research paper about religious

Religion Research Paper

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Introduction

Development of religion and belief, early explanations for religion and belief, eastern and western traditions, christianity, religious objects, symbols, and rituals, religion, manuscripts, and teachings, future directions.

• Bibliography

Religion and belief are of great importance for anthropological research on the development of humankind and its history, as they represent the human reaction to an extrahuman, holy, transcendent, or divine object. Almost no other terms of the mental and intellectual human life seem to have such a big and colorful variety as “belief ” or “religion.”

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At first, a look into the past: The term religion has its etymologic and historical roots in the ancient Roman world. A different context can be found for the terms personal belief or universal faith; they have their semantic origin in the Greek word pístis, which Saint Paul used in his letters, or in the Latin fides. Whereas religion gives the framework, belief fills this framework with individual religious activities. Faith means the universal religious activity of a group of people of the same religion. The Latin noun religio stems from the verb re-legere, which has the meaning “to do something diligently, to do something again, to re-read something,” according to Marcus T. Cicero (106–43 BCE). The prefix re- could even be translated as “to do something diligently again and again.” The careful execution of rituals was prescribed by rules, which were only valid through their exact observance. Therefore in the ancient Roman culture, the Latin noun religio expresses the right observance of cults and, as a consequence, the respect for the gods. The verb re-legere is the opposite of the verb neg-legere (to neglect).

The derivation of the noun religio from religare (to connect, to reconnect) is in general problematic, because this reconnection can be seen in a feeling of an inner attachment to something transcendent, which was not common to classical beliefs. In its character, religio is in Roman antiquity rather a virtue than a kind of feeling. Central in the diligent performance of rituals was a kind of “pious awe,” which was not so intensive that the acting person in religious affairs was moved inside. This is one of the reasons why ancient Roman religio is basically incomprehensible to us. Nowadays, the adjective religiosus means “pious.” In a later development, homo religiosus means “member of an order,” a person who lives according to the three evangelical counsels: poverty, chastity, and obedience. This person wants to be, in his religious life, a good example to others. It was this meaning of the word pious (religiosus) that brought the noun religion into the Christian-shaped, Western culture, and less the Latin noun religio, in the ancient Roman sense.

To exhaust the full meaning of religion or belief, it is not sufficient to speak only of devoutness or “expression of devoutness.” Religion and belief also cover the sentence fides quaerens intellectum (faith or belief that searches for insight). Therefore, it has also to do with rationality and the search for reasonable causes. Saint Augustine (354–430 CE), as an exponent of Christian antiquity, and Saint Thomas Aquinas (ca. 1224/5–1274 CE), as a philosopher of high scholasticism, shaped the concept of religio as identical with Christianity. Other, non-Christian religions or beliefs could only be classified as lex, secta, or fides.

The meaning of the term lex is universal, according to our expression “denomination” or “total structure of life.” There is also a lex Christianorum, which means “doctrine and law of the Christian faith.” By no means is the forming of the concepts “religion” and “belief ” steady or logical. Within the historical development, beginning with classical antiquity up to the advent of Protestantism in the 16th century, it is not possible to find a strictly continuous development to the modern term religion . So, religio cannot be translated by or equated with religion or belief in today’s meaning.

If the Christian context of the word religion is left aside, then religion and also belief can be defined as the relationship of a human to a personal or impersonal transcendent, in whatever shape of “the Real”: a divine persona or impersona. The meaning of the Western terms religion or belief , influenced by Christian thoughts, changes in other European and non-European languages from “something that is owed to the transcendence” to “law/doctrine” and “eternal, never-ending structure.”

As a result, the term religion is more objective than the rather subjective term belief . Also, the concepts of belief— characterized as individual, personal belief, or conviction— and faith—characterized as universal belief—can be differentiated. Religion is in general the system of faith that people of the same conviction have in common. Belief is the personal activity, the “personal” faith, within the framework of religion. Belief system is very near to religion, but it emphasizes the personal religious activity more than universal faith.

After this etymological study, the paradigmatic development of the modern terms religion and belief will now be described in order to give a contemporary view on them. A religion that prescribes a belief in a deity of imaginable terms is marked as rational, according to the Lutheran theologian and historian of comparative religion Rudolf Otto. In his classic work, The Idea of the Holy (1917/1925), Otto also asked for the objectivity of religion or belief, and emphasized the “contrast between Rationalism and profounder religion.” One cannot do justice to religion or belief only by rational terms. The two opposite characterizations of religion are, as Otto pointed out, the tremendum, or the “awefulness,” and simultaneously the fascinans, or the “fascinating.” The tremendum shakes people in awe in sight of the mysterious, completely different being, God. This form of fear is by far different than the “natural,” or ordinary fear of a human, and applies more to the general “world-fear.” The tremendum derives from a “numinous dread” that terrifies and fascinates people at the same time.

The Romanian historian of religion Mircea Eliade, who worked at the University of Chicago, addressed Rudolf Otto’s reflections at the beginning of his book The Sacred and the Profane (1957/1959). Eliade focused on the nature of religion or belief, describing the manifestations of religion and the religious in a world that dissociates itself more and more from religious dimensions. But even in a secular world, there is something sacred that is characterized by humans as the opposite of the profane. The process is always the same: the “completely different” is a reality that is not of our world and manifests itself on things that are components of our natural, profane world.

Eliade repeatedly spoke of homo religious, and he wanted to make clear that religion and belief belong to the human nature. Therefore, people live as long as possible in the sacred universe. By the word sacred, the dimension of the religious is described. This dimension surrounds, carries, and holds the human as a religious being. On the other side, a secular person, who is able to live without any religious feeling, has a completely different, secular experience of the universe. She lives in a desacralized world. The religious feeling has to find its way by another, maybe hidden means. The secular person lives totally differently from the homo religious.

Almost 150 years earlier than Eliade, Friedrich D. E. Schleiermacher, a German Lutheran theologian and philosopher, classified religion and belief as a “feeling,” as the French philosopher Jean-Jacques Rousseau did before him. Schleiermacher called religion a “feeling of infinity” in his second speech, “On the Nature of Religion,” of his five speeches appearing in On Religion (1799/1996).

The German philosopher of the Age of Enlightenment, Immanuel Kant, stood in strong contrast to the definition of religion or belief as “feeling.” In his work Religion Within the Boundaries of Mere Reason (1793/1998), Kant proved that there was no way to conclude the certain feature of direct divine influence by a feeling. Hence, according to Kant, religion must be based on reason alone in order to be universal. For Kant, religion had to be a “pure religion of reason.” Although these two characterizations of religion as a “feeling” (Schleiermacher) or as a “pure religion of reason” (Kant) are opposing, these two definitions of religion may be coincident in the fact that religion or belief is something according to human nature. Therefore, around the year 1800, a concept of internal religion developed, which remains effective today.

Statements on religion or belief by the Protestant theologians Ernst Troeltsch (1912/1981) and Paul Tillich (1955, 1961/1988) underlined this fact. In another way, Tillich’s works can be regarded as examples of the effective power of the concept of religion or belief. In a different approach to Immanuel Kant, he distanced himself to consider “feeling” as the basic determination of religion. If religion could be connected to the pure subjectivity of emotion, then it would decline, because religion would loose its seriousness, its truth, and its highest sense. Without a highest content, religion would stay empty. In his essay “Religion as a Function of the Human Mind?” (1955/1988), Tillich defined religion as “something that concerns us immediately,” in the deepest sense of the universe. That which “concerns us immediately” referred to all creative functions of the human mind. However, this did not mean that religion and belief are fictions of the mind, created by human beings.

According to Tillich, the human mind is able to be creative in relation to both itself and to the world. But this creativeness is limited by the relationship to God. Religions and beliefs contain all areas of the human life and of the mind, as they build the substance, the basis, and the depth of the human intellectual life. Therefore religion or belief is not based on a function of the mind at all. Religion is universal; belief is individual. They are consequently the unconditioned components in every situation of human life. Being moved by religion is always related to a religious object. In this context, Tillich emphasized two points: (1) Religion and belief are always related to a content, which cannot be explained in the end; and (2) religion has always a social dimension, too. Nobody is alone in being religiously moved or in feeling any kind of religious emotion. Therefore, the objectivity of religion is founded by its social dimension, according to Tillich. As a consequence, religion and belief are situated in the human being, who is touched by a “revealed unconditioned being,” by a religious object. This can generally be applied to everyone. “Religious reality,” however, goes along with a secret consciousness: tua res agitur, “your situation is concerned.”

Two definitions of the concept of religion can be found in Tillich’s work. Both differ crucially from the traditional one—religion or belief as the human answers to the transcendent. (1) Tillich spoke of an “autonomous religion” that does not know a representational God, nor, consequently, any form of prayer. But in contradiction to that, religion is not impious or lacking a God. It just does not know any kind of ecclesiastical objectification of God. With mysticism, it is different again, because mysticism elevates itself beyond the objectification of God. (2) In his later essay, “Christianity and the Encounter of the World Religions” (1961/1988), Tillich mentioned quasireligions, which are similar to religions and have some features in common with religions. But quasireligions are only related to secular objects and consequently to secular institutions. Tillich differentiates between quasireligions and pseudoreligions. Both pretend intentionally to be similar to religions. The expansion of the concepts of religion or of belief as inward phenomena, which have been developed since the beginning of the 19th century, became clear in Tillich’s considerations.

The two concepts of quasireligions and pseudoreligions must be strictly distinguished from traditional, historical religions. Similar to quasireligions is what Eric Voegelin (1938/1999) and Raymond Aron (1965/1968) spoke of as political religion. An explosive nature is exhibited in the relationship between religion and politics, as it is demonstrated in the concept of political religion, and later on in the concepts of state religion or civil religion. The term political religion has its roots in religio politica, going back to the early 17th century. Since the 1930s, it served to classify the politicaltotalitarian mass movements of this time in a critical attitude toward ideology. This modern “political religion,” however, must be clearly distinguished from the “political religion” of classical antiquity and the later concepts of state religion and civil religion, which tried to institutionalize the relationship between religion and politics, not always in a fruitful way.

Generally speaking, it is possible to identify religion or belief as being situated in a person. Religion or belief must be further defined as a relationship and interchange between a human being and transcendent reality, which is relevant for humans. But the relationship to transcendence is not the only decisive criterion for a religion or a belief. Religions and beliefs are rather connected by a kind of “family resemblance,” as defined by Ludwig Wittgenstein (1953/2001). They are determined by overlapping qualities, including holiness, prayers, and services. Religions and beliefs also show similarities that connect them. These similarities, however, must not necessarily be alike in every religion or belief. Regarding those similarities, the reference to transcendence plays, of course, an important role. John Hick (2005) pointed out that another fundamental “family resemblance” of religions and beliefs, in addition to their reference to the transcendence, is their soteriological content, which describes the ability of a religion or belief to redeem human souls and allow salvation. However different their contents and traditions may be, this soteriological quality is a feature that all religions and beliefs have in common in various manners. Also, the validity of religious traditions was of great importance for Hick.

Religion and belief in the modern ideology can carefully be defined as generic terms, or concepts, which slowly have grown in importance in our modern age. These concepts are very different from the ancient meaning of the word religio, which first described all imaginations, attitudes, and actions of a person concerning the ultimate reality. Humans accept the ultimate reality as powers or a power, spirits or demons, gods or God, the “Sacred” or the “Absolute,” or just “Transcendence.” In ancient times, religio was not used as a collective name for each belief or as a universal term, in which various beliefs were summed up. The term religio, representing the past view on religion or belief, was used in a very narrow sense from antiquity up to the 16th century. At first, religio referred to the exercising of the rituals prescribed by law, but only later with regard to the Christian denomination. In general, it took a long time before religio and later “religion” had achieved their meaning, which led to the modern understanding of “religion.” Religion is more than the mere name of a personal belief. It expresses that humans are concerned about something beyond them. Also, death obtains a different meaning within a religious worldview. Romano Guardini (1940/1998), the Catholic priest, theologian, and philosopher of religion, considered death as the gate to the other side of human life, which remains secret to those who still live in this world. For religious people, death is no longer the end of life but, instead, is the turning point to a different reality.

Summing up, the terms religion and belief can be characterized by the following three points:

• There are no universal terms for all religions or beliefsystems of humankind in each epoch.
• There is no term that includes all aspects of what ismeant by religion or belief today. Even all these terms together cannot cover every aspect now meant by religion or belief.
• Earlier terms of religio or religion stand in contrast to themodern meaning of religion. They emphasize the external practice of religion, the observance of ritual instructions and regulations, and the obedience to religious laws.

These three points, however, cannot unambiguously classify religions or beliefs and they do not ultimately define them. But they do outline the broad frame of the modern concept of religion and belief.

