Spirituality and it’s impact on health and well-being

Deepa Mohan

Introduction

Spirituality is a universal human experience, crossing cultural and geographical boundaries, although its substance and form may differ. Religion of one kind or another existed, and continues to exist, in all societies; and it has profound effects on the lives of those who practice it. Prayer is central to all religious practices. It is universal and ubiquitous, crossing cultural and geographical boundaries. It encompasses all religions, even those that do not specifically acknowledge an entity like God as in Buddhism. Although the form and object of worship may vary, offering prayers is a pervasive phenomenon that is considered neither unusual nor abnormal. Despite the universally prevalent and largely shared behavior and the belief that prayer is a means of propitiating gods or invoking supernatural forces/abilities to help improve human condition, contemporary social scientists in general and psychologists in particular paid little attention to this aspect of behavior until recently. In the absence of systematic studies on the effects of religious beliefs and practices on the health and well-being of people, health professionals tended generally either to ignore or dismiss religious practices as no more than societal idiosyncrasies or dub them as sheer superstitious behavior.

For nearly a century, many mental health experts portrayed religion as a neurotic influence on psychological functioning. In the early 1900’s Sigmund Freud, in his Obsessive Acts and Religious Practices (1907/1962) and Future of an Illusion (1927/1962) described religion as a “universal obsessional neurosis” and predicted its ultimate demise, as people would more and more learn to use the rational operation of their intellect. Of course, this has not happened, even in the developed societies of the West that swear by science and reason. On the contrary, it is projected that the 21st century would be the most religious among the last five centuries. Sauna (1969) in a scientific review published in the American Journal of Psychiatry concluded that, “the contention that religion as an institution has been instrumental in fostering general well-being, creativity, honesty, liberalism, and other qualities is not supported by empirical data.” Albert Ellis (1980) reiterated the view, which appears to have been broadly shared in the mental health field that “the less religious they [people] are, the more emotionally healthy they will tend to be.” Wendel Watters (1992) concluded that, “evidence that religion is not only irrelevant but actually harmful to human beings should be of interest, not only to other behavioral scientists, but to anyone who finds it difficult to live an unexamined life.”

There were only a few who opposed the view that religion was either irrelevant or harmful to health. Unlike his teacher and one-time colleague Freud, Carl Jung saw more to religion in the lives of his patients than neurosis. He wrote, “among all my patients in the second half of life … there has not been one whose problem in the last resort was not that of finding a religious outlook on life.” In contrast to Sauna, David Moberg (1965) noted in a review of relevant literature, “studies of happiness, morale, and personal adjustment have generally shown a direct relationship between good adjustment and such indicators of religiosity as church membership and attendance, Bible reading, regular listening to religious broadcasts, belief in an afterlife, and religious faith.” Psychologist Allen Bergin echoed a similar sentiment when he wrote “religion is at the fringe when it should be at the center” of interest to social scientists. Jung, Moberg, and Bergin were of course a small minority among health professionals to see positive benefits of religion on human health and wellness. More vocal were those who advocated skepticism.

Things took a different turn since the mid 1980s. Studies in the late 1980s and 1990s began to demonstrate the wide spread use and apparent benefits of religious practices in medical settings. A definitive scientific interest in religion, prayer, health, and well-being is now quite real. The thrust of interest of these studies is on the effect of prayer/religious beliefs/ practices on the health outcomes of clinical populations.

Prayer can be considered as the manifest behavior of the religious person; and religion is applied spirituality. The dynamics of religious beliefs in India are as varied as the cultures and subcultures inhabiting the Indian subcontinent. There is a belief in South Indian villages that epidemics are due to evil spirits surrounding the villages. Thus propitiating of gods and goddesses to get rid of diseases is the mode of dealing with diseases in these villages (Alam and Ramarao, 1998). In different regions, various gods and goddesses are propitiated for various diseases and disorders. For instance, Sitala devi, the small-pox goddess of India was now reportedly appeased for the disease outbreak of SARS. Indian theogyny has gods and goddesses that are appealed to for various purposes – health, wealth, prosperity, children, completion of tasks – all the needs, wants and desires of man for which he could do with divine assistance.

In the Indian context, prayer is such an integral part of life that its validity has never been questioned. There has been a failure in recognizing it as an area of scientific inquiry. Some may argue that it amounts to studying the obvious. However, that which is “obvious” also needs understanding. Moreso in the Indian cultural context where beliefs and rituals govern every aspect of daily life.

The evidence so far – A brief review

Happiness and well-being

Ziyad Marar (2003) in his book The Happiness Paradox, begins with the dilemma of the pursuit of happiness where there is no ‘certainty’, where life is plagued by a ‘lack of meaning’, where, according to the author, we are burdened with two questions: What do I want? And how ought I to live? (Rasmussen, 2004). What is happiness and what is it that gives us a sense of well being? The answers to these questions can be as varied as the needs and desires of each individual, influenced as much by religious orientation as is by a personal worldview. There is a sense of well being when happiness is experienced, in the absence of which, the best of all worlds is insufficient. When the body, mind, and soul is not distraught, a sense of happiness or well being prevails. Thus spiritual health or spiritual well being is an integral part of this state. The role of spirituality/religion in bringing about this feeling of well being is a focus of research, particularly in the present troubled times, in the hope that humankind is able to grasp that one crucial element that can be a sustained source of happiness in the midst of all the adversities of life.

