MJA
MJA InSight
MJA Careers
Supplement

Religion, spirituality and medicine in Australia: research and clinical practice

Harold G Koenig
Med J Aust 2007; 186 (10 Suppl): S45.

Studies demonstrating health benefits of religion are many and growing in number, and some claim the results are ripe for application in clinical settings.1,2 However, others argue that the research is not nearly as good or consistent as portrayed, and caution against acting rashly on inconclusive evidence.3,4 The goal of this supplement is to determine what this growing body of research means for Australian practitioners and patients.

Religion involves beliefs and practices related to the sacred, where the sacred is defined as God, the numinous (mystical or supernatural) or ultimate truth. Religion is a unique construct, different from other psychological and social phenomena. Spirituality, on the other hand, is more difficult to define, as its definition today has changed — from one based in religion to a more diffuse concept, self-defined by each individual. The result is that there is no widespread agreement on what spirituality means, producing a real challenge when trying to measure it.

Attempts to measure spirituality have taken two approaches:

  • Asking questions about religious involvement;

  • Asking questions about positive psychological characteristics, such as meaning and purpose in life, connectedness to others, peacefulness and high personal values.

There are two problems with the latter way of defining and measuring spirituality. The first is that atheists might claim that they are neither religious nor spiritual — yet argue, rightly, that their lives have purpose and meaning, that they experience connection with others, and that they maintain high personal values.

The second problem with defining spirituality in terms of positive psychological characteristics is that doing so produces a construct that is really a quasi-indicator of mental health. This makes it difficult or impossible to interpret research on the relationship between spirituality and health, especially mental health. Correlating a construct defined by indicators of mental health (spirituality) with another mental health construct (eg, wellbeing, life satisfaction, depression or anxiety) will always lead to an association between the two. Such an approach could also lead to false relationships between spirituality and physical health, given the strong links between mental and physical health.

The word spirituality, when used in research, should be restricted to those things that have something to do with the sacred (as defined above). If there is no connection with the sacred, then it should not be referred to as spiritual or spirituality. We already have psychological and social terms to deal with concepts that all humans have in common, regardless of belief, and I think we should keep these concepts distinct from religious terms. I realise that many others in both the United States and Australia will not share this opinion, including a number of authors who have contributed to this supplement. From a purely scientific standpoint, if we are to study the relationships between religion, spirituality and health, it is essential to have constructs that are clear and non-overlapping.

For these reasons, I refer mainly to religion when discussing relationships with mental and physical health. My definition of religion, however, is quite broad and means a lot more than just institutional religion or religious affiliation. Another reason for using religious language when discussing the research is that most published research has really been examining religion, even if it is presented and discussed in terms of spirituality.

However, when talking with patients in clinical practice, there are good reasons for using the word spirituality, rather than religion. Research shows that, while many patients do not distinguish between being religious or spiritual,5 others feel alienated from institutional religion and see themselves more as spiritual than as religious. This may be particularly true for patients in Australia. The term spirituality is vague enough to allow patients themselves to define the playing field.

Why should religion and health be connected? The argument is a rational one. If religious people have a world view that gives hope and meaning in the face of stress and loss, if they have social support from other members of the religious community, and if they live healthier lifestyles by smoking less, drinking less, and making more conservative, less risky decisions in marriage, the workplace, and recreational activities, there is good reason to expect that they will have better physical health as well. All of these factors influence health in ways that are increasingly being understood through the field of psychosomatic medicine.6 It should not be surprising, then, that in 2006 more than 70 published research studies examined the relationships between religion, spirituality and health, many finding positive relationships.7

The articles in this supplement review research on religion, spirituality and health relevant to Australian patients and practitioners and discuss the application of that research to clinical practice. Although not all of the research comes from Australia, the articles provide an important summary and background that will assist Australian researchers in designing and implementing future research. While most of the articles do not contain original research, they begin to address some of the research gaps identified by Peach in 2003.8 Williams and Sternthal9 assess the importance of religion and spirituality to Australians and discuss the evidence for both positive and negative effects of religion on health (→ Spirituality, religion and health: evidence and research directions). Eckersley10 looks at the relationship between spirituality, religion and health in a broad cultural context (→ Culture, spirituality, religion and health: looking at the big picture), while Wilding11 presents a case study to illustrate the meaning of spirituality at a personal level (→ Spirituality as a sustenance for mental health and meaningful doing: a case illustration). The different approaches to spiritual assessment in health care practice are summarised by Rumbold12 (→ A review of spiritual assessment in health care practice), and Winslow and Wehtje-Winslow13 raise a number of ethical issues relating to the provision of spiritual care (→ Ethical boundaries of spiritual care). Jantos and Kiat14 present evidence on the health benefits of prayer (→ Prayer as medicine: how much have we learned?), and D’Souza15 suggests ways in which clinicians can approach the subject of spirituality with their patients (→ The importance of spirituality in medicine and its application to clinical practice). Hopkins and colleagues16 focus on evidence-based strategies that could be implemented by church-associated organisations to reduce high-risk behaviours in young people (→ Developing healthy kids in healthy communities: eight evidence-based strategies for preventing high-risk behaviour), and, at the other end of the age spectrum, MacKinlay and Trevitt17 provide a model of spiritual tasks in later life (→ Spiritual care and ageing in a secular society).

