advanced methodologies

ADVANCED METHODOLOGIES

ADVANCED METHODOLOGIES in the Scientific Study of Religion and Spirituality

Edited by William Grassie Contributors Robert Emmons Niels Gregersen David Hufford Andrew Newberg Stephen Post Richard Sloan Rodney Stark David Sloan Wilson

Metanexus

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2010909947

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Contents Contributors .......................................................................................................... 7 Advanced Methodologies: An Introduction by William Grassie ........................ 13

I. Competitive Dynamics and the Cultural Evolution of Religions and God Concepts 1. 2. 3.

Returning God to the Social Scientific Study of Religion by Rodney Stark........................................................................................... 33 Evolution, Culture, and Religion by David Sloan Wilson ................................................................................ 43 Religious Evolution from the Perspective of Complexity Studies by Niels Henrik Gregersen........................................................................... 49

II. Religion, Spirituality, Healing, and Health Outcomes 4. 5. 6.

Strengths and Weaknesses in the Field of Spirituality and Health by David J. Hufford ...................................................................................... 73 Spirituality, Religion, and Health: A Skeptic’s View by Richard Sloan ........................................................................................ 117 The Cognitive Neuroscientific Study of Religion and Spirituality by Andrew Newberg .................................................................................. 129

III. Religion, Spirituality, and Human Flourishing 7. 8.

The Psychology of Spirituality and Human Flourishing by Robert Emmons .................................................................................... 149 Our Natural Spiritual Religious Inclinations and the Nature of Unselfish Love by Stephen Post .......................................................................................... 157

References 9. 10. 11. 12 13. 14. 15. 16. 17.

References: Introduction: Grassie.............................................................. 171 References: Chapter One: Stark................................................................. 173 References: Chapter Two: Wilson .............................................................. 175 References: Chapter Three: Gregersen ...................................................... 179 References: Chapter Four: Hufford............................................................ 185 References: Chapter Five: Sloan ................................................................ 233 References: Chapter Six: Newberg ............................................................ 237 References: Chapter Seven: Emmons ........................................................ 243 References: Chapter Eight: Post ................................................................ 251

Contributors

Robert Emmons is professor of psychology at University of California, Davis. He earned his Ph.D. in personality psychology at the University of Illinois at Urbana-Champaign in 1986. Dr. Emmons’s research is at the interface of personality psychology, the psychology of emotion, and religion. His primary interests are in the psychology of gratitude and the psychology of personal goals and how each is related to positive psychological processes, including happiness, well-being, and personality integration. Emmons is editor-in-chief of the Journal of Positive Psychology. He is author of the Psychology of Ultimate Concerns (Guilford Press), Words of Gratitude for Mind, Body, and Soul (Templeton Foundation Press), the Psychology of Gratitude (Oxford University Press), and THANKS!: How The New Science of Gratitude Can Make You Happier, forthcoming from Houghton-Mifflin. He is the recipient of a number of major research grants from the John Templeton Foundation, the Institute for Research on Unlimited Love, the National Institute for Disability Research and Rehabilitation, and the National Institute of Mental Health. Emmons currently serves on the advisory boards of Baylor University’s Institute for Studies of Religion and Biola University’s Institute for Research on Psychology and Spirituality. William Grassie is founder and executive director of the Metanexus Institute, which works to promote the constructive engagement of religion and science. Metanexus works with some four hundred partners at universities in forty-five countries and publishes an online journal to which Grassie is a frequent contributor. Grassie received his doctorate in religion from Temple University in 1994. He has taught in a variety of positions at Temple University, Swarthmore College, and the University of Pennsylvania. Prior to graduate school, Grassie worked for ten years in international relations and conflict resolution in Washington DC; Jerusalem, Israel; Berlin, Germany; and Philadelphia, Pennsylvania. Grassie is the recipient of a number of academic awards and grants from the American Friends Service Committee, the Roothbert Fellowship, and the John Templeton Foundation. In 2007-2008, Grassie served as a Senior Fulbright Fellow in the Department of 7


Buddhist Studies at the University of Peradeniya in Kandy, Sri Lanka. Grassie wrote The New Sciences of Religion: Exploring Spirituality from the Outside In and Bottom Up (Palgrave Macmillan, 2010) and Politics by Other Means: Science and Religion in the Twenty-First Century (Metanexus, 2010). Niels Henrik Gregersen is professor in the Department of Systematic Theology and codirector of the Centre for Naturalism and Christian Semantics at the University of Copenhagen. His research focuses on two primary areas: (1) how to develop a contemporary Christian theology in the context of secularized and multireligious Western societies. Within systematic theology, he specializes in the theology of creation but has written on most areas of Christian ideas and doctrine; and (2) how to bring about a mutual interaction between science and religion that also allows religious reflection to be an active player. Within the field of science and religion, he specializes in the philosophy of evolutionary biology and the sciences of complexity. His most recent publications include Theology in an Evolutionary World (in Romanian, 2007), The Gift of Grace: The Future of Lutheran Theology (Fortress Press, 2005), and From Complexity to Life: On the Emergence of Life and Meaning (Oxford University Press, 2003). Gregersen is currently editing a book for Cambridge University Press with Paul Davies on Matter and Information: from Physics to Metaphysics (forthcoming 2010). In addition, he has published some 150 articles in Nordic, German, and English anthologies and journals. Gregersen received his doctorate in theology from the University of Copenhagen in 1987. David Hufford retired in June 2007 from his position as university professor and chair of humanities and professor of neural and behavioral science and family and community medicine at Pennsylvania State University (Penn State) College of Medicine in Hershey. He is now university professor emeritus of humanities and psychiatry at Penn State and adjunct professor of religious studies at the University of Pennsylvania. Hufford’s research is centered in the ethnographic and phenomenological study of the beliefs of ordinary people—especially those beliefs that are in competition with the positions taken by official institutions. His inquiry has focused on spiritual experience, the experiential grounds for spiritual beliefs, and the role of reason in their development and persistence. Hufford is currently senior fellow in spirituality in the Brain, Mind and Healing Division of the Samueli Institute in Alexandria, Virginia. He is a founding member of the editorial boards of Alternative Therapies in Health and Medicine and the new journal Explore: The Journal of Science and Healing. Hufford’s book, The Terror That Comes in the Night, was recently translated into Japanese, Korean, Thai, and Greek. He earned his Ph.D. in folklore and folklife from the University of Pennsylvania. Hufford lives in Media, Pennsylvania, with his wife Mary Ann Bucklin and their four children. 8

CONTRIBUTORS

Andrew Newberg, MD, is an associate professor in the Department of Radiology at the hospital of the University of Pennsylvania, with secondary appointments in the Department of Psychiatry and the Department of Religious Studies. Upon graduating from the University of Pennsylvania School of Medicine in 1993, Newberg trained in internal medicine at the Graduate Hospital in Philadelphia serving as chief resident in his final year and subsequently completed a fellowship in nuclear medicine. He is board certified in internal medicine and nuclear medicine. Newberg’s research now largely focuses on how brain function is associated with various mental states, in particular, the relationship between brain function and mystical or religious experiences. The results and implications of this research are delineated in Newberg’s best-selling books How God Changes Your Brain (Random House, coauthored with Mark Waldman) and Why God Wont Go Away: Brain Science and the Biology of Belief (Ballantine/Random House, coauthored with Eugene d’Aquili and Vince Rouse). He is coauthor, along with Eugene G. d’Aquili, MD, of the book The Mystical Mind: Probing the Biology of Religious Experience (Fortress Press), which won the award for Outstanding Books in Theology and the Natural Sciences for 1999 sponsored by the Center for Theology and the Natural Sciences. Stephen G. Post is director of the Center for Medical Humanities, Compassionate Care, and Bioethics in the School of Medicine, Stony Brook University (SUNY). From 1998 through 2008, he was professor of bioethics, philosophy, and religion in the School of Medicine, Case Western Reserve University. Post is editor-in-chief of the Encyclopedia of Bioethics, third edition. He is president of the Institute for Research on Unlimited Love, founded in 2001 with a generous grant from the John Templeton Foundation, and devoted to high-level scientific research on unselfish love. Post received his Ph.D. in ethics from the University of Chicago Divinity School (1983), where he was an elected university fellow, a member of the Institute for the Advanced Study of Religion, and a preceptor in the Pritzker School of Medicine. Post is the author of more than 150 articles in peer-reviewed journals across the sciences, religion, and ethics. He has written seven scholarly books on altruism and love. His most recent book, published with Broadway Books/Random House, is Why Good Things Happen to Good People: The Exciting New Science That Proves the Link Between Doing Good and Living a Longer, Happier, Healthier Life, coauthored with Jill Neimark. Richard Sloan is Nathaniel Wharton professor of Behavioral Medicine in the Department of Psychiatry at Columbia University Medical Center and chief of the Division of Behavioral Medicine at the New York State Psychiatric Institute. His principal work focuses on identifying the autonomic nervous system mechanisms 9


linking psychological risk factors such as depression, hostility, and anxiety to heart disease. In addition, Dr. Sloan and colleagues have explored and criticized the purported links between religion, spirituality, and health that have appeared in popular and medical publications. They have examined the empirical basis of the claim that religious activity promotes health and identified significant ethical, practical, and even theological problems associated with making religious activity an adjunctive medical procedure. Sloan earned his Ph.D. at the New School for Social Research and subsequently was awarded a fellowship at Columbia University. He is the author of Blind Faith: The Unholy Alliance of Religion and Medicine (St. Martin’s Press). Rodney Stark is distinguished professor of the social sciences at Baylor University. He grew up in Jamestown, North Dakota, and began his career as a newspaper reporter. Following a tour of duty in the U.S. Army, he received his Ph.D. from the University of California, Berkeley, where he held appointments as a research sociologist at the Survey Research Center and at the Center for the Study of Law and Society. He left Berkeley to become professor of sociology and of comparative religion at the University of Washington. In 2004, he joined the faculty of Baylor University. He has published 30 books and more than 140 scholarly articles on subjects as diverse as prejudice, crime, suicide, and city life in ancient Rome. However, the greater part of his work has been on religion. He is past president of the Society for the Scientific Study of Religion and of the Association for the Sociology of Religion. He also has won a number of national and international awards for distinguished scholarship. Many of his books and articles have been translated and published in foreign languages, including Chinese, Dutch, French, German, Greek, Indonesian, Italian, Japanese, Korean, Polish, Portuguese, Romanian, Spanish, Slovene, and Turkish. David Sloan Wilson is distinguished professor of biology and anthropology at Binghamton University (SUNY). He earned his Ph.D. at Michigan State University. Wilson is best known for championing the theory of multilevel selection, which shows how adaptations can evolve at all levels of the biological hierarchy, with implications ranging from the origin of life to the nature of religion. He is author of nearly two hundred scientific articles published in biology, anthropology, psychology, and philosophy journals. His scholarly books include Unto Others: The Evolution and Psychology of Unselfish Behavior (with Elliott Sober, Harvard 1998), Darwin´s Cathedral: Evolution, Religion, and the Nature of Society (Chicago, 2002), and The Literary Animal: Evolution and the Nature of Narrative (coedited with Jonathan Gottschall, Northwestern 2005). Wilson also communicates to a general audience through his ScienceBlogs site and trade books, including Evolution for Everyone: How Darwin’s Theory Can Change the Way We Think About Our Lives and the forthcoming Evolving the City: An Evolutionist 10

CONTRIBUTORS

Contemplates Changing the World—One City at a Time. Wilson directs EvoS, a campus-wide program that uses evolutionary theory as a common language for the unification of knowledge. He delivered the distinguished Terry Lectures at Yale University in 2005.