Since ancient times, as many sources teach, people have had various religious or pseudoreligious systems. In the past, religions and beliefs were the result of natural phenomena, which led people to fear and to require that these natural phenomena be explained. Also, social facts and mechanisms had to be explained through religious patterns. Ancient Egyptian, Greek, and Roman religions show this function of early religions or belief systems. These religions and beliefs were polytheistic (i.e., there were many different gods, who had different things to take care of). In many cases, one god is honored as supreme among the others (e.g., Zeus in ancient Greek religion or Jupiter/Jove in ancient Roman religion). The holy or the deity was often linked with nature. Humans found in nature the powerful influence of God: Therefore trees or fountains or mountains (esp. the peak, like Mount Fuji in Japan) were adored as holy, or as the place where the deity lives. Also in totems, things of everyday life or symbols or even animals, the spirit of a deity is believed to be effective. Therefore, it is forbidden, it is a taboo, to kill an animal in which a deity is believed to be present. These original religious aspects can be found within African religions and beliefs, or within the religions of the Pacific islands.

In the Egyptian and Roman traditions, the emperor was adored as a god and found his place in the Pantheon after his death. Archaeological proofs of these ancient religions and belief systems can be found in the pyramids in Egypt, as well as in the ancient Roman temples around the Mediterranean Sea. From the onset of European culture, politics, religion, and society were interconnected within the ancient state, the Greek pólis or the Roman civitas. So religions and politics were interlinked in ancient European societies. Later on, these three aspects differentiated more and more. Today, politics, religions, and societies are almost separated, but one should be aware that humans are oriented toward religious belief, as civilians within a political state and a civil society. So it is useful to respect religion and belief even within a political point of view.

At the beginning of ancient Greek culture, the explanations for the reasons why the universe came to exist, and why it exists the way it does, were given in the myths of the writers Homer (ca. 8th century BCE) and Hesiod (ca. 8th century BCE). Next, there was a shift from mythos (myths) to lógos (reason). This shift can be found in the quotations and fragments of the pre-Socratic philosophers, who turned their interests toward nature and the reasons for natural phenomena. Thales of Miletus (ca. 624–546 BCE), for example, a philosopher of nature living on the Ionic coast (today’s Turkey), gave a precise forecast for a total eclipse by calculation, but people took him almost for a prophet, and, what is more, he could forecast a rich bearing of olives, so that he lent all the olive presses in his country for a small amount of money, and consequently he was able to borrow them for a very good price. The next step from myths to reason can be found in the philosophy of Plato (ca. 428/427–348/347 BCE), a disciple of Socrates (ca. 469–399 BCE). Plato underlined his arguments in his dialogues with myths, in order to explain them better to his disciples. Among them, there was another important philosopher, the educator of Alexander the Great, Aristotle (384–322 BCE). Aristotle was also very interested in investigating natural phenomena and in explaining the world by reason, not by myths.

The general aim of this early Greek philosophy was to explain the universe by using human reason rather than mythical explanations. As a result, the soul of a human should not be in a disturbed situation, but in a quiet state, which is characterized as eudaimonía (felicity). The early philosophical schools in ancient Greece always had the intention of caring for the soul by giving reasonable explanations for the universe and its existence. Consequently, these early philosophical schools played the role that religions or beliefs play in our own time.

Major Religions and Belief Systems

There are many religious systems, including ancient systems or natural religions, or smaller derivates from the major religions or belief systems. All religions and belief systems aim to provide answers to human questions on the transcendent and to major questions on life and death. People thus find orientation for their lives within these major religions and belief systems.

In general, Eastern traditions differ from Western traditions. Among Eastern traditions, which have more the character of belief systems than religions, there is Hinduism and Buddhism, but also Confucianism in China, which concentrates on the ethical life, and the animistic and polytheistic Shinto in Japan, which honors and prays to the ancestors. These are known as very old religious traditions in the Eastern part of the world.

The Western traditions are better described as religions than as belief systems. The most important are Judaism, Christianity, and Islam. All three of these religions refer in quite different ways to Abraham (ca. 2000 BCE) as an ideal of a pious and religious person.

Also, Zoroastrianism is counted among the major religious traditions or belief systems. It is considered to be the first monotheistic belief system, with Ahura Mazda as the universal God. But it is also a dualistic system; asha/arta is the principle of “truth” and “order” whereas druj, “lie,” is the opposite. Both principles “fight” against each other in the world. Zoroastrianism was founded by the prophet Zoroaster, or Zarathushtra, in the farmland area of today’s Western Iran. The main teachings of Zoroastrianism can be found in the scripture Zend-Avesta.

In Asia, the Hindu traditions are well known; the religion of the Vedas and the Upanishads is grounded in very old scriptures (e.g., the Bhagavad Gita or “Song of God”). The beginning of these traditions is about 4,000 years BCE in India. The Hindu traditions have a polytheistic basis, with Shiva and Vishnu as the central deities, but only one eternal aim: the unification of the individual soul, atman, with the highest spirit, Brahman . After several lives, the soul can enter the Brahman, leaving the system of reincarnation ( samsara ), if the karma, the balance of all individual actions, is good enough. Five elements are considered to be central for Hindu beliefs: (1) dharma (ethics and duties), (2) samsara (cycle of reincarnation), (3) karma (action and resulting reaction), (4) moksha (liberation from the cycle of rebirth), and (5) yogas (paths and practices). Though it is controversially debated among scholars whether the caste system is an important part of Hindu teaching, this social system remains strong even today. There are four castes, called varnas, beginning with the highest cast: (1) Brahmins (teachers and priests); (2) Kshatriyas (warriors, nobles, and kings); (3) Vaishyas (farmers, merchants, and businessmen); and (4) Shudras (servants and laborers). The caste system is very rigid. Marriage is only possible within one caste. People outside the caste system, Parjanya or Antyaja (or now Dalits), the “untouchables,” have almost no chance to progress in social life. Therefore, this system has often been criticized as discriminatory (e.g., by Mahatma Gandhi [1869–1948], whose ideal was absolute peacefulness).

Also in Asia, the Buddhist tradition is founded on the philosophy of Siddhartha Gautama Buddha (ca. 563–483 BCE), who was a teacher of spiritual wisdom. There are two main traditions in Buddhism: the Mahayana (great vehicle) Buddhism and the Theravada (ancient teaching) Buddhism. A smaller tradition is the Hinayana (low vehicle) Buddhism. Central Buddhist teachings contain the Four Noble Truths: (1) the nature of suffering ( dukkha ), (2) suffering’s origin ( samudaya ), (3) suffering’s cessation ( nirodha ), and (4) the way ( marga ) leading to the cessation of suffering. This “way” (marga) is characterized by the Noble Eightfold Path: (1) right view, (2) right intention (wisdom), (3) right speech, (4) right action, (5) right livelihood (ethical conduct), (6) right effort, (7) right mindfulness, and (8) right concentration (concentration). The Noble Eightfold Path contains the ethical “program” of Buddhism.

One aim of Buddhism is to bring cessation from suffering to the human soul. There are several traditions within Buddhism. Among them, there is Zen Buddhism in Japan and Tibetan Buddhism, whose head is the Dalai Lama. The monastic tradition is also very common in Buddhism, because its discipline helps the adherent to succeed in achieving the aim, the nirvana, as a unity of the individual soul with the universal in the absolute nothingness (nirvana).

The Mosaic tradition, later Judaism, is historically the first major tradition in Western culture. Christianity and Islam followed. In Judaism, humankind has been given the advice to follow God’s law, which was revealed on Mount Sinai, or Horeb to Moses. This revelation took place during the Exodus, the Jews’ escape out of Egyptian slavery. Moses was the leader of the people of Israel during that time. A life in accordance to the law will end up in felicity and prosperity, even after death. The prophets played a major role, because they renewed the concentration on God’s revelation within his law. During the reign of the Babylonian emperor Nebuchadnezzar II (ca. 630–562 BCE), the Jewish people were kidnapped and taken to Babylon. The Babylonian Talmud was written during this time, a commentary on the Torah, with respect to other commentaries and the oral tradition, in order to give a set of rules for everyday life. Literature interpreting the Torah is known as midrash.

When the people of Israel returned to the Holy Land, they built the first temple. In the year 70 CE, the temple was destroyed by the Romans, and the rabbinic phase began in Judaism. Rabbis are teachers of the Holy Scripture and they interpret for believers. They also give advice to pious Jews on how to manage life and how to decide in problematic situations. The halakha means to follow properly the way of the Jewish tradition.

Judaism today is quite various. There are liberal branches, as well as orthodox branches, whose believers observe the traditional religious law very strictly. As predicted in the prophecies of the Hebrew Bible, Jewish people still wait for the Messiah, who will come in the future in order to complete the divine law in his person.

In Christianity, Jesus Christ is believed to be the son of God, who came to redeem people. After the original sin of Adam and Eve, humankind survived for the redemption. The redeemer is Jesus Christ, who was crucified by the Romans after being accused, by the Jews in Jerusalem, of heresy for pretending to be the Messiah, and whose resurrection after 3 days astonished people, especially his own disciples. After another 40 days, Jesus Christ went up into heaven. After another 9 days, the Holy Spirit was sent down to earth in order to lead the faithful and to give consolation to them. God is the Holy Trinity in Christian tradition: God-Father, God-Son, God-Holy-Spirit.

Later, the Christian church developed into a more and more powerful institution, which secures the tradition of belief and teaching. Although crusades have occurred, the Christian doctrine is against force and tends toward peace on earth. In the year 1054 CE, the Eastern Greek Church turned away from the Latin Roman Church with the pope, the bishop of Rome, as Vicar of Christ and head of the church. Formally, there were two reasons for the East-West Schism: First, the Western and the Eastern traditions could not find a proper date for Easter, and second, the Eastern tradition could not agree to the filioque (“and by the Son”) within the credo, the big confession of the faith. The filioque means that the Holy Spirit was sent by the Father and Son together.

In the 16th century, the Protestant Reformation movements began with the Augustinian monk Martin Luther (1483–1546) in Germany, Huldrych Zwingli (1484–1531), and John Calvin (1509–1564) in Switzerland. The theologians Erasmus of Rotterdam (1466 or 1469–1536) and Philipp Melanchthon (1497–1560) both followed the Lutheran teaching and supported the Protestant teaching in the academic sector (e.g., by writing important letters). The Protestant Reformation movements wanted to renew the Western Church (e.g., by providing new translations of the Bible, and a new structure by changing the hierarchy). But in the end, these movements divided the church again as a result of a second big schism. Protestant Christianity then divided again into the many small movements and churches, or denominations, of today.

In 1534, the English Church separated from the Roman Church, and as a result the Church of England or Anglican Church was founded. The king or the queen of England is the head of the Anglican Church, and meanwhile the Archbishop of Canterbury exercises this office worldwide in the Anglican Church (e.g., the Episcopal Church in the USA). Whereas the High Church is near to the Catholic Church, the Low Church is nearer to the Protestant Church. So the Anglican Church regards itself as a “middle way” between Protestantism and Roman Catholicism.

In contrast to Protestantism, the Catholic Church keeps up its 2,000-year-old tradition and discipline, although the Second Ecumenical Council of the Vatican (1962–1965) has changed some elements in this tradition.

Islam was founded by the prophet Muhammad (ca. 570–632 CE), who had a direct revelation from God ( Alla – h ). This revelation is written down in the Koran, the holy book of Islam. In 622 CE, the first year of the Islamic calendar, Muhammad went from Mecca to Medina; this event is called the Hijra, or “walk,” which was the founding act of Islam. Sometime later, Muhammad returned to Mecca with his soldiers and gained a lot of followers and power. Islam regards itself as the final religion, which is based on the ultimate revelation given by God to Muhammad. This revelation gave perfection to the Mosaic and Christian revelation. Muhammad, the prophet of God, is the last and the highest of the prophets.

In the Islamic tradition, on each Friday there is a ritual prayer in the mosque. Ritual prayers are among the most important elements of Islam, the so-called Five Pillars of Islam: (1) fasting in the month of Ramadan, (2) the pilgrimage to Mecca (hajj), (3) ritual prayers (salát) several times a day, (4) charity (e.g., giving money to the poor), and (5) the profession of faith. Also, the observance of religious law (sharia), which contains rules for all areas of human life, is central to Islamic teaching. Islam is a religion or belief system of strict discipline, and it has gained a lot of influence in the states of both the Near East and the Middle East, as well as in Indonesia and Africa.

Each major religion or belief system knows certain objects and symbols, as well as rites. The rite is often connected with specific objects or symbols. In Buddhism, for instance, the wheel is a symbol of the recurrence of life and, more important, the Noble Eightfold Path. In the Mosaic tradition, the Star of David is the central symbol of identification. In Christianity, the cross, on which Christ was sacrificed, is the core symbol. And in the Islamic tradition, the half moon, as well as the sword, is central.

