The research on the relationship between religion and mental health has really exploded since the year 2000. Between 1980 and 1982, there were about 101 articles published in the literature. In the past two and a half years, there have been over 1,800 articles written -- research studies, discussions on the topic of religion and health. Comparing the three-year periods 20 years apart, there has been, literally, an 18-fold increase in the amount of attention this subject is being paid. The reason for the big increase is because the research has reached a critical mass of information such that now it's getting other scientists interested in the associations.Religion is a very powerful coping behavior, and it looks like religious beliefs and practices do seem to facilitate coping with major life circumstances, so that people who are more religious have greater well-being, lower anxiety, more purpose and meaning in life, more positive emotions. They experience less depression, less anxiety, less substance abuse. As a result, they turn out to be healthier. These mental health benefits have physical health consequences, so that religious people tend to have lower blood pressure, tend to have stronger immune systems and oftentimes will live longer, will have greater life spans than people who are less involved in religious practices.
Most of this research has been cross-sectional, which does mean that what is being established, largely, is an association. However, about 10 percent of this vast amount of research has been prospective, longitudinal, taking a time component into the research design, which means that you can actually predict ahead of time the mental health or the physical health of a person based on their religious beliefs and practices at an earlier time point, which suggests that there may be a causal relationship. In the mental health area, there have actually been clinical trials where people have been randomized to either get a religious mental health intervention or not get that intervention. And those getting the intervention do seem to recover more quickly from the depression or the anxiety. Those clinical trials buttress the findings from the cross-sectional and prospective studies.
We're close to proving [that religious involvement results in better health] because of the randomized clinical trials in the mental health area. That doesn't mean for physical health. In physical health, we don't have the randomized clinical trials that prove that religion results in better health. But other research suggests [that] that, indeed, may be the case.
Twenty years ago, I was a family physician in the Midwest. I was taking care of older adults who were rehabilitating from surgery, from various severe illnesses. At that time, I was interested in how people were coping with their illnesses. I had been a nurse prior to that, and as a nurse, we were interested in how patients were emotionally dealing with their situations. I would ask patients, "What enables you to cope?" And many times they would talk about their religious faith. They would talk about prayer or about God, about their congregation and how important that was in supporting them. And yet as a medical doctor and as a nurse, I had received absolutely no training or exposure to the potential benefits of the person's religious faith. That got me into how we can systematically study this area to demonstrate that there really is a benefit to these religious practices.
I was raised a Catholic and fell away from the Church when I was in high school and college and medical school. There's just no time, really, to devote to it. It was not until I was in my midlife years, as I started to deal with various tragedies in my own life, including a divorce and health problems, emotional problems, that my faith began to come back, because I saw what a benefit it was, at least in my own life. Right about that same time, I was beginning to study the relationships and discovering also that this was not just my own personal experiences, but other people were having these experiences as well.
Every scientist has a hypothesis and, in many respects, is biased toward that hypothesis. I'm not different. As a person of faith who has experienced himself the benefits of faith, my hypothesis is that this has benefits for other people, and I want to test that hypothesis. But as a good scientist, I have to design my studies in a way so that my own personal biases don't enter into that research. All scientists have biases. The good scientists design the research in a way and analyze it such that their biases don't enter into that scientific work.
There's not a lot of criticism, I think, from, particularly, people who are taking care of patients, doctors who are actually dealing with people struggling with medical and psychiatric illness. But there is one source of criticism from one group at Columbia University that feels that the research is weak and inconsistent. It is interesting that, given the growth of this field, there are not more critics. That is what shocks me in some respects -- that the criticism tends to be from people who are, clearly, oriented toward criticizing the area. It's not a general phenomenon. Most doctors realize, if they're taking care of suffering older people and pain, that faith makes a difference. It's hard to criticize, and the research that's coming out -- there's so much of it.
Studies show that doctors are somewhat less religious than the general population, but not that much less religious. Doctors in general tend to have beliefs and practices just like everybody else, and many times those are religious in nature. But they tend not to allow their own personal beliefs into their work; those two areas have been so separate. We've been trained to separate our personal beliefs and practices from our professional work. Most doctors keep them separate and don't really utilize those beliefs as part of their care for patients, when the patient may have the same beliefs acting as a resource.
Doctors are scientists, and they can't ignore the research that's coming out, because that's science just like the science that they're trained with. I think there's a growing openness within the medical profession to consider valuing the role that religion and spirituality play. Many doctors don't know what to do with that. But I think there's a growing value -- 85 percent of doctors indicate, even in skeptical studies, that faith seems to play a role in people's health. They believe that it makes a difference in the person's life. Again, they don't know what to do with that information.