11

Advanced Methodologies: An Introduction by William Grassie

The last decade has witnessed a resurgence of interest in the scientific study of religious and spiritual phenomena on the part of researchers in diverse fields. As one would expect, psychology, sociology, and anthropology still play central roles in these studies, but these disciplines are now also supplemented by economics, epidemiology, evolutionary psychology, cognitive neuroscience, and behavioral genetics, among others. This revival of interest is somewhat unexpected because many of these same social sciences were predicting during most of the twentieth century that religions would gradually diminish and disappear with the spread of science, education, and economic growth. Instead, we have witnessed a global revival of religious movements in many parts of the world, a source of both hope and concern in the twenty-first century. As someone formally trained in religious studies, I have observed many of these new scientific studies with some consternation. Religionswissenschaft, as the field is referred to in German, is “the scientific study of religion” as distinct from Theologie, but it turns out to be a science without a method. Instead religious studies as practiced in universities today involve exposure to multiple religious traditions and multiple methodologies (Sharpe 1986; Smith 1982, 2004; Taylor 1998; Day 2010). At the center is a term—religion—that we cannot define, though many have tried. Along with historical, archeological, scriptural, philological, theological, and philosophical modes of inquiry, graduate students in religious studies are typically exposed to the works of Ludwig Feuerbach, Karl Marx, Sigmund Freud, William James, J.G. Frazer, E.B. Tylor, Émile Durkheim, Max Weber, C.G. Jung, Clifford Geertz, and others (Preus 1996; Pals 2006). These early theorists of religion were also giants in the founding of the fields of psychology, sociology, and anthropology. For the most part, they all took a rather dim view of religion, hoping in fact that religions would diminish and eventually disappear (Berger et al. 1999). 13

INTRODUCTION

At some point in religious studies’ students’ careers, we had to specialize, focusing generally on one aspect of one tradition or on one particular mode of inquiry applied to some case study. But if the aspiring doctoral students had paid attention to the introductory graduate seminars taken and the introductory undergraduate courses taught, we knew that religion and spirituality were extremely complex and multilevel phenomena. We shared a fascination with the phenomena, one that is often quite personal, but we strove for some detachment and distance in our academic work. We cultivated an appreciation of different worldviews and cultures, even when we might be especially interested in one in particular. Colleagues in other departments often looked down on us as stepchildren of the academy, an accessory to the university chaplains, or an antiquated throwback to the days of the Protestant establishment, whose rule of higher education in the United States had only been recently been overturned (Marsden 1996).1 And as is sometimes the case in universities, some of the religious studies professors were indeed quite antiquated, if not in age then in their inability to leave the comfort of their humanistic training and narrow specializations. We certainly did not learn about neural networks and axon myelination. We were certainly not trained in regression analysis or survey-validation techniques. My own petition to the Graduate Education Committee in the Religion Department at Temple University to substitute statistics for one of my two foreign language requirements was denied. No matter, because as we will learn in essays collected in this volume, when it comes to religion and spirituality, it is hard to know what the dependent and independent variables really are. The confusion inside religious studies departments is best captured by perusing the program book of the annual meeting of the American Academy of Religion (AAR), which I have affectionately taken to calling the annual meeting of the Tower of Babel. Hundreds of interest groups compete for space and attention, often with no apparent commonality, in this official guild for professors of religion. We track different religions, different methods, and different causes. We are devotees of different theologians and philosophers. Our topics are both ancient and new. The only thing more disorienting than the program book is a tour of the massive book exhibition with many thousands of titles from publishers large and small on all variety of topics (AAR 2010). Like Socrates, who refused to believe the oracle that he might be the smartest person in Athens, the religious studies scholar can also make only a modest claim to any expertise in anything in particular in this crowd of social scientists. At least, we know that we are confused. We know we cannot define religion and even less so spirituality. We know that we speak many “languages” and have no common

1

14

See also Hollinger 1996 and Efron 2006 for an important Jewish-Christian subtext to the secularization of American universities in the twentieth century.

GRASSIE

method to the sometimes madness of our discipline. The social scientists in other guilds, who have recently rediscovered religion, naïvely thought they knew what they were studying. One sees this naïveté for instance in many of the early studies of spirituality and health, which treated “spirituality” as a unitary medical intervention or “religiosity” as a simple survey question. The sciences of religion are cursed with two big problems. First, many of the social scientists in the field are motivated by an atheist, antireligious bigotry. Others evince an apologetic bias to validate a religious worldview or perspective because they themselves are committed believers. Whether it is apologetic biases or atheistic bigotry, scientists should be free of such prejudices and prejudgments, if they hope to do good empirical research, reach valid conclusions, and construct useful theories. The difficulty of the subject matter in this case is proportional to its importance. Religion and spirituality, whatever the terms might actually mean conceptually and on the ground, are, in fact, extremely important for a whole slew of social scientific, philosophical, existential, political, practical, and metaphysical reasons. That intuition and insight, however confused I may be, certainly accounts in part for my committing my professional life to the study of religion and spirituality as a formal academic discipline. I suppose, once upon a time, there might have been more lucrative and practical career options for me, but at least this one is endlessly fascinating, potentially transformative, and yes, in some sense, extremely practical. Whether the object(s) of religious concern are real or not, their impacts on individual and social lives are undeniable and profound. Indeed, we should better reformulate the question to be not whether religions are true but only how. My training as a scholar in religious studies was invaluable as a foundation, but it also turned out to be inadequate. I really did need those courses on the cognitive neurosciences, physical anthropology, statistics, genetics, and a whole slew of other topics that fall outside of the normal domain of religious studies. I received some on-the-job training, however, when I started the Metanexus Institute in 1997, originally just a modest listserv promoting the constructive engagement of religion and science.2 Metanexus grew with funding from the John Templeton Foundation, focusing increasingly on the scientific study of religious and spiritual phenomena.

2

In 1997, I started the Meta-List, a moderated email listserv on religion and science that rapidly grew to several thousand subscribers. In 1998, I incorporated the Philadelphia Center on Religion and Science (PCRS) along with four faculty members at the University of Pennsylvania. In 2000, PCRS launched www.metanexus.net, a web journal. In 2001, PCRS and Metanexus merged identities to become the Metanexus Institute on Religion and Science, in part to reflect our increasingly international focus.

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INTRODUCTION

∞ Back in 2004, there were discussions between Metanexus and the John Templeton Foundation on problems in the scientific study of religious and spiritual phenomena. These discussions led to the creation the Templeton Advanced Research Project (TARP), a multimillion-dollar initiative to promote innovation in research methods and applications that would not be reductive or dismissive of religion and spirituality. As part of that endeavor, Metanexus commissioned eight field analyses by leading scholars. This volume collects those field analyses for the benefit of graduate students and the research community. The field analyses track three domains in which the request for proposals was issued the following: 1. 2. 3.

Competitive dynamics and cultural evolution of religions and God concepts Religion, spirituality, healing, and health outcomes Religion, spirituality, and human flourishing

For the most part, we sought research on the positive implications of religion and spirituality. Applicants for research funding were expected to study these field analyses as part of writing their proposals. The goal was not only to promote innovative research, but also to develop creative insights into the forces that shape and expand world religions and their conceptualizations of the sacred. I was privileged to work with a team of twelve distinguished judges and over sixty external peer reviewers to make the difficult selections of which projects utilized the most innovative methodologies and promised the most significant results. The project advisors and judges were the following: • • • • • • • • • • • • 16

Robert Emmons from the University of California, Davis Ralph Hood from University of Tennessee at Chattanooga David Hufford from Penn State College of Medicine Solomon Katz from the University of Pennsylvania Robert Nelson from University of Pennsylvania School of Medicine Martin Nowak from Harvard University Kenneth Pargament from Bowling Green State University Stephen G. Post from Case Western Reserve University Christina Puchalski from George Washington University School of Medicine Jeffrey Schloss from Westmont College Paul Root Wolpe from the University of Pennsylvania Robert Wuthnow from Princeton University

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In all, over four hundred qualified research proposals were received. Forty principal investigators were invited to submit full applications. Each full application received two extensive peer reviews before being ranked by the judges in an NSF-type selection process. In the end, eleven projects were funded in the three areas. Those projects are ongoing and the results forthcoming. In the process of managing this request for proposals and reading every application and every review, I received a remarkable postgraduate education in cutting-edge social scientific research. ∞ Most scientific studies of religion focus on specific faith communities and utilize a single social-scientific paradigm. What was unique about this project was the attempt to do broad comparative studies of religion and spirituality using multiple methods spanning disciplines as diverse as economics and the neurosciences. This orientation is reflected in the eight field analyses assembled in this volume organized topically by the three areas of funding in the TARP request for proposals. Part one deals with “Competitive Dynamics and Cultural Evolution of Religions and God Concepts.” This area sought to explore the mechanisms and cultural forces that shape religions and conceptualizations of God. How can we understand religion and spirituality as important creative and causal factors in the formation of societies? Envisioned in this area were approaches utilizing economic models, evolutionary psychology, rational choice theory, game theory, computer models and simulations, and other models for historical and cultural development. The first essay by Rodney Stark titled, “Returning God to the Social Scientific Study of Religion,” traces how Émile Durkheim and his intellectual descendants had banished god-talk from the study of religion. Religion was reduced to morality encoded by society. Variations in how people conceive of God or gods were no longer relevant data. Stark argues against this move and calls on social scientists to pay attention to how believers understand the image of god(s) as important data with empirical consequences. For instance, the effectiveness of religions in promoting individual morality, as claimed by Durkheimians, may be directly related to whether god(s) are perceived to be personal or impersonal, morally engaged, or amorally aloof. Stark presents some of his own survey research that suggests that these images of god(s) may have a more significant effect on morality than actual participation in religious rites and rituals, contrary to the assumptions of most Durkheimian social scientists. He calls for new qualitative research on cross-cultural, social-psychological, and organizational factors in differential consequences of various images of god(s). He leaves us with some provocations: 17

INTRODUCTION

Why do intellectuals seem so inclined to foster vague divine essences rather than conceive of God as an active, aware, concerned being? Can such impersonal images of God actually sustain the levels of individual religious commitment needed to sustain vigorous religious institutions? Or, can religions lacking both creeds and congregations, as is the case in what is referred to as New Age Spirituality, actually meet most people’s needs? What are the social effects of creedless, unorganized, religions? (42)

The second essay in this section is by David Sloan Wilson titled “Evolution, Adaptation and Religion,” advocates a revival of Durkheim’s functional account of religion married to a Darwinian understanding of cultural evolution. For Wilson, the images of god(s) would be the dependent variable, as religions adapt to their cultural and geographical environments through a group selection process. Religious scholars study the “proximate mechanisms for cultural evolution in the form of behavioral prescriptions, theological beliefs, and social practices.” The real drivers of cultural formation are not belief systems and religious ideologies but the necessities of survival and reproduction of differing religious “phenotypes” in social groups in specific environments and in competition with other groups. One of the major functions of religion, then, is promoting in-group cooperation, solidarity, and altruism and when contextually appropriate, also promoting out-group cooperation and generosity. Wilson puts forward a list of research questions for contemporary scholars: 1. 2.

3. 4.

5.

6. 18

How well adapted are religious groups to their respective environments? What role do theological beliefs and practices (including conceptions of God and religious conceptions of human nature) play in adapting religious groups to their respective environments? What can religion tell us about the process of cultural evolution in addition to its products? Religions usually promote harmony within groups but only sometime promote harmony among groups. What are the ecological, social, and cultural evolutionary factors that promote harmonious relations among religious groups? Religions are in part vehicles of practical knowledge that enable people to behave adaptively in their environments, but much of this knowledge is encoded and transmitted in a way that appears the very opposite of pragmatic. What accounts for this paradox, or more generally the advantages of encoding practical knowledge in ways that are not self-evidently pragmatic? How do religious cultural systems differ from other cultural systems?

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Wilson ends by pointing out the need for a balance between theoretical and empirical research and promotes what he calls a “consilient theoretical framework,” following the work of E.O. Wilson (1998). David Sloan Wilson notes that this research promises humanity “a more practical knowledge of how to bring the outcome of cultural evolution into alignment with positive religious and general ethical objectives.” We may only hope that this is the case. “From your mouth to God’s ears,” as the saying goes. The third and final essay in this first section of Advanced Methodologies is by Niels Henrik Gregersen and is titled “Religious Evolution from the Perspective of Complexity Studies: Six Theoretical Toolboxes.” Gregersen examines cellular automata, complex adaptive systems, game theory, rational choice theory, the cognitive science of religion, and autopoietic systems theory, all with a view to understanding the emergence, spread, stabilization, and evolution of religious semantic and behavioral systems. In complexity theory, we now have a conceptual framework in which the spiritual beliefs and practices can be both dependent and independent variables at the same time in a dynamic, interactive system that evolves and adapts. Complexity and chaos theories provide many new tools for modelling religious systems, systems that involve activities like mating, eating, converting, attacking, being injured, and cooperating. Sometimes these models can be represented with elegantly simple computational formula. Simple simulations can be designed to run on computers, which are suggestive of new ways to interpret religious movements and history. Gregersen writes the following: One task would be to show how the dynamics of religious evolution actually have taken place in historical communities, and how this dynamic is at work in present-day religious communities, where no religion is protected from external influences. This type of research will be commended to religious studies in general. Another research task will be to study whether these actual processes of inter-religious and inter-cultural exchange will benefit the rationality and inner coherence of a religious tradition, or not. This type of research will demand a theological approach to the cultural evolution of religious traditions. It may well be the case that certain forms of rationality can be identified in the very process of passing on a religious tradition and communicating it to others. (57)

Gregersen warns, much like David Sloan Wilson, that successful religious coping strategies do not imply the ontological plausibility of these strategies. Cognitively true and practically useful may not be correlated in human religious evolution and adaptation. 19

INTRODUCTION

∞ In part two, we consider the relationship between “Religion, Spirituality, Healing, and Health Outcomes.” We begin with a lengthy field analysis by David Hufford. The problem of defining and operationalizing the terms spirituality and religion in research is Hufford’s point of departure, curiously, not an issue broached in any of the earlier essays. Hufford favors a simple formulation reflecting ordinary usage in English as documented by the New Shorter Oxford English Dictionary (1993): spirituality means “the quality or condition of being spiritual,” and spiritual means “of, pertaining to or affecting the spirit or soul; and religion is defined as “the community, institutional aspect of spirituality.” He writes the following: Thus spirituality is the more general term, it includes religion, and spirituality is a core aspect of religion. This does not deny that there are “spiritual but not religious” individuals or that extrinsically religious people may not be especially spiritual. (77)

Hufford argues that the field of spirituality, religion, and health (S/RH) has been selectively biased toward mainline Protestant Christianity. The spiritual and religious perspectives of large segments of the United States, and indeed the world, do not figure in this research program. This is acutely seen in the artificial division of S/RH research from research on complementary and alternative medicine (CAM), noting that the latter almost always includes some spiritual “energy” as part of its etiology. Also ignored in most S/HR research is the Roman Catholic healing tradition, as well as many folk-medicine traditions. Hufford notes that the category “spiritual but not religious” characterizes large portions of the U.S. population not only today but going back to the seventeenth century. This amorphous group is also correlated with those who utilize CAM practices and may constitute the largest “religious” segment of the United States today. Most of the studies carried out have been epidemiological and observational in nature, for instance, in trying to correlate church attendance or “religiosity” to disease patterns and healing outcomes. S/RH researchers want to treat spiritual interventions as an independent variable in health and healing, but epidemiological studies do not lend themselves to specific controlled, clinical applications. Also biased against are studies of major spiritual transformational events, as in near-death experiences, in favor of daily, ordinary spiritual practices and experiences.3 Another problem in the S/RH field is that the research community has not engaged in interdisciplinary research with religious studies, the history of medicine,

3

20

Metanexus Institute ran a major research project on spiritual transformation. See Grassie and Katz 2006.