Professor Rao (see Chapter 1) establishes the distinction between spirituality and religion. As he states: Spirituality is to religion what science is to technology. Thus exploring the role of religion in health and general well being and happiness becomes an essential component of this inquiry. The religious ‘technologies’ include prayer, religious involvement, and attendance to a place of worship, reading/listening to religious literature/discourses, and a personal relation with God.

Veach and Chappel (1992) analyzed the dimensions of personal spiritual experience, spiritual well-being, sense of harmony, and personal helplessness on the Spiritual Health Questionnaire. They reported that spiritual well-being was positively related to psychological health and general well-being; sense of harmony. Ellison (1992) interviewed a sample of 2,107 Black adults (1979-80). They used regression analyses to control for factors such as age, education, sex, income, missing income, government aid, skin tone, physical unattractiveness, and self-esteem, and found that persons who engaged in frequent devotional activities (prayer, Bible study, etc.) were more open and less suspicious, and more enjoyable to interview. Those who reported that religion was an important source of moral guidance were also viewed as friendlier. Thus, personal religiousness was associated with interpersonal friendliness and empathy. Emphasizing the religious practices, Ferraro and Albrecht-Jensen (1991) reported that health status was inversely related to religious conservativeness (-.17, p<.05) and positively related to religious practice (.06, p<.01).

Poloma and Pendleton (1989) identified four types of prayers: meditative prayer, ritualistic prayer, petitionary prayer, and colloquial prayer, and related these to five dimensions of well-being. Controlling for education, sex, race, income, and age, meditative prayer was positively related to existential well-being and religious satisfaction; ritualistic prayer was positively related to negative affect; petitionary prayer was unrelated to any well-being dimension; and colloquial prayer was positively related to happiness. They further examined the examined relationship between well-being (life satisfaction, negative affect, happiness, existential well-being) and prayer experience, orthodoxy of belief, frequency of church attendance, born-again status, frequency of prayer, relationship with God, and church activities. They reported that religious satisfaction was the strongest correlate of well-being (existential well-being (p<.001), and life satisfaction to a borderline degree (p=.06)), when other domains and control variables were controlled; the strongest correlates of well-being (life-satisfaction and happiness) was frequency of prayer (negative) and prayer experience (positive); when type of prayer was examined, they report that when ritual prayer index was replaced by a conversational prayer index, the conversational prayer showed a positive relationship with general well-being; persons who have more positive experiences in prayer (prayer experience) are likely to have greater well-being (Poloma and Pendleton, 1990, 1991). O'Laoire (1997) in an experimental study of the effects of distant, intercessory prayer on self-esteem, anxiety, and depression, concluded that the agents of prayer actually had improvements in well-being that were superior to the subjects of the prayer. Shuler, Gelberg, and Brown (1994) in a survey of 50 homeless women, ages 18-44 from a family planning clinic for homeless women in the city of Los Angeles, reported that 48% of the sample indicated that prayer was effective in coping, and these subjects reported fewer worries (p<.05), fewer depressive symptoms (p<.05), less likelihood of drinking alcohol in past 6 months (42% vs 69%, p<.05) and to use cocaine daily (17% vs 42%, p<.05).

Carlson, Bacaseta, and Simanton (1988) determined the effects of devotional meditation (DM), consisting of a period of prayer and quiet reading and pondering of Biblical material, on physiological and psychological stress variables. They compared it to progressive relaxation (PR) delivered in 6 sessions, 20 minutes each, over 2 weeks; 36 undergraduates were randomly assigned by sex into 3 groups: DM, PR, and wait-list control (WL). The devotional meditation group had reduced muscle tension in 2 of 4 sites monitored, compared to the progressive relaxation group which had increased tension in 2 of 4 sites. At post-assessment session, anger and anxiety scores were significantly lower in DM compared to PR compared to WL control group, although no physiological differences between groups were observed.

Numerous studies have investigated the relation between religious activities and well-being. Myers and Diener (1995) in a random survey between 1980-86, of 169,776 persons in 16 nations, reported that religious involvement is associated with higher well-being, optimism, and positive expectations for the future. Lee and Ishii-Kuntz (1987) in a survey of 2,872 persons age 55 or over on social interaction, loneliness and well being among men, reported religious attendance as significantly and positively related to morale (p=.02), after controlling for ten other variables, including all the social variables. In a Canadian study on religious involvement and life satisfaction, results indicated life satisfaction in both men and women who were more religiously active (Gee and Veevers, 1990).

Koenig. McCullough, and Larson (2001) state that of almost 80% of the 100 studies that have been statistically examined, the the religion-well-being relationship shoes a positive correlation between religiousness and greater happiness, life satisfaction, morale, or other measures of well being (p. 117).

Depression

In a review of 250 epidemiologic studies on religion and nine areas of clinical disease, Levin and Vanderpool (1987) found 27 studies that included attendance at services as predictor variables, of which 22 revealed significant associations with better health.

