Even though there is much dispute among researchers regarding accurate definitions of spirituality and religion, it is generally accepted that spirituality concerns the exploration for the sacred, celestial, or transcendent side of life, while religion can be defined as a perception, influence, and behavior which emerges from a consciousness of, or alleged contact with, metaphysical entities which are deemed to perform an essential role in human life. Moreover, in contemporary society, the formation of a dichotomy is being witnessed: with spirituality representing the personal, subjective, inner-directed, unsystematic, liberating expression and religion signifying a formal, authoritarian, institutionalized inhibiting expression. Yet the concept of religion may further be separated into two categories: intrinsic and extrinsic religion. Intrinsic religion is an internalized faith which becomes an innate outlook on life. Extrinsic is focused more on individual practices driven by external motives, such as improved social standing or acceptance. Although religion and spirituality at times appear to be polarized concepts, for the moment, at least, it is impossible to completely segregate the two concepts as the search for the sacred occurs within various faith traditions, and most researchers agree that they are in fact overlapping constructs.
Associations Between Spirituality, Religion, and Health
Historically, it was argued that the study of the natural and explicable phenomena belonged to science, whereas the relatively unexplained belonged to religion. This was very pertinent to the field of medicine. Nowadays, however, there is a strong realization that health involves the interaction of mind, body, and more. In fact, health is far more than a physical matter. Much of this realization has been attributed to a substantial body of literature which has accumulated over the last number of decades connecting spirituality, religion, and communal religious involvement to a variety of health outcomes (Hill and Pargament 2003; Koenig 2009; McCullough and Willoughby 2009; Powell et al. 2003). The links between spirituality and health are discussed elsewhere in this encyclopedia (see “Spirituality”). Even though the vast majority of studies report a beneficial effect of religion on health, this research has been the subject of considerable controversy. For example, religious involvement is strongly correlated with health-related factors, such as functional status, lifestyle, and social support, which may confound associations between religious observance, beliefs, and health (Sloan et al. 1999). Further, longitudinal studies have found differential stress-buffering effects: protective against multiple events but not discrete events (Schnittker 2001). It could be that religious coping is used as a last resort when individuals feel overwhelmed when dealing with multiple stressful episodes, especially when their personal coping resources fail or prove to be inadequate (Gallagher et al. 2015). However, what adds to this controversy is that the precise mechanisms behind the links between religion and health are not yet clear and are the subject of much research (Powell et al. 2003; Seeman et al. 2003).
A number of possible psychological, social, and physiological mediators have been proposed to account for this connection. For example, it could be that prayer may help people deal with unpleasant situations or that faith promotes a positive disposition which facilitates coping. It is also becoming increasingly evident that religious/spiritual coping strategies can be divided into positive (e.g., seeking support from clergy, forgiveness, reappraisal) and negative (e.g., spiritual discontent, pleading for direct intercession, punishing God reappraisal) forms; positive forms typically relate to more positive outcomes, whereas negative religious coping strategies are generally related to more negative outcomes (Hill and Pargament 2003). Moreover, religious affiliations are associated with the practice of healthy lifestyles, and the social aspect of attending religious rituals, i.e., church, promotes social integration, all of which are linked to better health (Sloan and Ramakrishnan 2006). Further, religious attendance has been found to be inversely related to inflammatory cytokine high interleukin-6 levels (>5 pg/ml), providing supportive evidence of a direct link between religious observance and health (Koenig et al. 1997); this observed association was somewhat attenuated after controlling for age, sex, race, education, chronic illnesses, and physical functioning, implying that other factors may be driving the observed effects. In addition, the proponents of these links between religion and health would argue that the strongest evidence comes from intervention studies, demonstrating the positive effect of intercessory prayer on cardiovascular health (Townsend et al. 2002). However, in a very recent Cochrane Review, it was found that this particular evidence was rather weak and that trials of this type of intervention should not be undertaken, stating that they “would prefer to see any resources available for such a trial used to investigate other questions in health care” (Roberts et al. 2009). Another issue that needs to be addressed is the differential effects of intrinsic and extrinsic religion on psychological distress. Studies have indicated that intrinsic religious individuals who attend religious services demonstrate reduced anxiety, whereas extrinsically motivated individuals who attend services tend to portray anxiety (Koenig 2009). How these different religious concepts relate to physical health outcomes is still unclear, but the link between psychological distress and ill health is well established (Roberts et al. 2009; Rugulies 2002).
How to Measure Spirituality and Religion
Measuring spirituality and religion has proven to be a very difficult task due to the researcher’s inability to completely differentiate between religion and spirituality. This inadequacy has unlocked Pandora’s box, due to the paradoxical question: is one measuring or has one measured spirituality or religion? Or are these religious measurements tapping into other constructs such as social support? Nonetheless, there are a number of measures available for measuring spirituality (see entry on “Spirituality”) and religion: the Religious Involvement Scale (Piedmont et al. 2009) is a useful scale to test how involved individuals are in religious activities; the Multi-Religion Identity Measure (Abu-Rayya et al. 2009) is a scale which can be used accurately in order to distinguish between members of different religions; and the Religious Coping Scale (RCOPE) (Pargament et al. 2000) can be used to assess religious coping. If one wants to measure both spirituality and religion, the Assessment of Spirituality and Religious Sentiments (ASPIRES) (Piedmont 2004) scale can be used, which has proved to have reliability and discriminant validity. Finally, and more recently, an Implicit Christian Humanist Implicit Association Test (Ventis et al. 2010) has been developed to measure both religion and spirituality which may have stronger behavioral correlates.
References and Further Readings
- Koenig, H. G., Cohen, H. J., George, L. K., Hays, J. C., Larson, D. B., & Blazer, D. G. (1997). Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults. International Journal of Psychiatry in Medicine, 27, 233–350.CrossRefPubMedGoogle Scholar
- Koenig, H. G., McCullough, M. E., & Larson, D. B. (Eds.). (2001). Handbook of religion and health. New York: Oxford University Press.Google Scholar
- Piedmont, R. L. (2004). Assessment of Spirituality and Religious Sentiments (ASPIRES) technical manual. Columbia: Author.Google Scholar
- Roberts, L., Ahmed, I., Halls, S., & Davison, A. (2009). Intercessory prayer for the alleviation of ill health. Cochrane Database Systematic Review, 2, CD000368. doi:10.1002/14651858.CD000368.pub3.Google Scholar