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anthropology, philosophy, and other relevant fields. One consequence of this lack of interdisciplinary scholarship, in Hufford’s understanding, is “[t]he persistent use of ambiguous, universalizing definitions, mainly patterned on those taught by Christian existential theologians, notably Paul Tillich, reflect[ing] a kind of tacit theological commitment common in the academic community in general.” Another question addressed in Hufford’s essay is who should provide spiritual interventions in health care. There is some controversy on the issue of whether doctors, nurses, or chaplains should provide spiritual care to patients. The issue is debated on questions of ethics, appropriateness, and practicality. Hufford favors chaplains in the role of spiritual-care provider but notes there has been very little research on this question of who is the most effective provider of spiritual “interventions.” Hufford also calls for a new approach to the informatics of S/RH care and research. Information science is now at the center of medical research, and without the ability to classify, code, track, and assess spiritual interventions in clinical care, no progress will be made in studying the effectiveness of these services. In the end, Hufford sees many strengths in the field of S/RH in the increased trends in publication, in improved research design and evaluation, in changes in the mental health professions’ understanding of S/R, especially in relation to coping strategies, and in the development of more robust survey instruments, especially for Christian populations. “The question cannot be whether spirituality and health should be studied,” writes Hufford, “but must rather be how the topic should be studied.” Hufford has provided not only a thorough introduction in his field analysis, but also a long bibliography to help guide further study and research. Richard Sloan offers a critical assessment of religion, spirituality, and health in his field analysis. He cites studies that question the reputed connection between religion and health. While there may be a strong correlation between attendance at religious services and mortality rates, these and other studies are troubled by self-selection errors, residual confounders, measurement errors in self-reporting, and data dredging. “One of the central concerns of this literature,” writes Sloan, “is a lack of specificity of religion and spirituality, the putative ‘independent’ variables in these studies.” Sloan notes that a similar problem exists with the lack of specificity about supposed outcome variables from spiritual interventions. “The difficulty in clearly defining independent and dependent variables no doubt contributes significantly to the paucity of evidence described above.” In the case of intercessory-prayer studies, it is possible to design rigorous, double-blinded experiments with controls, but such studies that pass muster have returned null results. Sloan worries about ethical and theological issues in mixing religion and medicine. Clinicians have power in their role as medical experts and care providers. 21

INTRODUCTION

This power must not be used to coerce or manipulate vulnerable patients on behalf of religious ideologies. The juxtaposition of science and religion in our society often results in an emotional and highly polarized polemic. While these extremes do a disservice to the real complexities and ambiguities involved, it is important to remember that good scientific research depends on a process of testing by critics and skeptics. We are not likely to develop advanced methodologies in the scientific study of religious and spiritual phenomena without the participation of skeptical social scientists to keep researchers grounded and honest. The third essay in this section by Andrew Newberg addresses the cognitive neuroscientific study of religion and spirituality. Newberg notes the centrality of subjective experience in complex religious and spiritual phenomena and argues that the cognitive neurosciences offer many new objective insights. Newberg and his colleagues have done some of the pioneering work in brain imaging of spiritual experiences. Newberg reviews different instruments used by researchers to measure subjective experiences and then how to actually correlate these self-reports with new brain-imaging techniques. He provides a useful overview of EEG, PET, fMRI, and SPECT techniques, their strengths and limitations. “Functional neuroimaging studies of religious and spiritual phenomena,” writes Newberg, “might become one of the most important techniques since the results have physiological, clinical, and potentially philosophical relevance to the issues related to such phenomena.” Functional brain imaging allows researchers to study blood flow, metabolism, and the presence of neurotransmitters in the brain, for instance, serotonin, dopamine, opiates, and glutamate. Interpreting the results of functional imaging studies remains a major problem, as it is not always clear that what is being measured physiologically is causally related to the different subjective experiences reported. Newberg then goes on to discuss subject selection and comparison groups in brain-imaging studies of spiritual experiences, noting many of the challenges in defining and creating a control group and the difficultly of designing placebo controls for spiritual practices. For the most part, neuroimaging studies use individuals as their own comparison between “base state” and the “spiritual experience state,” but this has limitations in the types of conclusions that can be drawn given the potential diversity of such states. In terms of study design issues, Newberg identifies a number of research areas: (1) the neurophysiology of spiritual interventions, (2) spiritual interventions associated with psychopharmacological agents, (3) drug-induced spiritual experiences, (4) neuropathologic and psychopathologic spiritual experiences, (5) spiritual experiential development in infants, children, and adolescents, and (6) physical and psychological therapeutic interventions. All these studies require sophisticated biostatistical analysis from the research team. 22

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Finally, Newberg considers theological and epistemological implications of neuroimaging studies. Philosophy of mind is a rich and complicated field for reflection and debate, no less so than when the topic is spiritual experience. Do these subjective experiences have any real referent in the world? How are they different from hallucinations, which however vivid are not objectively real? Newberg believes that neuroimaging research provides modest support for the notion that the “objects” of subjective spiritual experience are in some sense “real.” A person who has a psychotic episode knows afterward that he was “crazy.” As Newberg writes: The same cannot be said, however, of many religious and spiritual states which appear to be “more real” than baseline reality and are vividly described as such by experiencers after they return to baseline reality. (146)

∞ The final set of field analyses focus on religion, spirituality, and human flourishing. In contrast to the antireligious biases in the social sciences that historically have tended to invest religion and spirituality with exclusively negative connotations, these field analyses were charged with exploring how religion and spirituality might contribute to promoting virtues and character strengths. How, we wondered, were religions involved in promoting noble qualities in humanity, including creativity, purpose, perseverance, gratitude, prayer, awe, responsibility, love, honesty, joy, humility, and generosity? Robert Emmons’s field analysis focuses on “The Psychology of Religion, Spirituality and Human Flourishing.” Sometimes referred to as positive psychology, the field seeks to study concepts such as forgiveness, hope, humility, gratitude, love, self-control, and wisdom, with the goal of understanding and promoting these virtues in individuals and communities. The field recognizes that the world’s religious traditions also affirm and promote these as universal principles and ethical imperatives. Basic research and intervention studies are now under way about how to cultivate these virtues. Some of this research is also making use of neuroimaging tools, as presented, for instance, in the previous section by Andrew Newberg, whose work tends to be based on studying spiritual prodigies and extreme religious states. Emmons wonders about studying common, everyday religious experiences and behaviors, for instance, in seeking neurological corollaries to religious experiences of everyday awe, gratitude, and worship. Are there different prayer patterns that can be correlated with brain states based on different styles of worship? Can we track individual differences in spiritual and character strengths across larger sample groups? Emmons warns, however, that “brain imaging is not the ‘Holy Grail’ because the brain image itself as revealed by imaging techniques has little bearing on the psychological or spiritual significance of the image.” 23

INTRODUCTION

Emmons is also interested in the developmental psychology of children and adolescents and the role of spirituality and religion in promoting human flourishing in this stage of life. He offers a provocative list of research questions: What is the developmental trajectory, say, of gratitude, humility or a sense of purpose? When do such qualities first appear? What would constitute valid, age appropriate measures of these and related virtues? What are the socialization and induction mechanisms that parents employ to cultivate these behaviors in children? What parenting processes (e.g. communication, conflict resolution) or styles are associated with gratitude, humility, and a sense of purpose? To what degree are these virtues individually or jointly predictive of positive outcomes such as school success, overall well-being, service, resiliency, health behaviors, and less risk taking? (153)

Similarly, Emmons calls for developmental studies of spirituality, religion, and human flourishing from young adulthood through old age. And whether a person is young or old, all these universal human character strengths and virtues are entangled with biology and culture, nature and nurture. Good studies will seek to measure and analyze multiple interacting variables. These human virtues and strengths—purpose, perseverance, gratitude, creativity, love, honesty, joy, humility, generosity, and so forth—should not simply be studied in isolation, but rather in ways that illuminate how they might be interactive and mutually dependent on each other and in relationship with spiritual attitudes and behaviors, as well as how cultural and religious differences might differentially impact the cultivation and expression of these qualities in humans. The translation of these studies into the treatment of mental health and illness is an obvious but difficult next step. Emmons calls for intervention studies to see how human flourishing can be promoted through spirituality and religion. Especially valuable would be large-scale intervention studies using randomly assigned placebo control groups. Emmons wonders what interventions would be most effective with different age-groups and populations and how “spiritual” emotions differ from “natural” variations. Like others in this volume, Emmons notes the challenges of measurement and relevant constructs. Without a major breakthrough in instrument development and statistical techniques, it is not likely that major progress will be made in this field. Emmons ends his field analysis by promoting a multilevel interdisciplinary paradigm (MIP). He rejects single analytic approaches with sectarian foci. Spirituality, whatever it may be, is certainly a complex and multifaceted phenomenon. MIP would involve evolutionary biology, cognitive science, theology, and philosophy, along with psychology, sociology, and anthropology: 24

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This paradigm recognizes the value of data at multiple levels of analysis, while making nonreductive assumptions concerning the value of spiritual and religious phenomena. Nonreductive implies that spiritual or religious phenomena cannot be accounted for solely in terms of existing psychological, social, or biological constructs and processes. (157)

Emmons provides an annotated bibliography, which is included in this volume. The last essay in part three and the final essay in this book is by Stephen Post, who argues that the spiritual and religious inclinations (SRI) are manifested in human nature and history and are suggestive of a “Creative Presence” in the universe. Aligning our thoughts and behavior with this Creative Presence is, then, the key to flourishing fully as individuals and societies. Post notes that this Creative Presence is typically understood to be other-regarding, unselfish love. The existence of an innate spiritual and religious inclination is itself largely an empirical question: First, human nature appears to include a powerful spiritual and religious inclination toward worshipful union with a presence in the universe that is higher than our own; second, a fully flourishing individual and society must make room for spirituality and religion (i.e., spirituality organized around group worship, rituals, symbols and acculturation) in their salutary forms; third, these salutary forms can be described in terms of the degree to which they result in unselfish love of others, centering on our shared humanity, rather than on some small fragment of humanity. (159)

While science qua science cannot prove the existence of a Creative Presence in the universe, the existence of these complex spiritual and religious inclinations is suggestive of two propositions—first, that SRI evolved with real selective benefits to the species and, second, that SRI have objective referents in the universe. Post offers a classical argument in a modern context, proposing that the highest good that humans can achieve in terms of excellence, fulfillment, and morality is to align ourselves with this Creative Presence. He promotes a universalist understanding of natural-law morality based on a transcendent order in the universe. Post argues that this Creative Presence as manifested in diverse religious traditions and cultural idioms is best understood as “unlimited love.” Post poses three core scientific questions with regard to human flourishing in the context of our SRI: 1.

How does spiritual and religious experience enhance the human capacity for a life of unlimited “exceptionless” love? 25

INTRODUCTION

2. 3.

What is the relationship between perceptions of perfect divine love and expanded love in the life of the individual and across a society? How do religious rituals and practices at their best increase the total amount of love energy in society and in the world?

