copyright 2005, daniel e. hall it ain’t necessarily so what a family physician needs to know...

• Copyright 2005, Daniel E. Hall

It Ain’t Necessarily So

What a Family Physician Needs to Know Before Interpreting

Studies on Religion and Health

The Rev. Daniel E Hall, MD, MDivFellow in Religion and Health, DUMC

Resident, General Surgery, UPMC

Assisting Priest, Church of the Holy Family


What You Need to Know

1. How to interpret the medical data about religion and health.

2. How to apply it……Wisely

• In both lectures, I aim to challenge some assumptions and hopefully spark new insight.


So what do we know about religion and health?

• Quite a lot, really.• Over 2000 studies, some quite

sophisticated• Multidisciplinary field encompassing

physical, mental and social health• Strongest data demonstrates robust

association between mortality and religious attendance.


Examples:

• Lower mortality, longer survival (39 of 52 studies)• Better immune function (5 of 5 studies)• Lower blood pressure (12 of 14 studies)• Less heart disease (11 of 16 studies) • Purpose and meaning in life (15/16)• Depression and its recovery (60/93)• Suicide (57/68)• Marital satisfaction and stability (35/38)• Social support (19/20)• Substance abuse (98/120)

Handbook of Religion and Health (Oxford University Press, 2001)


The World According ToGeorge Gershwin

“It ain’t necessarily so. The things that your liable to read in the bible…

(aka NEJM, Harrison’s, Time)

…..It ain’t necessarily so.”


Empiricism

What is religion? Try to define it.

How would you measure it?


History

• 15 Years ago: Poor Quality• Today: toe to toe with other research• Much more sophisticated

– Design– Statistics– Controls– Explanatory pathways/mechanisms

Koenig, et. al., Handbook of Religion and Health (Oxford University Press, 2001)McCullough, ME (1999) Research on religion-accommodation counseling: Review and meta-

analysis. J of Counseling Psychology, 211-222.Levin, J. S., and H. Y. Vanderpool. 1987. Is frequent religious attendance really conducive to

better health? Toward an epidemiology of religion. Soc Sci Med 24(7):589–600.


• ICIHS Consensus Conference– 1997, 1200 articles– 2003, >2000 articles

• What was new? Not much.– The wider application of existing

methodology generated more of the same kinds of findings.

– Double edged sword of growing respect. As the field became a “field” less freedom and creativity in cracking new nuts.


• What do all those 2000 papers tell us? (On my most cynical day…)

On the whole, “Religion” (poorly understood and even more poorly measured) has a small, robust, positive association with “health” (slightly better understood and measured).


“Without attention to the epistemological matters of

conceptualizing and operationalizing ‘religion’ in

meaningful ways, no amount of methodological and analytical

sophistication will be sufficient to generate meaningful findings”

Levin, J. S., and H. Y. Vanderpool. 1987. Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion.

Soc Sci Med 24(7):589–600.


Conceptualizing Religion

• How can we do this better?

• Why is it important?– Impossible to interpret the medical

literature without knowing how the study conceives its subject, and perhaps more importantly, how it measures that subject.

– Healthy skepticism: It ain’t necessarily so.


Measuring Religion?

How has it been done so far?


Religious Measurement

• Over 100 instruments exist

• Impressive depth and breadth

• Lots of valuable information


Multidimensional Construct

• Organized Religiosity (attendance)• NonOrganized Religiosity (private prayer,

scripture reading)• Intrinsic/Extrinsic• Functional Measures

– Spiritual Well Being– Coping

• History• Spiritual Experiences• Multidimensional Measures


Duke University Religion Index (DUREL)

1. How often do you attend church or other religious meetings?

2. How often do you spend time in private religious activities, such as prayer, meditation or Bible study?

3. In my life, I experience the presence of the Divine (i.e. God).

4. My religious beliefs are what really lie behind my whole approach to life.

5. I try hard to carry my religion over into all other dealings in life.

Koenig HG, et al. “Religion index for psychiatric research (DUREL).” Am J Psychiatry 1997;154:885-6.


