the effect of strong religious beliefs on coping with stress

THE EFFECT OF STRONG RELIGIOUS BELIEFSON COPING WITH STRESS

MARY JOSEPH*

Department of Psychiatry, Medical College of Virginia; Hunter Holmes McGuire Department of Veterans A�airsMedical Centre. Richmond, VA, USA

HISTORICAL PERSPECTIVES

We will zigzag through history in quantum leaps,and ®nally come to rest in the present time anddiscuss what research has revealed regarding strongreligious beliefs in coping with stress. The origins ofreligion date back to prehistoric times, but there isno de®nite proof regarding the meaning ofmaterials associated with religions of those times.For example, deposition of o�erings, ®nds at burialplaces, representation of deities and idols and cultic®gures in rock drawings or paintings, and altars,temples and foundations of world pillars representfootprints on the sands of time that have to becompared to structures in historic times in anyattempt to interpret their meaning. For conven-ience sake, we can designate all religions after3000 BCE as of the historic or literate times. Forthousands of years, beliefs, chants and folklorewere handed down orally from generation togeneration prior to the advent of written language.The Sumerians were the ®rst to invent a writtenlanguage and hence have the oldest legend; this isrepresented in the Epic of Gilgamesh. One story inthis great epic is that of the great ¯ood whichdestroyed the whole earth except for Utnapishtimand his family, animals and craftsmen. Because ofhis ardent faith and piety, Utnapishtim had foundgreat favor with the chief god of the Sumerians, Ea,who in a dream told him to build a boat accordingto certain speci®cations so that he would be savedwhen the rest of mankind was destroyed by the¯ood. The same story is found in the Akkadian,Babylonian and Assyrian literature, where therewas a man rewarded for being pleasing in thesight of God. Likewise, in the Bible (Genesis),Noah, his family and his animals were saved with

similar instructions from God. These men of faithwere to reseed human kind on Earth.

Much of the data suggest that the early religionswere monotheistic, which then degenerated intopolytheism and later into priestcraft. The latterresulted in the development of the priestly class,who taught men to fear the wrath of the gods.Sacri®cial o�erings and chants evolved as a meansto prevent ill e�ects. Goods in the form of food andgold o�erings, animal and sometimes human sacri-®ces were common in the older civilizations toplacate the gods or spirits or in thanksgiving for agood harvest or victory in war. Thus, since thebeginnings of history strong religious beliefs havehad a calming and joyous e�ect on themind, thoughsometimes instilling fear in the believer (Fig. 1).

Many of the living religions of today startedbetween 500 BCE and 500 CE; Vedantism turnedinto Hinduism and the ancient Semitic religiondeveloped into Judaism during this period. Most

CCC 0748±8386/98/040219±06$17.50# 1998 John Wiley & Sons, Ltd.

STRESS MEDICINEStress med. 14, 219±224 (1998)

Fig. 1 Ð Historical development of the world's religions andcivilizations

*Correspondence to: Dr. M. Joseph Ð Mental Health ServiceLine, McGuire VAMC (116A), 1201 Broad Rock Boulevard,Richmond, VA 23249, USA.

of these religions preached non-violence and peace.Animal sacri®ces were given up for more symbolicforms of worship. During this time, Indian Yogisand Buddhist monks had been practicing yoga andmeditation, and thus soliciting the relaxationresponse. Benson1 studied the monks in Sikkim,measuring the vital signs of men who were employ-ing ancient Tibetan meditation. While patients hehad measured in Boston experienced an average10±17 per cent drop in metabolism from the relaxa-tion response, one monk experienced a decrease of64 per cent, the lowest level ever documented in ahuman being. This was the mechanism by whichthey sustained themselves in the face of extremeenvironmental conditions.