These empirical questions, of course, quickly draw us into profound philosophical and theological reflections, as well as existential and pragmatic challenges of right livelihood and action in the world today. Post provides an annotated bibliography to guide us in this continued inquiry. ∞ In reflecting on this collection of essays as a whole, along with the four hundred proposals received in TARP and the extensive review and selection process we engaged in, I am motivated to make some closing observations on what advanced methodologies in the scientific study of religious and spiritual phenomena might entail beyond what has already been stated herein. I will argue first that the scientific study of religious and spiritual phenomena should be guided by what I call nonreductive functionalism. Second, I will argue that health, healing, and flourishing can be promoted through a complex distributed process that I call the deep semiotics of health. Nonreductive functionalism. There is no single scientific paradigm or analytic framework from which to understand the complex phenomena of religion and spirituality. Religions and spiritualities, however they are defined, are multivariable and multileveled phenomena. Scientists and scholars can try on many different reductionist approaches and explanatory strategies to religion, but we need to remember that each one acts as an epistemological filter for what we see and what we do not see. None of these approaches will be adequate, though altogether will enlarge our understanding of religion and spirituality and give us a new appreciation of this enduring dimension of human life (Grassie 2010). In this sense, nonreductive functionalism is not unlike Robert Emmons’s call in his essay for a multilevel interdisciplinary paradigm. In employing the term functionalism, I imply that religions and spiritualities exist and persist in part because they serve diverse human purposes. These functions work on the level of both individuals and groups. The sciences of religion must be open to understanding how religions differentially benefit individuals and groups and why they arose and thrived in the past and continue to do so in our contemporary world. Of course, to say that religions can be functional also implies that they can be dysfunctional, so we need to pay attention to the dark side of religion. Function and dysfunction often turn out to be closely related and context-specific. In social-scientific terminology, religions operate as both dependent and independent variables in human history and in individual lives. Here, we will find many points in common with the essays of all the contributors to this volume. 26

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In using the term nonreductive, however, I am also making a larger metaphysical claim about the structure and limits of science. Science is not a unified epistemology, though it turns out to be a unified body of knowledge. It is better to talk about many different sciences, each with its own methods of inquiry and validation determined by the nature of the phenomena studied as adjudicated through the rigors of peer review. Science is a complex, diverse, and multileveled enterprise. An adequate philosophy of science today recognizes that there are emergent phenomena and that different methodologies need to be employed to account for different levels of complexity. Religions and spiritualities are certainly complex and emergent phenomenon and, therefore, must be studied with multiple methodologies, none of which exhausts the possible meanings of the phenomena. Correlations do not necessarily mean causation, and causation does not necessarily mean explanation, because processes can be interpreted at different levels to account for different kinds of causation (Polanyi 1958; Haught 2006). From a scientific perspective, however, there is no a priori reason to privilege one religious tradition or spiritual perspective over another. We have three logical options with regard to the possible truth of religious and spiritual intuitions. The first option is that all religions are grossly mistaken and contain no insights into ultimate reality. The question of why humans have made such colossal cognitive blunders throughout the ages and across cultures still cries out for scientific explanation. The second option is that there is one true religion and the others are inferior and mistaken. This scandal of particularism also cries out for some kind of explanation, including some kind of cognitive reconciliation with contemporary science and a robust apologetics vis-à-vis the supposed singular superiority over other traditions. Peacefully managing religious exclusivism is, then, a major challenge in our global civilization. The third option is that all religions are partly true. In this understanding, religious stories and doctrines evolved in culturally and historically specific ways, but ways that nevertheless transcend their specificity to establish universal profundities. If there were no mapping of religion onto some kind of truths in the universe and in the human person, then it would be difficult to understand why and how religions persist and why they evoke such fierce commitments and debates. Religions, in this third view, are then tested and filtered through centuries of human experience and must now be retested, winnowed, and reinterpreted in light of scientific realities. This third option is explicitly supported in Stephen Post’s discussion of a Creative Presence manifested in the universe and human lives and one that I carefully develop from the “outside in” and the “bottom up” in my book The New Sciences of Religion (2010). Nonreductive functionalism as a scientific orientation in the study of religious and spiritual phenomena, therefore, leaves open the possibility that religion and spirituality are in some sense true, perhaps true about the most profound and important existential issues that humans face. The question now becomes not 27

INTRODUCTION

whether religions and spiritualities are true but how they are true. In particular, we need to know how to interpret spirituality and religion in light of the pluralism of perspectives and the insights of science. The sciences of religious and spiritual phenomena have now thrown us back into religious studies and more humanistic and philosophical modes of inquiry, though different for the journey. The Deep Semiotics of Health. Though modern physicalist medicine and alternative spiritually based healing practices approach questions of health and healing with fundamentally different assumptions, there now exists a foundation for common cause and collaborative research in promoting better health outcomes for patients and societies. This new foundation arises primarily through insights derived from modern physicalist medicine, specifically placebo studies, psychoneuroendrocrinology, psychoneuroimmunology, and social contagion theory. I call these the deep semiotics of health, and it has implications far beyond medicine (Grassie 2010). Otherwise known as placebos and nocebos, psychosocial somatic effects in medicine tend to be disparaged on both sides of the science-and-religion divide. Calling something a “placebo” is widely perceived to be a criticism, indeed an insult, in the contemporary research climate. Ayurvedic medicine, for instance, may have a placebo benefit for patients, but it is not evidence-based medicine, tested with the rigors of random-controlled studies. Prayer may have a placebo effect for patients, but it is not “real” medicine. Curiously, there is not a single mention of placebos in the index of the oft-referenced Handbook of Religion and Health (Koenig, McCullough, and Larson 2001). Given that rigorous, evidence-based, scientific medicine is itself quite a recent phenomenon in the history of medicine and still a work-in-progress, it seems rather regressive now to celebrate the placebo. And yet psychosocial somatic effects are involved in all medical therapies, whether they be orthodox scientific or alternative traditional. There are now several decades of placebo studies to validate this fact, including measurable biochemical responses in brains and bodies of subjects (Harrington 1997, 2008; Kaptchuk, Finniss, Miller, and Benedetti 2010). To this we can add new insights from psychoneuroendrocrinology and psychoneuroimmunology that provide naturalistic accounts of “top-down” causation in which mental states affect bodily functions (Sternberg 2001). We can further add new epidemiological studies of “social contagion” in which positive and negative behaviors and attitudes, including many indicators of physical health, are mysteriously “transmitted” indirectly through communities and social networks (Christakis and Fowler 2009). Psychosocial somatic effects cannot be isolated in the mind-brain-body of a patient. Instead, they are encoded through complex social and cultural interactions over a lifetime, which include the “liturgy” and “symbols” of modern medical care, as reinforced by the stories of individuals, the narratives of movies and television, and the ubiquity of advertisements. 28

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All this points to a profound and important role for psychosocial somatic therapies, which might now be thought of and studied as an extension of standard medical treatments. Placebos, now broadly understood as any psychosocial somatic effect, may be the most effective and important tool in any healer’s tool box. We can now think of ways to improve and enhance the semiotics of health in clinical contexts, as well as in distributed public-health settings. It is possible to utilize the placebo effect better to promote health outcomes without selling snake-oil therapies (Bausell 2007, 291-94). The intentional uses of placebos, however, raise many complex medical, ethical, and epistemological problems. Clinicians should be working with patients and patient-support networks to harness the patient’s spiritual-mental powers to create powerful endogenous transformations in the endocrine and immune systems. The wisdom of spiritual-healing traditions is that the more elaborate the healing ritual, the more effective the placebo. Hopeful expectations tend to heal. Ritualized hope in groups tends to heal more effectively than hoping alone. Is there a way systematically to individualize, ritualize, and study these psychosocial somatic interventions as a supplement to the standard scientific treatments? This would require clinicians to customize the context of health care to the culture and beliefs of each particular patient. An intake questionnaire might be used to provide each patient with symbols, rituals, objects, music, and care, alongside the best standard medical treatments, to enhance the patient’s ability to harness the placebo effect to promote healthier outcomes. For instance, new technologies make it possible to customize the spiritual-clinical environment with an infinite variety of scriptures, poems, music, images, and videos, even in crowded hospitals and nursing homes. Curiously, patients respond positively to the placebo effects, even when they are told that they are receiving a placebo! Gains in efficiency, cost savings, and improved health outcomes might be significant, if placebo studies can be extrapolated and generalized to a truly integrated medical delivery models. An intervention study, however, would not target individual patients, but rather an entire hospital or nursing home to study before-and-after health outcomes and costs of care based on the utilization of psychosocial somatic care as a supplement to the standard medical treatment along with insights from social contagion theory. While the evidence for pervasive and profound psychosocial somatic effects in healthcare comes primarily from physicalist medicine, epistemological implications of these insights suggest limits to physicalist reductionism. All health and healing are partially psychosocial somatic in universal and unpredictable ways. Psychosocial somatic effects are instances of “top-down” causation in which “spirit” acts on mind, mind acts on brain, brain acts on body, and body acts on disease through the endocrine, immune, and other systems. The medicine of spirituality, in this view, can be understood as an attempt to control this dynamic. Psychosocial somatic healing and the deep semiotics of health are examples of nonreductive functionalism in the 29

INTRODUCTION

scientific study of religious and spiritual phenomena, a paradigm that I advocate in my book (Grassie 2010). All peoples and philosophies are implicated in the deep semiotics of health, which we increasingly understand through science. Practitioners of modern scientific medicine need to be self-critical in recognizing the symbolic, liturgical, and semiotics practices that they engage in and promote. They need to be proactive in ethically harnessing these and other psychosocial somatic therapies in promoting the well-being of their patients, themselves, and their societies. The medicine of religion is minimally this deep semiotics of health, from which we cannot extract ourselves, even in the practice of modern scientific medicine. This material semiosis of health—spirit-mind-brain-body-society-spirit—is traditionally the domains of religion, where significant “expertise” has been accumulated over the millennia. Through the medicine of religion and the tools of modern science, we might learn how better to harness this “magic” in creating better health outcomes for our patients and ourselves. This deep semiotics of health has implications for promoting human flourishing in schools and communities, businesses and institutions, governments and the world. ∞ The contributors to this volume have brought to bear an enormous range of expertise and insight for which we are grateful. I note in closing that it is easy to pose questions and imagine possibilities. The real work is in testing these intuitions through cleverly designed empirical research as adjudicated by rigorous peer review. Here, the research is still ongoing in a patchwork of studies, which are increasingly suggestive of a profound and critical role of spirituality and religion in promoting human health and well-being. Perhaps these studies will never be conclusive, given the complexity and profundity of religious and spiritual phenomena. We may hope, however, to make progress, not simply in understanding the phenomena but in designing interventions that promote health, healing, and well-being among individuals and societies in ways that better embody universal character strengths and virtues and that support efforts to create a safer, more prosperous, and more peaceful world for future generations.

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I. COMPETITIVE DYNAMICS AND THE CULTURAL EVOLUTION OF RELIGIONS AND GOD CONCEPTS

Chapter One Returning God to the Social Scientific Study of Religion by Rodney Stark For much of the twentieth century, the social scientific study of religion was essentially a Godless field. Not only because so many practitioners were nonbelievers, but because little or no attention was paid to God when analyzing religious phenomena. In keeping with Émile Durkheim’s solemn assurances, God was banished from definitions of religion and was ignored in both research and theorizing. In his immensely influential work, Durkheim dismissed Gods as unimportant window dressing, stressing instead that rites and rituals are the fundamental stuff of religion. In a long review of Part VI of Herbert Spencer’s The Principles of Sociology, Durkheim (1886/1994, 19) condemned Spencer for reducing religion “to being merely a collection of beliefs and practices relating to a supernatural agent.” He continued with the following: The idea of God which seemed to be the sum total of religion a short while ago, is now no more than a minor accident. It is a psychological phenomenon which has got mixed up with a whole sociological process whose importance is of quite a different order . . . We might perhaps be able to discover what is thus hidden beneath this quite superficial phenomenon . . . Thus the sociologist will pay scant attention to the different ways in which men and peoples have conceived the unknown cause and mysterious depth of things. He will set aside all such metaphysical speculations and will see in religion only a social discipline.

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RETURNING GOD TO THE SOCIAL SCIENTIFIC STUDY OF RELIGION

Fifteen years later, Durkheim had not wavered in his conviction that Gods are peripheral to religion, noting that although the apparent purpose of rituals is “strengthening the ties between the faithful and their god,” what they really do is strengthen the “ties between the individual and society . . . the god being only a figurative representation of the society” (1912/1995, 227). Thus began a new social science orthodoxy: Religion consists of participation in rites and rituals—only. In practice, this usually meant nothing more “religious” than comparisons of Catholics, Protestants, and Jews—as in Durkheim’s famous, long-admired, but remarkably flawed Suicide (1897/1951). This set the model for subsequent studies, even though it easily can be demonstrated that rather than being an inessential “minor accident,” conceptions of God are the most fundamental aspect to religions. One must wonder why anyone can think it plausible that the abundance of religious rites and rituals found in all human cultures are sustained without any apparent rationale. That is, Durkheim and his disciples were not even content to claim that people worship illusions, for then they would have to restore the Gods, illusory or not, to the core of religion. Instead, they have even dismissed illusory Gods, thereby proposing, at least by implication, that people knowingly pray to and worship the empty void. Remarkably, when confronted with this implication of the claim that religions are Godless, some well-known anthropologists have in fact affirmed that religious rites, including prayers, are not directed toward the Gods! We are asked to accept that even primitive tribal priests realize there are no Gods and are fully aware that their ritual actions are devoted merely to sustaining group solidarity (Beattie 1966; Price 1984; Sperber 1975). Rodney Needham (1972) has gone so far as to deny that there is any human mental state that can properly be called religious belief, and therefore that all religious activity is purely socioemotional expression. It requires a great deal of sophisticated social scientific training for a person to accept such nonsense. People pray to something! To something above and beyond the material world. To something having the ability to hear prayers and having the supernatural powers needed to influence nature and events. Such somethings are Gods. Variations in how God or the Gods are conceived are the crucial difference among faiths and cultures.