You cannot prove, in my opinion, anything about God, or that God answers prayer, or anything that's supernatural. I think that's outside the natural tools of science that we have at our disposal. What we can show, though, is what impact does believing in God, going to church, reading the Bible, going to synagogue, mosque -- what impact do those beliefs and practices have on a person's mental and physical health? That we can study.
A healthy lifestyle is part of the effect, and that's very important. Why are [people] living a healthy lifestyle? A lot of that has to do with the beliefs. Why are they not smoking? Why are they not drinking? Why are they not having sex outside of marriage? It's because the preacher is preaching that you need to respect your body, you need to be faithful to your wife and family. That's part of the religious effect. It's not the entire effect, because we know that psychological and social factors also play a role. But health behaviors are a big part of that effect, and we try to control for that in our analyses to try to explain how religion affects health.
Having faith and being optimistic can definitely influence one's outcome. However, what this research shows is that having faith specifically in religion helps people more than having faith in other things. That's what we're studying. We're comparing people with faith in religion versus faith in family or work or hobbies, and the religious people seem to do better.
If you lived a healthy lifestyle, if you had a strong family and lots of friends, if you had a belief system that helped you cope with death and life and suffering and religion had no part of it, you'd have the same health benefits. The problem is, most people aren't in that situation. Most people don't have a worldview that makes sense of death and suffering and loss, don't have a ton of friends that are supportive or a family that encourages and supports them, and don't live a healthy lifestyle because they're simply human and are pulled to these various kinds of temptations that affect our health. So religion is a package of things that brings together all of those different areas in a person's life.
Religion is very personal in the lives of patients. However, 20 years ago doctors were skeptical and squeamish about asking about sexual histories, asking about sexual lifestyles and partners. We today don't hesitate to take a sexual history because we know it's connected with the person's health. The same thing [is true] with religion. I think right now, sure, doctors are uneasy about it and don't want to ask and aren't sure why they should ask, but the research is showing that it's connected with health and medical decision making and these kinds of things that affect the person's health.
We're not recommending that people get religion to get healthier. We don't even know, if people pursue religion for health reasons alone, whether that has a health benefit. What we are showing is that people who are already religious have health benefits. And we're presuming that they're religious not for health reasons but for other, more valid reasons.
We did a study just two years ago demonstrating that people who are angry at God, who feel that God doesn't love them [and] is punishing them with their illness -- they die more quickly over time, even independent of their physical health or social support or mental health. We don't know how that effect really works, in fact. But we do know that religious struggles can impact physical health and affect mortality ratios, and that study's published in the ARCHIVES OF INTERNAL MEDICINE. There [were] 450 people followed for a two-year period after discharge. That's a Duke study, [and] actually in that particular study people who were feeling angry at God and deserted by God weren't the religious people. These are the people who talk with God when things are going bad and ignore God when things are good, and the only time they have a conversation with him is when they're mad at him.
There is a lot of research that's coming out suggesting that religion is related to better mental health and better physical health. We are still early in this research field. We cannot really say anything absolutely definitively. However, there's enough evidence thus far to suggest that doctors need to begin to communicate with patients about these issues in a sensitive way, and I think that's what needs to be done. You cannot say that it's proven beyond a shadow of a doubt that religion makes you healthy; that's correct, but where there is a lot of smoke, there's probably some fire.
I have occasionally prayed with my patients; I don't do it as a routine. These are patients that I've known for many years and that I have a relationship with and that I know a little bit about their spiritual background, and I have prayed with patients in that circumstance. The impact that has on a patient sometimes is greater than anything else that I've done, any medication that I've prescribed, any psychotherapy I've done. Saying a prayer for a person, with a person who is under real distress -- the doctor saying the prayer just makes a huge difference to patients. I don't know why, but it just does.
In medicine we are dealing with things that are spiritual, whether we acknowledge it or not. You are talking about people's lives that are potentially becoming disabled, losing their jobs, affecting their families, dealing with death and disability and suffering.
Those are spiritual areas. And patients almost naturally understand that their medical care is in some way connected to the spiritual part of their being. When the doctor addresses both, I think that just fills a real need that some patients have.
I believe that all doctors should be open to praying with their patients if the patient wants the doctor to do that. However, I don't think a doctor should be forced to do that. I think it's a personal decision on the doctor's part on whether to pray with the patient, even if the patient asks.
A theological problem needs to be addressed from a theological perspective, such as a chaplain or a pastoral counselor who can help a person deal with feeling their faith isn't strong enough. There's also the issue, I think, that many of us want to get better to such a point that our health eventually becomes our god, and that we use God in order to achieve what we really want, which is our god, which is health. The first commandment is "Thou shall have no gods before me," and that includes health. Healing may not be physical healing. Healing may be social, may be emotional; it may be spiritual. God may decide we need that more than we need the physical healing. Great faith oftentimes doesn't develop until people get sick and suffer and are forced out of themselves, so you can never conclude that a person is sick because of a weak faith.