We now come to the middle ages in Europe,the time de®ned as the period between 476 CE,when the Roman empire fell, to May 29, 1453 CE,when the Turkish Sultan Mohammed II attackedConstantinople. Emperor Constantine XI died®ghting (the in®del) and Constantinople becameIstanbul. The Crusades were fought in the name ofreligion during the middle ages. Religious warshave occurred from ancient times and continue tothis day, in¯icting pain, su�ering and catastrophicstress on thousands of people. In striking contrastin the middle ages, the monasteries were seen as asafe haven by people in distress. In the westernhemisphere, medicine was the domain of the churchand the monks until the eighteenth century CE.Physical symptoms as well as mental symptomswere treated by the monks. Chanting and repeti-tious prayers were the beginnings of meditativepractices to control stress and anxiety.

EFFECTS OF STRONG BELIEF SYSTEMS

It has to be said that any strong belief, whetherreligious, an ideology or the placebo e�ect, canhave profound e�ects on the body and mind, oftenpositive but sometimes negative. Religious ritualsare very powerful mechanisms and when used intimes of stress can invoke the calm they producedduring childhood experiences, for example con-fession and Holy Communion in the Catholicchurch. Rituals, when negatively perceived, arestressful to the extent that they can cause suddendeath. Voodoo is a set of religious practices said tohave originated in Africa that is still being practicedby the native populations of Africa, Haiti, SouthAmerica and the West Indies. Some aboriginaltribes in Australia, New Zealand and the Paci®c

Islands have a similar set of beliefs and practices.Tribal medicine men in these areas cast a spell onan intended victim. This ritual supposedly sodisturbs the spirit of the victim that disease anddeath can result.

Physical illness, mental anxiety, depression andmarital discord are some of the most commonstresses in life. It is only in the last 25 years thatsystematic studies on the e�ect of religion, faith orspirituality on healing and stress reduction havebeen carried out.

Matthews et al.2 have produced an annotatedbibliography of clinical research on religion andspirituality. Vanderpool and Levin3 have provideda very good de®nition for religion: `Religion is acomprehensive picturing and ordering of humanexistence in nature and the cosmos'. `Spirituality isa belief system focusing on intangible elements thatimpact vitality and meaning to life events', accord-ing to Maugans and Wadland.4 The followingexcelling description of faith by Sir William Osler5

cannot go without mention: `Nothing in life ismore wonderful than Faith; the one great movingforce which we can neither weigh in the balance nortest in the crucible . . . mysterious, inde®nable,known only for its e�ects, Faith pours out anunfailing stream of energy while abating neither jotnor tittle of its potency.' Another positive expres-sion by Luko� et al.6 is that `religion and spirit-uality are among the most important factors thatstructure human experience, beliefs, values, beha-vior and illness patterns'. This may be the reasonfor belief in God or the Universal Spirit all over theworld (Fig. 2).

Fig. 2 Ð Source:Data from 1975±1976 Worldwide Gallup Poll:Princeton Religion Research Center (1976). Religion in America.Princeton, NJ. Note that belief in God in the United States inDecember 1994 was 96 per cent

220 M. JOSEPH

# 1998 John Wiley & Sons, Ltd. Stress med. 14, 219±224 (1998)

NEGATIVE EFFECTS OF EXTREMERELIGIOUS BELIEFS

Let us now look at a di�erent perspective onreligion and spirituality. In 1964, none other thanthe National Academy of Sciences (USA) declaredthat, `Religion and Science are mutually exclusiverealms of thought whose presentation in thesame context leads to misunderstanding of bothscienti®c theory and religious belief'. The Groupfor the Advancement of Psychiatry,7 in 1976, calledreligion a borderline psychosis . . . a regression, anescape, a projection upon the world of a primitiveinfantile state. Freud in 19598 labeled religion,`a universal, obsessional neurosis, infantile help-lessness, a regression to primary narcissism'.Ellis,9 President of the Rational Emotive TherapyInstitute, wrote, `devout orthodox, or dogmaticreligion (or what might be called religiosity) signi®-cantly correlates with emotional disturbance'.Watters,10 Professor of Psychiatry at McMasterUniversity, in his book entitled Deadly Doctrine,wrote, `Christian indoctrination is a form ofmental and physical abuse that can adversely a�ectbodily health in the same way a drug can. Theseideas have not been de®nitely tested or proven byresearch.'