To be depressed is like being in the depths of a personal hell, dried of all enthusiasm and verve for life, by its burning fires. In an existential crisis, such as that which depression brings on, faith in self, life, and god are questioned. Solace does not seem to appear from the relations that otherwise sustain the self and give meaning to life. At times such as these, a fervent plea from the depths of the soul is sent out. The native wisdom of the individual of turning to spirituality/religion was one that was ignored by mental health professionals. Caro, Miralles, and Rippere, (1983), in a cross cultural study analyzed the answers to the question “What's the thing to do when you’re feeling depressed?” Among the 12 most common responses given by the British (4%) and Spanish (4%) surveyed was “taking comfort in one's religion”. It was found to be the fourth most common response. 2% of Spanish and 4% of British indicated, “pray.”

During the past decade, (western) psychiatry has taken a more comprehensive look at the patient’s religious/spiritual outlook as a complex dimension of the patient’s well being, and a potentially important component in the therapeutic process (Larson et. al., 2001). In recognition of its role in mental health, the American Psychiatric Association included in the DSM IV a new non-psychopathological category entitled “Religious or Spiritual Problem” in the section labeled “Other conditions that may be a focus of clinical attention” (APA, 1995). Though historically some theorists have dismissed religion/spirituality as an inherently harmful clinical factor, quantitative research in the last 15 years has discovered elements of religion linked with beneficial mental health outcomes (Gartner, Larson, and Allen, 1991). In contrast, Fehring, Brennan, and Keller (1987) reported that religious well-being and spiritual maturity was unrelated to depression outcome.

The majority of these studies, particularly those conducted within the past decade, have demonstrated a positive relation between Judeo-Christian beliefs and practices and mental health (Koenig and Larson, 1998). These results are likely to be replicated in other world religions. As the philosophies underlying Semitic religions and the Asian religions are different, a comparison of their religious beliefs and practices and their influences on mental health would shed light on the mechanisms of the influence.

In examining the role of the type of religiosity in depression, Koenig, George, and Peterson (1998) reported that depressed patients with higher intrinsic religiosity scores had 70% more rapid remissions than patients with lower scores. In this study, greater intrinsic religiosity independently predicted shorter time to remission. Commerford and Reznikoff (1996) concluded that public religiosity was more strongly associated with self-esteem and lower depression than was intrinsic religiosity. These results indicate the role of social network in the well-being process.

In a randomized clinical trial of 21 depressed Christian students (11 female), ranging from 19-36 years old; matched according to severity of depression and then randomly assigned to experimental and control groups; Pecheur and Edwards (1984) conducted a secular and religious version of cognitive behavior therapy. In comparison to a wait-list control (n=7) group, both religious and secular cognitive behavior therapies were found to be more effective. Although not significantly different from each other, religious CBT showed consistent trend towards better scores than secular CBT. After 1 month, the Beck’s Depression Inventory was repeated and showed no significant difference between religious cognitive behavior therapy and secular cognitive behavior therapy groups. Propst (1980) compared the efficacy of religious and nonreligious imagery for the treatment of mild depression in religious individuals. In this cognitive behavior therapy model, no significant difference between the two models was observed, indicating that religious imagery works at least as well as other group therapy techniques for treating mild depression in religious college students. In another study, the influence of the therapist’s beliefs on the outcome was also investigated. Propst and colleagues (1992) reported that patients who received religious cognitive therapy from non-religious therapists and patients who received non-religious cognitive therapy from religious therapists, did better (p<.05).

The aspect of social support in religious behavior as a mediating factor in outcomes has been a consistent hypothesis in attempting to understand the role of religiosity on mental health by increasing the quality and quantity of social resources (Ellison, 1994). Braam, Beekman, et al. (1997), in a study on older Dutch citizens, concluded that religious involvement was particularly inversely related to depression among those with small social network and with a low sense of mastery. In another study Braam, Beekman, and colleagues (1998) reported the role of positive self-perceptions among church members and higher social integration as contributory factors in fewer depressive symptoms.

Strawbridge and colleagues (1998), based on a cross-sectional study of 2537 participants aged 50-102, reported that religiosity may buffer the effects of some stressors on depression, but may exacerbate others. Religiosity (measured as organizational and non-organizational religiosity) buffered the effects of financial and health problems on depression, but exacerbated depression among those facing family crises. These authors concluded that, “as an antidote for depression though, religiosity should be prescribed with great care; it might make the patient better, but it also would just might make things worse”(p S124). Because family cohesion is valued highly by the religious, when there are problems in this area due to unruly children, marital conflict, or difficulties caring for an older parent or other relative, greater religiousness may actually exacerbate the stress that the person experiences. The usual coping resources enhanced by religion may be most helpful for stressors perceived as resulting from outside the individual (like poor health or financial stress). In contrast, for family problems thought to be due to personal or spiritual defects or shortcomings, religious resources may not be as helpful. According to Fernando (1975) “loosening of communal bonds and/or weakening of religious behavior is of particular relevance to depression among Jews in comparison to Protestants.”