Critique

• Valuable information: Absolutely– Psychometrically advanced and well-validated– MD approach isolates potential “pathways”

• Tendency to over-generalize– Particularly in popular press– “religion” is good/bad for your health

• Near exclusive reliance on self-report• Little or no attention to the specific context of

religious belief or practice– Existing approaches lump together widely divergent

worldviews


Context is Critical

• Existing measures assess “religiousness-in general”– True for both global assessments and functional

measures—most instruments are context-free.• Locate subjects on a continuum of intensity

from “very religious” to “not at all religious”.• Driving question: How are “religious” people

different than “secular” people.• Assumption: It doesn’t matter what you

believe, so long as you DO believe.


Religiousness-in-General


Religiousness-in-General

• This approach supported by some polls• Favored by the rising preference for

“spirituality” as something more generic and universal than “religion”.

• But it doesn’t describe the religious landscape

• Lumps together widely divergent worldviews and belief systems

• Intensely religious Jews, Muslims, Unitarian Universalists are analyzed in the same group.


The Religious Landscape


Civil Religion

• Content of Civil Religion• Nominal Theism• Minimalist moral order• American way of life • Limited specificity—not a traditional religion

• “Cultural Christianity”• Biblical metaphors adapted to national myth

– Washington::Moses– Lincoln::Christ

• Liturgical calendar: – Thanksgiving, President’s Day, Memorial Day, etc

Bellah, R. N. (1967). "Civil Religion in America." Daedalus: Journal of the American Academy of Arts and Sciences 96(1): 1-21.


Confounding Findings:End of Life Decision-making


What does this mean?

• Measure specific faith traditions

• But….

• Spirituality is in vogue

• American Gladiators of Religion– My God is better than your God


How to redeem the existing measures?(pun intended)

• Perhaps the existing measures are actually better understood as measures of SECULARITY.

• What do I mean by that?– Precision


Precision: Measures of Secularity

Figure 3: Hitting the Target

Figure 3a: Less Precise Figure 3b: More Precise

Secular Religious


Hitting the Target


Secularity and Health

• The existing research may better be understood as demonstrating a small, but consistent health liability for those who approach the world from a deliberately secular worldview.

• Yes, this is a bit inflammatory…but I think it is a more accurate interpretation.


Deep Breath

One or two questions before we move on


Live and in Pay Per View

A one night engagement only

WWF SMACKDOWN!Weber v. Aquinas

(Worldview Wrestling Federation)


Conceptualizing Religion

• How did we come to assume “religion” as such exists?

• Once, there was no “secular”.• The concept of religion is only 300 years old• Concurrent with “modernity”

– Nominalists, Renaissance, Enlightenment

• Presumes the “objective” perspective from “nowhere”.

Hall DE, Koenig HG, Meador KG. Conceptualizing "religion": How language shapes and constrains knowledge in the study of religion and health. Perspectives in Biology & Medicine. 2004;47(3):386-401.


Of Cocoa, Frosting and Cake

• Dominant paradigm for religion as an optional frosting added to the vanilla cake of generic human experience.

• Weber, Durkheim, Eliade, Wm James

• Predicated on “generic human experience”

• Predicated on the Enlightenment epistemology called Foundationalism


Foundationalism

• Foundation of “universal” knowledge• Accessible to all people• Lock away particular, individual convictions• Empirical observation and the application of

reason• Extremely powerful at answering particular

types of questions. • Part and parcel with modernity• But it wasn’t always so.


The Bad News

• Foundationalism is dead or dying

• Objectivity doesn’t exist

• Living through a revolution of epistemology

• Trust, not proof, plays a much larger role in our systems of knowledge than we like to admit.


Cultural-Linguistic Contingency

• If we can’t have proof, what is left?• Knowledge is contingent on the cultural-

linguistic context in which it is meaningful• Electrons that are looked at

• Chocolate cake is not the same thing as vanilla cake with chocolate frosting

• Ingredients are the same• All the difference in the order of mixing


Unmediated Knowledge

• This is the way

scientists are trained to think

• This is the way our culture is trained to think


Unmediated Knowledge

• But it just isn’t possible


Mediated Knowledge

• None of us are a blank slate

• All knowledge is mediated through some interpretive lens

• Sunrise is different for:– Aquinas– Copernicus– Einstein


Mediated Knowledge

• However, the lens is often invisible—hidden by unconscious assumptions

• Yet, nonetheless, the lens constrains both the possible questions and the possible answers

• Degree of certainty is contingent on how much we trust the lens.


Multiple Lenses

• More than one lens shapes our knowledge of the world.

• Physician• Scientist• Husband/Father• American• Woman/Man• Black/White


Compound Lenses

• Both the number and the order of the lenses matter.


