squamous nuclear and no nuclei cells; Evolution: Cessation of the lower back pain, enhanced well-being, reference to the improvement of eye condition;

Case 4: female, 40 years old, Gymnastic teacher;*M.C: macular cyst with hypogastrium pain for four years; Procedure: Abdominal Incision on the right iliac fossa, removal of fragment and stitching; removal of fragment at the bulbar conjunctive; Histology: 1) mature adipose tissue, 2) stratified epithelium not ceratinized and connective tissue fibrovascular; Evolution: Reduced discomfort and partial visual improvement;

Case 5: female, illiterate, cook;*M.C.: headaches for 8 years due to chronic sinusites with polips on the maxilar sinus; Procedure: nasal scrapping; Pain: no Histology: epithelium stratified involved by cylindric cells from respiratory epthelium and blood clothing; Evolution: no alteration in the condition;

Case 6: Male, 69 years old, accountant technician;*M.C: Loss of visual capacity due to retinal hemorrage; Procedure: corneal scrapping; Pain: no; Citology: nuclear and no nuclei squamous cells; Evolution: no alteration;

Case 7: male; Procedure: nasal scrapping; Citology: epithelial cells, multicilliate secretory cells, bacterial colonies;

Case 8: Male; Procedure: removal of dorsal tumor;Macroscopy: Fibrous-adipose tissue weighting 210 grams; Histology: adipouse lobular mature tissue, vascularized, compatible with a lipoma.

Case 9: male; Procedure: extraction of the left inferior molar; Histology: destruction of teeth enamel (caries) and chronical inflammatory process;

Case 10: Male; Procedure: nasal scrapping; Citology: polymorficnuclear squamosal (flaky) cells in considerable amount and bacterial colonies.

[*M.C. = main complaint]

Conclusions
Based on the surgeries, which were the object of this study, the extracted tissues were shown to be authentic, and although there is no use of analgesic or antiseptic procedures, there were no records of infections and only one patient had referred pain. As there has been no proof of fraud, the phenomenon demands further studies to provide adequate explanation for the analgesic effect and the non occurrence of infection. Further studies are also required to determine the efficacy of such procedures and to evaluate the healing methods, as the surgeries themselves may extract tissues that are not necessarily pathologic.

Since other authors also describe the benefit of spiritual treatments, it is essential to establish a further understanding of its efficacy and the methods of psychic healing. This would allow the adaptation of useful forms of treatment to allopathic medicine, and to exclude harmful or useless procedures. A serious dialogue around the subject would not imply the sharing of religious beliefs, but merely consider it's implications seriously and to not underestimate the reasons why so many people get involved. Neither a blind belief nor renitent disbelief would be helpful to patients or to encouraging the further development of medicine.