IMAGES OF GOD The social scientific study of religion has three main components, and whether recognized or not, images of God are of central importance to them all: cross-cultural (including cultural evolution), social-psychological, and organizational.

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Cross-cultural The fallacy of omitting God from social scientific studies of religion is nowhere more apparent than in relation to Durkheim’s most famous proposition, that in all cultures, religion functions to sustain the moral order. Many regard this as the closest thing to a “law” that the social scientific study of religion possesses. As formulated by Durkheim, religion exists because it unites humans into moral communities, and while law and custom also regulate conduct, religion alone “asserts itself not only over conduct but over the conscience. It not only dictates actions but ideas and sentiments” (1886/1994, 21). In one form or another, this proposition appears in nearly every introductory sociology and anthropology text on the market. But it’s wrong. Even Durkheim might have had second thoughts had he read Edward Tylor (1871/1958, 446), who was careful to point out that only some kinds of religions have moral implications: To some the statement may seem startling, yet the evidence seems to justify it, that the relation of morality to religion is one that only belongs in its rudiments, or not at all, to rudimentary civilization. The comparison of savage and civilized religions bring into view . . . a deep-lying contrast in their practical action on human life . . . the popular idea that the moral government of the universe is an essential tenet of natural religion simply falls to the ground. Savage animism [religion] is almost devoid of that ethical element which to the educated modern mind is the very mainspring of practical religion. Not, as I have said, that morality is absent from the life of the lower [cultures] . . . But these ethical laws stand on their own ground of tradition and public opinion, comparatively independent of the animistic beliefs and rites which exist beside them. The lower animism is not immoral, it is unmoral.

Tylor was correct. The proposition about the moral functions of religion requires a particular conception of the supernatural as a being or beings deeply concerned about the behavior of humans toward one another. Such a conception of God(s) is found in many of the major world faiths, including Judaism, Christianity, Islam, and Hinduism. But it appears to be largely lacking in the supernatural conceptions prevalent in much of Asia and in animism and folk religions generally. It would seem to follow, therefore, that the moral behavior of individuals would be influenced by their religious commitments only in societies where the dominant religious organizations give clear and consistent expression to divine moral imperatives—that the moral effectiveness of religions varies according to the moral engagement of their Gods.

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Unconscious divine essences, such as the Tao, or purely psychological “God” constructs, such as Paul Tillich’s “ground of being,” are unable to issue commandments or make moral judgments. Conceptions of the supernatural are irrelevant to the moral order unless they are beings—things having consciousness and desires. Put another way, only beings can desire moral conformity. Even that is not sufficient. Gods can only lend sanctions to the moral order if they are concerned about, informed about, and act on behalf of humans. Moreover, to promote virtue among humans, Gods must be virtuous—they must favor good over evil. Finally, Gods will be effective in sustaining moral precepts, the greater their scope—that is, the greater the diversity of their powers and the range of their influence. All-powerful, all-seeing Gods ruling the entire universe are the ultimate deterrent. Two conclusions follow from this discussion. First, the effects of religiousness on individual morality are contingent on images of Gods as conscious, morally concerned beings; religiousness based on impersonal or amoral Gods will not influence moral choices. Second, participation in religious rites and rituals will have little or no independent effect on morality. A recent paper tested these conclusions, based on data for the United States and thirty-three other nations (Stark 2001b). The results were consistent and overwhelmingly supportive. In each of twenty-seven nations within Christendom, the greater importance people placed on God, the less likely they were to approve of committing various violations of the criminal laws. The correlations between God and morality were as high in Protestant as in Roman Catholic nations and where average levels of church attendance were high or low. Indeed, participation in Sunday services (a measure of ritual activity) was only weakly related to moral attitudes and these correlations disappeared or became very small when the God “effects” were removed through regression analysis. That is, God matters; ritual doesn’t. The findings are similar for Muslim nations, where the importance placed on Allah is very strongly correlated with morality, but mosque attendance is of no significance. In India, too, concern for the Gods matters, but temple attendance has no detectable effect on morality. But, in Japan, where the Gods are conceived of as many, small, and not particularly interested in human moral behavior, religion is irrelevant to moral outlooks—concern about the God(s), visits to temples, prayer, and meditation, all are without any moral effects. Nor are there God or temple effects on morality in China. These results show that, in and of themselves, rites and rituals have little or no impact on the major effect universally attributed to religion—conformity to the moral order. Thus, it seems necessary to amend the “law” linking religion and morality as follows: Images of Gods as conscious, powerful, morally concerned beings function to sustain the moral order. This, of course, raises the issue of how societies develop such an image of God. Having banished the Gods, Durkheim and those who have followed his lead could not formulate such a question, let alone pursue it. Yet it retains compelling intellectual 36

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merit and priority. Unfortunately, questions concerning cultural evolution are the most difficult matters faced by social science since, unlike biological evolution, cultural evolution leaves no fossils. To use modern-day ‘primitive’ cultures as a stand-in for the past may be risky—there may be aspects of their cultures that prevented them from evolving and which greatly separate them from those cultures that did evolve. Keeping that possibility in mind, it still may be useful to examine the religions of contemporary primitives in search of cues as to the cultural starting point. Of course, there have been a number of well-known efforts to examine the evolution of the Gods (Albright 1940/1957; Barnes 2000; Bellah 1964; Burrow 1871/1903; Caird 1899; Frazier 1922/1950; Freud 1912-1913/1950; Swanson 1960; Tylor 1871/1958). Aside from the fact that most of these works were done rather long ago, they suffer, in various degrees, from three serious defects. First, most are very descriptive, lacking in both explanatory efforts and clear exposition of causal mechanisms. Second, they tend to rely far too heavily on hypothetical primitive cultures. Third, many of them make no effort to hide their antagonism toward religion and their intentions to discredit it. Perhaps more trustworthy results concerning these matters could be gained from historical studies. For example, much is known about classical paganism, about Jewish monotheism, about early Christianity, about Islam, about Buddhism, and about Taoism. Far more can be done with these historical materials to chart the evolution of monotheism than has been attempted. In any event, the cultural evolution of the Gods clearly is a topic presenting immensely attractive challenges. And equally clearly, competition among images of God is a key element in any such analysis.

SOCIAL-PSYCHOLOGICAL Here are included all studies of the nature of individual religiousness and of its social and psychological correlates. Here, too, God has been almost completely omitted from the research menu. Early in the 1960s, Charles Y. Glock and I began preparing the first two major surveys of religious belief and behavior even conducted in the United States. As we wrote drafts of the basic questionnaire, we consulted some other social scientists and also some religious leaders and theologians. Many of these consultants challenged the emphasis we were placing on belief, claiming that a “common core religion” had come to so dominate American religious life that there no longer were any significant variations in belief—most people having abandoned the literal and unsophisticated beliefs of an earlier, uneducated era. Intellectuals writing about this core religion claimed that it placed little emphasis on doctrine, and, perhaps for that reason, they were remarkably vague about what core believers did believe. What was strongly conveyed was that everyone had become a ‘liberal’ Protestant, 37


except, of course, those who were Catholics or Jews (Herberg 1960; Kallen 1951; Lee 1960; Williams 1952). Thus, in agreement with Durkheim (whom many cited), religion was not a set of beliefs, but a set of practices. Hence, the appropriate way to measure religion was by asking about the frequency of church attendance and whether one was a Protestant, Catholic, Jew, Other, or None. From this perspective, it seemed silly to devote many items to belief, and it would be especially futile to ask people about their belief in God, because, in some sense, everyone does believe, making such a question largely meaningless. As evidence of this, many cited the Gallup Poll, which had asked several times: “Do you, personally, believe in God?” In each instance at least 96% had answered “Yes.” Of course, it required little imagination to wonder if everyone meant the same thing by “God.” In any event, Glock and I were not deterred by all this advice (some of it remarkably ill-tempered), partly because our pretesting revealed that although “everyone” in the various liberal seminaries may have come to believe the same things (or, more accurately, to disbelieve in them), many American Christians (perhaps most) clearly did not fit the liberal mold. So not without some hesitance, I wrote an item about God that allowed for degrees of certainty and a slight variation in one’s image of God. Which of the following statements comes closest to expressing what you believe about God? 1. 2. 3. 4. 5. 6. 7.

I know God really exists, and I have no doubts about it. While I have doubts, I feel I do believe in God. I find myself believing in God some of the time, but not at other times. I don’t believe in a personal God, but I do believe in a higher power of some kind. I don’t know whether there is a God, and I don’t believe there is any way to find out. I don’t believe in God. None of the above represents what I believe. What I believe about God is_________ ________________________ (please specify).1

The first survey to use this item was based on a sample of church members in the liberal San Francisco Bay Area, and it produced remarkable evidence against any notion of a common core American religion—Christians even disagreed about

1

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Fewer than 1 percent wrote in their own answer, nearly all of them featuring the omnipotent powers of God.

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God. Only 41% of Congregationalists (now the United Church of Christ) expressed undoubted faith (no. 1), and 16% chose the “higher power” response (no. 4). Among Methodists, 60% chose response number one, and 11% chose number four, as did 63 and 12% of the Episcopalians. In contrast, 81% of Missouri Lutherans and 99% of the Southern Baptists chose number one, and the rest of their fellow members chose response number two (Stark and Glock 1968). The second survey was based on a national sample of the adult population. Only 22% of Unitarians and 63% of Congregationalists selected response number one, as compared with 96% of Southern Baptists. Overall, 79% of Protestants and 85% of Catholics expressed unwavering faith in God (Stark and Glock 1968). Subsequently, the same question was asked of a large sample of Protestant clergy in the state of California. Again there were vast denominational differences: 45% of Congregationalist clergy selected answer one, as did 52% of the Methodists, 64% of the Episcopalians, 89% of the Missouri Lutherans, and 97% of the Southern Baptists. Altogether, 67% of these clergy expressed unwavering faith in God (Stark, Foster, Glock, and Quinley 1971). A similar item about Jesus produced even greater variation. Among California Church members, only 40% of Congregationalists and a bare majority of Methodists and Episcopalians expressed certainty that Jesus “is the Divine Son of God,” while 93% of Missouri Lutherans and 99% of Southern Baptists took this position. In addition, 28% of Congregationalists and 21% of Methodists believed that Jesus was not divine at all, but only a man (Stark and Glock 1968). These findings suggested that American religion has not coalesced into a common theological core, at least not a liberal core. Differences remain on matters so fundamental as the image of God. Our analysis of the data showed that the question about God was central to all other aspects of religious belief and commitment. However, this did not restore God to an important place in the social scientific study of religion. In most subsequent studies, the “religious factor” continued to be nothing but comparisons of Protestants and Catholics (and sometimes, if the samples were large enough, Jews were compared as well).

ORGANIZATIONAL Large numbers of studies in the social scientific study of religion focus on religious organizations and groups: churches, denominations, prayer groups, and the like. Unfortunately, nearly all of these have been case studies; there have been all too few quantitative studies that really used organizations as the units of analysis. Instead, nearly all quantitative studies have used group membership as a proxy measure of individual beliefs and practices, transforming an organizational variable into one that is social-psychological. As already noted, most studies of religious effects have merely involved comparing members of one group with another. 39


Recently, this practice was substantially improved when, instead of crude Protestant-Catholic contrasts, denominations were clustered into six categories and Protestants were divided into mainline, evangelical, and African-American (Steensland et al. 2000). Specific religious bodies were placed in one of these categories mainly on the basis of the distribution of religious beliefs among their members. Thus, many members of groups classified as mainline expressed doubts about such things as miracles, while most of those in the evangelical groups accepted miracles as true. For analyzing group differences, such as the growth of the evangelicals and the decline of the mainline bodies, this would be an adequate way to proceed. Unfortunately, this denominational variable usually is used, not to analyze groups, but to classify individuals in terms of their religious orientation. That is, all persons affiliated with a mainline denomination are classified as being religiously liberal for purposes of analysis. This is needlessly bad measurement—large standard deviations obtain on the belief items, not only within the mainline set, but within each denomination, whether mainline or evangelical. It would be far better to classify individuals on the basis of their actual beliefs, rather than to rely on a crude inference based on their denominational affiliation. New research by Bader and Froese (forthcoming) “correct” the Steensland et al. approach by using a modest scale measuring images of God to classify individuals and comparing this with the results obtained when these same individuals are classified on the basis of their denomination. Correlations between the God scale and such things as attitudes about abortion and sexual morality, which are presumably influenced by an individual’s religious outlook, are far higher than when people are characterized by their images of God rather than by their denominational affiliation. Moreover, as a matter of expedience, it is far easier and less expensive to ask people about their beliefs than it is to discover their actual denomination and to code it—unless, of course, one settles for Protestant, Catholic, Jew, Other, and None.

