IN FOCUS: Religion, spirituality, and health – Part II

Doctor praying for help. Young woman medical doctor surgeon or nurse portrait.

In December 2011, the Journal of Behavioral Medicine dedicated an entire issue to studies focusing on religion, spirituality, and health. Many of these papers attempt to correct shortcomings in the previous religion-health literature, including a lack of good theoretical grounding and lack of longitudinal, or long-duration, research methodologies. This is Part II of a two-part article summarizing and reviewing the studies from this issue.

The concepts of intrinsic and extrinsic religiosity, mentioned in Part I of this article, play a major role in most social scientific research into religion and health. A team of researchers led by Steven Pirutinsky of Columbia University trained their investigative lens on the interaction between depression, physical health, and intrinsic religiosity – participating in religion for its own sake, without necessarily expecting social or material rewards – among Orthodox and non-Orthodox Jews. Their research model was complex but insightful: they expected that, among both Orthodox and non-Orthodox Jews, intrinsic religiosity would predict less depression in people suffering from physical ailments. However, since non-Orthodox Judaism emphasizes community, social justice, and interpersonal relationships, Pirutinsky and his colleagues expected that intrinsic religiosity would benefit non-Orthodox Jews mainly by boosting their social support networks. In contrast, they expected intrinsic religiosity to benefit Orthodox believers more directly, since Orthodox Judaism focuses more directly on a personal relationship with God and devotional worship rather than on community engagement.

Their results bore out their hypotheses: among both Orthodox and non-Orthodox Jews, being physically ill predicted higher rates of depression…except among the intrinsically religious. Among intrinsically religious believers (those who agreed with statements such as “My religious beliefs are what really lie behind my whole approach to life”) being physically ill had no effect on depression at all – deep religiosity seemed to protect against the depressing side effects of sickness.

Pirutinsky and his colleagues found that social support mediated this relationship among non-Orthodox Jews, but not among Orthodox believers. For the Orthodox, intrinsic religion was about a relationship with the Divine, and a good relationship appeared to protect against depression. For the non-Orthodox, being intrinsically religious seemed to lead them rather to better relationships with their peers and fellow congregants, which in turn buffered against depression. The upshot: working in two very different ways, deep, personal religiosity seemed to ward off depression in two very contrasting groups of Jewish believers.

In addition to the contrast between intrinsic and extrinsic religiosity, the distinction between religiousness per se and the related, but different, concept of spirituality has played a major role in much spirituality-health research. Many of the papers reviewed in this article offered their own definitions, but one paper that focused on mental and physical health in the wake of 9/11 provided descriptions that seem generally representative. The authors, led by Daniel N. McIntosh of the University of Denver, construed religiousness as “participation in religious social structures,” while spirituality was described as a “subjective, individual, lived-out commitment to spiritual or religious beliefs.”

By following a cohort of nearly 900 respondents over three years following the terrorist attacks of September 11th, 2001, the authors of the study were able to see whether religiousness or spirituality predicted better coping and better overall health after the trauma. Both religiosity and spirituality boosted positive emotions, while religiosity actually predicted fewer mental or musculoskeletal illnesses and spirituality predicted fewer infectious diseases. Meanwhile, highly religious people had fewer cognitive intrusions – sudden, unwanted thoughts about a trauma, in this case 9/11. Highly spiritual people had more cognitive intrusions at first, followed by a steeper decline over time. McIntosh and his colleagues suggested this may be because “spiritual” people may have a greater-than-average “need to integrate events into their belief systems.” This cognitive need prompts such people to dwell on images of a trauma in its immediate aftermath. Then, as the meaning of the experience is slowly digested in the context of the spiritual worldview, thoughts about the trauma quickly fade away.

Another group of researchers, this one led by Amy L. Ai of the University of Pittsburgh, distinguished between general spirituality, which is often found in the context of religious commitment, and secular spirituality. Secular spirituality, Ai and her colleagues claimed, often emphasizes interconnectedness and the beauty of nature rather than specific religious doctrines. Their study compared different versions of reverence, which they defined as a “feeling of deep respect, love, and awe.” Subjects were asked about the circumstances in which they had felt reverent, with religious reverence arising from religious services, private prayer, reading scripture, and meditation. Secular reverence was encountered while being in nature, while appreciating music or art, when serving others, or while feeling loved and supported. Experiences of secular reverence were equated with secular spirituality.