Koenig, McCullough, and Larson (2001) in the Handbook of Religion and Health surmise that research on religion and depression supports five conclusions: First, the data on religious affiliation and depression suggests that two religious groups -- Jews and people who are not affiliated with any religion -- are at elevated risk for depressive disorder and depressive symptoms. Second, people who are involved frequently in religious community activity and who highly value their religious faith for intrinsic reasons may be at reduced risk for depression. Conversely, people who are involved in religion for reasons of self-interest or extrinsic gain are at higher risk for depression. While the longitudinal data do not definitely prove causal inference, they do provide considerable circumstantial evidence in support of causality. Third, measures of religious involvement, particularly private religious activities and religious beliefs, are not as strongly related to depression as are organizational religious activities or intrinsic religious commitment. Fourth, religious involvement plays an important role in helping people cope with the effects of stressful life circumstances. Some forms of religious coping are related to a lower likelihood of depression during or after stressful life events, while others appear to be “red flags” for greater depression risk. Furthermore, although religious activities buffer against the deleterious effects of some psychological stressors (particularly health and financial stressors), they may exacerbate the effects of others (family related stress). Fifth, prospective cohort studies and quasi experimental and experimental research all suggest that religious or spiritual activities may lead to a reduction in depressive symptoms and that religiously accommodative psychotherapy is at least as effective as secular psychotherapy for depression. (p. 135).

Health

In a review of 250 epidemiologic studies on religion and nine areas of clinical disease, Levin and Vanderpool (1987) found 27 studies that included attendance at services as predictor variables, of which 22 revealed significant associations with better health.

Mueller, Plevak and Rummans (2001) through their meta-analysis of published studies concluded that addressing the spiritual needs of the patient may enhance recovery from illness. Pargament, Koenig, Tarakeshwar, Hahn, (2001) in their study on religious struggle as a predictor of mortality among medically ill elderly patients concluded that hospitalized men and women who experience a religious struggle with their illness appear to be at increased risk of death. In a series of studies, Koenig et. al. (2001) have looked into various aspects of the relationship between religious activity and health outcomes. They examined the effect of prayer on mortality (Helm, Hays, Flint, Koenig, and Blazer, 2000), which showed an association between private religious activity and longer survival in certain population subgroups. In a six-year follow-up study of 3,968 older adults, Koenig, Hays, Larson, George, Cohen McCullough, Meador, and Blazer, (1999) concluded that older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently. This effect on survival was reported to be equivalent to that of not smoking cigarettes vs. smoking. A number of studies (Strawbridge et al., 1997; Oman and Reed, 1998; Koenig et al., 1999; Hummer, Rogers, Nam and Ellison, 1999; Glass, Mendes et al., 1999; Larson, Larson and Koenig, 2001; Koenig, 1998) have discovered that religious activity -- particularly when it occurs in the setting of community (such as involvement in religious worship services and associated voluntary activity) -- is associated with a longer life span. Even when religious activities do not affect the course of physical disease or prolong life, they may still enhance the quality and meaning of life (Koenig 2001).

Townsend, Kladder, Ayele, and Mulligan (2002) assessed the impact of religion on health outcomes via systematic, critical review of the medical literature. They reviewed all randomized controlled trials published from 1966 to 1999 and all non-randomized controlled trials published from 1996 to 1999 that assessed the relationship between religion and measurable health outcomes. They reported that non-randomized controlled trials indicate that religious activities appear to benefit blood pressure, immune function, depression, and mortality.

Chronic pain

As in dealing with pain of the psyche, evidence points towards the efficacy of the technologies of spirituality in decreasing chronic pain of the body. Tu (1980) indicates that the role of pain in strengthening and purifying the person is common to Christianity, Buddhism, and Confucianism. The Buddhist sees pain as a defining characteristic of human life that is to be endured in a matter-of-fact manner. The Confucian views pain as a trial but also believes that a cure is both desirable and necessary for well-being. Shaffer (1978) notes that both Hinduism and Christian Science view pain as an illusion brought on by false beliefs and incorrect thinking. While the Christian Scientist concentrates on God and the good in the world, the Hindu seeks to gain understanding and attain detachment form the world (the source of pain) that is illusion (cf. Koenig et al.. 2001, p. 350). Abraido-Lanza, Guier, and Revenson (1996) reported that the most commonly used coping strategy after engaging in activities to deal with chronic pain of arthritis was use of religion. According to McBride et al.. (1998) moderate spirituality was associated with significantly lower pain than low spirituality (p=.008), although high spirituality was associated with nonsignificantly greater pain (curvilinear relationship). In an assessment of loneliness and spiritual well-being in chronically ill adults with rheumatoid arthritis and healthy adults Miller (1985) reported an inverse relationship between spiritual well-being and loneliness in both ill (-.27, p<.01) and healthy (-.39, p<.001) groups. Ill subjects had higher spiritual well-being (94.3 vs 83.7, p<.01) than healthy subjects. The author concluded “chronic illness may be a factor in stimulating the person’s valuing religion, having faith in God, and having a relationship with God.”