Then there are facts which need no testing.The Nazis killed 6 million Jews in the name ofrace and religion. The disastrous e�ects of Jones-town in Guayana, the killing power of DavidKoresh at Waco Texas and the deathly ¯ight of theHeavens Gate members on the wings of a meteorare horri®c examples of the toxic e�ects of religiongone to extremes. Pruyser11 has examined thenegative uses of religion; among these are thefollowing:

. Sacri®ce of intellect

. Rationalization for hatred, aggression andprejudice

. Thought control and promotion of excessivedependency

. Surrender of agency, dissociation and disavowal

. Justi®cation for being judgemental and insensi-tive to situations

. Displacement of the body (self-punishment,asceticism)

. Obsessional thinking (as in guilt)

While the above is observable, there are farless systematic studies on the negative e�ectsof religion.

HOW DOES IT WORK?

Benson,12 in his book Timeless Healing: The Powerand Biology Of Belief, states that, `worship servicesare full of potentially therapeutic elements, music,aesthetic surroundings, familiar rituals, prayer andcontemplation, distraction from everyday tensions,the opportunity for socializing and fellowship andeducation' (p. 166). Certain religious groups, forexample the Mormons, Seventh Day Adventists,Amish and Hutterites, who promote a healthy life-style by prohibiting alcohol and tobacco use, andencourage hard work and good diet, have less lung,bladder and colon cancer. There are at least16 studies on this subject.13 An understandable,albeit simple, biological mechanisms of the e�ect ofreligion on health as postulated by Koenig is givenin Fig. 3.

Koenig13 (p. 68) explains the basis of the Judeo-Christian belief. `Anyone can, at any time and inany place, talk with the all powerful, all present, allknowing, all merciful Creator and Sustainer of theuniverse, and can in¯uence what God does; and ifnot in¯uence what God does then receive strengthto cope with whatever adversity may come along.Even death itself is no victor over the believerwhose soul is immortal. There is no sin or mistakein life that cannot be confessed and forgiven. Thus,no matter what a person has done in the past, heor she can start life fresh again by recommittingone's life to God. Guilt, which religion itselfcan provoke, is erased by the simple act of askingfor forgiveness. Not surprisingly, such beliefs mayhave powerful psychological consequences, andmay indeed bring comfort to those who are lonely,anxious, discouraged, or feeling out of control.'

Fig. 3 Ð Prevention model for religion's e�ects on physicalhealth

RELIGIOUS BELIEFS AND COPING WITH STRESS 221


Christian fundamentalists continue to preach ®reand brimstone as punishment for sins. In many ofthe eastern religions there is no eternal damnation,but at death souls transmigrate into other livingbeings to be perfected and ®nally attain Nirvana orMoksha.

INTRINSIC VS EXTRINSIC RELIGION

An interesting research ®nding is that persons whouse religion as a means to an end do not experiencethe psychological bene®ts of religious practice.14 Itis those who involve themselves in religion as anend in itself (ie persons with intrinsic faith) who aremore likely to experience greater life satisfactionand less worry and anxiety. Alvarado et al.15 con-cluded from their research that `attempting tolower one's death anxiety or death depression bygreater religious participation is not a guaranteedremedy. Perhaps faith, belief, and commitmentmust come before one experiences the lowering ofdeath discomfort.

