The Influence of Religion on Health
Religion is a subject that we encounter daily, either because we follow a specific faith and the rules established by it, or because we meet people who proclaim their faith unabashed, or because we know it is a taboo subject in social conversations. It is probably better to ask someone how much they earn, or about their health history, then to ask them to what religion they practice. Religion is considered too personal a subject. In scientific discourse it is only recently that religion has received any special attention. Previously considered as outside of the sphere of research for the perceived impossibility in using any scientific method to study it, religion is now prominent in scientific studies that investigate its influence on health (Miller & Thorensen, 2003).
Religion is not only “researchable,” but it is also of essential interest to clinicians, doctors, patients and health psychologists. Religion has the benefit of empowering the individual through connecting him/her to a community, and to a superior force, that might in turn give psychological stability (Oman & Thorensen, 2003). This ability to empower could be used by health psychologists in medical settings (and not only) to help those who struggle with a disease or to promote a healthier lifestyle. However, because this resource is not investigated and used at its full capacity, health psychology risks promoting a cultural iatrogenesis (healer-induced disability to cope with illness) (Oman & Thorensen, 2003). In a world dominated by a culture of consumption, religion offers a venue for individuals to commit to something beyond themselves, in addition to empowering the community, overall. This empowering happens through consciousness of religious principles, such as the sanctity of human life, shared identity, meaningful roles in the community and society at large, a variety of spiritual, social and economic support, social networks, and even leadership for social change and protection in time of conflicts.
In light of these considerations, Oman and Thorensen (2003) point out that health psychology should cultivate an understanding of how religion and spirituality are felt, lived, and experienced by the populations of interest. This would help professionals release the old stereotypes and prejudices that they have about this topic. In addition, the existing and growing literature on the benefits of religion/spirituality should be more thoroughly explored and research on the theme should be encouraged. Finally, with the aid of community health psychology, the field of health psychology at large should move towards promoting culture as a means of understanding between health care provider and patient and in the interest of prevention, as well.
Conceptualizing Spirituality and Religion and Methodological Considerations
In healthcare literature religion and spirituality are most of the time used interchangeably, although they have quite different meanings (Miller & Thorensen, 2003). Spirituality is defined in individual terms, characterized by experiences involving meaning, connectedness, and transcendence, whereas religion is defined in communal terms, characterized by institutionalized practices and beliefs, membership and modes of organization (Pesut, Fowler, Taylor, Reimer-Kirkham & Sawatzky, 2008; Miller & Thorensen, 2003). Thus, whereas spirituality is understood at the level of the individual, religion is more of a social phenomenon, and as such is included in the more overarching concept of spirituality. Religion can also be conceptualized as religiousness, as an individual phenomenon, characterized by the adherence of an individual to specific beliefs and practices (Miller & Thorensen, 2003). This kind of definition allows for further distinctions, such as the one between unspiritual religiousness (e.g., observing some practices for the social benefits), or unreligious spirituality (e.g., mystical experiences of individuals without a religious context). Of course, a definition for spirituality and religiousness has to be broad enough to include all individuals and applicable to all religious denominations (Miller & Thorensen, 2003).
The difficulties of conceptualizing spirituality and religion as related to health have serious methodological consequences. Miller and Thorensen (2003) summarize two approaches that could be applied to the research on spirituality/religion and health: the unique variance approach and the causal modeling approach. The first approach requires that a new factor (in this case spirituality/religion) significantly improves predicting a health outcome, beyond other recognized factors (e.g., family history, gender, socioeconomic status, age, or stress). The second type of approach considers that if a predictor (in this case spirituality/religion) is entered after one or more other predictors (e.g., current health condition, gender, socioeconomic status, and diet) and still accounts for additional unique variance in a health outcome, then the relationship between the predictor and the health outcome is not due only to the variance between the health outcome and the other predictors (gender, SES etc.). If these other predictors are entered first in a regression equation, they will account for most of the proportion of variance in the health outcome. Then when the spirituality/religion predictor is entered, it might show a significant increase in the proportion of variance. And, if it does not, it might be that indeed the predictor does not contribute to the health outcome or it might be that the covariance fallacy is responsible for the result (which is the confusion of correlation with causation). Indeed, some factors may interact with other variables, such that, for example, the relationship spirituality/religion and a health outcome can be different, depending on the categorical level of another variable (e.g. socioeconomic status or gender). In addition, spirituality/religion can mediate the relationship between another variable (e.g., quality of life) and a health outcome (Miller & Thorensen, 2003).
Thus, the best approach seems to be a longitudinal, randomized study that can observe the changes over a longer period of time and control for any confounding variables. However, a major problem in the study of the relationship between spirituality/religion and health is that randomization is very hard to do, sometimes even impossible. For example, if randomization is possible in the case of studying meditation, it is impossible in the case of studying religion: one cannot randomly assign people to a religion or another but has to choose form the already-existing pool of believers, and try to control for other variables (e.g. match them for age, gender, SES etc.).
How Do Spirituality and Religion Influence Health?