Kabat-Zinn, Lipworth, and Burney (1985) used mindfulness meditation in a sample of chronic pain patients. Results showed statistically significant reduction in pain symptoms, mood disturbance, psychological symptoms; pain-related drug utilization decreased and self-esteem increased. A comparison group of patients in the pain clinic did not show similar improvement after traditional treatment protocols. In comparison to patients scoring low on spiritual experiences (scale focuses on a wide definitions of spirituality) those scoring high on spiritual experiences showed a moderate decrease in pain symptoms Kass et al. (1991).

In the Handbook of Religion and Health Koenig, McCullough, and Larson summarize that “psychological and social factors strongly influence the experience of physical pain. The “gate theory” of pain suggests a physiological mechanism for producing this effect. Because of the strong relationship between religiousness and psychosocial factors, a similar association may exist between religion and pain.” (p. 357).

Hypertension

Hypertension is a common life threatening disorder that can lead to coronary heart disease, stoke, congestive failure, diabetes, and renal dysfunction. Hixson, Gruchow, and Morgan (1998) carried out multiple regression path analyses to determine the direct and indirect effects of religiosity on blood pressure. The direct effects of religiosity on systolic blood pressure (SBP) and diastolic blood pressure (DBP) were more substantial than the indirect effects through the intermediate health variables, though not significant. In general, DBP was more influenced by religiosity than SBP, and the dimensions of intrinsic religiosity and religious coping were most influential, although again not statistically significant.

Koenig, George et al. (1998) explored the relationship between religious activities and blood pressure in older adults in a probability sample of 3,963 persons age 65 years or older. Cross-sectional analyses revealed small (1-4 mm Hg) but consistent differences in measured systolic and diastolic blood pressures between frequent (once/wk) and infrequent (< once/wk) religious service attenders. Lower blood pressures were also observed among those who frequently prayed or studied the Bible (daily or more often). Blood pressure differences were particularly notable in Black and younger elderly, in whom religious activity at one wave predicted blood pressures 4 years later. Among participants who both attended religious services and prayed or studied the Bible frequently, the likelihood of having a diastolic blood pressure of 90 mm Hg or higher was 40% lower than found in participants who attended religious services infrequently and prayed or studied the Bible infrequently (OR 0.60, 95% CI, 0.48-0.75, p<.0001). Among participants told they had high blood pressure, religiously active persons were more likely to be taking blood pressure medication; this could not, however, explain the differences in blood pressure observed. While most religious activity was associated with lower blood pressure, those who frequently watched religious TV or listening to religious radio actually had higher blood pressures. The role of a sedentary life style is quite evident in this study. The variance in results for systolic and diastolic pressures need to be examined.

Benson (1977) in a review of literature on hypertension and relaxation response reported that both yoga and meditation showed reduction in systolic and diastolic blood pressure. Alexander, Schneider et al. (1996) comared five hypertension risk measures (obesity, alcohol use, physical inactivity, dietary sodium potassium racial, and a composite measure) with transcendental meditaion. Transcendental meditation, in both high and low risk groups, significantly declined systolic and diastolic pressures compared with control subjects. Koenig and colleagues (2001) in their review of literature summarize “of the 16 studies that have examined the relationship between level of religious involvement and blood pressure, 14 (88%) found lower blood pressure among the more religious; diastolic blood pressures, in particular, are lower among religious than among non-religious subjects. Furthermore, certain religious practices, such as meditation, may directly lower blood pressure by inducing a relaxed state (p. 263). Ai, Dunkle, Peterson, and Bolling (1998) demonstrated that after controlling for post-cardiac surgery depression, social support, and number of other illnesses, prayer was associated with less current psychosocial distress (F=8.4, p<.005).

Levin, and Vanderpool (1989) reviewed seven blood pressure studies conducted between 1960 and 1987; all but 1 found that religious commitment was associated with lower blood pressure. They also reviewed studies that look at religious affiliation and reported that highly devout groups that restrict certain behaviors or diets have lower blood pressures and hypertension-related diseases. Rates of CAD vary across religious groups. (Koenig et al. 2001, p. 249). Levin and Vanderpool (1989) porposed that a salutary effect of religion on blood pressure might result from some combination of a variety of biological, social, psychological, and behavioral factors, including promotion of beneficial healthy lifestyle behaviors, hereditary predispositions in particular groups, healthful coping and social support effect of religious practice; benefical psychodmnamics of particlar religious beliefs systems, religious rites, and faith. Koenig et al. further state, “it is likely that diet, health behaviors, and quality of social and family life account for much of this lowered risk.”

Future directions

The above optimism regarding the religon-helath link, however, is not shared uniformly by health professionals. While the bulk of the studies are thus generally suggestive of the beneficial effects of religious practices on health, this area of research is not without its share of controversy. A few surveys do call into question the validity of the above claims on methodological grounds. For example, Sloan and Bagiella (2002) critically examined the claim made in many published articles that religious people tend to be healthier. They observed: “Of the 266 articles published in the year 2000 and identified by Medline search, only 17% were relevant to claims of health benefits associated with religious involvement. About half of the articles cited in the comprehensive reviews were irrelevant to these claims. Of those that actually were relevant, many either had significant methodological flaws or were misrepresented, leaving only a few articles that could truly be described as demonstrating beneficial effects of religious involvement. We conclude that there is little empirical basis for assertions that religious involvement or activity is associated with beneficial health outcomes. The evidence for the relationship between prayer and health is, in some sense, inconclusive.”

