Faith and Health
by Patricia Murphy
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Current Views
Books Reviewed
God, Faith, and Health: Exploring
the Spirituality-Healing Connection.
Jeff Levin.
New York: John Wiley and Sons, 2001.
272 pp. $24.95 (Hardcover).
Handbook of Religion and Health.
Harold G. Koenig, Michael E. McCullough,
and David B. Larson.
New York: Oxford University Press. 2000.
712 pp. $65 (Hardcover).
The Healing Connection.
Harold Koenig and Gregg Lewis.
Nashville, Tenn.: Word Publishing, 2000.
240 pp. $21.99 (Hardcover). |
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Never has religion and health as a
topic appeared in the public press
and in major medical, psychiatric, and
psychological journals as frequently as
in the past five years. There are bold
claims that religious people are less
likely to die from a variety of disorders
than those who are nonreligious and
that religious folk are likely to have
lower blood pressure. Some medical
and religious professionals find these
conclusions hard to believe. The
research can be methodologically weak,
often the author has a bias, and results
are often used to draw conclusions the
data do not support. Yet, some of this
research is exactly what is needed to
clarify the need for spiritual care and the
tasks facing those involved in it.
The books reviewed here provide
entrée into the role of faith in medicine
from the differing perspectives of major
contributors to the dialogue. In God, Faith,
and Health: Exploring the Spirituality-Healing
Connection, Jeff Levin provides
the religious reader with a clear summary
of findings in a way that proposes why
religion may be beneficial. Harold Koenig,
Michael E. McCullough, and David B.
Larson provide a deeper approach in the
masterpiece Handbook of Religion and
Health. Koenig and Lewis's The Healing
Connection seems to flow from Koenig's
zeal—he is clearly the book's primary
author—and lacks the tight, critical perspective
about the relation of religion and
health that is so evident in his research
with other coauthors. Yet some readers
will find that Koenig's autobiographical
material offers insight into the personality
of one of the most prolific researchers
in the field. I will start this review with
Levin's book to set the backdrop for the
more scientific approach in the Handbook
and will then conclude with comments
on Koenig and Lewis's work.
Don't skip the introduction to God,
Faith, and Health. It sets a friendly tone
by inviting the reader into the community
of researchers in Levin's network
and offers a sense that researchers are
often sincere about religion as well as
qualified in their scientific field. Levin,
a devout Jew, was the first scientist to
receive a grant from the National Institutes
of Health for an epidemiological
study of the religion-health connection.
As is true throughout the book, Levin
carefully explains what epidemiologists
do and specifies the limits to the conclusions
that can be drawn from their
findings. This is an important warning.
Generally studies show there are associations
between religion and health, but
they cannot definitively claim a direct
link. The causal chain Levin proposes in
his "theosomatic principle" has solid
backing, though not proof, in the
research literature.
The religious person will find the
organization of the book appealing. The
first section starts with the external aspect
of religion, attendance at worship, and
examines why this can be beneficial. The
next section examines private spirituality,
and the last tackles the mystical. Each
chapter begins with a vignette exemplifying
the topic at hand and ends with
questions for discussion.
God, Faith, and Health provides
widely accepted evidence for the first
theosomatic principle: "Religious affiliation
and membership benefit health
by promoting healthy behavior and
lifestyles." Brief summaries of some of
the research makes the evidence
digestible for the person unfamiliar with
empirical studies. The arguments themselves
are intuitively appealing. Half
seriously, half tongue in cheek, Levin
asks the question some critics raise:
Does this mean people should join a
religious group in order to be healthier?
His commonsense response is that people
make faith decisions on a very different
basis and are not likely to choose
religion for the sake of health.
Sociologists like Chris Ellison,
another important researcher in this area,
often point to the social support that
public participation in worship provides.
Principle 2, "Regular religious fellowship
benefits health by offering support
that buffers the effects of stress and isolation,"
is an appealing argument even
for the nonbeliever. Studies show that
this aspect of religion is particularly
important for aging populations.