INTERCESSORY PRAYER

The e�ect of intercessory prayer has not goneunnoticed. Dossey16 and Schlitz17 have writtenextensively on this topic. An exciting study wasdone by Byrd,18 in which he worked with patientsin the coronary care unit and had a prayer groupwhich was randomly assigned to pray for some ofhis patients. He then matched these patients with acontrol group of patients for whom there was noprayer. The possible confound in this study is thatany patient who has a loved one is probably beingprayed for. But Byrd hoped that such prayerwould randomize across the study. Another pilotand replication study was recently completed byTarg and Sicher, who explored distant healing fortreatment of advanced AIDS. Both studies foundthat the prayed for patients showed signi®cantlyfewer complications and a much quicker recoverytime than the group that was not prayed for.O'Laoire, a transpersonal psychologist and aCatholic priest, for his dissertation used the samekind of research design, except that this time heworked with healthy participants. He had a groupof healers pray for half of the study group and hefound no signi®cant di�erences between those whowere prayed for and those who were not. What he

did ®nd was signi®cant improvements in thehealers. With these studies, the novel ideas ofnon-local consciousness16 and quantum healing19

can all be explored.

CURRENT TRENDS

In the 1980s and 1990s, with the emergence of NewAge spirituality and alternative medicine, there isnow much interest in the traditional religions aswell as yoga, meditation, re¯exology, aromatherapyand massage therapy, eliciting the relaxationresponse in di�erent ways to relieve stress. Thirtymedical schools in the United States have alreadyincorporated Faith and Medicine courses in themedical school curriculum. The emphasis is onteaching medical students to inquire into thepatient's belief system and see how it can enhancehealing or slow the process of healing. TheTempleton Foundation o�ers 25,000 dollar grantsfor medical schools to implement a strong Faithand Medicine course in the medical curriculum.There are several conferences on spirituality andhealing conducted by prestigious universities,including Harvard, with help from the TempletonFoundation. The National Institutes of Health(USA) has a division for Alternative Medicinewhich provides grants to study non-traditionalways of improving health, including the e�ects ofreligion. The overwhelmingly positive e�ects ofreligious factors on health are summarized inTables 1 and 2.

CONCLUDING REMARKS

It is easily seen that extreme negative religiousbeliefs can have disastrous results. There istremendous stress on an individual when he orshe falls ill, and believing that there is a higherpower that you can trust to see you throughadversity is a great relief. Persons under stress fromfamilial and societal pressures also can have relieffrom anxiety and depression through a strongbelief that the Almighty who feeds the birds of theair and clothes the lilies of the ®eld will surely ®nda way for His people. This article has concentratedon studies mostly done in western countries.Whether the conclusions drawn can be generalizedto religions other than Judeo-Christianity is notclear and more research needs to be done in this

222 M. JOSEPH


area. Benson,12 who has been studying the natureof belief for 25 years at Harvard, states, `In myscienti®c observations I have learned that nomatter what name is given the In®nite Absoluteyou worship, no matter what theology youascribe to, the results of believing in God are thesame' (p. 200). `Science without religion is lame,religion without science is blind,' said AlbertEinstein.

ACKNOWLEDGEMENTS

The author thanks Mrs Deborah A. Draughnfor typing the numerous revisions on this manu-script. The author would also like to acknowledgeSebastian Joyce, PhD for valuable advice andDrs Harold Koenig, DaleMatthews and the GallupOrganization for permission to use tables and®gures.

Table 1 Ð The in¯uence of religious factors on health

Condition No. of studies No. of studies in whichhealthful e�ectswere present

Per cent in whichhealthful e�ectswere present

Reduced alcohol use 18 16 89Reduced nicotine use 6 8 100Reduced drug use 12 12 100Improved psychological symptoms

including adjustment and coping15 14 93

Reduced depression 17 12 71

Note: Data summarized from: D. A. Matthews, D. B. Larson and C. P. Barry, The Faith Factor: An Annotated Bibliography ofClinical Research on Spiritual Subjects, Vol. 1. John Templeton Foundation, 1994.