Such criticisms notwithstanding, the evidence of the relationship between religious practices, especially prayer, and health is highly suggestive, even if inconclusive at this time. A good deal of skepticism is prompted by the Western scientific mindset that looks with suspicion at anything that smacks of religion or spirituality, which is seen as antithetical to science. There is also a real fear of straying into the realm of the supernatural. The Indian mindset is somewhat different. In the native Indian tradition, there is no separation of science and spirituality, no dichotomy between natural and the so-called supernatural. For many in India the putative positive effect of prayer on health and well-being is by no means surprising. It is not uncommon in India to offer prayers and engage in worship to overcome illness and misfortune. One wonders if these practices would have lasted as long as they did without reinforcement in real life. Of course, superstitions also survive for centuries; but then they too might have a useful role when not dysfunctional.

If religious involvement does have beneficial health outcomes, as many of the published reports seem to suggest, then we may ask: How does this relationship work? What is its modus operandi, the process that underlies the presumed effect? What is the channel? Who is the source? These important, though often tricky, questions have no easy answers. The favored explanation is a secular one. Religious beliefs and practices may have psychological effects, which in turn bring about somatic changes. If indeed religious beliefs and activities help to reduce anxiety, stress and depression, they could also help to shield their negative effects on general health and well-being.

As Koenig (2001) and Koenig, Larson and Larson (2001) surmise, when people become physically ill, many rely heavily on religious beliefs and practices to relieve stress, retain a sense of control, and maintain hope and sense of meaning and purpose in life. It is suggested that religion (a) acts as a social support system, (b) reduces the sense of loss of control and helplessness, (c) provides a cognitive framework that reduces suffering and enhances self-esteem, (d) gives confidence that one, with the help of God, could influence the health condition, and (e) creates a mindset that helps the patient to relax and allow the body to heal itself. Again, the values engendered by religious involvement such as love, compassion, charity, benevolence, and altruism may help to successfully cope with debilitating anxiety, stress, and depression. All this may be true. Yet, there are issues that go beyond these explanations. For example, if the observed effects of distant intercessory prayer on the health of patients, who did not even know that someone was praying for them, are genuine, as they seem to be, the above secular explanations become clearly inadequate. We need more than a healthy mindset on the part of the patient to recover from illness. There may be more to religion than being a social and psychological support system.

Clearly, this area needs further investigation. Studies in different religious groups and across different cultures having different lifestyles and worldviews should throw some more light on the efficacy of religion as a contributory factor in mediating health benefits. In the Indian context, prayer is such an integral part of our lives that we have never questioned its validity. We have failed to recognize it as an area of scientific inquiry, not only to address the validity issue, but also the dynamics of prayer and its influence on the individual. It may be stated that it amounts to studying the obvious. However, that which is “obvious” also needs understanding. More so in the Indian cultural context where beliefs and rituals govern every aspect of our daily lives. There is tremendous investment, in all interpretations of the term, in this universal endeavor.

The Institute for Human Science & Service is exploring this area by undertaking a research that explores the spirituality/religion-health relation in a study that aims to investigate the extent of religious coping among college students and its influence on their general well-being and happiness, and in coping with depression. It further aims to explore the effect of religious beliefs and practices on patients suffering from diabetes, hypertension, arthritis, and migraine. This study is an attempt to replicate results obtained from a predominantly Judeo-Christian background to a Hindu sample. Aside from the question of prayer per se, the results otained will shed some light on the influence of different philosophies on coping with illness.

References:

Abraido-Lanza, A. F., Guier, C., & Revenson, T. A. (1996). Coping and social support resources among Latinas with arthritis. Arthritis Care and Research, 9(6), 501-508.

Ai, A. L., Dunkle, R. E., Peterson, C., & Bolling, S. F. (1998). The role of private prayer in psychological recovery among midlife and aged patients following cardiac surgery (CABG). Gerontologist, 38, 591-601.

Alam, M. M, Rama Rao B. (1998) Religious practices in South India to cure diseases. Bull Indian Inst Hist Med Hyderabad, Jan;28(1):1-5

Alexander, C. N., Schneider, R. H., Staggers, F., Sheppard, W., Clayborne, B. M., Rainforth, M., Salerno, J., Kondwani, K., Smith, S., Walton, K. G., Egan, B. (1996). Trial of stress reduction for hypertension in older African Americans. II. Sex and risk subgroup analysis. Hypertension 28(2):228-237.

American Psychiatric Association. (1994) Diagnostic and statistical Manual of Mental Disorders. 4thed.  Washington DC: Author.

Benson, H. (1977). Systemic hypertension and the relaxation response. New England Journal of Medicine, 296, 1152-1156.