In part two, Levin looks at the
benefits of private spirituality, beginning
with the personal benefits of worship
and prayer. Research published in
mainline scientific journals relies on
evidence obtained by some kind of measurement.
So far, worship and private
prayer are measured by frequency of
activity or their importance to the person
responding. The reader who attends
worship knows there is much more to
public participation than social support.
The benefits of songs, prayers, ritual,
and other aspects of worship have yet to
be studied. Some of these benefits are
probably physiological, an aspect that
secular studies have only begun to measure.
Using a review by Michael McCul-lough
in Journal of Psychology and
Theology, Levin offers his third principle:
"Participation in worship and prayer
benefits health through the physiological
effects of positive emotions."
It is fairly common in general studies
that relate faith to health to focus on
beliefs. In an interesting discussion of
the fourth principle, "Religious beliefs
benefit health by their similarity to
health-promoting beliefs and personality
styles," the author suggests some
beliefs that could be harmful to health,
such as a belief that God will heal without
using healthcare services. While he
is honest about the possible downside of
some beliefs, he offers well accepted
evidence for the general benefits of religious
belief for health. This positive
influence on health seems related to
the social and moral teachings of many
religions. Members of religious groups
that teach free will are more internally
directed and more likely to take responsibility
for seeking health care when
they are ill. The field of psychosomatic
medicine links psychological traits and
states of individuals to their physiological
reactions and symptoms. Many
denominations offer religious tenets that
promote self-esteem and offer ways of
coping with illness or stress. Psychological
well-being derived from reli-gion,
in turn, affects physical health.
Another dimension of religion that
is included in many large surveys is the
person's own sense of religiousness measured
by a question like, "How religious
are you?" with possible responses from
"very" to "not at all." In several surveys
of varied ethnic groups, persons who
were more strongly religious were
healthier and expressed a greater sense
of well-being. Levin cites passages about
hope from many world scriptures and
links hope with better health. This leads
him to offer his fifth principle: "Simple
faith benefits health by leading to
thoughts of hope, optimism, and positive
expectation."
In part three, Levin ventures into
less commonly accepted dimensions of
religion in relation to health, the mystical
and the transpersonal. Nonetheless,
for the religious person, these dimensions
offer an interesting possibility. The
reader needs to remember the warnings
that the data available suggest association,
not causes. While generally the
author proposes that better health results
from mystical experience, numinous
experience could also be the result of the
openness of a healthy mind. Furthermore,
as Levin notes, intense experiences
of good and evil like the ones
described in this chapter can be symptoms
of psychological problems. Until
we do more careful work that takes into
account markers of mental health, the
mystical link between religion and health
will remain fuzzy. We are fortunate to be
living in a time when scientists are
exploring the relationship of spirituality
and health through sophisticated methods
such as monitoring blood pressure.
There is, for example, evidence that meditation
lowers blood pressure. The future
probably holds ways to explore better
the sixth principle: "Mystical experiences
benefit health by activating a healing
bioenergy or life force or altered states of
consciousness."
The final principle, "Absent prayer
for others is capable of healing by paranormal
means or by divine intervention,"
is offered with the acknowledgment
that the evidence available, so far, is not
conclusive. This section describes many
of the investigations that have attempted
to explore the phenomenon of intercessory
prayer. Although these studies are
less apt to be taken seriously in the field
of medicine, their collection and description
in one place is very worthwhile.
Levin offers a clear summary of
the tremendous amount of work exploring
a link between faith and health.
Levin's cautions about how to understand
results keep his contributions
within the parameters of what has been
largely accepted by other scientists. The
goal of most research in the medical
field is to promote better health or better
quality of life for those with diminished health. The discussion questions
for reflection at the end of each chapter
take this work from the realm of theory
into application.