Symbols serve to give meaning to rites. In Jewish service, for example, the scrolls of the Torah must not be touched by humans, because they are absolutely sacred and represent God’s presence. Therefore signs exist, sometimes formed like a human hand, with which the scrolls of the Torah can be touched in order to follow the lines, which have to be cited. Another symbol in Jewish service is the shofar, a horn (e.g., from a ram, which is blown in preparation for and during Yom Kippur, the Day of Atonement, when humans reconcile with God). Yom Kippur is celebrated 10 days after Rosh Hashanah, the Jewish New Year.

In the Catholic Holy Mass, wine and bread are leavened and then transubstantiated into the blood and body of Christ as an unbloody renewal of the Crucifixion of Christ. The Host is then essentially Christ, and it is carefully venerated and adored. Also, the Virgin Mary is venerated in the Catholic faith as the Mother of Jesus Christ (i.e., the Mother of God). In the Protestant traditions, the transubstantiation is interpreted in a different way. The essential real presence of Christ is limited to the moment of the transubstantiation. Also, the veneration of the Virgin Mary and the saints is not common in the Protestant tradition. In order to venerate the Corpus Christi (body of Christ), the Virgin Mary, or the saints, there are often processions of Christians, especially in the Catholic tradition.

The pilgrimage ( hajj ) to Mecca, one of the holy cities of Islam, has its aim in circling around the Kaaba, or “cube.” The Kaaba is a thousand-year-old small building and the most sacred place in Islam. In the Eastern corner of the Kaaba, there is the Black Stone, the most important feature of the “cube.” All Muslims pray in the direction of Mecca, as it is the center of Islam.

Also, ritual dances or specific music or songs help to bring people into a state of mind that leads them toward a deeper understanding of the transcendent. The location for rites is, in most cases, a sacred place or a temple (in Christianity, a church), which can be seen as the house of God. These “houses of God or gods” attach a specific place to religions or beliefs, thereby providing an identity for them; also, they provide a meeting point for the believers as a kind of “home.”

Religions and belief systems express themselves in teachings, on the one hand manifested by oral traditions and on the other by sacred manuscripts. The basis for most of the teachings is a divine revelation.

The most common religious manuscript in our times is the Holy Bible, the “book of books.” But in the Far East, we have a lively tradition of Holy Scriptures: In the Vedas and Upanishads, Indian religious wisdom is written down, as in the Bhagavad Gita, or Song of God, as mentioned earlier. In the Bhagavad Gita, Sanjaya, who has a supernatural eye, tells the blind-born king Dhritarashtra about the big battle (between the near-related royal families of the Pandavas and Kauravas) that took place in the region where now the city of Delhi is located.

Judaism and Christianity refer in different ways to the Holy Bible. The Mosaic tradition is based on the five books of Moses, the Mosaic law or the Torah, the books of the prophets, and the psalms. Another important writing of Jewish tradition is The Guide of the Perplexed by Moses Maimonides (ca. 1135–1204), which considers religious and philosophical aspects, and helps to interpret the Jewish law properly. Maimonides’s influence on Jewish thinking still remains intense. Christianity is also based on the Old Testament, partly equivalent to the Hebrew Bible ( Tanakh ), but also on the New Testament: the Four Gospels, the Acts of the Apostles, the Epistles of Saint Paul, and the General or Catholic Epistles, as well as the Apocalypse of Saint John.

In the Koran, or “the recitation,” the holy book of Islam, the revelation to Muhammad resulted in the central teachings of Islam, which are the core of the religious law, the sharia. Furthermore, the sunna, the history of the life of Muhammad, is the model of a good life for a Muslim. In Islam, the religious law, the sharia, has a great meaning, so the most important religious leaders are judges.

Teachings of all religions provide explanations for the beginning of the universe, as in Genesis, the first book of the bible, moral teachings, and orders for a good life, which must match the will of God. These moral teachings belong to the realm of natural rights, which are similar in all religions and belief systems and their teachings. Natural rights follow human nature and therefore human rationality. Religious teachings give answers to crucial human questions concerning the universe, ethical problems, and life and death.

In the field of religions and beliefs, many fruitful future research areas can be found. The humanities, especially the studies of religion, which are linked to anthropological and sociocultural research, create new research areas: using the structuralistic method of the French ethnologist Claude Lévi-Strauss, rituals are analyzed in order to discover the common structures of rituals in different religions or beliefs. Furthermore, the discourse of religions and beliefs are examined as well. Therefore, the dynamics and controversies within this discursive process are analyzed and described in order to obtain more results concerning the relationship between different religions and belief systems.

Also, the aesthetics of religions or beliefs are currently under scrutiny. Religions and beliefs can be described as aesthetical systems or systems of symbols, which influence the human realization of reality. The aesthetics of religion build up a systematic coherence for religions and belief systems. Another field of interest is the influence of religions and beliefs on different human societies and politics, because religions and belief systems provide ethical rules and values. Psychological studies examine the inner processes caused by the personal beliefs of a human being, for example during religious examinations, such as prayers or meditations. Very important for future research on religion is the investigation of human nature. All religions or belief systems provide concepts of human nature. This question of human nature is important for answering many questions and solving many problems in terms of the sciences in the future (e.g., in human-genetics research).

Also, in philosophy and theology, there are new areas of research, especially the examination of the relationship between rationality and religion or belief. For example, the context of metaphysical considerations of late antiquity and the appearance of Christian revelation in the first centuries, beginning with early Fathers of the Church like Origen (185–254 CE) and ending with Saint Augustine (354–430 CE). During that time, theology has its origins in the confrontation of philosophy and religion. A major rational concentration on religious thoughts can be found in the Middle Ages (e.g., in the Summa Theologica, written from 1264–1274, of Saint Thomas Aquinas). The rationalism of the European Enlightenment emphasized critical views grounded in logic and nature. After rationalism, German idealism included religion systematically within philosophy as a philosophical perfection of the spirit. The German philosopher Friedrich Nietzsche (1844–1900) understood his philosophical work as a negative profile of religion in contrast to Christian thinking, which, he posited, is not suitable to human nature. But in the 20th and 21st centuries, religions and beliefs soon came back to the intellectual agenda. Therefore, religions and beliefs are truly fruitful objects for future research, as well as for anthropological research.

Summing up, the following three points are important for an anthropological perspective of religions and beliefs:

• Religions and belief systems want to give humans aspecial place in the universe and within reality itself, which is of course a different orientation from the scientific worldview, but nevertheless one way to consider the universe and humans within it.
• People may not want to refer to religion or beliefs assomething entirely made by humans. For many people, religions and beliefs should include a serious transcendental relationship (e.g., based on a revelation). Otherwise, religion is in danger of becoming an ideology, which may lead people to the use of force and cruelty, as in totalitarian political systems. Such systems are often characterized as political religions, like fascism, national socialism, or communism.
• Moreover, religions and belief systems need not be rigidsystems of moral teachings in order to suppress others. Religions offer guidelines for life respecting the truth, with the aim being a future life (of the soul) in truth and peace. In religions and belief systems, people want to live their lives in accordance with God, as fruitful and successful individuals. And, what is more, people want to gain the hope for eternal life or redemption after death, which thereby gives a meaningful sense to human existence, like a gate to paradise, near to God or the transcendent.

Religions and beliefs belong to many fields in the humanities: theology, philosophy, sociology, history, religious studies, and psychology (among others). It is very important that, in many perspectives on human life, religion and belief play a role as an answer to the question of the sense of human life and death. In religions and belief systems, humans seek answers to many other questions as well, especially in terms of ethical questions and the question of a good life. As a result, religions and belief systems play a major role within anthropological considerations of any kind.

Bibliography:

• Adair, J. R. (2008). Introducing Christianity. New York: Routledge.
• Ankerberg, J., & Weldon, J. (2008). The facts on world religions. Eugene, OR: Harvest House Publishers.
• Aron, R. (1968). Democracy and totalitarianism (V. Ionescu, Trans.). London: Weidenfeld & Nicolson. (Original work published 1965)
• Brague, R. (2003). The wisdom of the world: The human experience of the universe in Western thought (T. L. Fagan, Trans.). Chicago: University of Chicago Press.
• Brague, R. (2007). The Law of God: The philosophical history of an idea (L. G. Cochrane, Trans.). Chicago: University of Chicago Press.
• Comfort, R. (2008). World religions in a nutshell. Alachua, FL: Bridge-Logos.
• Cowan, D. E., & Bromley, D. G. (2007). Cults and new religions: A brief history. Malden, MA: Blackwell.
• D’Amato, S. E. (2006). Myths and mythology. In H. J. Birx (Ed.), Encyclopedia of anthropology (Vol. 4, pp. 1657–1661). Thousand Oaks, CA: Sage.
• Eliade, M. (1959). The sacred and the profane: The nature of religion. New York: Harcourt, Brace. (Original work published 1957)
• Geertz, C. (1975). The interpretation of cultures: Selected essays. London: Hutchinson.
• Geertz, C. (2008). Religion. In P. A. Moro, J. E. Myers, & A. C. Lehmann (Eds.), Magic, witchcraft, and religion: An anthropological study of the supernatural (7th ed., pp. 6–15). New York: McGraw-Hill.
• Guardini, R. (1998). Eternal life: What you need to know about death, judgment, and life everlasting. Manchester, NH: Sophia Institute Press. (Original work published 1940)
• Hick, J. (2005). An interpretation of religion: Human responses to the transcendent (2nd ed.). New Haven, CT: Yale University Press.
• Johnson, P. G. (1997). God and world religions: Basic beliefs and themes. Shippensburg, PA: Ragged Edge Press.
• Jones, R. R. (2006). Religion and anthropology. In H. J. Birx (Ed.), Encyclopedia of anthropology (Vol. 5, pp. 2003–2006). Thousand Oaks, CA: Sage.
• Kant, I. (1998). Religion within the boundaries of mere reason and other writings. Cambridge, UK: Cambridge University Press. (Original work published 1793)
• Lamb, R. (2006). Religious rituals. In H. J. Birx (Ed.), Encyclopedia of anthropology (Vol. 5, pp. 2011–2014). Thousand Oaks, CA: Sage.
• Lévi-Strauss, C. (1983). Structural anthropology (M. Layton, Trans.). Chicago: University of Chicago Press.
• Maier, H. (Ed.). (2004–2007). Totalitarianism and political religions (3 vols; J. Bruhn, Trans.). New York: Routledge.
• McGrath, A. E. (2007). Christian theology: An introduction (4th ed.) . Malden, MA: Blackwell.
• Meister, C., & Copan, P. (Eds.). (2007). The Routledge companion to philosophy of religion. New York: Routledge.
• Mitchell, D. W. (2008). Buddhism: Introducing the Buddhist experience (2nd ed.). New York: Oxford University Press.
• Moro, P. A., Myers, J. E., & Lehmann, A. C. (Eds.). (2008). Magic, witchcraft, and religion: An anthropological study of the supernatural (7th ed.) . New York: McGraw-Hill.
• Morris, B. (2006). Religion and anthropology: A critical introduction. Cambridge, UK: Cambridge University Press.
• Nigosian, S. A. (2008). World religions: A historical approach (4th ed.). Boston: Bedford/St. Martin’s.
• Otto, R. (1925). The idea of the holy: An inquiry into the nonrational factor in the idea of the divine and its relation to the rational. New York: Oxford University Press. (Original work published 1917)
• Rodrigues, H., & Harding, J. (Eds.). (2008). Introduction to the study of religion. New York: Routledge.
• Schleiermacher, F. D. E. (1996). On religion: Speeches to its cultured despisers. Cambridge, UK: Cambridge University Press. (Original work published 1967)
• Segal, E. (2008). Introducing Judaism. New York: Routledge.
• Seitschek, H. O. (2006). Religion. In H. J. Birx (Ed.), Encyclopedia of anthropology (Vol. 5, pp. 1998–2003). Thousand Oaks, CA: Sage.
• Tillich, P. (1988). Main works: Writings on religions (Vol. 5). Berlin: de Gruyter. (Original works published 1955, 1961)
• Troeltsch, E. (1981). The social teaching of the Christian churches. With an introduction by H. Richard Niebuhr (O. Wyon, Trans.). Chicago: University of Chicago Press. (Original work published 1912)
• Voegelin, E. (1999). Modernity without restraint. Edited with an introduction by Manfred Henningsen. Baton Rouge: Louisiana State University Press. (Original work published 1938)
• Williams, J. (2008). Islam: Understanding the history, beliefs, and culture. Berkeley Heights, NJ: Enslow.
• Wittgenstein, L. (2001). Philosophical investigations (G. E. M. Anscombe, Trans.). Oxford, UK: Blackwell. (Original work published 1953)
• Young, S. (2007). New York: Marshall Cavendish Benchmark.

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• v.2012; 2012

Religion, Spirituality, and Health: The Research and Clinical Implications

Harold g. koenig.