Bergin A. E. (1980). Psychotherapy and religious values. Journal of Consulting and Clinical Psychology; 48:95–105. [PubMed Citation]

Braam, A. W., Beekman, A. T. F., Eeden P., Deeg, D. J. H., Knipscheer K. P. M., Tilburg W. (1998). Religious denomination and depression in the older Dutch citizens. Journal of Aging and Health, 10, 483-503

Braam, A. W., Beekman, A.T.F., van Tilburg, T.G., Deeg, D.J.H., & van Tilburg, W. (1997). Religious involvement and depression in older Dutch citizens. Social Psychiatry and Psychiatric Epidemiology, 32, 284-291.

Carlson, C.R., Bacaseta, P.E., Simanton, D.A. (1988). A controlled evaluation of devotional meditation and progressive relaxation. Journal of Psychology and Theology, 16, 362-368.

Caro, I., Miralles, A., & Rippere, V. (1983). What's the thing to do when you're feeling depressed? A cross-cultural replication. Behavior, Research, and Therapy, 21, 477-483.

Commerford, M. C., & Reznikoff, M. (1996). Relationship of religion and perceived social support to self-esteem and depression in nursing home residents. Journal of Psychology, 130, 35-50.

Ellis, A. (1980). Psychotherapy and aesthetic values: A response to A. E. Bergin’s “Psychotherapy and religious values.” Journal of Consulting and Clinical Psychology, 48, 635-639.

Ellison, C.G. (1992). Are religious people nice people? Evidence from the National Survey of Black Americans. Social Forces, 71, 411-430.

Ellison, C. G. (1994). Religion, the life stress paradigm, and the study of depression. In J.S. Levin (ed.), Religion in Aging and Health: Theoretical Foundations and Methodological Frontiers. Thousand Oaks, CA: Sage, pp 78-121.

Fehring, R. J., Brennan, P. F., & Keller, M. L. (1987). Psychological and spiritual well-being in college students. Research in Nursing & Health, 10, 391-398.

Fernando, S. J. M. (1975). A cross-cultural study of some familial and social factors in depressive illness. British Journal of Psychiatry, 127, 46-53.

Ferraro, K. F., & Albrecht-Jensen, C. M. (1991). Does religion influence adult health? Journal for the Scientific Study of Religion, 30, 193-202.

Freud, S. (1907/1962). Obsessive Acts and religious practices. In: Strachey J (editor and translator). Standard edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth Press.

Freud, S. (1927/1962) Future of an illusion. In: Strachey J (editor and translator). Standard edition of the Complete Psychological Works of Sigmund Freud.. London: Hogarth Press.

Gartner, J., Larson, D. B., Allen, G. (1991). Religious commitment and mental health: A review of the empirical literature. Jouranl of Psychology and Theology. 19(1), 6-25.

Gee, E. M., and Veevers, J. E. (1990). Religious involvement and life satisfaction in Canada. Sociological Analysis, 51, 387-394.

Glass, T. A., Mendes de Leon, C., Marottoli, M. A., Berkman, L. F. (1999). Population based study of social and productive activities as predictors of survival among elderly Americans. British Medical Journal, 319:478–85.

Helm, H., Hays, J. C., Flint, E., Koenig, H.G., Blazer, D. G. (2000). Effects of private religious activity on mortality of elderly disabled and nondisabled adults. Journal of Gerontology (Medical Sciences), 55A, M400-M405. [PubMed Citation]

Hixson K. A., Gruchow, H. W., Morgan, D. W. (1998). The relation between religiosity, selected health behaviors, and blood pressure among adult females. Preventive Medicine. 27, 545-552.

Hummer, R., Rogers, R., Nam, C., Ellison, C. G. (1999). Religious involvement and US adult mortality. Demography; 36:273–85. [PubMed Citation]

Jung, C. (1963). Modern man in search of soul. New York: Harcourt Brace Jovanovich, 1933.

Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163-190.

Kass, J. D., Friedman, R., Leserman, J., Zuttermeister, P. C., Benson, H. (1991). Health outcomes and a new index of spiritual experience (INSPIRIT). Journal for the Scientific Study of Religion, 30, 203-211.

Koenig, H. G. (1998). Handbook of religion and mental health. San Diego, CA: Academic Press,

Koenig, H. G., George, L K, Cohen, H. J., Hays, J. C., Blazer, D. G., Larson, D. B. (1998). The relationship between religious activities and blood pressure in older adults. International Journal of Psychiatry in Medicine, 28, 189-213.

Koenig, H. G., George, L K, Peterson, B, L. (1998). Religiosity and Remission of Depression in Medically Ill Older Patients. American Journal of Psychiatry, 155(4), 536-542.

Koenig, H. G., Larson D. B., Larson, S. S. (2001) Religion and coping with serious medical illness. Annals of Pharmacotherapy, Mar;35(3):352-9. [PubMed Citation]

Koenig, H. G., McCullough, M. E.,and Larson, D. (2001). Handbook of religion and health.  NY: Oxford University Press.

Koenig, H. G. and Larson, D. B. (1998). Encyclopedia of Mental Health. Vol. 3. Academic Press.

Koenig, H. G., Hays, J.C., Larson, D.B., George, L.K., Cohen H.J., McCullough, M.E., Meador, K.G., and Blazer, D.G. (1999). Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults. Journal of Gerontology: Medical Sciences, 54A(7), M370-M376. [PubMed Citation]

Larson, D. B., Larson, S. S., Koenig, H. G. (2001). Longevity, and religion: does research find a link? Annals of Pharmacotherapy.