All respondents were middle-aged inpatients recovering from open-heart surgery. Ai and her colleagues found that subjects who reported high levels of secular reverence had significantly shorter hospital stays after surgery than patients who experienced religious reverence or no reverence at all. Interestingly, religious reverence and private religiousness seemed to predict higher rates of depression, both in the immediate period following surgery and at a three-year followup. The only religious or spiritual variable that predicted a shorter hospital stay was secular reverence.

The results from these and hundreds, if not thousands, of other studies give rise to a clear trend: our spiritual lives seem to have a genuine effect, although often of only small to middling size, on our mental and sometimes our physical well-being. While occasionally religion or – less often – spirituality are linked with negative outcomes, the preponderance of research instead suggests a generally positive effect. The final study reviewed here dramatically highlights these relationships, demonstrating strong, even dramatic, correlations between two important variables – view of God and disease progress in HIV/AIDS.

For this study, Gail Ironson of the University of Miami led a team of researchers in investigating HIV patients’ spiritual beliefs over a period of four years. They found that patients who had a positive view of God – thinking of God as benevolent and forgiving – suffered significantly slower disease progression over the four years, as measured by the increase in viral load and decrease in HIV-fighting CD4 white blood cells, than average. On the flip side, those patients whose views of God were negative – harsh, judgmental, or punishing – exhibited much faster disease progress. These effects remained significant even after the investigators controlled for church attendance, health behaviors such as alcohol and drug use, and levels of mental illness or distress.

What’s more, the effect sizes were striking. People who scored low on positive view of God saw their HIV viral load increase more than eight times faster than patients who expressed positive views of God. Those who lacked a positive view of God lost T-cells a full five times faster than their religiously sunnier compatriots. Patients’ views of God were statistically as influential on physical health outcomes as depression, which before this study was the single largest psychological predictor of HIV progression. The authors suggested that benevolent, forgiving views of God may significantly reduce physiological stress, which means less cortisol and norepinephrine churning through the bloodstream. Those two stress hormones can seriously impair immune and tissue function if present in high doses over time. It’s possible, therefore, that believing in a friendly God actually has a powerful, physiological impact on the immune system.

Of course, this and many of the other theoretical causes advanced in these papers are still untested. Scientists right now are making the first serious advances into explaining the religion-health connection using more complex models and sophisticated physiological theories, but if the history of science is any indication, most of these theories will turn out to be wrong – or at least to seriously need correction. Future research will depend on increased knowledge of neurofunctioning in mind-body interactions such as the placebo effect, and you can bet it’ll also need to be driven by better, more nuanced understanding of the concepts of religion and spirituality. The original research in this field was mostly done by Protestant, white, American men, and many of the categories still in use today reflect this (certainly valuable, but nonetheless limited) intellectual heritage. Understandings of religion that take into account different traditions and complex cultural and linguistic contexts will be a necessity if research is to advance.

Naturally, many researchers also have personal agendas, and those agendas are found in various degrees of concealment here and elsewhere in the field. Many researchers, for example, are biased toward spirituality and against what they take to be corrupt institutionalized religion. Some of them may be the authors of the studies in this review that claim to find benefits for individualized spirituality and risks in conventional religion. Others are deeply religious – often Evangelist Christians – and hope to prove that religion aids health because of the power of the Judeo-Christian God. Still others are motivated by more unconventional worldviews, such as New Age or Hinduism-influenced conceptions of a universal life force. It’s not always clear where the line of objectivity is in this research, and because of this the debates about the gritty theoretical details will doubtless continue, sometimes heatedly, far into the future.

Still, the increasing sophistication of research in the field of religion and health points to a growing awareness among scientists and physicians that the relationship between spiritual life and practices and well-being is real, has impacts on people’s lives, and demands to be better understood. The realms of spirituality, religion, and illness are, after all, not so conceptually opposed – they each have to do with our relationship to the world as a whole and how we fit into it. If we’re sick, the world doesn’t seem like such a great place. If we’re angry at God, that confuses our relationship to the world too. Looking for health – mental, physical, or spiritual – means renegotiating and picking our way through these relationships. Hopefully, we can find a way to experience meaning and to kick our illnesses at the same time.

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