1 Departments of Medicine and Psychiatry, Duke University Medical Center, P.O. Box 3400, Durham, NC 27705, USA

2 Department of Medicine, King Abdulaziz University, Jeddah 21413, Saudi Arabia

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

1. Historical Background and Introduction

Religion, medicine, and healthcare have been related in one way or another in all population groups since the beginning of recorded history [ 1 ]. Only in recent times have these systems of healing been separated, and this separation has occurred largely in highly developed nations; in many developing countries, there is little or no such separation. The history of religion, medicine, and healthcare in developed countries of the West, though, is a fascinating one. The first hospitals in the West for the care of the sick in the general population were built by religious organizations and staffed by religious orders. Throughout the Middle Ages and up through the French Revolution, physicians were often clergy. For hundreds of years, in fact, religious institutions were responsible for licensing physicians to practice medicine. In the American colonies, in particular, many of the clergy were also physicians—often as a second job that helped to supplement their meager income from church work.

Care for those with mental health problems in the West also had its roots within monasteries and religious communities [ 2 ]. In 1247, the Priory of St. Mary of Bethlehem was built in London on the Thames River [ 3 ]. Originally designed to house “distracted people,” this was Europe's (and perhaps the world's) first mental hospital. In 1547, however, St. Mary's was torn down and replaced by Bethlehem or Bethlem Hospital [ 4 ]. Over the years, as secular authorities took control over the institution, the hospital became famous for its inhumane treatment of the mentally ill, who were often chained [ 5 ], dunked in water, or beaten as necessary to control them. In later years, an admission fee (2 pence) was charged to the general public to observe the patients abusing themselves or other patients [ 4 ]. The hospital eventually became known as “bedlam” (from which comes the word used today to indicate a state of confusion and disarray).

In response to the abuses in mental hospitals, and precipitated by the death of a Quaker patient in New York asylum in England, an English merchant and devout Quaker named William Tuke began to promote a new form of treatment of the mentally ill called “moral treatment.” In 1796, he and the Quaker community in England established their own asylum known as the York Retreat [ 6 ]. Not long after this, the Quakers brought moral treatment to America, where it became the dominant form of psychiatric care in that country [ 6 ]. Established in Philadelphia by the Quakers in 1813, “Friends Hospital” (or Friends Asylum) became the first private institution in the United States dedicated solely to the care of those with mental illness [ 7 ]. Psychiatric hospitals that followed in the footsteps of Friends Asylum were the McLean Hospital (established in 1818 in Boston, and now associated with Harvard), the Bloomingdale Asylum (established in 1821 in New York), and the Hartford Retreat (established in 1824 in Connecticut)—all modeled after the York Retreat and implementing moral treatment as the dominant therapy.

It was not until modern times that religion and psychiatry began to part paths. This separation was encouraged by the psychiatrist Sigmund Freud. After being “introduced” to the neurotic and hysterical aspects of religion by the famous French neurologist Jean Charcot in the mid-1880s, Freud began to emphasize this in a widely read series of publications from 1907 through his death in 1939. Included among these were Religious Acts and Obsessive Practices [ 8 ], Psychoanalysis and Religion [ 9 ], Future of an Illusion [ 10 ], and Moses and Monotheism [ 11 ]. These writings left a legacy that would influence the practice of psychiatry—especially psychotherapy—for the rest of the century and lead to a true schism between religion and mental health care. That schism was illustrated in 1993 by a systematic review of the religious content of DSM-III-R, which found nearly one-quarter of all cases of mental illness being described using religious illustrations [ 12 ]. The conflict has continued to the present day. Consider recent e-letters in response to two articles published in The Psychiatrist  about this topic [ 13 , 14 ] and an even more recent debate about the role of prayer in psychiatric practice [ 15 ]. This conflict has manifested in the clinical work of many mental health professionals, who have generally ignored the religious resources of patients or viewed them as pathological. Consider that a recent national survey of US psychiatrists found that 56% said they never, rarely, or only sometimes inquire about religious/spiritual issues in patients with depression or anxiety [ 16 ]. Even more concerning, however, is that the conflict has caused psychiatrists to avoid conducting research on religion and mental health. This explains why so little is known about the relationship between religious involvement and severe mental disorders (see Handbook of Religion and Health ) [ 17 ].

Despite the negative views and opinions held by many mental health professionals, research examining religion, spirituality, and health has been rapidly expanding—and most of it is occurring outside the field of psychiatry. This research is being published in journals from a wide range of disciplines, including those in medicine, nursing, physical and occupational therapy, social work, public health, sociology, psychology, religion, spirituality, pastoral care, chaplain, population studies, and even in economics and law journals. Most of these disciplines do not readily communicate with each another, and their journal audiences seldom overlap. The result is a massive research literature that is scattered throughout the medical, social, and behavioral sciences.

To get a sense of how rapidly the research base is growing see Figure 1 . The graphs plot the number of studies published in peer-reviewed journals during every noncumulative 3-year period from 1971 to 2012. Note that about 50% of these articles are reports of original research with quantitative data, whereas the other 50% are qualitative reports, opinion pieces, reviews, or commentaries. Google Scholar presents a more comprehensive picture since it includes studies published in both Medline and non-Medline journals. These graphs suggest that the volume of research on R/S and health has literally exploded since the mid-1990s.

Religion spirituality and health articles published per 3-year period (noncumulative) Search terms: religion, religious, religiosity, religiousness, and spirituality (conducted on 8/11/12; projected to end of 2012).

2. Definitions

Before summarizing the research findings, it is first necessary to provide definitions of the words religion and spirituality that I am using. There is much controversy and disagreement concerning definitions in this field, particularly over the term “spirituality,” and space here does not allow a full discussion of these complex issues. For an in depth discussion, including an exploration of contamination and confounding in the measurement of spirituality, I refer the reader to other sources [ 18 – 20 ]. Here are the definitions we provided in the Handbook .

“[Religion] Involves beliefs, practices, and rituals related to the transcendent , where the transcendent is God, Allah, HaShem, or a Higher Power in Western religious traditions, or to Brahman, manifestations of Brahman, Buddha, Dao, or ultimate truth/reality in Eastern traditions. This often involves the mystical or supernatural. Religions usually have specific beliefs about life after death and rules about conduct within a social group. Religion is a multidimensional construct that includes beliefs, behaviors, rituals, and ceremonies that may be held or practiced in private or public settings, but are in some way derived from established traditions that developed over time within a community. Religion is also an organized system of beliefs, practices, and symbols designed (a) to facilitate closeness to the transcendent, and (b) to foster an understanding of one's relationship and responsibility to others in living together in a community.” [ 21 ].

“Spirituality is distinguished from all other things—humanism, values, morals, and mental health—by its connection to that which is sacred, the transcendent . The transcendent is that which is outside of the self, and yet also within the self—and in Western traditions is called God, Allah, HaShem, or a Higher Power, and in Eastern traditions may be called Brahman, manifestations of Brahman, Buddha, Dao, or ultimate truth/reality. Spirituality is intimately connected to the supernatural, the mystical, and to organized religion, although also extends beyond organized religion (and begins before it). Spirituality includes both a search for the transcendent and the discovery of the transcendent and so involves traveling along the path that leads from nonconsideration to questioning to either staunch nonbelief or belief, and if belief, then ultimately to devotion and finally, surrender. Thus, our definition of spirituality is very similar to religion and there is clearly overlap.” [ 22 ].

For the research review presented here, given the similarity in my definition of these terms and the fact that spirituality in the research has either been measured using questions assessing religion or by items assessing mental health (thereby contaminating the construct and causing tautological results), I will be using religion and spirituality interchangeably (i.e., R/S).

3. Method of the Review

I summarize the research findings between R/S and health first in the area of mental health outcomes, then for health behaviors, and finally for physical health outcomes. The information presented here is based on a systematic review of peer-reviewed original data-based reports published though mid-2010 and summarized in two editions of the Handbook of Religion and Health [ 23 , 24 ]. How these systematic reviews were conducted, however, needs brief explanation. This is particularly true for ratings of study methodology that are used to summarize the findings below.

The systematic review to identify the studies presented in the Handbooks and summarized in this paper was conducted as follows. We utilized a combination of strategies to identify the studies (excluding most reviews or qualitative research). First, we systematically searched online databases (PsycINFO, MEDLINE, etc.) using the search words “religion,” “religiosity,” “religiousness,” and “spirituality” to identify studies on the R/S-health relationship. Second, we asked prominent researchers in the field to alert us to published research they knew about and to send us research that they themselves had conducted. Third, if there were studies cited in the reference lists of the studies located, we tracked down those as well. Using this method, we identified over 1,200 quantitative original data-based publications during the period 1872 to 2000 and 2,100 studies examining the R/S-health relationship from 2000 to 2010. All of these studies are described in the appendices of the two editions of the Handbook. Based on other reviews of the research conducted around this same time period (but more limited), we estimate that our review captured about 75% of the published research. Bear in mind that many, many more qualitative studies have been published on the topic that were not included in this review.

In order to assess the methodological quality of the studies, quality ratings were assigned as follows. Ratings of each of the more than 3,300 studies were made on a scale from 0 (low) to 10 (high) and were performed by a single examiner (HGK) to ensure rating consistency. Scores were determined according to the following eight criteria: study design (clinical trial, prospective cohort, cross-sectional, etc.), sampling method (random, systematic, or convenience), number of R/S measures, quality of measures, quality of mental health outcome measure, contamination between R/S measures and mental health outcomes, inclusion of control variables, and statistical method, based on a scheme adapted from Cooper [ 25 ]. Cooper emphasized the definition of variables, validity and reliability of measures, representativeness of the sample (sample size, sampling method, and response rates), research methods (quality of experimental manipulation and adequacy of control group for clinical trials), how well the execution of the study conformed to the design, appropriateness of statistical tests (power, control variables), and the interpretation of results.

To assess the reliability of the ratings, we compared HGK's ratings on 75 studies with the ratings made by an independent outside reviewer (Andrew Futterman, Ph.D., professor of psychology, College of the Holy Cross, a scientist familiar with the scoring criteria and active in the field of R/S-health research). When we examined correlations between HGK and Futterman's ratings, we found them moderately correlated (Pearson r = 0.57). Since scores of 7 or higher indicated higher quality studies, we also compared the scores between the two raters in terms of lower (0–6) versus higher (7–10) quality. This was done by dichotomizing scores into two categories (0–6 versus 7–10) and comparing the categories between the two examiners. The kappa of agreement ( κ ) between the two raters was 0.49 (where kappas of 0.40 to 0.75 indicate good agreement [ 26 ]). Overall, the raters agreed on whether quality was low or high in 56 of the 75 studies or 75%. I now summarize the results of the systematic review described above.

4. Religion, Spirituality, and Mental Health

Approximately 80% of research on R/S and health involves studies on mental health. One would expect stronger relationships between R/S and mental health since R/S involvement consists of psychological, social, and behavioral aspects that are more “proximally” related to mental health than to physical health. In fact, we would not expect any direct or immediate effects of R/S on physical health, other than indirectly through intermediary psychosocial and behavioral pathways. With regard to mental health, we would expect R/S to boost positive emotions and help neutralize negative emotions, hypothesizing that it serves as both a life-enhancing factor and as a coping resource. With regard to the latter, there is both qualitative and quantitative research suggesting that R/S helps people to deal better with adversity, either external adversity (difficult environmental circumstances) or internal adversity (genetic predisposition or vulnerability to mental disorders).

In the present paper, I have chosen to cite original reports as examples of the most rigorous studies in each area based on ratings in the Handbooks (i.e., 7 or higher on 0–10 scale). Cited here are both positive and negative studies reporting significant relationships. For some topics, such as well-being and depression, there are too many high-quality studies to cite, so only a few examples of the best studies are provided.

4.1. Coping with Adversity

In the first edition of the Handbook [ 27 ], we identified 110 studies published prior to the year 2000 and 344 studies published between 2000 and 2010 for a total of 454 studies. Among these reports are descriptions of how R/S helped people to cope with a wide range of illnesses or in a variety of stressful situations. These include people dealing with general medical illness [ 28 , 29 ], chronic pain [ 30 ], kidney disease [ 31 ], diabetes [ 32 , 33 ], pulmonary disease [ 34 ], cancer [ 35 , 36 ], blood disorders [ 37 ], heart/cardiovascular diseases [ 38 , 39 ], dental [ 40 ] or vision [ 41 ] problems, neurological disorders [ 42 ], HIV/AIDS [ 43 ], systemic lupus erythematosus [ 44 ], irritable bowel syndrome [ 45 ], musculoskeletal disease [ 46 ], caregiver burden [ 47 – 49 ],  psychiatric illness [ 50 , 51 ], bereavement [ 52 , 53 ], end-of-life issues [ 54 , 55 ], overall stress [ 56 – 58 ], natural disasters [ 59 , 60 ], war [ 61 , 62 ] or acts of terrorism [ 63 ], and miscellaneous adverse life situations [ 64 – 66 ]. In the overwhelming majority of studies, people reported that R/S was helpful.

