"Drafting science to the cause of supporting a supernatural belief system is a tricky business from the outset," remarks Jeff Dahms, in his review of 'The Link Between Religion and Health. Psychoneuroimmunology and the Faith Factor', edited by Harold G Koenig and Harvey Jay Cohen (272 pages, Oxford University Press; ISBN: 0195143604, February 2002).

"For the overwhelming bulk of scientists," he observes, "many of whom are theists themselves, science is grounded in methodological naturalism. Science looks completely askance at explanations that have a miracle in the fifteenth line. It could be otherwise of course. We might convene a kind of international summit of scientific organizations and vote on whether to include supernatural explanation in scientific accounts. This is not going to happen in the absence of completely overwhelming evidence of its necessity as it would rend forever the coherence of explanation as we now know it. Those who would propose that we do just this have every right of course to make the case. But it needs to be done explicitly and completely forthrightly rather than obliquely and under the disguise of a regular scientific agenda as mostly happens at the moment."

And yet, Dahms notes:

"Into this milieu ride Koenig and Cohen. Both men are widely experienced physicians in their own right. In their many professional roles they are also members of the scientific staff of the Center for the Study of Religion/Spirituality and Health at Duke University. They have edited and written contributory chapters in a marvelous and very useful book. Many skills were brought to the endeavour from their respective distinguished careers in medicine, but it is the clarity of their understanding of the overarching issues in the field that strikes one first. And the book can be read by the most committed of naturalists (such as this reviewer) without their hearts skipping a beat. It is a strictly empirical account of the correlations between religious activity and health outcomes and the putative psychophysiological mechanisms. Supernatural explanation is completely eschewed in considering the processes involved. Whether this is a temporary suspension of belief or the native position of the authors is not made clear. Nonetheless to the great benefit of the reader the exposition is cleanly of one kind."

Scroll down to find out more about Link Between Religion and Health.

Today's columnist, Jeff Dahms, is a physician-surgeon and research scientist associated with Sydney University's teaching hospitals and who works intermittently in primary care in the developing countries of Asia and the Americas. His scientific interests are in mind/brain evolution and the philosophy of science, particularly in the fundamental areas of physics and biology, and in relational areas such as the science religion discussion.

-- Stacey E. Ake

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Subject: Religion & Health, Koenig & Cohen, and the Faith Factor From: Jeff W. Dahms Email: <jwdahms@wisdoc.net>

A Review of 'The Link Between Religion and Health. Psychoneuroimmunology and the Faith Factor' Edited by Harold G Koenig and Harvey Jay Cohen

With some trepidation I recently started reading 'The Link Between Religion and Health. Psychoneuroimmunology and the Faith Factor' edited by Harold G Koenig and Harvey Jay Cohen. Religion and health has been getting a lot of press in the last few years and the general quality of the discussion has been very poor. It seems that whenever there is a strong emotional and a priori belief element involved in an area, systematic coherent evaluation is replaced by vague wishful thinking. Witness the perennial US cultural debacle of the evolution/creation debate. Here is the problem.

Some 90-95% of the US population confesses to being theists of some variety, and a large fraction of these have a traditional supernatural underpinning to their faith. In this world of 'Sunday in the pews', supernatural intervention in the natural causal order is a routine part of the scheme of things. God and other higher beings are understood to intervene in human affairs on their own initiative and in response to prayer - frequently.

With the move in recent years for science and religion to accommodate each other at least in some intellectual quarters, dealing with these supernatural assumptions of religion has been a major headache for those committed to the endeavor. One solution that has major support is a strongly interactive/melding vision of science and religion generating attempts at scientific religion and religious science.

There has been a flood of writing and research of hugely variable quality purporting to map the supernatural efficacy of prayer and the benefits of a religious life in ensuring health, prosperity and success. Sometimes the reference to the supernatural basis of this is explicit but more often it is simply implied. Accounts of studies of the religion/health correlation will include reference to 'natural' mechanisms but broadly hint that there is something 'extra' going on. This is a very unfortunate practice and smacks of intellectual hustling rather than honest thought.

Drafting science to the cause of supporting a supernatural belief system is a tricky business from the outset. For the overwhelming bulk of scientists, many of whom are theists themselves, science is grounded in methodological naturalism. Science looks completely askance at explanations that have a miracle in the fifteenth line. It could be otherwise of course. We might convene a kind of international summit of scientific organizations and vote on whether to include supernatural explanation in scientific accounts. This is not going to happen in the absence of completely overwhelming evidence of its necessity as it would rend forever the coherence of explanation as we now know it. Those who would propose that we do just this have every right of course to make the case. But, it needs to be done explicitly and completely forthrightly rather than obliquely and under the disguise of a regular scientific agenda as mostly happens at the moment.

Into this milieu ride Koenig and Cohen. Both men are widely experienced physicians in their own right. In their many professional roles they are also members of the scientific staff of the Center for the Study of Religion/Spirituality and Health at Duke University. They have edited and written contributory chapters in a marvelous and very useful book. Many skills were brought to the endeavour from their respective distinguished careers in medicine, but it is the clarity of their understanding of the overarching issues in the field that strikes one first. And the book can be read by the most committed of naturalists (such as this reviewer) without their hearts skipping a beat. It is a strictly empirical account of the correlations between religious activity and health outcomes and the putative psychophysiological mechanisms. Supernatural explanation is completely eschewed in considering the processes involved. Whether this is a temporary suspension of belief or the native position of the authors is not made clear. Nonetheless to the great benefit of the reader the exposition is cleanly of one kind.