STUDYING IMAGES OF GOD About twenty years ago, Andrew Greeley began to support the frequent inclusion of a set of items about images of God in the General Social Surveys. Respondents are told: “There are many different ways of picturing God,” and then presented with sets of paired attributes and asked to place themselves on a continuum stretching from one attribute to the other. Several examples are the following: Mother 1-2-3-4-5-6-7 Father Judge 1-2-3-4-5-6-7 Lover

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Although the items have been repeated in most General Social Surveys, they have been put to very little use—even Father Greeley has made very little use of them. For one thing, it is not clear what these dimensions mean. In addition, the distributions are quite skewed. Typically half or more of the respondents place themselves at 7 Father, while fewer than 2% opt for 1 Mother. In similar fashion, most respondents see God as a Judge, few as a Lover. This is not to suggest that Greeley chose invalid attributes to which to apply semantic differential techniques, but that the items aren’t very subtle and thereby push Americans into substantial agreement in choosing among these particular features. On the other hand, there is sufficient variation to permit Bader and Froese to include four of these items along with two other questions to build their scale and to discover the centrality of images of God in studying the consequences of individual religiousness. Moreover, Greeley’s items and Bader and Froese’s scale are a great improvement over the single question about belief in God I wrote in the early 1960s (although this remains the “standard” item in surveys). Even so, there is far too little basis for imposing these options (such as Father/Mother), rather than some others, on respondents, and quantitative studies necessarily impose a set of options. Before formulating any new survey items to assess images of God, it would seem wise to more carefully explore qualitatively what dimensions are pertinent. Without adequate knowledge of what people do believe about God, one runs the risk of missing the essence of their religiousness in precisely the way as happened in this survey interview conducted in Great Britain several years ago (Davie 1994). Interviewer: “Do you believe in God?” Respondent: “Yes.” Interviewer: “Do you believe in a God who can change the course of events of earth?” Respondent: “No, just the ordinary one.” There is reason to suppose that this respondent would have firmly agreed that God can do miracles but did not when this definition of miracles was substituted for the term. To discover what this respondent actually believes, one would need to probe her inner religious life more deeply than has been typical. Tactically speaking, we need to do considerable qualitative research in preparation for more fruitful and valid quantitative research. Then we can create more penetrating and revealing items about conceptions of God. An interesting possibility is to explore variations in the images of God across occupations and social structures. One would suppose that the images of God prevalent among academics, for example, would differ rather sharply from those prevalent among stockbrokers or military officers. Indeed there are substantial 41


reasons to predict that physical scientists, especially mathematicians and physicists, will hold a more active image of God than will social scientists or professors in the humanities (Stark 2003). But it will require some sophisticated explorations to develop and ask the appropriate questions. In similar fashion, qualitative work should precede efforts to study cross-cultural variations in the images of God(s) and the social consequences of such beliefs. In the study of religion and the moral order discussed above, images of God were based on the dominant religion of a society (Christian, Muslim, Shinto, etc.) and the actual item used to classify individuals was not their image of God, but their answer to the question: “On a scale of from 1 to 10, how important is God in your life?” The rather powerful results obtained by such a vague measure strongly suggest that deep insights can be gained into cultures if we can accurately isolate their dominant image of God and/or the distribution of various images of God. And this, of course, ties back to questions concerning the cultural evolution of the Gods.

CONCLUSION Clearly there is much to be done. Among the pending matters, work on the cultural evolution of the Gods requires only time and talent, since no original data collection would seem to be needed. But these cultural studies can benefit greatly from improved and extended study of images of God from the social-psychological perspective. Among the questions that can be addressed and which may be of considerable interest to those studying the evolution of the Gods are these: Why do intellectuals seem so inclined to foster vague divine essences rather than conceive of God as an active, aware, concerned being? Can such impersonal images of God actually sustain the levels of individual religious commitment needed to sustain vigorous religious institutions? Or can religions lacking both creeds and congregations, as is the case in what is referred to as new age spirituality, actually meet most people’s needs? What are the social effects of creedless, unorganized religions? The point being that in the end, all major approaches to the social scientific study of religion are closely intertwined and mutually informative.

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Chapter Two Evolution, Culture, and Religion

by David Sloan Wilson Religions are in part cultural systems that succeed or fail on the basis of their properties. Religions vary in their behavioral prescriptions, theological beliefs, and social practices. The differences are heritable in the sense that a given religion transmits its properties through time with at least a moderate degree of fidelity. If the differences make a difference in terms of birth, immigration, survival, and emigration (the inputs and outputs of a demographic equation), then a winnowing process appears inevitable. Religions should become adapted to their environments, as surely as organisms become adapted through genetic inheritance mechanisms. Despite the basic plausibility of religious cultural evolution, it is not at present an active field of inquiry. This neglect can be traced to the turbulent history of the study of cultural evolution in general. Early theories of cultural evolution owed more to Herbert Spencer than to Charles Darwin and attempted to order societies on a continuum from “primitive” to “advanced.” This linear view of long-term cultural evolution, which easily lent itself to racist and imperialistic doctrines, was rejected during the early twentieth century in favor of the view that cultures cannot be ranked with respect to advancement (Carniero 2003). The new view could have been given an evolutionary formulation (e.g., most cultures are well adapted to their respective environments), but instead it resulted in an intellectual apartheid between “biology” and “culture” that has persisted to this day. As astonishing as it might seem, most of the advances in evolutionary biology during the second half of the twentieth century have not been applied to the study of human cultures—religious or otherwise—until very recently. We are currently witnessing a renaissance in the study of culture from an evolutionary perspective (Boehm 1999; Bowles 2003; Carniero 2003; Deacon 1998; Diamond 1997, 2004; Fehr and Gachter 2002; Fehr and Fischbacher 2003; Gintis 2000; Gintis et al. 2005; Henrich 2003; Henrich et al. 2004; Koppl 2004; 43

EVOLUTION, CULTURE, AND RELIGION

Nisbett 2003; Odling-Smee et al. 2003; Richerson and Boyd 2004; Sober and Wilson 1998; Tomasello 1999; Wilson 2002, 2004). The new paradigm bears almost no resemblance to previous conceptions. Far from forcing cultures into a linear sequence, it attempts to show how our species evolved (by genetic evolution) a capacity for symbolic thought and cumulative social transmission that amounted to a new nongenetic mechanism of inheritance. Given a fast-paced process of cultural evolution built by genetic evolution, modern cultural evolutionists then attempt to explain the explosive adaptive radiation that took place as humans spread over the globe, filling the ecological niches of approximately five hundred mammalian species (Pagel and Mace 2004) and vastly expanding the scale of social organization within a period of a few thousand years. The scientists and scholars who have joined this effort include evolutionary, developmental, and neurobiologists, biological and cultural anthropologists, psychologists, economists, philosophers, and historians, providing a model of what E.O. Wilson (1998) called consilience. These very recent developments have profound implications for the study of religion that flow in both directions. Those interested in religion gain a powerful conceptual framework for studying religious change and diversification. Those interested in culture gain an extensive and at times almost unbelievably detailed body of empirical knowledge of religious cultures around the world and throughout history—a temporal fossil record and current inventory, so to speak. Unlike the biological fossil record, which leaves almost no trace of the genetic, developmental, and physiological mechanisms that give rise to the phenotype, religious scholarship preserves the analogous proximate mechanisms for cultural evolution in the form of behavioral prescriptions, theological beliefs, and social practices (the proximate mechanisms) that influence how members of religious communities actually behave (the phenotype that is subject to the winnowing process of selection). There are also profound practical implications of studying religion from a modern cultural evolutionary perspective. Positive religious objectives include a desire for peaceful and cooperative relations within and among groups, a wish to be part of something benign and larger than oneself, a belief that individuals and societies can be transformed into something much better in the future than the past or present, and a more immediate desire to transmit our best values to our own children and the next generation. These objectives are possible but not inevitable outcomes of cultural evolution. Concepts such as “truth,” “wisdom,” “spiritual understanding,” and “harmony” are not the same as the evolutionary concept of “adaptation.” If we wish to achieve the former, we must understand their complex relationship with the latter. We must abandon the comforting—but false and strangely passive—belief that evolution is carrying mankind toward a benign “Omega point” (Teilhard de Chardin 1959). What we stand to gain is a more practical knowledge of how to bring the outcome of cultural evolution into alignment with positive religious and general ethical objectives. 44

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The Metanexus Institute and John Templeton Foundation are in a unique position to create a funding platform for this topic area that places equal value on the practical and basic scientific implications. In the following sections, I will recommend a number of specific areas that should be targeted for funding, along with a few that should not because they are already receiving sufficient attention or have not yet become sufficiently consilient with other bodies of knowledge.

SPECIFIC AREAS THAT SHOULD BE TARGETED FOR FUNDING 1.

How well adapted are religious groups to their respective environments? The phenotypic traits associated with any given religion might be adaptive or nonadaptive. As adaptations, they might benefit groups relative to other groups, individuals relative to other individuals within groups, or cultural “memes” as parasitic organisms in their own right. If nonadaptive, they might have been adaptive in past environments or by-products of traits that function adaptively in non religious contexts. These are the major hypotheses that evolutionary biologists attempt to evaluate for all traits, and they provide an excellent framework for the study of religion. At present, there is little agreement about the basic adaptedness of religion. Some authors (such as Sosis 2004 and Wilson 2002) interpret religions as impressively adaptive, while others (such as Atran 2002; Atran and Norenzayan 2005; and Boyer 2001) regard religion primarily as a nonadaptive by-product of traits that provide benefits in earlier environments and nonreligious contexts. These interpretations need not remain “just so stories.” Evolutionary biologists routinely determine the facts of the matter for traits in nonhuman species and similar progress can be made for the subject of religion. Especially needed are collaborations between individuals who are at the forefront of cultural evolutionary theory and individuals who have deep empirical knowledge of past and present religious groups.

2.

What role do theological beliefs and practices (including conceptions of God and religious conceptions of human nature) play in adapting religious groups to their respective environments? This is a more refined version of question 1. Religious conceptions of God and human nature vary widely, not only at a large scale (e.g., Christianity vs. Buddhism) but also at a small scale (e.g., Calvinism vs. Quakerism within Christianity). What accounts for such an amazing diversity of religious belief? Perhaps it is simply a product of human imagination without functional significance. Or perhaps differences in theological belief make a difference in how they motivate people to behave. Only empirical research can settle the issue, which once again requires a collaboration between those who possess detailed knowledge of specific religious systems and those who are accustomed to testing evolutionary hypotheses. Religious scholars have studied 45


the origin and fate of new theological conceptions against the background of physical and social environments in extraordinary detail. This information is waiting to be organized by a modern cultural evolutionary theoretical framework. 3.

What can religion tell us about the process of cultural evolution in addition to its products? The fact that genetic replication is a high-fidelity process is not an accident. It is a result of evolution (sometimes called “the evolution of evolvability”) that requires an elaborate machinery, including the failure to replicate (strategic innovation) during periods of environmental stress. Similarly, cultural mechanisms of inheritance are the product of past genetic and cultural evolution and are probably more sophisticated than most researchers are currently aware. The study of religion can provide knowledge about how cultural traits—especially those that make an important difference in terms of influencing behavior—are transmitted (or lost), both horizontally (within generations) and vertically (across generations). Possibilities include the concept of sacredness and the use of powerful narratives that are more memorable and have more emotional force than legal-sounding prescriptions. The rapid pace of cultural evolution means that the mechanisms of cultural transmission can themselves evolve to keep pace with other cultural innovations such as writing, printing, and electronic media (Aunger 2002).

4.

Religions usually promote harmony within groups but only sometime promote harmony among groups. What are the ecological, social, and cultural evolutionary factors that promote harmonious relations among religious groups? Evolution in general and cultural evolution in particular is inherently multilevel (Sober and Wilson 1998): Groups that function well become common by replacing less functional groups in some sense, whether by a process of economic or military competition or by psychological and social processes such as imitation, imposition, and so on. Genocide is one form of between-group selection that is morally abhorrent. Groups voluntarily adopting new practices because they work better is another form of between-group selection that is morally benign. The full spectrum of between-group selection processes have operated throughout history, including but not restricted to religious groups. It is astonishing how most discourse on this subject takes place in ignorance of basic evolutionary principles. Obviously, it is a priority of the first rank to understand when between-group selection takes violent vs. nonviolent trajectories.

5.