The difficulty in conceptualizing spirituality/religion comes from the multidimensionality of these concepts (Miller & Thorensen, 2003), and extends to the problem of how exactly spirituality/religion influence health. This, in turn, emphasizes the fact that there are multiple interpretations of how spirituality/religion influences health and a number of pathways through which this happens. Four most prominent such pathways have been proposed: health behaviors (through prescribing a certain diet and/or discouraging the abuse of alcoholic beverages, smoking, etc., religion can protect and promote a healthy lifestyle), social support (people can experience social contact with co-religionists and have a web of social relations that can help and protect whenever the case), psychological states (religious people can experience a better mental health, more positive psychological states, more optimism and faith, which in turn can lead to a better physical state due to less stress) and ‘psi’ influences (supernatural laws that govern ‘energies’ not currently comprehended by science but possibly understandable at some point by science). Because spirituality/religion influence health through these pathways, they act in an indirect way on health (Oman & Thorensen, 2002).
Moreover, four interpretations of how spirituality/religion influence health have been proposed. The first of these, the ‘any pathway’ interpretation, considers that spirituality/religion can influence health through any of the four pathways noted above (health behaviors, social support, psychological states and psi influences). The second interpretation, the ‘psychobiological’ one, considers that spirituality/religion influence health through psychoneuroimmunological or psychoneuroendocrinological pathways beyond the benefits that religion has through health behaviors and social support. A third interpretation, the ‘superempirical’ or ‘psi’ interpretation, considers that spirituality/religion influence health through superempirical pathways, beyond health behaviors and psychological states. Finally, the ‘psychobehavioral’ interpretation, stresses that religion can influence health through various psychological conditions such as character, will-power, focused attention or increased motivation beyond pathways such as social support (Oman & Thorensen, 2002).
By emphasizing the conceptualizing of spirituality/religion and by considering the inherent methodological issues of research on spirituality/religion and health, the stage is set for focusing on the research as such. Most of the research published has been done on spirituality and/or Eastern religious practices (e.g., meditation, yoga, relaxation exercises) and health. Other research has looked at Judeo/Christian/Muslim religious practices (in particular, synagogue/church/mosque attendance and/or prayer) and health.
The Relationship between Spirituality and Health
The research investigating the influences of spirituality and various Eastern religious practices, such as yoga or various types of meditation, is extensive (Seeman, Fagan-Dubin & Seeman, 2003). Many of these studies look into the relationship between meditation and various physiological measures. Because the literature is so extensive, only some representative studies will be cited here. The most documented relationship is the influence of meditation on blood pressure (Patel et al., 1985; Sudsuang, Chentanez & Veluvan, 1991; Schneider et al., 1995; Schmidt, Wijga, Von Zur Muhlen, Brabant & Wagner, 1997). In a randomized, longitudinal study, the influence of meditation/relaxation techniques on the incidence of cardiovascular disease (participants were judged as being at high risk for it if they had two or three of the following risk factors: smoking, high blood pressure and high cholesterol) was investigated (Patel et al., 1985). Results showed that at eight weeks, eight months and four years afterwards, the participants that followed the meditation/relaxation techniques program had a significantly lower blood pressure. A second study involving a randomized design looked at the influence of transcendental meditation and progressive muscle relaxation on blood pressure in a sample of older African American adults (Schneider et al., 1995). The group in the transcendental meditation condition showed reduced systolic and diastolic pressure significantly more (almost twice) than the group in the progressive muscle relaxation, and the group in the life-style education classes. This study is very interesting considering the sample used. Most of the studies usually use White or Asian, male, college students as participants. However, an important issue of these studies is that they did not address meditation as a religious/spiritual practice.
Another study compared a group of individuals from a residential area in Sweden participated in a three-month yoga and meditation training program with a group of individuals from a residential area in Germany that did not participate in the program (Schmidt et al., 1997). The Swedish participants showed decreased blood pressure following the three months program (especially those with elevated levels) compared to the German participants. Finally, a group of male college students that followed a Dhammakaya Buddhist meditation program showed a reduction in systolic and diastolic pressure, compared to a control group of male college students that did not follow the program (Sudsuang et al. 1991).
This last study also showed that the college students following the meditation program had lower stress hormone levels (specifically cortisol) at the end of the program (Sudsuang et al., 1991). Another study that also looked at cortisol levels in a control group of young adults, this same group after 3-4 months of practicing transcendental meditation, and another group, of long-time (3-5 years) practitioners of transcendental meditation (Jevning, Wilson & Davidson, 1978). For the control group, the levels of cortisol did not change, while for the short-term practice of meditation, the levels decreased but not significantly. For the long-term practitioners, however, the cortisol levels deceased significantly and remained like that after the sessions of meditation. In addition, Walton, Pugh, Gelderloss and Macrae (1995), in a cross-sectional study, investigated the differences in the levels of various hormones and minerals between healthy, young adults who did not practice any stress-reducing technique and a similar group that had practiced transcendental meditation for a long time. The latter group showed lower levels of cortisol, aldosterone and norepinephrine. One other study analyzed levels of cortisol, β-endorphin and adrenocorticotropic hormone (ACTH) in two groups: one of practitioners of transcendental meditation and another of non-practitioners (Infante et al., 1998). Results showed that the meditation practitioners had no diurnal rhythm for ACTH and for β-endorphin, as compared to the control group. However, a methodological issue of the last three studies is that they did not make use of randomization, relying on data from groups of individuals that had already practiced or not meditation (Seeman et al., 2003). Ironson et al. (2002) found that private religious and spiritual feelings were associated with long survival in HIV-positive and AIDS patients, and the having a general sense of peace was strongly related to lower levels of cortisol, and thus showing that physiological benefits might come from non-organized spiritual beliefs.Continued on Next Page »