Koenig, Cohen and their chapter authors cover all the expected territory and much more. They begin with introductory chapters on psychoneuroimunology (PNI) and religion and the history of PNI. There are eight chapters devoted explicitly to stress and the issues of cancer, autoimmune disease, susceptibility to infection, wound healing and HIV/AIDS, Three chapters are devoted to the specifics of Eastern and Western religious traditions and the implications of the PNI/religion connection for society and culture. Finally two chapters are devoted to the specifics of physiological and religious research measures and avenues for future research. The technical material assumes a considerable degree of biomedical literacy although there is some grading of the physiological explanations. Less technical readers should not be put off by this, as it is possible to get a good sense of the explanation by skimming the more difficult tracts.

The book is largely a weaving together of two topics

* PNI in general and its relation to health

And

* Religion as a special case of PNI in action

Detailed accounts and helpful line diagrams very well illustrate the many interacting mechanisms involved in PNI. Readers who skim these sections will take away a sense of the marvelous subtlety and intricacy of the systems involved. Numerous studies are quoted outlining the relationship between various aspects of religious life and multiple measures of morbidity and mortality. The many religious measures include everything from church attendance to the depth of profession of belief whilst the health measures range from mortality measures to psychological satisfaction scales. The authors consider the possibility of course that some third factor may be involved as the explanation in what are almost all correlational studies. Perhaps certain psychological features predispose both to religious belief and to the behaviors that enhance health outcomes.

The psychological mediators in religion's influence on health are suggested to be

* Altered cognitive appraisal of negative experience lowering stress levels * Religious community social support that buffers against stress * Religious fellowship and a reinforced psyche that can substitute for the health risks in alcohol, tobacco and other drugs

The very detailed account of PNI psychophysiology pathology and immunology and the voluminous collation of studies linking various aspects of religion and health are the main strengths of the book - and they are very impressive.

The comments that follow relate to the kinds of questions that arise from this work if we accept its central thesis rather than any perceived inadequacies in what is a huge volume of information in a relatively slim text.

Psychosomatic medicine is a large and relatively mature field. It would be hard to find anyone medically informed who did not have at least some appreciation of the vast body of research that connects psyche and soma both positively and negatively. Religious belief and group affiliation is particular strong element of psychological life for many so it is completely unsurprising that it probably has the health correlations ascribed (Both positive and negative of course). The many studies cited mat be soft and of course open to the usual criticisms but the underling conclusion I suspect is unproblematic. Many interesting issues arise if we accept the conclusions of the book and move along to the wider questions that arise. For instance, is there something special about religious belief and religious group affiliation that distinguishes it from other powerful positive beliefs and group support mechanisms? That is, does it have some particular edge in the psyche/soma stakes? Surely this would be interesting to investigate.

Studies in the USA that consider this might have a particular design problem. Because of the very high degree of religious belief in the US versus other nations in the developed world it is difficult to get good matching control groups. Non-believers in the US tend to come from special subgroups rather than being smoothly distributed across the population. As an extreme example the National Academy of Sciences has almost the reverse of the belief distribution of the population (some 95% do not believe in a personal God), but they are hardly a useful control group. Comparisons to other developed countries with very much lower rates of religious belief like those in Europe are possible but these bring their own design difficulties.

Which religious systems get better health outcomes and what are the critical psychological features that give particular health benefits? How do these religious groups compare in terms of their health benefits to non-religious belief systems and social groups? In the words of the authors, 'Determining which aspect of immune functioning relate specifically to which aspects of religion will be critically important.' Does the religious community want to go down this track not knowing where it will lead and agreeing to accept the conclusions whatever they may be? There is always a catch in cutting a deal with the devil - in this case the scientific method. What if it turns out that some lesser particularly authoritarian sect can demonstrate the best health indices instead of our favorite mainstream church? What if joining rotary and being a devoted jazz lover is the ultimate prescription for health?

And what about these health indices?

For example, a religion of greed or exploitation (or in the more usual dilute form, just not really giving a damn) may very well increase ones longevity even though it's at the expense of others. The strongest predictor of health is poverty and a religion that reinforces the socioeconomic power differential raises the health standard for those with the relative power. My religion may be very good for my health but very bad for the health of others.

Moreover, what is to be done about the vast bulk of believers whose philosophic calculus includes routine supernatural intervention in our affairs? Is a 100% successful account of the PNI axes and health an undercutting perspective? It would be ironic if the two authors were to end up contributing to creeping naturalism.

Furthermore, how fine-grained one can get with religious notions that must necessarily be operational? What meaning do descriptions like 'degree of spirituality' have?

We can construct operational measures like 'attends church X times a week' or self rates his/her spirituality on a ten point scale. Then degree of spirituality means whatever it is that we are measuring, rather like the meaning of IQ for example. Anything but the most general measures of religious parameters risks becoming an exercise in counting archangels on pinheads.

The authors suggest that the discoveries about the relationship between PNI and health might be a substantial boon to a health system that is very expensive and inequitable. Were it even possible to in some way dispense the benefits of the religion health relationship, it strikes me as a very curious religion that would accept the inequity of the system as an implacable given.

Koenig and Cohen have edited and authored a supremely worthy text. It is comprehensive enough in some sections to serve as a primary medical resource yet is still largely accessible to an audience with a working knowledge of biology. Their thesis that religion is a major determinant of psychosocial life in America and therefore a potent driver of the PNI axes seems very well supported. It certainly accords with the general literature in the field of psychosomatic medicine. Having been given us this robust starting point in considering religion and health even more interesting questions await us.

We should look forward to further contributions from the Koenig/Cohen team.

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Published   2002.09.16