Religions are in part vehicles of practical knowledge that enable people to behave adaptively in their environments, but much of this knowledge is encoded and transmitted in a way that appears the very opposite of pragmatic. What accounts for this paradox, or more generally, the advantages of encoding

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practical knowledge in ways that are not self-evidently pragmatic? Some aspects of human psychology and culture are self-evidently pragmatic. There is little need to wonder about a farmer who discovers a better way to grow crops and transmits this knowledge (actively or passively) to others. Religion begs for an explanation in part because it appears to flaunt this kind of practical reasoning. There is more need to wonder about why the farmers sacrifice a portion of their harvest to the Gods. One possibility is that the elements of religion that appear impractical are impractical. Another possibility is that seemingly impractical elements turn out to be practical when judged by the standard of what they cause people to do. Both possibilities are plausible hypotheses that have occupied the attention of religious theorists and scholars throughout history. As with the study of between-group interactions, however, most discourse has taken place in ignorance of basic evolutionary principles—in this case the distinction between proximate and ultimate causation. The fundamental question is: When are behaviors that are “rational” or “practical” in the ultimate sense caused by mechanisms that appear “rational” or “practical” in the proximate sense? Framing and testing the hypotheses in these terms can result in much more progress in the future than in the past. 6.

How do religious cultural systems differ from other cultural systems? Human social organizations can be religious or nonreligious in character. Indeed, the basic question “What is religion?” leads to the identification of numerous component traits (such as spirituality, symbolic systems that place an emphasis on sacredness, and belief in entities that cannot be empirically verified) that also exist outside religion. Religion is a very fuzzy set! The history of any geographical region (such as Europe) reveals a complex interplay between religious and nonreligious organizations (Poggi 1978). The fact that religious and nonreligious social organizations interact with each other in cultural evolution means that the study of religion cannot be confined to religion. It must take place within the context of a theory that includes but is not restricted to religion.

7.

The need for a balance between theoretical and empirical research. Science requires a feedback process between hypothesis formation and testing. A theory can do no better than outline a number of plausible alternatives. If these alternatives can’t be tested against the facts of the real world, then the scientific process stagnates. In the absence of an appropriate theory, empirical information piles up like snowdrifts. Disorganized information is almost as bad as no information at all, and once again the scientific process stagnates. These platitudes about science might seem out of place if they did not describe the current study of religion so well. There is an enormous amount of empirical information on religion, but most of it is not organized with respect to an 47


appropriate theoretical framework. There are many theories of religion, but often they remain highly speculative and do not attempt to seriously engage the data. In short, what everyone knows (or should know) about the scientific process needs to be implemented for the study of religion. Grant proposals in this program should evaluated in part for their ability to establish a genuine feedback between hypothesis formation and testing. 8.

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The need for a consilient theoretical framework. Scientific progress requires not only a theory but the right theory. It might sound suspect to claim that there is a single right theory (evolution), in contrast to potential alternatives such as rational choice theory, Marxist theory, complex systems theory, behaviorism, cognitive psychology, social constructivism, functionalism, methodological individualism, and so on. However, if we restrict ourselves to purely biological subjects, there is a single right theory—evolution—however much our understanding of the theory has changed in the past and will change in the future. Any naturalistic understanding of human phenomena must be consistent with evolutionary theory and can be deeply informed by evolutionary theory, a form of consistency that E. O. Wilson (1998) termed consilience. This does not mean that evolutionary theory renders all previous theories obsolete. Most, if not all, major theoretical and intellectual frameworks have some explanatory value but need to be understood in the context of evolutionary theory rather than as alternatives. For example, humans undeniably reason in cost/benefit terms and maximize certain utilities at least some of the time, which is the essence of rational choice theory. However, this impressive ability must have evolved by a process of genetic and/or cultural evolution and by itself cannot possibly explain all human phenomena, which has been the ambitious claim of rational choice theory. As neither separate nor adequate by itself, rational choice theory must be understood in the context of evolutionary theory, an intellectual development that is only just now in the process of taking place (Gintis 2003). The same can be said for social constructivist theories of human behavior, which have an important core of truth—after all, cultural evolution is by definition a process of social construction—but will be much better studied within the framework of evolutionary theory than as a vaguely articulated alternative. When the Metanexus Institute and the John Templeton Foundation titled its funding initiative “Competitive Dynamics and Cultural Evolution of Religions and God Concepts,” it properly recognized that all human phenomena must be consistent with evolutionary theory to be explained within the framework of science. Moreover, this recognition needs to go beyond a vague acknowledgement to include a sophisticated understanding of the theory and empirical methods of evolutionary science.

Chapter Three Religious Evolution from the Perspective of Complexity Studies by Niels Henrik Gregersen This essay aims to present some distinctive theoretical approaches within complexity studies, which commend themselves for application to studies on the evolution and dynamics of religious systems, including concepts of God and divinity. The theoretical approaches to be presented are all based on recent developments within the sciences of complexity: cellular automata (CA), complex adaptive systems (CAS) including biosemiotics, game theory (GAT) including rational choice theory (RCT), cognitive science of religion (CSR), and autopoietic systems theory (AST). In each case, the theoretical background of the approaches will be presented, and some examples of their application on religious evolution and concepts of divinity or ultimate reality will be given. The purpose of this analysis is to facilitate research programmes that either wish to apply some already elaborated explanatory models on the empirical case of religious evolution, or even to develop new science-based methods for dealing with the emergence, proliferation, and stabilization of religious semantic systems. From the outset, it should be admitted that there exists no such thing as a unified “scientific approach to religion.” There are many such attempts, and despite the occasional rhetoric of their respective protagonists, the results remain rather modest, or, when immodest, mostly unfounded. Eventually, the field of studying the cultural evolution of religion is still in its nascence. With GAT and CSR as notable exceptions, none of the other approaches have yet developed into genuinely coherent research programs. An important incentive for theology and religious studies, however, is—in the words of Edward Slingerland (2008, 298)—to overcome the “biversity” of humanistic disciplines such as anthropology, art history, comparative literature, theology, and religious studies and learn to apply what is usable from the natural 49

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sciences on the investigation of religious traditions. In my view, there is a call, especially for inventive and theoretically minded scholars, to develop new methods and approaches, and to use methods known from the biological and economic sciences when exploring the evolutionary dynamics of religious systems. Needless to say, the particular approaches that are presented below should neither be seen as exhaustive nor as mutually exclusive. Other approaches should be consulted as well, and the explanatory power of each approach may well be supplemented with insights from one of the other approaches. Common to the theories presented below is the combination of formalistic or computational aspects with a Darwinian perspective on the evolution of cultures. Thus the underlying assumption is twofold. First, it is not only possible but also advantageous to use methods known from the natural sciences in the understanding of the evolution of religious systems of meaning. Second, any cultural and religious semantics has to cope with the problem of reproducing itself and hence to adapt itself successfully to ever-new contexts under evolutionary pressures analogous to those known from the fields of biology and economics. The computerization of the sciences since the 1970s indeed offers attractive formalistic approaches to the study of the dynamics of cultural systems. The main scientific question is here not so much “What are the constituents of culture (natural resources, institutions, communities, language etc.)?” New questions are born, such as “How does nature and culture work?” and not least, “How did natural and cultural systems evolve?” (cf. Bak 1997).

CELLULAR AUTOMATA (CAS) AND THE CULTURAL DYNAMICS OF RELIGION Let me begin with the study of cellular automata (CA). The idea of cellular automata goes back to John von Neumann and the program of cybernetics in the early 1950s (von Neumann 1966). Cybernetics was concerned with the construction of control systems that are able to move, channel, and combine information bits according to predescribed computational rules. For example: If situation A, then do AB; if B, then do BAB. A cellular automaton is a primitive artificial world. Its “space” is a grid consisting of equal squares, usually on a two dimensional lattice. The initial conditions of CAs can be set either as specific or as random states. The “time” of CAs depends on the transition rules that determine how the cubic cells are to be changed, moved, removed, or reproduced at each computational step. CAs thus use individual-based modeling, that is, the “organisms” are placed in cubic cells on the grid, and their “actions” are specified by the number and features of cells in their immediate neighborhood. In 1969, John Conway developed an efficient computer model called Game of Life (Gardner 1970). The rule for this two-dimensional CA is that the state 50

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transitions depend on the states of the other eight neighbors of the cell (also the diagonal ones). The rules are so-called totalistic rules, in so far as the rule is determined by the total number of the neighboring colors, not on their particular positions relative to the cell. Furthermore, the cells have only two states, black and white. Now the transition rules are as follows: * * *

If two of the neighboring cells are black, the cell is unaltered (mimicking equilibrium). If three are black, the cell becomes back (mimicking reproduction). In all other cases the cells become white (mimicking extinction).

Most would agree that this is simple. Very simple indeed. It is “die” or “divide.” Nonetheless, the evolving features of these systems can be highly complex. One can try out different initial conditions and see how the system proceeds. When the program is played, one notices clusters of cells (“populations”) and pulsating processes of near-extinction and sudden regeneration; one also notices how populations meet and reinforce one another. All this is beautiful in itself. But the most astonishing feature is the emergence of “gliders,” that is, localized structures that develop in one general direction and create exciting self-organizing structures that are far from simple. The Game of Life thus also models historical lines of descent, some of which continue to grow endlessly and continue to elicit new structures, new forms of order. The question is now whether these computer-generated systems can be said to follow a few more general patterns. The seminal work of the physicist and computer scientist Stephen Wolfram has been devoted to this question since the early 1980s (summarized in Wolfram’s A New Kind of Science, 2002). In order to be able to investigate the world of CAs systematically and unbiased, Wolfram chose the simplest possible CA, a one-dimensional CA with only two colors (black and white). Any step forward is then determined by only the three cells in the row immediately over the cell, which has to make a “decision.” The three upper row cells thus have only 2 x 2 x 2 = 8 possible combinations of color. With only two colors, the possible rules for deciding the next step for any cell are 2 8 = 256 possibilities. During his systematic search, Wolfram discovered the universal feature that all CAs fall into four main classes. Class I consists of those CAs that simply die out very quickly. It is not difficult to predict that if the rules do not allow for enough reproduction of black cells, the screen will soon be all white, and vice versa. Formally expressed, the system fades away into a single “limit point” attractor. Class II rules are a little more lively, but eventually they begin to oscillate repetitively between a few states. Even though we see no evolving logic, we can nonetheless discern distinctive nested structures, where smaller patterns are part of wider patterns. Formally expressed, they form a dynamical system as a two-point attractor. 51

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Class III rules are more interesting in that they develop chaotic systems, though again with some self-similar structures appearing all over, but in this case not repetitively. Class III systems thus display randomness and look like some of the systems found in the mathematical chaos theory: the spontaneous evolution of CAs is neither derived from the initial conditions nor from a specific tuning between initial conditions and the mathematics of chaos. Rather, the random patterns are intrinsic to the class III rules. Class IV, however, contains by far the most interesting features, which appear at the creative edges between the regular patterns of class II and the random patterns of class III. These are rare indeed, but quite significant, because they show that highly complex and “interesting” behavior can be produced against the background of very simple rules. Patterns here grow without coming to a fixed point attractor, without repeating the same structures but also without displaying the randomness that characterizes class III. The amount of systems in each class, however, seems to correspond inversely with their interesting features. That is, around two-thirds of the 256 rules produce the infertile class I states, but around one-third of the patterns continue to grow, as we see it in classes II, III, and IV. Only 14% yield the more interesting patterns (Wolfram 2002, 57). However, in an evolutionary arms race, these were the ones to whom the future belonged! Now the question is, Can CAs be used to model and understand religious evolution? Let me just mention two examples from the more recent literature. The British mathematician John Puddefoot (2002) has applied Wolfram’s four class typology to different forms of religious discourse. As he points out, the exclusivist claim of salvation within some religious traditions has the formal structure of a single point attractor of class I. By contrast, religions seeking a sort of cognitive equilibrium with its environmental culture follow the oscillating patterns of class II systems. More individualistic and eclectic forms of religiosity, such as new age, follow the pattern of chaotic systems, whereas the strongest candidate for a highly competitive religions may be found in class IV, where we find that novelties in religious discourse emerge at the critical edge between class II and class III phenomena. Thus the recurrent pattern of internal stability (for example, in the form of liturgical or textual, or interpretive communities) and continuous dissipation under the constant pressure of cultural inputs from other religions and cultures may be seen as the strongest candidate for religious self-development. My second example is the so-called jihad model (Thomsen, Rickers, Krink, and Stenz 2002). This is a consistent attempt to use a cellular automaton model on religious evolution. The model is a so-called multiagent system (MAS) based on individual agents. More specifically, the artificial world consists of five general features: 52

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1. 2.

A world (represented as a sufficiently large, but finite two-dimensional lattice), 2 times 200 individual agents with the following four attributes: (a) An individual location in space, by which each individual agent is surrounded by the eight neighbors in their immediate environments. (b) An energy level between 100 as their upper limit and 20 as the lowest hunger limit, below which any agent has to prioritize the search for food. (c) An age which is determined by the remaining life span, while also being codetermined by the technological level of the culture of which the religion is a part. (d) A religion with certain variable characteristics as defined below.

