Religion, Health, and Questions of Meaning

Andrew W. Garrison, MD

Disclosures

Research on the relationship between religion and health dates to at least 1872, when Francis Galton investigated the effects of intercessory prayer on mortality among English royalty, clergy, and missionaries.[1] Galton concluded that intercessory prayer did not seem to affect mortality, and the topic received scant further attention in the medical literature until the late 20th century. Since then, a surge in studies on religion, spirituality, and health has prompted renewed debate about the appropriate role for religion and spirituality in the clinical setting. On one side of the debate, advocates for a partnership between religion and medicine cite a growing body of literature that suggests a link between religiosity and improved health.[2,3] Indeed, there is evidence that religiosity may be associated with reduced all-cause mortality, disability, cancer mortality, cardiovascular disease occurrence, and medical service utilization.[4] Proponents of this position also state that, despite their potential health benefits, religious activities often constitute a significant part of patients' identities, influence patients' mechanisms of coping with disease, and inform patients' decisions about medical management. For these reasons alone, advocates recommend that healthcare providers acknowledge and address the spiritual concerns of their patients,[2,5,6] primarily by taking a spiritual history[5] or encouraging patients to make use of health-promoting resources from their own religious traditions.[7]

Critics of the religion and health movement claim that the magnitude of associations between religious practice and better health is actually quite weak and is based on data from methodologically flawed studies.[8] They also argue that, regardless of any potential health benefit that may be gained from increased religiosity, ethical concerns should prevent physicians from integrating religious practice with clinical practice.[9] They note that a physician's professional status, which is based on medical rather than theologic expertise, is abused when he or she makes recommendations about spiritual or religious matters. Furthermore, critics contend that although physicians may take a patient's religious commitments into account while providing care, it does not necessarily follow that physicians ought to take on religion as an intervention. Sloan and coworkers[8] analogize that physicians do not encourage patients to marry just because marriage is associated with lower mortality. Opponents of the union between spirituality and medicine lastly argue that supporting a patient's religious beliefs may actually do harm, particularly by inadvertently encouraging the belief that the patient's illness is due to a moral shortcoming.

Despite burgeoning interest in the relationship between religion and health, few have analyzed this topic from a theologic perspective.[10] Studies to date have generally measured religiosity by quantifying and dichotomizing communal behaviors, such as attending religious services or solitary practices (such as praying or reading religious texts).[11,12] Commentators writing from a theologic perspective consider such a quantitative approach to be overly reductionistic, and suggest closer consideration of the implications of subjecting religious beliefs to standard methods of scientific investigation.[10,13] Shuman and Meador,[10] 2 proponents of this theologic view, point out that in contemporary medical literature the concepts of belief systems are treated as more important than the particularities of the respective religious traditions -- that is, whether a patient is "religious" or "not religious" is more important than the doctrinal content of the patient's religious tradition. They argue that when religion is operationalized in this way, the act of belief -- whether it is measured by observing a subject's religious behavior or by attempting to quantify spirituality -- is incorrectly understood to be more important than the content of that belief.[10] It is this sort of understanding that is implicated, for example, when researchers recommend that physicians encourage their patients to make use of health-promoting resources from the patient's own religious tradition,[7] insofar as the physician is unconcerned with the exact beliefs and rituals of that particular tradition.

Indeed, some theologians warn against the misunderstandings that may result in considering religion generically. In a seminal work, Lindbeck[14] used sociologic, anthropological, and historical sources to argue that religion is more accurately understood as being analogous to a culture or language than as a belief or action rooted in feelings of faith, that is, the only way that we can describe someone as religious is by reference to a particular religion, one that is determined by its unique language, account of the ends of human life, description of a deity, and more. By this understanding, it is inaccurate to assume that there is a common core of faith that is shared among persons of different faiths and can therefore be measured. Consequently, no one is generically religious or spiritual; such descriptions instead necessarily involve a specific religion -- even if it is constituted by a vague and pragmatic spirituality of one's own choosing.[10] Conceiving of worship or prayer in terms of patients' health benefits may therefore be to interpret these practices differently from how most major religious traditions have done throughout history, the ultimate concern of most major traditions being with worship and faithfulness rather than with health. In a sense, the "religion" of "religion and health" may be a very different one from the religions of history.

The divergence of opinion between researchers and theologians on this subject is readily illustrated in the example of intercessory prayer, a form of prayer in which persons petition divine intervention for a particular outcome or event to occur. For researchers, intercessory prayer is an intervention that can be studied in a way analogous to any other therapy. Some theists, on the other hand, object to the implicit labeling of prayer as a type of technology, such as cardiac catheterization or diuretic medications. Instead, for them, it is a locus for encountering and entering into relation with God.[15] They believe that prayer both requires and expresses faith in a deity; to conceive of prayer with regard solely to its efficacy requires no faith and thus is not prayer.[16] To study prayer as an intervention -- rather than a way of encountering a deity that is known only through the communal stories and practices of a particular religion -- is, according to Bishop,[16] a physician and Episcopal priest with training in philosophy, to study a "pale, weak, and meaningless image of its former self that is not identifiable by anyone of faith as prayer."

Theologic arguments also identify the importance of attending to the specific content of a patient's religious practice and faith: A physician who supports a patient's participation in Appalachian snake-handling rites is encouraging a different practice from supporting a Muslim patient's daily prayer. Although the prevailing viewpoint within the medical literature is that physicians should not engage in theologic discussions with patients about the nature of God, sin, or suffering,[5] even advocating that physicians encourage patients to pursue their own religious beliefs challenges physicians with the inappropriate assignment of distinguishing between appropriate and inappropriate religious practices, a task that even many clergy would avoid.[17]

The discussion about religion and medicine raises questions about authority and wider ends within the practice of medicine: To what extent should patients, physicians, researchers, or theologians define the integration of spirituality with medicine? Ultimately, there is little agreement as to whether religious beliefs and practices are fundamentally instruments that can be used in the service of improved health, or instead are ways of being faithful to a specific set of practices and beliefs that will not necessarily provide health in exchange for worship.

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