Larson, D. B., Larson, S. S. and Koenig, H. G. (2001). The patient’s spiritual/religious dimension: A forgotten factor in mental health. Directions in Psychiatry, 21 (21), 306-334.

Lee, G. R., & Ishii-Kuntz, M. (1987). Social interaction, loneliness, and emotional well-being among the elderly. Research on Aging, 9, 359-482.

Levin, J. S., & Vanderpool, H. Y. (1987). Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Social Science & Medicine, 24, 589-600.

Levin, J. S., & Vanderpool, H. Y. (1989). Is religion therapeutically significant for hypertension? Social Science & Medicine, 29, 69-78.

Marar, Ziyad (2003), The Happiness Paradox . London: Reaktion Books,

McBride, J. L., Arthur, G., Brooks, R., Pilkington, L. (1998). The relationship between eight patients spirituality and health experiences. Family Medicine, 30 (2),122-126.

Moberg, D. O. (1965). Religion in old age. Geriatrics, 65; 20:977–82. [PubMed Citation]

Mueller, P. S., Plevak, D. J., Rummans, T. A. (2001) Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clinic Proceedings, 76(12): 1189-91 [PubMed Citation]

Myers, D.G., & Diener, E. (1995). Who is happy? Psychological Sciences, 6, 10-19.

O'Laoire, S. (1997). An experimental study of the effects of distant, intercessory prayer on self-esteem, anxiety, and depression. Alternative Therapies in Health and Medicine, 3(6), 38-53.

Oman D, Reed D. (1998). Religion and mortality among the community-dwelling elderly. American journal of Public Health, 88:1469–75.

Pargament, K. I., Koenig, H..G., Tarakeshwar, N., Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A two-year longitudinal study. Archives of Internal Medicine, 161, 1881-1885. [PubMed Citation]

Pecheur, D., & Edwards, K.J. (1984). A comparison of secular and religious versions of cognitive therapy with depressed Christian college students. Journal of Psychology and Theology, 12, 45-54

Poloma, M. M., & Pendleton, B.F. (1990). Religious domains and general well-being. Social Indicators Research, 22, 255-276.

Poloma, M. M., Pendleton, B. F. (1989). Exploring types of prayer and quality of life: A research note. Review of Religious Research, 31, 46-53.

Poloma, M. M., & Pendleton, B. F. (1991). The effects of prayer and prayer experiences on measures of general well-being. Journal of Psychology and Theology, 19, 71-83.

Propst, L. R. (1980). The comparative efficacy of religious and nonreligious imagery for the treatment of mild depression in religious individuals. Cognitive Therapy and Research, 4, 167-178.

Propst, L. R., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992). Comparative efficacy of religious and nonreligious cognitive-behavior therapy for the treatment of clinical depression in religious individuals. Journal of Consulting and Clinical Psychology, 60, 94-103.

Rasmussen, D. (2004). Review essay: Living with paradox. Philosophy and Social Criticism, 30 (4), 515–517.

Sanua, V. D. (1969) Religion, mental health, and personality: a review of empirical studies. American Journal of Psychiatry; 125:1203–13. [PubMed Citation]

Shaffer, J. A. (1978). Pain and suffering: Philosophical perspectives. In W. T. Reich (ed.), Encyclopedia of Bioethics, Vol. 4 (pp.1181-1185). New York: Free Press.

Shuler, P. A., Gelberg, L., & Brown, M. (1994). The effects of spiritual/religious practices on psychological well-being among inner city homeless women. Nurse Practitioner Forum, 5(2), 106-113.

Sloan, R. P., Bagiella, E. (2002) Claims about religious involvement and health outcomes. Annals of Behavioral Medicine, Winter;24(1):14-21

Steffen, P. R., Hinderliter, A. L., Blumenthal, J. A., and Sherwood, A. (2001). Religious coping, ethnicity, and ambulatory blood pressure. Psychosomatic Medicine, 63, 523-530. [PubMed Citation]

Strawbridge, W. J., Cohen, R. D., Shema, S. J., Kaplan, G. A. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health; 87:957–61.

Strawbridge, W. J., Shema, S. J., Cohen, R. D., Roberts, R. E., Kaplan, G. A. (1998). Religiosity buffers effects of some stressors on depression but exacerbates others. Journal of Gerontology: Social Sciences, 53, S118-S126.

Townsend, M., Kladder, V., Ayele, H., Mulligan, T. (2002) Systematic review of clinical trials examining the effects of religion on health. Southern Meedical Journal, Dec;95(12):1429-34 [PubMed Citation]

Tu, W. (1980). A religiophilosophical perspective on pain. In H. W. Koster, D. Kosterlitz, and L. Y. Terenius (eds.), Pain and Society, (pp. 63-78).

Veach, T. L., & Chappel, J. N. (1992). Measuring spiritual health: A preliminary study. Substance Abuse, 13, 139-147.

Watters, W. (1992). Deadly doctrine: health, illness, and Christian god-talk. Buffalo, N.Y.: Prometheus