Why does this matter?

• “Religions” function like one of these lenses.

• Religion as “worldview”:– “A comprehensive, self-referentially

complete interpretation of the human condition that does not require reference to any external narrative or tradition.


What is religion?

• Not defined by its ingredients.• Chocolate cake v. Vanilla & chocolate frosting

• Not a set of beliefs• Virgin birth, Resurrection, Holy Spirit, etc

• Not a set of experiences• Mystical communion with the divine• Sense of God’s love, etc

• Religion is the framework of meaning that binds together various beliefs and experiences in distinct relationships.


So What?

Five implications for the scientific study of religion and health.


1-Secularism is not objective

• No intrinsic privilege over other rational worldviews

• Frosting/Cake model distorts religion• Outside looking in• Forces religion into secular categories

• Better to study from “the inside” of the unique cultural-linguistic tradition

• Science Secular


2-Measure fluency not content

• Learning a worldview (or religion) is like learning a foreign language

• Grammar and syntax are not enough• Must also have skill putting it together: fluency

• Religious belief and experience are not enough….must also be fluent

• Measurement requires some assessment of “performance” by someone else who is fluent


3-“Spirituality” is not a universal language

• Spirituality:Religion::Linguistics:Language• Textbook in linguistics Shakespeare’s

Sonnet XII• Spirituality-in-General is about as useful as

Esperanto• Individualized Expressions of Religion

• Sheila and private languages

• Religion-in-General like a meta-analysis without primary data.


The Religious Landscape


4-Religion isn’t a “therapy”• Therapeutic model of faith

• Is religion “good for your health?”• Implication that doctors might “prescribe” faith.• Problematic from both theological and methodological

perspectives.• Will the “effect” be the same if people “get” religion in order to live

longer?• “Idolatry “ of “replacing God with a personalized, manipulable sense of

well-being.”• Changing a worldview is both methodologically and ethically

problematic.• Conversion rare• Proselytism inappropriate

• If not a therapy, then what is it?

Shuman, J. J. and K. G. Meador (2003). Heal Thyself: Spirituality, medicine, and the distortion of Christianity. New York, Oxford University Press.


Worldview as demographic risk factor

• Like Japanese men and gastric cancer, there may be patterns of disease, specific to particular worldviews, that are relevant to healthcare.

• Goal isn’t so much to intervene as it is to better understand risk factors and guide appropriate care.

Religion

MentalHealth

SocialSupport

HealthBehaviors

StressHormones

ImmuneSystem

Autonomic Nervous System

DiseaseDetection &TreatmentCompliance

Smoking High Risk Behaviors Alcohol & Drug Use

Infection

Cancer

Heart Disease

Hypertension

Stomach &Bowel Dis.

Accidents& STDs*

Gen

etic

sus

cept

ibili

ty, G

ende

r, A

ge, R

ace,

Edu

catio

n, I

ncom

e

Liver & Lung Disease

Stroke

Chi

ldho

od T

rain

ing

Adu

lt D

ecis

ions

Val

ues

and

Cha

ract

er

Adu

lt D

ecis

ions

* Sexually Transmitted Diseases

From Handbook of Religion and Health (Oxford University Press, 2001)

Model of Religion's Effects on Health


5-Worldviews may have consequences

• Dangerous and threatening• Challenge entrenched belief and power

• Meaningful findings will require asking these dangerous questions in a responsible way.

MacIntyre A. Whose Justice? Which Rationality? Notre Dame, IN: University of Notre Dame Press; 1988.


• What do all those 2000 papers tell us? (On my most cynical day…)

On the whole, “Religion” (poorly understood and even more poorly measured) has a small, robust, positive association with “health” (slightly better understood and measured).


A Fork in the Woods?

• Steps to the next level• Different Questions• Better Answers

• Will require attention to the Levin’s epistemological challenges of conceptualizing and operationalizing “religion” in more meaningful ways.

• Don’t have the answers, but these are some first steps


Conclusions

• Religion and Health: It ain’t necessarily so…

(or at least not how we once thought)• Applying the scientific method to the study of religion

has unique challenges• Be careful as you try to interpret findings from studies

written by authors who may or may not think this carefully about epistemological and conceptual challenges of “religion”.


Questions?

copyright 2005, daniel e. hall it ain’t necessarily so what a family physician needs to know...

Documents