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Spirituality and religiosity

"Spirituality" generally refers to concepts that are much harder to define and measure, such as "personal views and behaviours that express a sense of relatedness to the transcendental dimension or to something greater than the self".⁹ Spirituality can encompass belief in a higher being, the search for meaning, and a sense of purpose and connectedness. Obviously, there can be a wide overlap between religiosity and spirituality.

Spirituality and mental health

This was one of the main reasons why these two pioneers of psychology parted company. The observation that Freudian psychoanalysis is probably associated with negative effects on people's health may, however, throw into question Freud's understanding of human nature.¹¹ Nevertheless, many of Freud's attitudes have deeply etched their way into psychiatric theory and practice:

Mainstream psychiatry, in its theory, research and practice, as well as its diagnostic classification system, has tended to either ignore or pathologise the religious and spiritual issues that clients bring into treatment.¹²

The negative attitude towards religiosity in many quarters of contemporary medicine and psychiatry is out of keeping with the weight of evidence which clearly shows that it has a beneficial effect on mental and physical health.⁸ The findings are consistent across prospective and retrospective studies, whether or not they control for other lifestyle and socioeconomic factors, and whether they examine prevention of illness, coping with illness, or recovery (see Box).

Many studies have linked a lack of religiosity to depression. Religious commitment is associated with a reduced incidence of depression¹³ and a quicker recovery from depressive illness for the elderly.¹⁵ Two separate reviews of the literature have supported this: those with high levels of "religious involvement", "religious salience" and "intrinsic religious motivation" were at reduced risk,¹⁴ and religious commitment was inversely related to suicide risk in 13 of 16 studies reviewed.¹³ One study showed a fourfold increased risk of suicide for non-churchgoers compared with regular attenders,²² and no study has shown an increased risk of suicide among churchgoers.

Other data suggest that religiosity protects against drug and alcohol misuse, one of the most commonly used and maladaptive ways for dealing with depression. One study showed that 89% of alcoholics (but only 20% of the control group) had lost interest in religious issues during their teenage years.²⁰ In another study it was found that doctors (who are a high-risk group for substance misuse) were less likely to develop an alcohol problem in later life if they had had a religious commitment while in medical school.²¹ Religious affiliation, even if accompanied by alcohol misuse, seemed to protect against heavy use or the associated extreme clinical and social consequences.

The reasons why people with a sense of religious commitment are less likely to become depressed may include a feeling of social connectedness, exposure to messages about healthy living, or perhaps the reduced exposure to drug-taking behaviour. However, studies controlling for these factors have still found religiosity to be independently protective. So there may be other reasons, such as the comfort that comes from believing in a benevolent and caring God, the view that justice always prevails in the end, or that adverse events always have a meaning and a message. Such attitudes would buffer enormously against the ill-effects of life stresses and the depression that often follows.

The important role that mental health plays in the development and progression of physical illness goes part way to explaining why religious commitment is associated with reduced risk of conditions such as hypertension, heart disease and cancer.^26,27,29,30 A population study over nine years showed that all-cause mortality was significantly reduced and life expectancy increased (to 82 years v. 75 years) for regular churchgoers. The findings were not explainable by the accepted lifestyle and social variables,²⁴ and were consistent with other data.²⁵

Unfortunately, examples of the negative effects of religion are generally more newsworthy in the medical and general press than the positive ones. For example, in a review of a series of preventable paediatric deaths, it was found that some parents' religious views played an important part in delaying the seeking of medical care.³¹ Sometimes this negative press is for a good reason, but this is not an argument against spirituality, but rather against blind faith unsupported by reason.

Relevance to clinical medicine

This is no flattery: these are counsellors
That feelingly persuade me what I am.
Sweet are the uses of adversity,
Which, like the toad, ugly and venomous,
Wears yet a precious jewel in his head.
(As You Like It; Act 2, Scene 1)

Gauging a patient's spiritual awareness, at very least, should form an important part of a thorough history. One can not really be said to know another person without an understanding of his or her responses to the most important questions that human beings ask themselves. Without this knowledge, treatment of especially sensitive conditions like depression or terminal illness will take place in the dark. Broaching philosophical and spiritual issues requires considerable sensitivity, cultural tolerance and the ability to be non-dogmatic. When done effectively, it can facilitate counselling and psychotherapy enormously,³² but each doctor and patient needs to explore these issues in his or her own way. Even if we are not religious ourselves, we should invite discussion in a respectful way, taking care not to push a line of thought, whether it be religious or secular. Religious sensitivities and biases, like political ones, can make discussion divisive and difficult. More in-depth questions about spirituality and religion should probably be referred to culturally appropriate "non-medical experts".

At present, despite the large body of evidence on the connection between religiosity and health, little if any reference is made to this issue in medical education and practice. If a physical factor was found to be of as much importance to health it would certainly not be ignored, but then science is always most comfortable with what it can most easily measure. It is reasonable for medical students and practitioners to be aware of this field of evidence so that they can provide a more holistic approach to information giving, psychotherapy and treatment. Unfortunately, a perceived lack of holism is a central reason why many people look outside the biomedical model for their healthcare.³³

For many people, especially the young, the search for meaning is becoming a rarer pursuit in the bustle of modern material life. People pursue meaning and fulfilment by as many paths as there are people, but perhaps we often search in places which can not provide it. If the search is misdirected, disappointment, stress, depression and social conflict may be inevitable sequelae of such existential pain. Perhaps these issues will become increasingly relevant for future generations, for whom the lack of meaning will come at an increasing cost. Maybe a balanced form of spirituality which is not scientifically naive nor culturally intolerant may be a prerequisite for the mental and material wellbeing of an all too often dispirited community and healing profession.