Table 2 Ð The in¯uence of religious factors on health

Condition No. of studies No. of studies inwhich healthful

e�ects were present

Per cent in whichhealthful e�ectswere present

Reduced hostility 4 4 100Reduced general anxiety 11 8 73Reduced death anxiety 15 10 67Improved general health 5 4 80Reduced blood pressure 5 4 80Improved quality of life in cancer patients 8 7 88Improved quality of life in heart disease patients 6 4 67Increased survival 9 8 89


Table 3 Ð The in¯uence of religious factors on psychological measurements

Psychosocial measurement No. of studies No. of studies in whichpositive e�ectswere present

Per cent in whichpositive e�ectswere present

Greater life satisfaction 13 12 92Greater marital satisfaction 3 3 100Greater well-being 16 15 94Greater altruism 5 3 60Greater self-esteem 4 2 50


RELIGIOUS BELIEFS AND COPING WITH STRESS 223


REFERENCES

1. Benson, H., Lehmann, J. W., Malhotra, M. S.,Goldman, R. F., Hopkins, J. and Epstein, M. D.Body temperature changes during the practice ofgTum-mo Yoga. Nature 1982; 295; 234±236.

2. Matthews, D. A., Larson, D. B. and Barry, C. P.The Faith Factor: An Annotated Bibliographyof Clinical Research on Spiritual Subjects, Vol. I.National Institute for Health Care Research,Rockville, MD, 1993.

3. Vanderpool, H. Y. and Levin, J. S. Religion andmedicine: How are they related? J. Religion Health1990; 29(1): 9±20.

4. Maugans, T. A. and Wadland, W. C. Religion andfamily medicine: A survey of physicians and patients.J. Fam. Pract. 1991; 32(2): 210±213.

5. Osler, W. The faith that heals. Brit. Med. J. 1910: 1:470±472.

6. Luko�, D., Lu, F. and Turner, R. Toward a moreculturally sensitive DSM-IV: Psychoreligious andpsychospiritual problems. J. Nerv. Ment. Dis. 1992;180: 673±682.

7. Group for the Advancement of Psychiatry. Mysti-cism: Spiritual Quest or Mental Disorder. Group forthe Advancement of Psychiatry, New York, 1976.

8. Freud, S. Obsessive Actions and Religious Practices,Standard Edition, Hogarth Press, London, 1962.

9. Ellis, A. Psychotherapy and atheistic values:A responde to A. E. Bergin's `Psychotherapyand religious values'. J. Consult. Clin. Psychol.1980; 48: 642±645.

10. Watters, W. W. Deadly Doctrine: Health, Illness, andChristian God-Talk. Prometheus Books, Amherst,NY, 1992.

11. Pruyser, P. The seamy side of current religiousbeliefs. Bull. Menninger Clin. 1977; 41: 329±348.

12. Benson, H. Timeless Healing: The Power andBiology of Belief. Simon and Schuster, New York,1997.

13. Koenig, H. G. Is Religion Good for Your Health?:The E�ects of Religion on Physical and MentalHealth. Haworth Press, New York, 1997.

14. Baston, C. D. and Ventis, W. L. The ReligiousExperience. Oxford University Press, New York,1982.

15. Alvarado, K. A., Temper, D. I., Bresler, C. andThomas-Dobson, S. The relationship of religiousvariables to death depression and death anxiety.J. Clin. Psychol. 1995; 51: 202±204.

16. Dossey, L. Healing Words: The Power of Prayerand the Practice of Medicine. Harper Edge, SanFrancisco, 1993.

17. Schlitz, M. Intentionality and intuition and theirclinical implications: A challenge for science andmedicine. Advances: J. Mind±Body Health, 12(2):58±66.

18. Byrd, R. C. Positive therapeutic e�ects of inter-cessory prayer in a coronary care unit population.South. Med. J. 1991; 8: 7.

19. Chopra, D. Quantum Healing: Exploring the Fron-tiers of Mind/Body Medicine. Bantam DoubledayDell, New York, 1989.

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the effect of strong religious beliefs on coping with stress

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