4.2. Positive Emotions

Positive emotions include well-being, happiness, hope, optimism, meaning and purpose, high self-esteem, and a sense of control over life. Related to positive emotions are positive psychological traits such as altruism, being kind or compassionate, forgiving, and grateful.

4.2.1. Well-Being/Happiness

By mid-2010, at least 326 quantitative, peer-reviewed studies had examined relationships with R/S. Of those, 256 (79%) found only significant positive associations between R/S and well-being (including eight studies at a statistical trend level, that is, 0.05 < P < 0.10). Only three studies (<1%) reported a significant inverse relationship between R/S and well-being. Of the 120 studies with the highest methodological rigor (7 or higher in quality on the 0–10 scale), 98 (82%) reported positive relationships (including two at a trend level) [ 67 – 77 ] and one study reported a negative relationship (but only at a trend level) [ 78 ].

4.2.2. Hope

At least 40 studies have examined relationships with R/S, and of those, 29 (73%) reported only significant positive relationships with degree of hope; no studies found an inverse relationship. Of the six highest quality studies, half found a positive relationship [ 79 – 81 ].

4.2.3. Optimism

We located 32 studies examining relationships with R/S, and of those, 26 (81%) reported significant positive relationships. Of the 11 best studies, eight (73%) reported significant positive relationships [ 82 – 85 ]. Again, as with hope, no studies reported inverse relationships.

4.2.4. Meaning and Purpose

At least 45 studies have examined relationships with R/S, and 42 (93%) reported significant positive relationships. These studies were often in populations where there was a challenge to having meaning and purpose, such as in people with chronic disabling illness. Of the 10 studies with quality ratings of 7 or higher, all 10 reported significant positive associations [ 86 – 89 ].

4.2.5. Self-Esteem

Critics have claimed that R/S adversely affects self-esteem because it emphasizes humility rather than pride in the self [ 90 ]. Furthermore, R/S could exacerbate guilt in some for not living up to the high standards of conduct prescribed by religious traditions, resulting in low self-esteem. We found 69 studies that examined associations with R/S, and of those, 42 (61%) found greater self-esteem among those who were more R/S and two (3%) reported lower self-esteem. Of the 25 studies with the highest methodological rigor, 17 (68%) reported greater self-esteem [ 91 – 98 ] and two (8%) found worse self-esteem [ 99 , 100 ]. Not surprisingly, these findings are parallel to those of depression below (in the opposite direction, of course).

4.2.6. Sense of Control

Although one might expect R/S to correlate positively with an external locus of control (i.e., the Transcendent controlling events), and some studies confirm this, the majority of research finds a positive correlation with an internal not an external sense of control. Of 21 studies that have examined these relationships, 13 (61%) found that R/S was related to a greater sense of personal control in challenging life circumstances. Of the nine best studies, four reported significant positive relationships (44%) [ 101 – 104 ] and three report significant negative relationships (33%) [ 105 – 107 ], whereas the two remaining studies reported complex or mixed results (significant positive and negative associations, depending on R/S characteristic). R/S beliefs may provide an indirect sense of control over stressful situations; by believing that God is in control and that prayer to God can change things, the person feels a greater sense of internal control (rather than having to depend on external agents of control, such as powerful other people).

4.2.7. Positive Character Traits

With regard to character traits, the findings are similar to those with positive emotions. With regard to altruism or frequency of volunteering, 47 studies have examined relationships with R/S. Of those, 33 (70%) reported significant associations, whereas five (11%) found less altruism among the more R/S; of the 20 best studies, 15 (75%) reported positive relationships [ 108 – 113 ] and two (10%) found negative associations [ 114 , 115 ] (both concerning organ donations, which some religions prohibit). With regard to forgiveness, 40 studies have examined correlations with R/S, and 34 (85%) reported significant positive relationships and no studies found negative associations. Among the 10 highest quality studies, seven (70%) reported greater forgiveness among the more R/S [ 116 – 119 ], a finding that recent research has supported [ 120 ]. Regarding gratefulness, five of five studies found positive associations with R/S [ 121 , 122 ], and with regard to kindness/compassion, three of three studies reported significant positive relationship with R/S [ 123 ]. Admittedly, all of the studies measuring character traits above depend on self-report.

4.3. Depression

As with self-esteem, mental health professionals have argued that R/S might increase guilt by focusing on sin and could thus lead to depression. Again, however, this has not been found in the majority of studies. Given the importance of depression, its wide prevalence in the population, and the dysfunction that it causes (both mental and physical), I describe the research findings in a bit more detail. Overall, at least 444 studies have now examined relationships between R/S and depression, dating back to the early 1960s. Of those, 272 (61%) reported significant inverse relationships with depression (including nine studies at a trend level), and 28 (6%) found relationships between R/S and greater depression (including two studies at a trend level). Of the 178 studies with the highest methodological rigor, 119 (67%) reported inverse relationships [ 124 – 135 ] and 13 (7%) found positive relationships with depression [ 136 – 148 ].

Of 70 prospective cohort studies, 39 (56%) reported that greater R/S predicted lower levels of depression or faster remission of depression, whereas seven (10%) predicted worse future depression and seven (10%) reported mixed results (both significant positive and negative associations depending on R/S characteristic). Of 30 clinical trials, 19 (63%) found that R/S interventions produced better outcomes than either standard treatment or control groups. Two studies (7%) found standard treatments were superior to R/S interventions [ 149 , 150 ] and one study reported mixed results.

Note that an independent review of this literature published in 2003 found that of 147 studies involving 98,975 subjects, the average correlation between R/S and depression was −0.10. Although this is a small correlation, it translates into the same effect size that gender has on depressive symptoms (with the rate of depression being nearly twice as common in women compared to men). Also, the average correlation reported in the 2003 review was 50% stronger in stressed versus nonstressed populations [ 151 ].

A widely renowned psychiatric epidemiology group at Columbia University, led by Lisa Miller and Myrna Weissman, has come out with a series of recent reports on R/S and depression studying a cohort of low- and high-risk children born to parents with and without depressive disorder. The findings from this cohort support an inverse link between R/S and depression, particularly in high-risk individuals [ 152 – 154 ].

4.4. Suicide

Correlations between R/S and suicide attempt, completed suicide, and attitudes toward suicide are consistent with those found for depression, self-esteem, and hope. Those who are depressed, without hope, and with low self-esteem are at greater risk for committing suicide. At least 141 studies have now examined relationships between R/S and the suicide variables above. Of those, 106 (75%) reported inverse relationships and four (3%) found positive relationships. With regard to the 49 studies with the highest methodological rigor, 39 (80%) reported less suicide, fewer suicide attempts, or more negative attitudes toward suicide among the more R/S [ 155 – 170 ] and two (4%) found positive relationships (one study in Delhi, India [ 171 ], and one in college students distressed over R/S concerns [ 172 ]).

4.5. Anxiety

Anxiety and fear often drive people toward religion as a way to cope with the anxiety. Alternatively, R/S may increase anxiety/fear by its threats of punishment for evil deeds and damnation in the next life. There is an old saying that emphasizes this dual role: religion comforts the afflicted and afflicts the comforted. Sorting out cause and effect here is particularly difficult given the few prospective cohort studies that have examined this relationship over time. However, a number of clinical trials have also examined the effects of R/S interventions on anxiety levels. Overall, at least 299 studies have examined this relationship, and of those, 147 (49%) reported inverse association with R/S (three at a trend level), whereas 33 (11%) reported greater anxiety in those who were more R/S. Of the latter, however, only one was a prospective study, one was a randomized clinical trial, and 31 (94%) were cross-sectional studies (where it was not clear whether R/S caused anxiety or whether anxiety increased R/S as a coping response to the anxiety). Of the 67 studies with quality ratings of seven or higher, 38 (55%) reported inverse relationships [ 173 – 182 ] and seven (10%) found positive relationships (greater anxiety among the more R/S) [ 183 – 189 ].

Among these 299 studies were 239 cross-sectional studies, 19 prospective cohort studies, 9 single-group experimental studies, and 32 randomized clinical trials. Of the 19 longitudinal studies, 9 (47%) reported that R/S predicted a lower level of anxiety over time; one study (5%) found an increase in anxiety (among women undergoing abortion for fetal anomaly) [ 189 ], seven reported no association, and two reported mixed or complex results. Of the nine experimental studies, seven (78%) found a reduction in anxiety following an R/S intervention (before versus after comparison). Of the 32 randomized clinical trials, 22 (69%) reported that an R/S intervention reduced anxiety more than a standard intervention or control condition, whereas one study (3%) found an increase in anxiety following an R/S intervention in persons with severe alcohol dependence [ 190 ].

4.6. Psychotic Disorder/Schizophrenia

We identified 43 studies that have examined relationships between R/S and chronic psychotic disorders such as schizophrenia. Of the 43 studies examining psychosis, 14 (33%) reported inverse relationships between R/S and psychotic symptoms (one at a trend level), 10 (23%) found a positive relationship between R/S and psychotic symptoms (one at a trend level), eight reported mixed results (significant negative and positive associations, depending on the R/S characteristic measured), and one study reported complex results. Of these studies, seven had quality ratings of seven or higher; of those, two found inverse relationships, two found positive relationship, two reported mixed results (negative and positive), and one found no association. Note that the two studies finding inverse relationships between R/S and psychosis were both prospective studies [ 191 – 193 ], finding that R/S predicted better outcomes in subjects with psychotic disorders or symptoms. Of the two studies reporting positive relationships (both cross-sectional), one study found that importance of religion was significantly and positively associated with religious delusions [ 194 ] (not surprising), and the other study found that importance of religion was associated with “psychotic-like” symptoms in a national sample of Mexican Americans [ 195 ]; since the latter study involved participants who were not mentally ill, religion-related cultural factors may have influenced this finding. For a recent and more comprehensive discussion of R/S, schizophrenia, other chronic psychotic disorders, and the challenges distinguishing psychotic symptoms from religious beliefs, the reader is referred elsewhere [ 196 ].

4.7. Bipolar Disorder

Despite it's importance and wide prevalence, we could locate only four studies examining the relationship between R/S and bipolar (BP) disorder. Two found a positive association between R/S and bipolar disorder, and the remaining two reported mixed findings (both positive and negative correlations, depending on R/S characteristic). Of the two studies with high-quality ratings, one found a positive association and the other reported mixed findings. The first study of 334 US veterans with BP disorder found that a higher frequency of prayer or meditation was associated with mixed states and a lower likelihood of euthymia, although no association was found between any religious variable and depression or mania [ 197 ]. A second study examined a random national sample of 37,000 Canadians and found that those who attributed greater importance to higher spiritual values were more likely to have BP disorder, whereas higher frequency of religious attendance was associated with a lower risk of disorder [ 198 ]. In a qualitative study of 35 adults with bipolar disorder (not included in the review above), one of the six themes that participants emphasized when discussing their quality of life was the spiritual dimension. Over one-third of participants in that study talked about the relationship between BP disorder and R/S, emphasizing struggles to disentangle genuine spiritual experiences from the hyperreligiosity of the disorder. In another report, a case of mania precipitated by Eastern meditation was discussed; also included in this article was a review of nine other published cases of psychosis occurring in the setting of meditation [ 199 ].

4.8. Personality Traits

Personality traits most commonly measured today in psychology are the Big Five: extraversion, neuroticism, conscientiousness, agreeableness, and openness to experience. These are assessed by the NEO Personality Inventory [ 200 ]. Another personality inventory commonly used in the United Kingdom is the Eysenck Personality Questionnaire, which assesses extraversion, neuroticism, and psychoticism [ 201 ]. Relationships between personality traits and R/S using these measures have been examined in many studies [ 202 ]. With regard to psychoticism (a trait that assesses risk taking or lack of responsibility, rather than psychotic symptoms), 19 studies have examined its relationship to R/S, with 84% of those reporting significant inverse relationships (and no studies reporting a positive relationship). There have been at least 54 quantitative studies examined relationships between R/S and neuroticism, of which 24% found an inverse relationship and 9% reported a positive relationship (most of the remaining found no association). Concerning extraversion, there have been 50 studies, with 38% reporting a positive relationship with R/S and 6% reporting an inverse or negative relationship. With regard to conscientiousness, there have been 30 studies, of which the majority (63%) reported significant positive relationships with R/S and only 3% found significant inverse relationships. For agreeableness, 30 studies have examined relationships with R/S, and 87% of these studies reported positive relationships (no studies report inverse relationships). Finally, there have been 26 studies examining openness to experience, and of those, 42% found positive relationships with R/S and 12% reported negative relationships. Thus, R/S persons tend to score lower on psychoticism and neuroticism, and higher on extraversion, conscientiousness, agreeableness, and openness to experience. They score especially low on psychoticism and especially high on agreeableness and conscientiousness. These personality traits have physical health consequences that we are only beginning to recognize [ 203 – 205 ].