Koenig and Larson, who are specialists
in psychiatry, and McCullough, a
psychologist, are solid researchers in
their own right. Their outstanding publication,
Handbook of Religion and
Health, could become one of the most
valuable tools available for those wanting
to undertake research themselves or to
understand better work that has been
undertaken so far. The solid scientific
quality of their work is demonstrated in
the fact that a very positive review of the
handbook has already appeared in the
Journal of the American Medical Association.
1 Although the scientist will find
this book the most pleasing of the three
reviewed here, the writing style makes
the material accessible not only to
researchers but to healthcare and religious
professionals as well.
The trio takes on the daunting task
of critically reviewing the research conducted
between 1900 and 2000 that
measures the relationship between religion
and various mental and physical
health outcomes. The introduction
explains why there is growing interest
in this field, and, more importantly, provides
an explanation of how the 1,200
studies reviewed were selected. The criteria
for evaluation reflect the reality that
not all research, even if it is published, is
good research. A table at the end of the
book highlights each study and rates its
quality. Not every reader will pore over
this table, but this critical ranking offers
validity to contents of the handbook.
Along with summaries of the
research, organized according to health
issues, this book contains other treasures.
An important and recent development
in research is the attempt to
clarify the terms "religious" and "spiritual."
According to the book, religion is
an organized system of beliefs, practices,
rituals, and symbols designed (a)
to facilitate closeness to the sacred or
transcendent—God, higher power, or
ultimate truth/reality—and (b) to foster
understanding of one's relationship and
responsibility to others living together in
community; while spirituality is the personal
quest for understanding answers to
ultimate questions about life, about
meaning, and about relationship to the
sacred or transcendent, which may or
may not lead to or arise from the development
of religious rituals and the formation
of community.
A diagram clarifies the distinction
and overlap of the two for five major
religious groups: Islam, Buddhism,
Christianity, Judaism, and Hinduism;
and a table tells how many adherents
each of these religions have, both in the
United States and in the world. This is
followed by an explanation of different
dimensions of religion: religious belief,
denomination, organizational religiosity,
nonorganizational religiosity, subjective
religiosity, religious commitment/motivation,
religious quest, religious experience,
religious well-being, religious
coping, religious knowledge, and religious
consequences. A comprehensive
history of religion, science, and medicine
going back as far as 6000 B.C. locates the
current sense that there is a link with a
very long and old tradition. This history
is worth reading in its own right.
Reflecting twentieth-century debate
on whether religion is helpful or harmful
to its participants, a chapter is devoted to
the positive effects of religion. After a
selection of scriptural passages and quotations
of religious writers, there is a
brief history of the pastoral care movement. In order to understand the debate
about religion and health, it is important
to read the ensuing chapter on the negative
effects of religion. This includes
the classic opposition by Freud as well as
the more current objections by Albert
Ellis, the founder of the Rational Emotive
Therapy technique. The latter discussion
is already outdated because of Ellis's
recent article claiming that some religious
beliefs are quite similar to his
healthy beliefs.2 That Ellis changed his
approach reflects the convincing evidence
of the overall benefits of religion
for persons of faith. Nonetheless, the
treatment of negative consequences of
religion provides a balanced approach by
the authors who approach their task as
scientists.
This handbook is intended to
serve as a reference and is accessible
because of good organization. In the
section titled "Research on Religion
and Mental Health," the volume covers
the topics of well-being, depression, suicide,
anxiety disorders, schizophrenia
and other psychoses, alcohol and drug
use, delinquency, marital instability, and
personality. The next part, "Research on
Religion and Physical Disorders,"
includes heart disease, hypertension,
cerebrovascular disease and the brain,
immune system dysfunction, cancer,
mortality, religion and disability, pain
and other somatic symptoms, and health
behaviors. The authors provide enough
statistical information to satisfy the
expert in research, but not in a way that
might overwhelm the average reader.
