Come all ye faithful

Published: 20/12/2001, Volume III, No.5786 Page 24 25

At a time when formal religious observance is diminishing in the UK, interest is growing among healthcare professionals in matters religious and spiritual.New-age and complementary therapies are flourishing, the number of NHS chaplains has more than doubled, and there is interest in the spiritual duties of healthcare staff, particularly nurses, in relation to patient care.

Research suggests that a spiritual belief system can affect physical and mental health, with benefits ranging from extended life-expectancy to increased success in heart transplants and reduced pain levels in cancer sufferers (see box).

Most research on the effect of spirituality on health has focused on religious beliefs and communities rather than non-specific, non-religious spirituality.

‘Religion’ has generally been equated in the western world with theistic Jewish and Christian religious forms, rather than traditions such as Buddhism and Hinduism. But the findings might well apply to other religions and less specific types of spirituality.

Positive correlation between spirituality and health is not surprising.Medicine and health psychology are developing a holistic understanding of patients in which their physical, emotional and spiritual needs are interlinked. For example, the field of psychoneuro-immunology has exposed how psychological factors can affect the risk of suffering from particular immune-related diseases.And in psychiatry, the lines between the biological, psychological and sociological aetiology and treatment of mental health problems are blurring.

‘Spirituality’ is often used as a more inclusive substitute for the word religion.Definitions are various, fluid and imprecise. Spirituality can be understood as that aspect of human existence which relates to structures of significance that give meaning and direction to a person’s life and helps them deal with the vicissitudes of existence. It is associated with the human quest for meaning, purpose, selftranscending knowledge, meaningful relationships, love and a sense of the holy. It may, or may not, be associated with a specific religious system.

Spirituality offers a powerful interpretative framework within which an individual can:

• make sense of their experiences (including illness);
• develop a sense of relational connection with the transcendent, self and others;
• cope and heal in ways often unavailable from more established therapeutic sources.

When spirituality is expressed within a specific religious framework, other health-related dimensions emerge. Religions provide shared rituals, narratives, symbols and guidance through scriptures, prayer and modes of social support - all shown to contribute to the development and maintenance of mental and physical health.

It has been suggested that religion lowers stress and dissipates long-term effects of stress on the immune and cardiovascular systems.

Studies of the impact of prayer and meditation support the view that stress reduction is an important health benefit, particularly for women.

1Another factor consistently related to better health is involvement within a religious community.

Religious people are less likely to abuse alcohol or drugs, smoke, engage in dangerous sexual practices or risk-taking behaviours.

2Being part of a faith community enables regular close contact with valued others, and the experience of being valued helps build self-esteem and healthy coping strategies. It has been shown to reduce significantly the risk of suicide in young people and the likelihood of depression and anxiety, particularly among women. And adherence to a particular faith tradition realigns an individual’s thinking and can enable them to cope constructively with trauma and illness, though the implications of this for health depend on how the religious coping manifests itself. In the collaborative style of coping, God is seen as a partner sharing the burden in a constructive way. This is correlated with good health and healthy coping.

In the deferring style, the individual hands over all responsibility for their problems to God. In times of trouble they do not act, but wait for God to act in a protective fashion. This is correlated with poor health and an inability to cope with trauma and change.

In the self-directing style of coping, the person assumes full responsibility for their actions and considers themselves capable of solving problems.

While not in itself necessarily negative, it does not use the health-bringing aspects of a God-image shown to be effective in collaborative coping.

Clearly, religion appears to have considerable therapeutic potential. But like any powerful belief system, religion and other expressions of spirituality also have potential for harm, for example when they:

• are used to justify hatred, aggression and prejudice;
• are judgmental, restricting and exclusive;
• encourage inappropriate feelings of guilt;
• replace mainstream medical care.
• become associated with a negative God image and deferring coping styles.

4,5,6 If religion and spirituality are to be understood and therapeutically incorporated into healthcare, it is necessary to hold in tension these potentially negative dimensions with the documented health benefits.

The Patient’s Charter states the right of health service users to have their spiritual needs recognised and addressed.But there is a lack of clarity about the nature and definition of religion and spirituality.