4.9. Substance Abuse

If R/S influences one domain of mental health, it is in the area of substance abuse. With regard to alcohol use, abuse, and dependence, at least 278 studies have now examined relationships with R/S. Of those, 240 (86%) reported inverse relationships and only 4 studies (1%) indicated a positive relationship. Of the 145 studies with the best methodology, 131 (90%) reported inverse relationships [ 206 – 221 ] and only one study found a positive relationship [ 222 ]. Findings are similar with regard to drug use or abuse. We located 185 studies, of which 84% reported inverse relationship with R/S and only two studies (1%) found positive relationships. Of the 112 best studies, 96 (86%) reported inverse relationships [ 223 – 238 ] and only one study found a positive relationship [ 239 ]. The vast majority of these studies are in young persons attending high school or college, a time when they are just starting to establish substance use habits (which for some will interfere with their education, future jobs, family life, and health). Thus, the protective effects of R/S on substance abuse may have influences on health across the lifespan.

4.10. Social Problems

Here I examine research in two areas of social instability (delinquency/crime and marital instability) and two areas of social stability (social support and social capital). Given the emphasis that most major world religions place on human relationships, love, and compassion, one might expect that some of the strongest relationships with R/S would be found here, and they are indeed.

4.10.1. Delinquency/Crime

At least 104 studies have examined relationships with R/S. Of those, 82 (79%) reported significant inverse relationships (five at a trend level), whereas three (3%) found positive relationships with more delinquency/crime. Of the 60 studies with quality ratings of 7 or higher, 49 (82%) reported inverse relationships [ 240 – 252 ] and only one study found a positive relationship [ 253 ]. Of particular interest are the 10 studies examining relationships between R/S and school grades/performance in adolescents and college students between 2000 and 2009, of which all 10 (100%) found that more R/S youth did better than less religious youth [ 254 ].

4.10.2. Marital Instability

We identified 79 studies that examined relationships with marital instability. Of those, 68 (86%) found R/S related to greater marital stability and no studies reported an association with greater marital instability. Of the 38 methodologically most rigorous studies, 35 (92%) reported significant relationships between R/S and greater marital stability [ 255 – 265 ]. An independent meta-analysis reviewing research conducted before the year 2000 likewise concluded that greater religiousness decreased the risk of divorce and facilitated marital functioning and parenting [ 266 ].

4.10.3. Social Support

There is substantial evidence indicating a relationship between R/S and social support. Of 74 quantitative peer-reviewed studies of R/S and social support, 61 (82%) found significant positive relationships, and none found inverse relationships. Of the 29 best studies, 27 (93%) reported significant positive relationships [ 82 , 267 – 274 ]. For older adults in particular, the most common source of social support outside of family members comes from members of religious organizations [ 275 , 276 ].

4.10.4. Social Capital

Social capital, an indirect measure of community health, is usually assessed by level of community participation, volunteerism, trust, reciprocity between people in the community, and membership in community-based, civic, political, or social justice organizations. Research has examined relationships between R/S and social capital. We located a total of 14 studies, with 11 (79%) finding significant positive relationships between R/S and level of social capital, and none reporting only inverse relationships. Almost all of these studies were of high quality, and of the 13 studies with ratings of seven or higher, 10 (77%) found that R/S was related to greater social capital [ 277 – 280 ].

5. Explaining the Relationship: R/S and Mental Health

R/S influences mental health through many different mechanisms, although the following are probably the predominant ones (see Figure 2 ). First, religion provides resources for coping with stress that may increase the frequency of positive emotions and reduce the likelihood that stress will result in emotional disorders such as depression, anxiety disorder, suicide, and substance abuse. Religious coping resources include powerful cognitions (strongly held beliefs) that give meaning to difficult life circumstances and provide a sense of purpose. Religions provide an optimistic worldview that may involve the existence of a personal transcendental force (God, Allah, Jehovah, etc.) that loves and cares about humans and is responsive to their needs. These cognitions also give a subjective sense of control over events (i.e., if God is in control, can influence circumstances, and be influenced by prayer, then prayer by the individual may positively influence the situation). Religious beliefs provide satisfying answers to existential questions, such as “where did we come from,” “why are we here,” and “where are we going,” and the answers apply to both this life and the next life, thus reducing existential angst. These beliefs also help to normalize loss and change and provide role models of persons suffering with the same or similar problems (often illustrated in religious scriptures). Thus, religious beliefs have the potential to influence the cognitive appraisal of negative life events in a way that makes them less distressing. For people with medical illness, these beliefs are particularly useful because they are not lost or impaired with physical disability—unlike many other coping resources that are dependent on health (hobbies, relationships, and jobs/finances).

Theoretical model of causal pathways for mental health (MH), based on Western monotheistic religions (Christianity, Judaism, and Islam). (Permission to reprint obtained. Original source: Koenig et al. [ 17 ]). For models based on Eastern religious traditions and the Secular Humanist tradition, see elsewhere. (Koenig et al. [ 24 ]).

Second, most religions have rules and regulations (doctrines) about how to live life and how to treat others within a social group. When individuals abide by those rules and regulations, this reduces the likelihood of stressful life events that reduce positive emotions and increased negative ones. Examples of stressful life events that religion may help people avoid are divorce or separation, difficulties with children, financial stress resulting from unfair practices in the marketplace, incarceration for lawbreaking (cheating or crime), and venereal diseases from risky sexual practices. Religions also usually discourage the use of drugs and excessive amounts of alcohol that increases the risk of engaging in the behaviors above (crime, risky sex) that are associated with negative mental health consequences.

Third, most religions emphasize love of others, compassion, and altruistic acts as well as encourage meeting together during religious social events. These prosocial behaviors have many consequences that buffer stress and lead to human support when support is needed during difficult times. Because religion encourages the helping of others and emphasizes a focus outside of the self, engagement in other-helping activities may increase positive emotions and serve to distract from one's own problems. Religion also promotes human virtues such as honesty, forgiveness, gratefulness, patience, and dependability, which help to maintain and enhance social relationships. The practice of these human virtues may also directly increase positive emotions and neutralize negative ones.

Thus, there are many possible mechanisms by which R/S may enhance mental and social health. This is not to say that R/S always does so. Religion may also be used to justify hatred, aggression, prejudice, and the exclusion of others; gain power and control over vulnerable individuals (as seen in cults); foster rigid thinking and obsessive practices; lead to anxiety, fear, and excessive guilt over minor infractions (and even self-mutilation in some cases); produce psychosocial strains due to failure to live up to high religious standards; lead to escape from dealing with family problems (through excessive involvement in religious or spiritual activities); and delay diagnosis and effective mental health care (due to antagonistic relationships with mental health professionals). While R/S is not a panacea, on the balance, it is generally associated with greater well-being, improved coping with stress, and better mental health. This relationship with mental health has physical health consequences (see Section 7 below).

6. Religion, Spirituality, and Health Behaviors

Religious doctrines influence decisions about health and health behaviors. In the Judeo-Christian scriptures, for example, there is an emphasis on caring for the physical body as a “Temple of the Holy Spirit” (see 1 Corinthian 6:19-20) [ 281 ]. Religious scriptures in other faith traditions also emphasize the person's responsibility to care for and nourish their physical body [ 282 – 284 ]. Behaviors that have the potential to harm the body are usually discouraged. This is reflected in teachings from the pulpit and influences what is considered appropriate within religious social groups. In summarizing the research on R/S and health behaviors, I cite only a few of the studies with high-quality ratings since there are so many.

6.1. Cigarette Smoking

The influence of R/S is most evident in it's “effects” on cigarette smoking. At least 137 studies have examined relationship between R/S and smoking, and of those, 123 (90%) reported statistically significant inverse relationships (including three at a trend level) and no studies found either a significant or even a trend association in the other direction. Of the 83 methodologically most rigorous studies, 75 (90%) reported inverse relationships with R/S involvement [ 213 , 285 – 294 ]. Not surprisingly, the physical health consequences of not smoking are enormous. Decreased cigarette smoking will mean a reduction in chronic lung disease, lung cancer, all cancers (30% being related to smoking), coronary artery disease, hypertension, stroke, and other cardiovascular diseases.

6.2. Exercise

Level of exercise and physical activity also appears linked to R/S. We located 37 studies that examined this relationship. Of those, 25 (68%) reported significant positive relationships (two at a trend level) between R/S involvement and greater exercise or physical activity, whereas six (16%) found significant inverse relationships. Of 21 studies with the highest quality ratings, 16 (76%) reported positive associations [ 82 , 295 – 300 ] and two (10%) found negative associations [ 296 , 301 ].

Writers in the popular press have encouraged the combining of R/S activity and exercise through “prayer walking” [ 302 , 303 ] and “walking meditation.” [ 304 ].

At least 21 studies have examined relationships between R/S and a healthy diet. A healthy diet here involves increased intake of fiber, green vegetables, fruit, and fish; low intake of snacks, processed foods, and fat; regular vitamin intake; frequent eating of breakfast; overall better nutrition (following recommended nutritional guidelines). Of those studies, 13 (62%) found a significant positive association between R/S and a healthier diet (one at a trend level) and one found a worse diet [ 305 ]. Among the 10 studies with the highest quality ratings, seven (70%) reported a better diet among those who were more R/S [ 213 , 306 – 310 ]. In addition, we identified 23 studies that examined relationships between R/S and blood cholesterol levels. Of those, more than half (12 studies) found significantly lower cholesterol among those who were more R/S, whereas three studies (13%) reported significantly higher cholesterol levels. Of the nine best studies, five (56%) reported lower cholesterol [ 311 – 313 ] or a lowering of cholesterol in response to a R/S intervention [ 314 , 315 ], whereas one found higher cholesterol (but only in Mexican American men) [ 316 ].

6.4. Weight

Although R/S people tend to eat a healthier diet, they also eat more of it. This, then, is the one health behavior that places R/S individuals at greater risk for medical illness. At least 36 studies have examined the associations between weight (or body mass index) and R/S involvement. Of those, 14 (39%) found a positive relationship (R/S associated with greater weight), whereas only seven (19%) reported an inverse relationship. The situation does not improve when results from the most rigorously designed studies are examined. Among the 25 studies with the highest quality ratings, 11 (44%) reported greater weight among the more R/S [ 82 , 317 – 322 ] and five (20%) found lower weight (or less underweight [ 323 ]). Lower weight among the more R/S appears only in a few religious groups (Amish [ 324 ], Jews [ 325 ], and Buddhists [ 326 ]), in those with certain demographic characteristics (white, older, and high education) [ 327 ], and in response to a specific R/S intervention [ 328 ] or practice [ 314 , 329 ]. Faith-based weight-reduction programs in religious communities have been shown to be effective [ 328 , 330 , 331 ].

6.5. Sexual Behavior

We identified 95 studies that examined relationships between R/S and risky sexual activity (sex outside of marriage, multiple partners, etc.). Of those, 82 studies (86%) found significant inverse relationships with R/S (one at a trend level) and only one study (1%) found a significant relationship with more risky sexual activity [ 332 ]. Of the 50 highest quality studies, 42 (84%) reported inverse relationships [ 333 – 343 ] and none found a positive one. If those who are more R/S engage in less risky sexual behavior, this means they should have fewer venereal diseases, that is, less syphilis, gonorrhea, herpes, chancroid, chlamydia, viral hepatitis, and human papillomavirus and human immunodeficiency virus, many of which have serious physical health consequences.

7. Religion, Spirituality, and Physical Health

There is rapidly growing evidence that stress and negative emotions (depression, anxiety) have (1) adverse effects on physiological systems vital for maintenance of physical health and healing [ 344 – 346 ], (2) increase susceptibility to or worse outcomes from a wide range of physical illnesses [ 347 – 351 ], and (3) may shorten the lifespan prematurely [ 352 , 353 ]. Social support, in turn, has long been known to protect against disease and increase longevity [ 354 – 356 ]. By reducing stress and negative emotions, increasing social support, and positively affecting health behaviors, R/S involvement should have a favorable impact on a host of physical diseases and the response of those diseases to treatment. As in the earlier sections, I cite high-quality studies as examples. Since there are fewer high-quality studies for physical health than for mental health or for health behaviors, I cite all of the studies with ratings of seven or higher.