References

1. Murray C, Lopez A. The global burden of disease. Cambridge, Massachusetts: Harvard School of Public Health, on behalf of the World Health Organization and the World Bank, 1996.
2. Cantor C, Neulinger K, De Leo D. Australian suicide trends 1964-1997: youth and beyond? Med J Aust 1999; 171: 137-141.
3. Mathers CD, Vos ET, Stevenson CE, Begg SJ. The Australian Burden of Disease Study: measuring the loss of health from diseases, injuries and risk factors. Med J Aust 2000; 172: 592-596.
4. Rey J. The Epidemiological Catchment Area (ECA) study: implications for Australia. Med J Aust 1992; 156: 200-203.
5. Miller M, Rahe R. Life changes scaling for the 1990s. J Psychosom Res 1997; 43: 279-292.
6. McKelvey R, Davies L, Pfaff J, et al. Psychological distress and suicidal ideation among 15-24 year olds presenting to a general practice: a pilot study. Aust N Z J Psychiatry 1998; 32: 344-348.
7. Resnick M, Bearman P, Blum R, et al. Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. JAMA 1997; 278: 823-832.
8. Matthews D, McCullough M, Larson D, et al. Religious commitment and health status: a review of the research and implications for family medicine. Arch Fam Med 1998; 7: 118-124.
9. Reed P. Spirituality and wellbeing in terminally ill hospitalised patients. Res Nurs Health 1987; 9: 35-41.
10. Freud S. Civilisation and its discontents. In: Strachey J, editor. The standard edition of the complete psychological works of Sigmund Freud. Vol. 20. London: Hogarth, 1959.
11. Grossarth-Maticek R, Eysenck H. Prophylactic effects of psychoanalysis on cancer-prone and coronary heart disease-prone probands, as compared with control groups and behaviour therapy groups. J Behav Ther Exp Psychiatry 1990; 21: 91-99.
12. Lukoff D, Fu FG, Turner R. Cultural considerations in the assessment and treatment of religious and spiritual problems. Psychiatr Clin North Am 1995; 18(3): 467-485.
13. Gartner J, Larson D, Allen G. Religious commitment and mental health: a review of the empirical literature. J Psychol Theol 1991; 19: 6-25.
14. McCullough M, Larson D. Religion and depression: a review of the literature. Twin Research 1999; 2(2): 126-136.
15. Koenig H, George L, Peterson B. Religiosity and remission of depression in medically ill older patients. Am J Psychiatry 1998; 155: 536-542.
16. Oxman T, Freeman D, Manheimer E. Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. Psychosom Med 1995; 57: 5-15.
17. Saudia TL, Kinney MR, Brown KC, et al. Health locus of control and helpfulness of prayer. Heart Lung 1991; 20: 60-66.
18. Koenig H, Cohen H, Blazer D, et al. Religious coping and depression in elderly, hospitalised medically-ill men. Am J Psychiatry 1992; 149: 1693-1700.
19. Williams D, Larson D, Buckler R, et al. Religion and psychological distress in a community sample. Soc Sci Med 1991; 32: 1257-1262.
20. Larson D, Wilson W. The religious life of alcoholics. South Med J 1980; 73: 723-727.
21. Moore R, Mead L, Pearson T. Youthful precursors of alcohol abuse in physicians. Am J Med 1990; 88: 332-336.
22. Comstock G, Partridge K. Church attendance and health. J Chronic Dis 1972; 25: 665-672.
23. Propst LR, Ostrom R, Watkins P, et al. Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. J Consult Clin Psychol 1992; 60: 94-103.
24. Hummer R, Rogers R, Nam C, et al. Religious involvement and U.S. adult mortality. Demography 1999; 36: 273-285.
25. Clark K, Friedman H, Martin L. A longitudinal study of religiosity and mortality risk. Journal of Health Psychology 1999; 4: 381-391.
26. Fraser G, Sharlik D. Risk factors for all-cause and coronary heart disease mortality in the oldest old: the Adventist Health Study. Arch Intern Med 1997; 157: 2249-2258.
27. Kune G, Kune S, Watson L. Perceived religiousness is protective for colorectal cancer: data from the Melbourne Colorectal Cancer Study. J R Soc Med 1993; 86: 645-647.
28. Larson DB, Koenig HG, Kaplan BH, et al. The impact of religion on men's blood pressure. J Religion Health 1989; 28: 265-278.
29. Levin J, Vanderpool H. Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Soc Sci Med 1987; 24: 589-600.
30. Craigie F, Larson D, Liu I. References to religion in the Journal of Family Practice: dimensions and valency of spirituality. J Fam Pract 1990; 30: 477-480.
31. Asser S, Swan R. Child fatalities from religion motivated medical neglect. Pediatrics 1998; 101: 625-629.
32. Hassed C. Western psychology meets Eastern philosophy. Aust Fam Physician 1999; 28: 1057-1058.
33. Astin J. Why patients use alternative medicine: results of a national study. JAMA 1998; 279: 1548-1553.
34. Einstein A. Out of my later years. New York: Philosophical Library, 1950.

Authors' details

Reprints will not be available from the author.
Correspondence: Dr C S Hassed, Department of Community Medicine and General Practice, Monash University, 867 Centre Road, East Bentleigh, VIC 3165.
craig.hassedATmed.monash.edu.au

©MJA 2000
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