While there is clear evidence that religion is often a positive force for health, more research is needed - in particular into the effects of different religious traditions on health and wellbeing; ways in which spirituality and religion affect people’s lives and reactions and experiences of illness; and the possibilities for health promotion.

We also need research into how the health service might deal more effectively with these dimensions in the lives of service users.And if spirituality and religion do prove inevitable and generally positive factors in human lives, we should also look at the spiritual needs of healthcare workers, perhaps making their occupation more healthy. l John Swinton is senior lecturer in practical theology at Aberdeen University and a registered mental health nurse.Stephen Pattison is professor in religious and theological studies at Cardiff University and a former healthcare chaplain.

Key points A growing body of research suggests that religion and spirituality can have a positive effect on mental and physical health.

Like any other powerful belief system, they also have potential for harm.

Further research is needed if they are to be understood and therapeutically incorporated into healthcare.

REFERENCES

1Loewenthal KM.Mental Health and Religion.

Chapman and Hall, 1995.

2Koenig HG (Ed).

Handbook of Religion and Mental Health. Academic Press, 1998.

3Pergament KI. Psychology of Religion and Coping: theory, research, practice.The Guilford Press, 1997.

4Allport GW, Ross M.

Personal religious orientation and prejudice.

J of Personality and Social Psychology 1967; 5 (4): 432-443.

5Hartz GW, Everett HC.

Fundamentalist religion and its effect on mental health.

J of Religion and Health, 1989; 28(3): 207-217.

6Asser SM, Swan R. Child fatalities from religionmotivated medical neglect.

Pediatrics 1998; 101 (4): 625-629.

Mind over matter: the published studies l Religion has been associated with the prevention of cardiovascular disease, reduced serum cholesterol levels and reduced myocardial infarction - attributed to the stress reduction inherent in membership of a devout community.

Koenig HG. The Healing Power of Faith: science explores medicine’s last great frontier. New York: Simon and Schuster, 1999.

Religion and spirituality have been associated with increased success in heart transplants, reduced pain levels in cancer sufferers, increased longevity among elderly people and reduced mortality after cardiac surgery.

Larson DB, Swyers JP, McCullough M. Scientific Research on Spirituality and Health: a consensus report. National Institute for Healthcare Research, 1997.

A meta-analysis identified 42 studies showing a link between church attendance and other forms of worship and measures of reduced mortality.This was explained by healthier lifestyles, increased social support, enhanced coping resources and the stress-relieving dynamics of receiving strength and comfort from religious faith.

McCullough ME, Hoyt WT, Larson DB, Koenig H, Thoresen C. Religious involvement and mortality: a meta-analytic review. Health Psychology 2000;19(3): 211-222.

A study showed the risk of diastolic hypertension was 40 per cent lower in people who attended religious services at least once a week and prayed or studied the Bible at least daily.

Koenig HG et al. The relationship between religious activities and blood pressure in older adults. Int J of Psychiatry in Medicine 1998; 28 (2):189-213.

Church attendance has been correlated with improved immune functioning and protection from certain stress-related diseases.One study found that those who attended church at least once a week were half as likely as non-attenders to have elevated levels of interleukin-6, an immune system protein involved in a range of age-related disease.

Koenig HG, Cohen HJ, George LK, Hays JC, Larson DB, Blazer DG.

Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults. International J of Psychiatry in Medicine 1997; 27 (3): 233-250.

Evidence suggests religion and spirituality are good for mental health.Benefits include protection from depression and anxiety, improved self-image and self-esteem, positive cognitive alignment and access to prayer, meditation and other forms of stress-relieving symbols and rituals.

Swinton J. Spirituality in Mental Health Care: rediscovering a forgotten dimension. Jessica Kingsley Publishers, 2001.

Research into depression in women in the Outer Hebrides showed those with some sort of religious connection (assessed by their level of church attendance) were less likely to become depressed than those without a church connection.The religious community seemed to protect from the effects of social isolation, provide and strengthen family and social networks, give a sense of belonging and self-esteem and offer spiritual support in times of adversity.

Prudo R, Harris T, Brown GW. Psychiatric disorder in a rural and an urban population: 3. Social integration and the morphology of affective disorder.

Psychol Med 1984; 14 (2): 327-345.