7.1. Coronary Heart Disease (CHD)

Given the strong connections between psychosocial stressors, health behaviors, and CHD, it is not surprising that there is a link with R/S. Our review uncovered 19 studies that examined associations between R/S and CHD. Of those, 12 (63%) reported a significant inverse relationship, and one study reported a positive relationship. Of the 13 studies with the most rigorous methodology, nine (69%) found inverse relationships with CHD [ 357 – 365 ] and one found a positive one [ 366 ]. In addition, there have been at least 16 studies examining relationships between R/S and cardiovascular reactivity, heart rate variability, outcomes following cardiac surgery, and other cardiovascular functions. Of those, 11 studies (69%) reported that R/S was significantly related to positive cardiovascular functions or outcomes [ 367 – 374 ] or to lower levels of inflammatory markers such as C-reactive protein [ 375 – 377 ] and fibrinogen [ 378 ] that place individuals at high risk for cardiovascular disease.

7.2. Hypertension

The word “hypertension” itself suggests a relationship with stress or tension, and high blood pressure has been linked to greater psychosocial stress [ 379 – 381 ]. At least 63 studies have examined the relationship between R/S and blood pressure (BP), of which 36 (57%) reported significantly lower BP in those who are more R/S (five at a trend level) and seven (11%) reported significantly higher BP (one at a trend level). Of the 39 highest quality studies, 24 (62%) report lower BP (including one at a trend level) among those who are more R/S [ 382 – 394 ] or in response to an R/S intervention [ 328 , 395 – 404 ] (including a study whose results were reported twice, once for the overall sample and once for the sample stratified by race).

Two lower quality studies [ 405 , 406 ] and five well-done studies [ 407 – 411 ] (13%, including one at a trend level), however, reported higher BP in the more R/S or with religious fasting. The reason for an association between R/S and higher BP is not entirely clear. Perhaps, in certain population subgroups, intrapsychic religious conflict between psychosexual drives and religious standards creates unconscious stress that elevates BP. However, there is another possibility. This may be related to confounding by ethnicity. Three of the five studies reporting increased BP with increased R/S included in their samples a large proportion of ethnic minorities (samples from large urban settings such as Detroit and Chicago, made up of 36% to 100% African Americans). Since African Americans are more likely to have high BP (40% with hypertension) [ 412 ] and because African Americans are also the most religious ethnic group in society [ 413 ], it may be that controlling for race in these analyses is simply not sufficient to overcome this powerful confound.

7.3. Cerebrovascular Disease

Relationships between R/S, hypertension and other cardiovascular diseases or disease risk factors ought to translate into a lower risk of stroke. We located nine studies that examined this relationship, of which four reported a lower risk of stroke, all having quality ratings of seven or higher [ 414 – 417 ].

One study, however, reported significantly more carotid artery thickening, placing R/S individuals at higher risk for stroke [ 418 ]. Again, however, 30% of that sample was African American an ethnic group, known to be both highly religious and at high risk for stroke.

7.4. Alzheimer's Disease and Dementia

Physiological changes that occur with stress and depression (elevated blood cortisol, in particular) are known to adversely affect the parts of the brain responsible for memory [ 419 – 421 ]. The experience of negative emotions may be like pouring hydrochloric acid on the brain's memory cells [ 422 ]. By reducing stress and depression through more effective coping, R/S may produce a physiological environment that has favorable effects on cognitive functioning. Furthermore, R/S involvement may also engage higher cortical functions involved in abstract thinking (concerning moral values or ideas about the transcendent) that serve to “exercise” brain areas necessary for retention of memories. Regardless of the mechanism, at least 21 studies have examined relationships between R/S involvement and cognitive function in both healthy persons and individuals with dementia. Of those, 10 (48%) reported significant positive relationships between R/S and better cognitive functioning and three (14%) found significant negative relationships. Of the 14 studies with the highest quality ratings, eight (57%) reported positive relationships [ 423 – 430 ] and three (21%) reported negative relationships with cognitive function [ 431 – 433 ]. Studies finding negative relationships between R/S and cognitive function may be due to the fact that R/S persons have longer lifespans (see below), increasing the likelihood that they will live to older ages when cognition tends to decline. More recent research supports a positive link between R/S and better cognitive function in both dementia and in old age [ 434 , 435 ].

7.5. Immune Function

Intact immune function is critical for health maintenance and disease prevention and is assessed by indicators of cellular immunity, humoral immunity, and levels of pro- and anti-inflammatory cytokines. We identified 27 studies on relationships between R/S and immune functions, of which 15 (56%) found positive relationships or positive effects in response to a R/S intervention, and one (4%) found a negative effect [ 436 ]. Of the 14 studies with the highest quality ratings, 10 (71%) reported significant positive associations [ 437 – 443 ] or increased immune functions in response to a R/S intervention [ 444 – 447 ]. No high-quality study found only an inverse association or negative effect, although one study reported mixed findings [ 448 ]. In that study, religious attendance was related to significantly poorer cutaneous response to antigens; however, it was also related (at a trend level) to higher total lymphocyte count, total T-cell count, and helper T-cell count. In addition, importance of religious or spiritual expression was related to significantly higher white blood cell count, total lymphocyte count, total T cells, and cytotoxic T cell activity.

There have also been a number of studies examining R/S and susceptibility to infection (or viral load in those with HIV), which could be considered an indirect measure of immune function. We identified 12 such studies, of which eight (67%) reported significantly lower infection rates or lower viral loads in those who were more R/S (including one at a trend level); none found greater susceptibility to infection or greater viral load. Ten of the 12 studies had quality ratings of 7 or higher; of those, seven (70%) reported significant inverse associations with infection/viral load [ 440 , 441 , 449 – 454 ].

7.6. Endocrine Function

Because stress hormones (cortisol, epinephrine, and norepinephrine) have a known influence on immune (and cardiovascular) functions, they are important factors on the pathway between R/S involvement and health [ 455 , 456 ]. We identified 31 studies that examined R/S and associations with or effects on endocrine functions. Of those, 23 (74%) reported positive relationships or positive effects and no studies reported negative associations or negative effects. Of the 13 methodologically most rigorous studies, nine (69%) reported positive associations with R/S [ 457 – 461 ] or positive effects of an R/S intervention (all involving Eastern meditation) [ 462 – 465 ]. We (at Duke) are currently examining the effects of religious cognitive-behavioral therapy on a host of pro- and anti-inflammatory cytokines, cortisol, and catecholamines in patients with major depressive disorder, although results will not be available until 2014 [ 466 ].

7.7. Cancer

At least 29 studies have examined relationships between R/S and either the onset or the outcome of cancer (including cancer mortality). Of those, 16 (55%) found that those who are more R/S had a lower risk of developing cancer or a better prognosis, although two (7%) reported a significantly worse prognosis [ 467 , 468 ]. Of the 20 methodologically most rigorous studies, 12 (60%) found an association between R/S and lower risk or better outcomes [ 469 – 480 ], and none reported worse risk or outcomes. The results from some of these studies can be partially explained by better health behaviors (less cigarette smoking, alcohol abuse, etc.), but not all. Effects not explained by better health behaviors could be explained by lower stress levels and higher social support in those who are more R/S. Although cancer is not thought to be as sensitive as cardiovascular disorders to psychosocial stressors, psychosocial influences on cancer incidence and outcome are present (discussions over this are ongoing [ 481 , 482 ]).

7.8. Physical Functioning

Ability to function physically, that is, performing basic and instrumental activities of daily living such as toileting, bathing, shopping, and using a telephone, is a necessary factor for independent living. Persons who are depressed, unmotivated, or without hope are less likely to make attempts to maintain their physical functioning, particularly after experiencing a stroke or a fall that forces them into a rehabilitation program to regain or compensate for their losses. Several studies have examined the role that R/S plays in helping people to maintain physical functioning as they grow older or regain functioning after an illness. We identified 61 quantitative studies that examined relationships between R/S and disability level or level of functioning. Of those, 22 (36%) reported better physical functioning among those who were more R/S, 14 (23%) found worse physical functioning, and six studies reported mixed findings. Considering the 33 highest quality studies, 13 (39%) reported significantly better physical functioning among those who were more R/S (including one study at a trend level) [ 483 – 495 ], six (18%) found worse functioning [ 496 – 501 ], and five studies (15%) reported mixed results [ 82 , 124 , 502 – 504 ] (significant positive and negative associations, depending on R/S characteristic). Almost all of these studies involve self-reported disability and many were cross-sectional, making it impossible to determine order of causation—that is, (1) does R/S prevent the development of disability, (2) does disability prevent R/S activity, (3) does R/S promote disability, or (4) does disability cause people to turn to religion to cope with disability.

7.9. Self-Rated Health

There is more agreement across studies regarding the relationship between R/S and self-rated health (SRH) than between R/S and physical functioning. While based on participants' subjective impression, self-rated health is strongly related to objective health, that is, future health, health services use, and mortality [ 505 – 507 ]. Might R/S, perhaps because it is related to greater optimism and hope, influence one's self-perceptions of health in a positive way? At least 50 studies have now examined the relationship between R/S and self-rated health. Of those, 29 (58%) reported that R/S was related to better SRH, while five (10%) found that it was related to worse SRH. Of the 37 methodologically most rigorous studies, 21 (57%) reported significant positive relationships between R/S and SRH [ 503 , 508 – 527 ], whereas three (8%) found the opposite [ 528 – 530 ].

7.10. Pain and Somatic Symptoms

On the one hand, pain and other distressing somatic symptoms can motivate people to seek solace in religion through activities such as prayer or Scripture study. Thus, R/S is often turned to in order to cope with such symptoms. For example, in an early study of 382 adults with musculoskeletal complains, R/S coping was the most common strategy for dealing with pain and was considered the second most helpful in a long list of coping behaviors [ 531 ]. More recent research supports this earlier report [ 532 ]. On the other hand, R/S may somehow cause an increase in pain and somatic symptoms, perhaps by increasing concentration on negative symptoms or through the physical manifestations of hysteria, as claimed by Charcot in his copious writings around the turn of the 20th century [ 533 ].

We identified 56 studies that examined relationships between R/S and pain. Of those, 22 (39%) reported inverse relationships between R/S and pain or found benefits from an R/S intervention, whereas 14 (25%) indicated a positive relationship between R/S and greater pain levels (13 of 14 being cross-sectional). Of the 18 best studies, nine (50%) reported inverse relationships (less pain among the more R/S [ 534 ] or reduced pain in response to a R/S intervention [ 535 – 542 ]), while three (20%) reported positive relationships (worse pain in the more R/S) [ 543 – 545 ]. Research suggests that meditation is particularly effective in reducing pain, although the effects are magnified when a religious word is used to focus attention [ 546 , 547 ]. No clinical trials, to my knowledge, have shown that meditation or other R/S interventions increase pain or somatic symptoms.

7.11. Mortality

The most impressive research on the relationship between R/S and physical health is in the area of mortality. The cumulative effect of R/S, if it has any benefits to physical health, ought to reveal itself in an effect on mortality. The research suggests it does. At least 121 studies have examined relationships between R/S and mortality. Most of these are prospective cohort studies, where baseline R/S is assessed as a predictor of mortality during the observation period, controlling for confounders. Of those studies, 82 (68%) found that greater R/S predicted significantly greater longevity (three at a trend level), whereas six studies (5%) reported shorter longevity. Considering the 63 methodologically most rigorous studies (quality ratings of 8 or higher), 47 (75%) found R/S predicting greater longevity (two at trend level) [ 548 – 566 ], whereas three (5%) reported shorter longevity [ 567 – 569 ]. Another systematic review [ 570 ] and two meta-analyses [ 571 , 572 ] have confirmed this relationship between R/S and longer survival. The effects have been particularly strong for frequency of attendance at religious services in these three reviews. Survival among frequent attendees was increased on average by 37%, 43%, and 30% (mean effect being 37% across these reviews). An increased survival of 37% is highly significant and equivalent to the effects of cholesterol lowering drugs or exercise-based cardiac rehabilitation after myocardial infarction on survival [ 573 ].

8. Explaining the Relationship: R/S and Physical Health

How might R/S involvement influence physical health and longevity? There are at least three basic pathways: psychological, social, and behavioral (see Figure 3 ).

Theoretical model of causal pathways to physical health for Western monotheistic religions (Christianity, Islam, and Judaism). (Permission to reprint obtained. Original source: Koenig et al. [ 17 ]). For models based on Eastern religious traditions and the Secular Humanist tradition, see elsewhere (Koenig et al. [ 24 ]).

8.1. Psychological

As noted above, there is ample evidence that R/S—because it facilitates coping and imbues negative events with meaning and purpose—is related to better mental health (less depression, lower stress, less anxiety, greater well-being, and more positive emotions). Furthermore, several randomized clinical trials have shown that R/S interventions improve mental health (at least in those who are R/S). There is also much evidence that poor mental health has adverse physiological consequences that worsen physical health and shorten the lifespan (see earlier references). Thus, it stands to reason that R/S might influence physical health through psychological pathways.