The contributions presented here suggest that spirituality and religion are important to many Australian patients, and that the spiritual needs arising from religious beliefs should be identified and addressed as part of whole person health care. They also suggest that much more research in this area is needed in Australia. While some of the findings of US research may be applicable to Australian patients, there are important cultural differences between the two countries that may influence the relationship of religion to health and the needs of patients in this regard.

Harold G Koenig, MD, Professor,1 and Associate Professor2
1 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
2 Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Correspondence: 
Competing interests: 
None identified.
Reference Text: 
Koenig HG. An 83-year-old woman with chronic illness and strong religious beliefs. JAMA 2002; 288: 487-493.
Reference Order: 
1
PubMed ID: 
12132980
Reference Text: 
Koenig HG. Religion, spirituality and health: an American physician’s response. Med J Aust 2003; 178: 51-52.
Reference Order: 
2
PubMed ID: 
12526719
Reference Text: 
Sloan RP, Bagiella E, Powell T. Religion, spirituality, and medicine. Lancet 1999; 353: 664-667.
Reference Order: 
3
PubMed ID: 
10030348
Reference Text: 
Sloan RP, Bagiella E, VandeCreek L, et al. Should physicians prescribe religious activities? N Engl J Med 2000; 342: 1913-1916.
Reference Order: 
4
PubMed ID: 
10861331
Reference Text: 
Koenig HG, George LK, Titus P. Religion, spirituality and health in medically ill hospitalized older patients. J Am Geriatr Soc 2004; 52: 554-562.
Reference Order: 
5
PubMed ID: 
15066070
Reference Text: 
Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: implications for health. Nat Rev Immunol 2005; 5: 243-251.
Reference Order: 
6
PubMed ID: 
15738954
Reference Text: 
Center for Spirituality, Theology and Health, Duke University Medical Center. Research on spirituality, theology and health. Latest research. http://www.dukespiritualityandhealth.org (accessed Apr 2007).
Reference Order: 
7
Reference Text: 
Peach HG. Religion, spirituality and health: how should Australia’s medical professionals respond? Med J Aust 2003; 178: 86-88.
Reference Order: 
8
PubMed ID: 
12526730
Reference Text: 
Williams DR, Sternthal MJ. Spirituality, religion and health: evidence and research directions. Med J Aust 2007; 186 (10 Suppl): S47-S50.
Reference Order: 
9
Reference Text: 
Eckersley RM. Culture, spirituality, religion and health: looking at the big picture. Med J Aust 2007; 186 (10 Suppl): S54-S56.
Reference Order: 
10
Reference Text: 
Wilding C. Spirituality as sustenance for mental health and meaningful doing: a case illustration. Med J Aust 2007; 186 (10 Suppl): S67-S69.
Reference Order: 
11
Reference Text: 
Rumbold BD. A review of spiritual assessment in health care practice. Med J Aust 2007; 186 (10 Suppl): S60-S62.
Reference Order: 
12
Reference Text: 
Winslow GR, Wehtje-Winslow BJ. Ethical boundaries of spiritual care. Med J Aust 2007; 186 (10 Suppl): S63-S66.
Reference Order: 
13
Reference Text: 
Jantos M, Kiat H. Prayer as medicine: how much have we learned? Med J Aust 2007; 186 (10 Suppl): S51-S53.
Reference Order: 
14
Reference Text: 
D’Souza R. The importance of spirituality in medicine and its application to clinical practice. Med J Aust 2007; 186 (10 Suppl): S57-S59.
Reference Order: 
15
Reference Text: 
Hopkins GL, McBride D, Marshak HH, et al. Developing healthy kids in healthy communities: eight evidence-based strategies for preventing high-risk behaviour. Med J Aust 2007; 186 (10 Suppl): S70-S73.
Reference Order: 
16
Reference Text: 
MacKinlay EB, Trevitt C. Spiritual care and ageing in a secular society. Med J Aust 2007; 186 (10 Suppl): S74-S76.
Reference Order: 
17