FOR all but three years of my working life, I have been a hands-on, self-supporting parish priest and full-time academic theologian. In retirement, I still relish being a member of the clergy team at Holy Trinity Cathedral, Gibraltar, and at Hollingbourne, in Kent, as well as writing and editing publications in theology, and serving on bodies such as the BMA’s Medical Ethics Committee.
So the topic of faith and health is central to my life, both in the prayers for the sick that we offer every day at Holy Trinity, and in academic discussions about health-care ethics. But making connections between the two can be difficult.
Fortunately, the work of the US psychiatrist Harold Koenig has made it easier to make a connection between religious belonging and mental and physical health. Over the years, as co-director of the Center for Spirituality, Theology and Health at Duke University, in Durham, North Carolina, he has gathered a mass of detailed and, I believe, largely convincing evidence.
Most recently, he has produced (with Dana King and Verna Carson) a second edition of his 600-page Handbook of Religion and Health (OUP, 2012), together with several more popular works, such as Medicine, Religion, and Health (Templeton Press, 2008). He can also be viewed on YouTube talking about his research (www.youtube.com/watch?v=KBSv_AlS5fk).
Dr Koenig shows that across a range of mental-health areas (including depression, psychotic disorders, alcohol and drug use, and marital instability) and physical-health areas (including heart disease, dementia, immune functions, cancer, and mortality), the overall evidence indicates that those who are more involved in their religious communities are, on average, healthier, both mentally and physically, and tend to live longer than other people. It is important to emphasise “on average” here — this is evidence about populations, not about individuals.
The Handbook of Religion and Health sets out this extensive evidence, and grades its various strengths, admitting frankly at the outset that, “Because of the newness of this field and the ethical issues involved in double-blinded controlled trials of religious interventions on health, studies providing first-level evidence are relatively few.”
It is also not possible to provide causal explanations of these connections between religion and health that will satisfy sceptics and religious people alike. Much in this fascinating area is still disputed, but Dr Koenig’s work has done enough to convince me at least that these connections are both numerous and significant.
THE question, though, is what to do with this evidence. For parish priests, this is not really a problem. We continue, as we must, with our ministry of prayer and sacraments for those who are sick. I doubt if many of us think that miraculous cures are likely, but, from experience, we have found that being in the presence of God (through prayer or sacrament) is important for well-being.
But what do Christian doctors do while working in the NHS, apart from advising their patients to lead healthy lives, and treating them when they don’t; or when they do, but are just unlucky? Should they also promote prayer and the sacraments?
Not so long ago, a GP in Kent was reprimanded by the General Medical Council for recommending Christian faith to one of his patients (apparently without the patient having first prompted him to do so). Many regarded this as unprofessional behaviour on the part of a doctor employed by the NHS; I thought his behaviour was also theologically crass.
I do not regard Christian faith instrumentally, as a form of medicine. I would hope that I would remain a Christian, even if Christian faith were proved to be bad for my health (it is certainly bad for the pocket).
DR KOENIG has occasionally come near to this doctor’s position, and has been criticised for doing so. Dr Richard Sloan, author of Blind Faith: The unholy alliance of religion and medicine (St Martin’s Press, 2006), and his medical colleagues point out the obvious ethical problems of making such a direct link to public policy; but, without such a link, funding for research in this area is likely to remain precarious, and, as a result, research projects may well remain rather varied in quality.
Large, longitudinal, randomised, and scientifically stratified and controlled samples are likely to remain exceptions amid enthusiastic, but more amateur, research projects.
Dr Sloan and his colleagues argue that, “when doctors depart from areas of established expertise to promote a non-medical agenda, they abuse their status as professionals. . . We question enquiries into a patient’s spiritual life in the services of making recommendations that link religious practice with better health outcomes.”
To reinforce this point, they suggest that it would be just as inappropriate for doctors to advise the unmarried to marry on the grounds that marriage is also associated with lower mortality. In any case, they insist, “since all human beings, devout or profane, ultimately will succumb to illness, we wish to avoid the additional burden or guilt for moral failure to those whose physical health fails before our own” (The Lancet, 20 February 1999).
More typically, Dr Koenig’s approach is measured. He admits, for example, that “the evidence for religion and longer life is only moderate in strength” (Medicine, Religion, and Health). My atheist colleagues at university usually respond to this particular piece of evidence (if they believe it at all) with wry humour: “I would rather die younger than have a lifetime of endless religious services!”
There has been much discussion about whether it is churchgoing per se that is conducive to better mental and physical health. It could be that churchgoers are better at support ing each other than non-churchgoers.
From my own academic research, and working as a parish priest, I have found that church members also smoke considerably less than sports-club members. So that would help, too.
SOMETIMES, in his work, Dr Koenig talks about “spirituality” rather than “religion”. He used this concept in his book Spirituality in Patient Care (Templeton Press 2002), connecting it to well-being and life-satisfaction. This suggests an inner dimension to the connections.
Perhaps it is just that having a sense of purpose (any purpose) is good for your health. On that score Richard Dawkins, with his driven atheism, should do very well, health-wise.
Another response is to point to the harmful effects of religion. Any parish priest will know all about that. The researcher Nancy Schaefer, for instance, said that a young woman died after stopping her medication as a result of Morris Cerullo’s 1992 Mission to London (Healing and Religion by Marion Bowman, Hisarlik Press 2000). For this and other reasons, subsequent Cerullo missions were extensively lobbied by disability groups, and by the Anglican GP Peter May.
In addition, Dr Koenig admits that fundamentalism may generate considerable guilt in vulnerable individuals.
Yet he argues that such cases are comparatively uncommon. Nevertheless, a point remains that he may underestimate. If religious opposition to barrier contraception, even in the context of AIDS today, or to anaesthetics in the past, were included in the calculation, then the harmful effects of religion on health would be considerably more extensive.
DR SLOAN and his colleagues accept that “a thorough understanding of a patient’s religious values can be extremely important in discussing critical medical issues, such as care at the end of life. . . Irrespective of the practitioner’s religion, respectful attention must be paid to the impact of religion on the patient’s decisions about health care.”
But Dr Koenig goes further. He wants doctors to make “a spiritual assessment” of their patients, arguing that “all counselling with regard to health maintenance or disease prevention runs the risk of making patients feel guilty if they don’t follow recommendations and end up sick. . . Does the fear of inducing guilt prevent physicians from addressing these issues or making enquiries? No, it does not. Nor should it stop them from doing a spiritual assessment” (Spirituality in Patient Care).
It is at this point that Dr Koenig may cross the line into an “instrumental” understanding of religion. Fortunately, though, he recognises that not all patients will respond to this (in which event the doctor should simply move on); that there may be other secular forms of social support that benefit patients instead; and that both religious and non-religious patients alike will die eventually.
The debate is likely to continue for some time yet.
Professor Robin Gill is Editor of Theology and Canon Theologian at Gibraltar Cathedral.