8.2. Social

R/S involvement is associated with greater social support, greater marital stability, less crime/delinquency, and greater social capital. R/S beliefs and doctrines encourage the development of human virtues such as honesty, courage, dependability, altruism, generosity, forgiveness, self-discipline, patience, humility, and other characteristics that promote social relationships. Participation in a R/S community not only provides supportive social connections and opportunities for altruism (through volunteering or other faith-based altruistic activities), but also increases the flow of health information that may increase disease screening and promote health maintenance. Social factors, in turn, are known to influence both mental health and physical health and predict greater longevity [ 574 – 576 ]. Again, if R/S boosts supportive social interactions and increases community trust and involvement, then it should ultimately influence physical health as well.

8.3. Health Behaviors

Finally, R/S promotes better health behaviors, and is associated with less alcohol and drug use, less cigarette smoking, more physical activity and exercise, better diet, and safer sexual practices in the overwhelming majority of studies that have examined these relationships. Living a healthier lifestyle will result in better physical health and greater longevity. Consider the following report that appeared on CNN (Cable Network News). On January 3, 2009, after the death of the Guinness Book of World Records' oldest person, Maria de Jesus age 115, next in line was Gertrude Baines from Los Angeles. Born to slaves near Atlanta in 1894, she was described at 114 years old as “spry,” “cheerful,” and “talkative.” When she was 112 years old, Ms. Baines was asked by a CNN correspondent to explain why she thought she had lived so long. Her reply: “God. Ask Him. I took good care of myself, the way he wanted me to.” Brief and to the point.

8.4. Other Pathways

There are many ways by which R/S could have a positive influence on physical health, although the pathways above are probably the major ones. Genetic and developmental factors could also play a role in explaining these associations. There is some evidence that personality or temperament (which has genetic roots) influences whether or not a person becomes R/S. To what extent R/S persons are simply born healthier, however, is quite controversial. Note that more R/S persons are typically those with the least resources (minority groups, the poor, and the uneducated), both in terms of finances and access to healthcare resources. Karl Marx said that religion is the “opiate of the masses.” Rather than being born healthier, then, the opposite is more likely to be true for R/S persons. R/S could actually be viewed as acting counter to an evolutionary force that is trying to weed genetically vulnerable people from the population. R/S involvement is providing the weak with a powerful belief system and a supportive community that enables them to survive. For a more complete discussion of the role of genetic factors in the R/S-physical health relationship, see the Handbook [ 577 ].

Another important point needs to be made. Nowhere do I claim that supernatural mechanisms are responsible for the relationship between R/S and health. The pathways by which R/S influences physical health that researchers can study using the natural methods of science must be those that exist within nature—that is, psychological, social, behavioral, and genetic influences. Thus, this research says nothing about the existence of supernatural or transcendent forces (which is a matter of faith), but rather asks whether belief in such forces (and the behaviors that result from such beliefs) has an effect on health. There is every reason to think it does.

9. Clinical Implications

There are clinical implications from the research reviewed above that could influence the way health professionals treat patients in the hospital and clinic.

9.1. Rationale for Integrating Spirituality

There are many practical reasons why addressing spiritual issues in clinical practice is important. Here are eight reasons [ 578 ] (and these are not exhaustive).

First, many patients are R/S and have spiritual needs related to medical or psychiatric illness. Studies of medical and psychiatric patients and those with terminal illnesses report that the vast majority have such needs, and most of those needs currently go unmet [ 579 , 580 ]. Unmet spiritual needs, especially if they involve R/S struggles, can adversely affect health and may increase mortality independent of mental, physical, or social health [ 581 ].

Second, R/S influences the patient's ability to cope with illness. In some areas of the country, 90% of hospitalized patients use religion to enable them to cope with their illnesses and over 40% indicate it is their primary coping behavior [ 582 ]. Poor coping has adverse effects on medical outcomes, both in terms of lengthening hospital stay and increasing mortality [ 583 ].

Third, R/S beliefs affect patients' medical decisions, may conflict with medical treatments, and can influence compliance with those treatments. Studies have shown that R/S beliefs influence medical decisions among those with serious medical illness [ 584 , 585 ] and especially among those with advanced cancer [ 586 ] or HIV/AIDs [ 587 ].

Fourth, physicians' own R/S beliefs often influence medical decisions they make and affect the type of care they offer to patients, including decisions about use of pain medications [ 588 ], abortion [ 589 ], vaccinations [ 590 ], and contraception [ 591 ]. Physician views about such matters and how they influence the physician's decisions, however, are usually not discussed with a patient.

Fifth, as noted earlier, R/S is associated with both mental and physical health and likely affects medical outcomes. If so, then health professionals need to know about such influences, just as they need to know if a person smokes cigarettes or uses alcohol or drugs. Those who provide health care to the patient need to be aware of all factors that influence health and health care.

Sixth, R/S influences the kind of support and care that patients receive once they return home. A supportive faith community may ensure that patients receive medical followup (by providing rides to doctors' offices) and comply with their medications. It is important to know whether this is the case or whether the patient will return to an apartment to live alone with little social interaction or support.

Seventh, research shows that failure to address patients' spiritual needs increases health care costs, especially toward the end of life [ 592 ]. This is a time when patients and families may demand medical care (often very expensive medical care) even when continued treatment is futile. For example, patients or families may be praying for a miracle. “Giving up” by withdrawing life support or agreeing to hospice care may be viewed as a lack of faith or lack of belief in the healing power of God. If health professionals do not take a spiritual history so that patients/families feel comfortable discussing such issues openly, then situations may go on indefinitely and consume huge amounts of medical resources.

Finally, standards set by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) and by Medicare (in the US) require that providers of health care show respect for patients' cultural and personal values, beliefs, and preferences (including religious or spiritual beliefs) [ 593 ]. This point was reinforced by a personal communication with Doreen Finn ( [email protected] ), Senior Associate Director, who works under Mark Pelletier ( [email protected] ), Executive Director, JCAHO, Hospital Accreditation (January 6–12, 2012). If health professionals are unaware of those beliefs, they cannot show respect for them and adjust care accordingly.

9.2. How to Integrate Spirituality into Patient Care

What would I recommend in terms of addressing spiritual issues in clinical care?

First and foremost, health professionals should take a brief spiritual history. This should be done for all new patients on their first evaluation, especially if they have serious or chronic illnesses, and when a patient is admitted to a hospital, nursing home, home health agency, or other health care setting. The purpose is to learn about (1) the patient's religious background, (2) the role that R/S beliefs or practices play in coping with illness (or causing distress), (3) beliefs that may influence or conflict with decisions about medical care, (4) the patient's level of participation in a spiritual community and whether the community is supportive, and (5) any spiritual needs that might be present [ 594 ]. It is the health professional , not the chaplain, who is responsible for doing this two-minute “screening” evaluation. If spiritual needs are discovered, then the health professional would make a referral to pastoral care services so that the needs can be addressed. The spiritual history (and any spiritual needs addressed by pastoral services) should be documented in the medical record so that other health professionals will know that this has been done. Although notes need not be detailed, enough information should be recorded to communicate essential issues to other hospital staff.

Ideally, the physician, as head of the medical care team, should take the spiritual history. However, since only about 10% of physicians in the US “often or always” do so [ 595 ], the task often falls to the nurse or to the social worker. Although systematic research is lacking in this area, most nurses and social workers do not take a spiritual history either. Simply recording the patient's religious denomination and whether they want to see a chaplain, the procedure in most hospitals today, is NOT taking a spiritual history.

Second, R/S beliefs of patients uncovered during the spiritual history should always be respected. Even if beliefs conflict with the medical treatment plan or seem bizarre or pathological, the health professional should not challenge those beliefs (at least not initially), but rather take a neutral posture and ask the patient questions to obtain a better understanding of the beliefs. Challenging patients' R/S beliefs is almost always followed by resistance from the patient, or quiet noncompliance with the medical plan. Instead, the health professional should consult a chaplain and either follow their advice or refer the patient to the chaplain to address the situation. If the health professional is knowledgeable about the patient's R/S beliefs and the beliefs appear generally healthy, however, it would be appropriate to actively support those beliefs and conform the healthcare being provided to accommodate the beliefs.

Third, most health professionals without clinical pastoral education do not have the skills or training to competently address patients' spiritual needs or provide advice about spiritual matters. Chaplains have extensive training on how to do this, which often involves years of education and experience addressing spiritual issues. They are the true experts in this area. For any but the most simple spiritual needs, then, patients should be referred to chaplains to address the problem.

Fourth, conducting a spiritual history or contemplating a spiritual intervention (supporting R/S beliefs, praying with patients) should always be patient centered and patient desired. The health professional should never do anything related to R/S that involves coercion. The patient must feel in control and free to reveal or not reveal information about their spiritual lives or to engage or not engage in spiritual practices (i.e., prayer, etc.). In most cases, health professionals should not ask patients if they would like to pray with them, but rather leave the initiative to the patient to request prayer. The health professional, however, may inform R/S patients (based on the spiritual history) that they are open to praying with patients if that is what the patient wants. The patient is then free to initiate a request for prayer at a later time or future visit, should they desire prayer with the health professional. If the patient requests, then a short supportive prayer may be said aloud, but quietly, with the patient in a private setting. Before praying, however, the health professional should ask the patient what he or she wishes prayer for, recognizing that every patient will be different in this regard. Alternatively, the clinician may simply ask the patient to say the prayer and then quietly confirm it with an “amen” at the end.

Fifth, R/S beliefs of health professionals (or lack of belief) should not influence the decision to take a spiritual history, respect and support the R/S beliefs of patients, or make a referral to pastoral services. These activities should always be patient centered, not centered on the health professional. One of the most common barriers to addressing spiritual issues is health professionals' discomfort over discussing such issues. This often results from lack of personal R/S involvement and therefore lack of appreciation for the importance and value of doing so. Lack of comfort and understanding should be overcome by training and practice. Today, nearly 90% of medical schools (and many nursing schools) in the US include something about R/S in their curricula [ 596 ] and this is also true to a lesser extent in the United Kingdom [ 597 ] and Brazil [ 598 ]. Thus, spirituality and health is increasingly being addressed in medical and nursing training programs.

Sixth, health professionals should learn about the R/S beliefs and practices of different religious traditions that relate to healthcare, especially the faith traditions of patients they are likely to encounter in their particular country or region of the country. There are many such beliefs and practices that will have a direct impact on the type of care being provided, especially when patients are hospitalized, seriously ill or near death. A brief description of beliefs and practices for health professionals related to birth, contraception, diet, death, and organ donation is provided elsewhere [ 599 ].

Finally, if spiritual needs are identified and a chaplain referral is initiated, then the health professional making the referral is responsible for following up to ensure that the spiritual needs were adequately addressed by the chaplain. This is especially true given the impact that unmet spiritual needs are likely to have on both medical outcomes and healthcare costs. Given the short lengths of stay in today's modern hospital (often only 2–4 days), spiritual needs identified on admission are unlikely to be resolved by discharge. Therefore, a spiritual care discharge plan will need to be developed by the hospital social worker in consultation with the chaplain, which may involve (with the patient's written consent) contact with the patient's faith community to ensure that spiritual needs are addressed when the patient returns home. In this way, continuity of pastoral care will be ensured between hospital and community.

10. Conclusions

Religious/spiritual beliefs and practices are commonly used by both medical and psychiatric patients to cope with illness and other stressful life changes. A large volume of research shows that people who are more R/S have better mental health and adapt more quickly to health problems compared to those who are less R/S. These possible benefits to mental health and well-being have physiological consequences that impact physical health, affect the risk of disease, and influence response to treatment. In this paper I have reviewed and summarized hundreds of quantitative original data-based research reports examining relationships between R/S and health. These reports have been published in peer-reviewed journals in medicine, nursing, social work, rehabilitation, social sciences, counseling, psychology, psychiatry, public health, demography, economics, and religion. The majority of studies report significant relationships between R/S and better health. For details on these and many other studies in this area, and for suggestions on future research that is needed, I again refer the reader to the Handbook of Religion and Health [ 600 ].

The research findings, a desire to provide high-quality care, and simply common sense, all underscore the need to integrate spirituality into patient care. I have briefly reviewed reasons for inquiring about and addressing spiritual needs in clinical practice, described how to do so, and indicated boundaries across which health professionals should not cross. For more information on how to integrate spirituality into patient care, the reader is referred to the book, Spirituality in Patient Care [ 601 ]. The field of religion, spirituality, and health is growing rapidly, and I dare to say, is moving from the periphery into the mainstream of healthcare. All health professionals should be familiar with the research base described in this paper, know the reasons for integrating spirituality into patient care, and be able to do so in a sensible and sensitive way. At stake is the health and well-being of our patients and satisfaction that we as health care providers experience in delivering care that addresses the whole person—body, mind, and spirit.

Conflict of Interests

The author declares that he has no conflict of interests.

Acknowledgment

The support to write this paper was provided in part by the John Templeton Foundation.

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