The section on clinical implications
for health professionals suggests
that the health professional explore with
patients whether religion would help
them cope or heal. It also strongly
emphasizes the importance of chaplains
on the healthcare team and advocates the
use of local clergy. After a gloomy
description of the cutback in chaplaincy
services in many hospitals, this section
points to the need to investigate the
impact of chaplaincy services on healthcare
costs. The authors would like to see
chaplains integrated into the multidisciplinary
care team by participating in
morning and evening rounds; supporting
patients, family, and hospital staff; participating
in discharge planning, espe-cially
by connecting with the person's
home religious community; providing
spiritual assessment of all incoming
patients; and providing religious services
and sacraments. Having provided suggestions
for pastoral counselors and religious
educators, the book uses the overall
results of research in religion and health
to identify some of the most important
tasks for local clergy in educating congregants
about health care.
Not only researchers, but all concerned
about health, should be grateful
for the wealth of information this volume
provides to support better research
in the future. The section on priorities
for further research is a gold mine in
itself. Besides pointing to specific topics
that could enhance our knowledge, the
section outlines design issues and provides
a thorough treatment of measurement
tools. For serious investigators,
this section in itself is worth the cost of
the book. Although the size and cost of
the book might discourage its purchase,
taken as a whole it is an invaluable reference
for healthcare providers, chaplaincy
departments, and local clergy.
As for The Healing Connection,
many readers probably would not get
past the first two chapters. This part of
the book would certainly cause the
skeptic to be critical of any of Koenig's
work. The first section, an autobiography,
provides a complex picture of
someone who seems fairly intense and
driven. I found myself wondering about
the nature of some of the spiritual experiences
Koenig describes. Koenig himself
acknowledges that some behaviors
earlier in his life, before his healing,
show signs of mental illness. The high
need for achievement and perfection
that Koenig portrays makes clear why
his work is of such high quality.
"Publish His Glorious Acts," the
first chapter in the section on Koenig's
research, reflects this book's theme of
witnessing to God's healing power. The
author provides information about his
studies in a simple way, illustrating findings
with stories. Because some of the
stories he tells border on the miraculous,
the scientist and the less fervent
reader—someone who is not Christian—
might question the benefits of religion
in everyday situations.
The final section of the book, "The
Link for Us," is definitely worthwhile.
Koenig looks at common types of negative
coping that can be associated with
poorer prognoses. With each type, he
offers ways to address the problem that
results from the negative coping. Any
person providing spiritual care would do
well to read this section. In a chapter
summarizing the meaning of his
research, Koenig acknowledges that
research in no way proves that God
exists, nor does it guarantee that faith
heals physically in every individual case.
As other believers know, faith can
always heal in some way at a deep level
of our being. He concludes the book
with very practical suggestions for providing spiritual care for individuals and
congregations.
These books appear at a very
important time in our country. Fifty-six
percent of Americans 3 report that religion
is very important in their lives, and
68 percent of Americans over 50 have
some religious affiliation. The link
between religion and health has important
implications in the face of limited
access to health care and the growing
number of elderly. Faith is a resource we
cannot overlook. All three of these books
take research to the level of practice.
Levin makes the research interesting
and readily understandable. Koenig and
colleagues present probably the most
valuable contribution to this field written
to date. Unfortunately, Koenig and
Lewis's work could provide ammunition
for critics of studies linking religion
to better health. Nonetheless, read
carefully, it has the merit of providing
beneficial suggestions.
NOTES
1. Harriet S. Meyer. Review of Handbook of
Religion and Health, by Harold Koenig,
Michael McCullough, and David B. Lar-son,
Journal of the American Medical
Association 286 (2001): 465–466.
2. Albert Ellis, "Can Rational Emotive
Behavior Therapy (REBT) Be Effectively
Used With People Who Have Devout
Beliefs in God and Religion?" Profession-al
Psychology–Research and Practice 31
(2000): 29–33.
3. Gallup, G. H. Jr., "Religion in America
2002: Will America experience a spiritual
transformation?" Princeton, N.J.: Prince-ton
Religious Research Center (2002).
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Second Opinion #10
Publisher: Park Ridge Center, Chicago
Date: April, 2002.
ISSN: 0890-1570
112 pages.
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