3.

Two (or more) religious populations are simulated in each experiment, and each religion is again characterized by four parameters, (a) The enlightenment level influences (i) the maximum age of the agents (by 50%), (ii) their combat strength, and (iii) their likelihood of converting others to their religion. (b) The aggressiveness level simulates the likelihood of combating a neighboring individual from another religion. (c) The belief intensity determines the likelihood of converting other, or being converted to another religion. (d) The birth rate is defined by the religious disposition either to mate and create offspring or not to mate.

4.

The individual agents have the following five choices of action: (a) Mating (requiring two neighboring individuals of the same religion) (b) Eating (consuming available food resources scattered around in the CA, thus upgrading the energy level of the individual agents) (c) Attacking (thereby converting the other in case of superiority and downgrading the energy level of the former enemy) (d) Converting (changing the religion of the other) (e) Random walk (when no other rule applies)

5.

These actions, in term, are constrained by threshold values that represent the costs involved in the activities of mating, eating, converting, attacking, and being injured. These threshold values are the variables that can be redefined from one computer experiment to another. One could say, for instance, that 53

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mating (and getting offspring) costs fifty energy units; eating, one; converting, five; injury, thirty-five; and attacking, two energy units. On these assumptions, of course, attacking is modeled as a relatively risk-free strategy, which is hardly realistic on a battlefield, where the actors do not know the strength of the other part, and where wounds are not healed as fast as on the computer screen. Much is debatable about the perhaps all too theoretic setup of this jihad model (as it unfortunately is called). But still some unexpected insights came out the study. For example, it turns out that a religion with a belief intensity of 100, which at the same time also forbids reproduction (birth rate = 0), can still piggyback on the major control religion by way of continuous conversions. A pattern of population cycles emerges, very much like the pattern we see in the coevolution of biological host-parasite relationships. In fact, the parasite religion here grows in periods of decline of the bigger religion, and vice versa. This looks very much like class II CAs in Wolfram’s typology. It would be interesting to see, if one could here further explore the model in order find examples of classes III and IV (Gregersen 2005). Another interesting feature of the jihad model is that relatively segregated geographic regions are continuously produced between two competing religions. Out of “individual” actions, clusters of religious communities are formed. The formation of ghettos, on this model, is a natural expectation. I have discussed this model at some length here, because it shows that “hard” formalistic approaches are indeed applicable to more “soft” areas of study, such as religious evolution. Suffice it to say that there is a long route from observations to computer models and to the complexities of the interconnected systems in more fluid and open-ended environments. An improved model should therefore be able revise itself in the stress tests of being applied to real-world complexities. The process of computer modelling involves a long process of reality checks. Computational models will include a design cycle of observation, informal description, formal model, computer model, simulation, and least but not last: model verification by reiterated observation (Krink 2004).

COMPLEX ADAPTIVE SYSTEMS (CAS) What is missing from the CA approach is the function of learning that is characteristic for Complex Adaptive Systems (CAS), and no less for religious traditions. The idea of CAS has been developed by the computer scientist John Holland since the mid-seventies (Holland 1975/2001, 1995, 1998), and has since then played a major role in the Santa Fe Institute for Complexity Studies (Gell-Mann 1994; Cowan, Pines, and Meltzer eds. 1994/1999; Gregersen ed. 2003). Many simple adaptive systems have an internal program that controls the system-environment exchanges. Think of a thermostat, which directly adapts to the environment by 54

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controlling the input-output relations of temperature. A thermostat is certainly an example of organized adaptive complexity; however, it is not an example of self-organized complexity. The program of a thermostat does not develop itself under the influence of the environment. It connects directly, in a prefigured way, to the relevant aspects of its environment (“now too hot, now too cold”). In the case of CAS, by contrast, a self-selective process takes place within the system. Inside the organism, an internal schema of the environment is carved out which is then—by trial and error processes—adjusted to the subsequent experiences of that system. Wouldn’t this idea of complex adaptive systems be a confirmation of neo-Darwinian selection processes? Yes and no. Yes, because a mechanism of selection is certainly at work in these quasi-cognitive processes; one could here argue (with Karl Popper and other proponents of evolutionary epistemology) that if an organism’s schema of reality is fundamentally misleading, it will soon begin to starve, have difficulties in finding a mate—and over time it will be outselected. But no, CAS also transcends standard neo-Darwinian theory. For the interesting claim of CAS is that adaptation is something that happens at all levels of reality: at the level of the ecosystem (think of the emergence of the earth atmosphere of oxygen, etc.), at population level (think of foxes surviving in cities), at the level of the individual organism (learning processes), at the cell level (think of the neurons in the human brain), and at the gene level (the prioritized unit of selection and reproduction in the received view of neo-Darwinism). CAS thus transcends the standard biological view of adaptation, according to which adaptation is “a property of an individual organism, not of an ecosystem,” as John Maynard Smith has pointed out (in Cowan, Pines, and Meltzer 1994, 580). Thus it seems that the idea of complexity may enlarge our standard picture of adaptation significantly. If learning processes take place at many levels (see also Depew and Weber eds. 2003), there are also many “agents” of evolution, for whom the environmental influence “makes a difference.” We are here approaching a biosemiotic view of evolution, according to which something (the environmental influences at large) means something specific (“light,” “food,” “mating”) for somebody (an organism with internal, preferential schemas for orientation). Thus the idea of complex self-adaptation is structurally in accordance with the pragmatist Charles Sanders Peirce’s definition of a sign: A sign means something (reference) to somebody (the interpreter) in a certain respect (the context). In his Biosemiotics, the Danish biologist Jesper Hoffmeyer (2008) has recently offered a coherent theoretical account for rethinking basic concepts of biology within a Peircean approach to biological features. Also the neurologist and evolutionary anthropologist Terrence Deacon (1997) uses a combination of a Peircean view of animal and human languages, with an emphasis on evolutionary learning as developed by the American psychologist James Mark Baldwin. “Baldwinian evolution” falls fully within the Darwinian paradigm of evolution but highlights 55

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the particular role of learning and behavioral flexibility as means for “amplifying and biasing natural selection because these abilities enable individuals to modify the context of natural selection that affects their future kin” (Deacon 1997, 322). Observe that if Deacon’s Baldwinian approach is fundamentally right, then the learning activities of organisms play an active (at higher levels even a self-reflective) role for the formation and transmission of meaning. Animals and humans orient themselves by developing social systems of gestures and signals and (in the case of human behavior) an open-ended communication by virtue of symbolic language. In this view, religious representations and behaviors can neither be seen as pure reflexes of external environmental conditions (as in B.F. Skinner’s program of behaviorism), nor can they be seen as purely mechanical reactivations of internal mental schemata (as proposed by the CSR approaches, see below). Rather it is in the interplay between active and self-developing organisms and their environments that new representations and behaviors are formed. As in the case of the AST (see below), it is at the creative interface between organismic communities and their distinctive environments that meaning emerges, is transmitted, and is changed during evolution. Representations cannot be severed from communication, and the “genotypic” transmission cannot be separated from the active involvements of “phenotypic” organisms. Now imagine that one were to regard specific religious systems as examples of CAS. One would then be able to identify certain internal programs that serve to stabilize the code of this or that religion, such as holy scriptures, recurrent liturgies, rituals (reenacted at individual or communal level), and doctrines. In very strict religious communities, these programs will be used very much like a preset thermostat that a priori determines what should be included or excluded, among the environmental inputs. Imagine again, however, that the element of evolutionary learning or adaptation came into the focus of some specific religious community. In this case, the communal interpretation of the holy scriptures would come into focus alongside a reflection on the style, in which liturgies are performed, and on the use of rituals in given context. The words and concepts used in scripture, liturgy, and rituals may thus find different applications, including concepts of divinity and the goals of a given society. Seen from a linguistic perspective, this would mean that the lexical terms (e.g., “God,” or “Buddha-Nature”) no longer possess a fixed semantic value, but are functioning like indexical pointers, the content of which will have to be specified within larger semantic discourse systems (“stories” or “myths”), the meaning of which again are codetermined by their use by specific groups or individuals. Semantic flows will begin to take precedence over against stable meanings. Since lexical terms no longer flow unsupported by discourse systems, and discourse systems gain their meaning from their particular contexts of usage, it is highly probable that scholars will be able to identify many examples of “mixed discourse,” that is, a discourse by which, say, Christian concepts are made fluid and understandable by concepts from 56

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other religions (often called “syncretism”), or elucidated by reference to secular sources of knowledge such as science (often referred to as “secularization”). In the light of the theory of CAS, such flows of religious insight would be more the rule than the exception, a view recently substantiated by field-based anthropological studies (Jørgensen 2008). Moreover, it would be theoretically expected that similar patterns of the evolution of religious concepts would take place both in more “liberal” and in more “conservative” interpretations of religious belief. The modern phenomenon of religious “fundamentalism” supports this theoretical expectation (Christoffersen et al. eds. 2010) Against this theoretical background, one could think of two distinctive types of research that may complement one another in the study of the cultural dynamics of religious evolution. One task would be to show how the dynamics of religious evolution actually have taken place in historical communities, and how this dynamic is at work in present-day religious communities, where no religion is protected from external influences. This type of research will be commended to religious studies in general. Another research task will be to study whether these actual processes of interreligious and intercultural exchange will benefit the rationality and inner coherence of a religious tradition or not. This type of research will demand a theological approach to the cultural evolution of religious traditions. It may well be the case that certain forms of rationality can be identified in the very process of passing on a religious tradition and communicating it to others (Luhmann 2000). For in every communication, which involves human arbiters, there will be certain performance-based selection from the rich resources of religious tradition; some traits of traditional religion will be reinforced, whereas other traits will sink into oblivion.

FROM PRISONER’S DILEMMA TO EXTENDED GAME THEORY (GAT) One way to formalize such studies is game theory. Game theory is, like the theory of CA, based on individual agents, who (in a sort of contrived thought experiments) are imagined to perform specific strategies of choice vis-à-vis other actors. More precisely, GAT is the study of the ways in which strategic interactions among players produce specific outcomes according to the preferences of those players, although the net-result may transcend the intentions of the individual players (Ross 2004). Game theory often shares the assumption of rational choice theory, according to which actors make their choices by following the supposedly most beneficial (and hence “rational”) strategies for themselves (see Young ed. 1997; Stark and Bainbridge 1987). Game theoretical analysis has often been formalized in the context of the prisoner’s dilemma, in which we have only two actors that are forced to share the same scarce resources within a closed setting and have the choice between 57

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collaboration or competition. Since W. D. Hamilton’s foundational work on “The Genetical Background of Social Behavior” (Hamilton 1964), we have seen a suite of sociobiological studies aiming to explain collaborative behavior as based on the sharing of genetic material, but also on reciprocal altruism without a genetic kinship (Trivers 1971; Axelrod 1990, 1997), or on an indirect reciprocity without a direct payoff for the individual (Alexander 1987; Nowak and Sigmund 1998). What has come out of these well-known studies is a renewed emphasis on the importance of reiterated experiments so that one’s first choice may be altered under influence of the choices of the other agent(s). Thus if a collaborative behavior is met by nonreciprocation from the other agent(s), it may be more advantageous to change strategy and defect the next time, or to expand the time horizon so that the other agent(s) are given new chances of collaboration. The shared assumption is that cooperation will benefit all actors, especially if one can find a strategy for stopping or punishing cheaters. Life and morality may be “non-zero sum games,” to put it with Robert Wright (2000). It is not a zero sum game in which the benefits of the one necessarily implies disadvantages to the other. Reiterated prisoner’s dilemmas are able to model evolutionary learning processes on a relatively simple framework. Based on the foundational work of John Maynard Smith (1982) on so-called evolutionary stable strategies (ESS), agents are not seen only as rational players, since both genes and organisms can follow several distinctive patterns, each leading to evolutionary stable behavior. Hereby the field of evolutionary GAT has been created (Samuelson 1997; overview in Alexander 2009). This model has also been successfully applied to political contract theory (Skyrms 1996) and, more interesting to religious studies, also to the study of the formation and proliferation of empathy and behaviors of fairness (Page and Nowak 2002) or even the study of the specific semantics of the Hebrew Bible (Brams 2003). Likewise interesting from a theological perspective, however, are the attempts to model collaborative behavior at the more complex level of social groups (rather than individual agents). One of the most influential and compelling studies of this sort is Elliott Sober’s and David Sloan Wilson’s Unto Others: The Evolution and Psychology of Unselfish Behavior (Sober and Wilson 1999). This study argues that biological and economic research should separate the motivational issue of benevolence or malevolence at the psychological level from the functional issue of how to stabilize a social collaboration at the higher level of complex societies. They point out, for example, that social coexistence may stabilize the emergence of new moral codes by simply expelling or punishing individual cheaters (who misuse the altruism of other agents). Insofar as the keepers of moral systems (such as police and judges) are legitimized by the society at large, they incur, each individually, only modest personal risks in exercising justice; however, their job is quintessential for the functioning of the society as a whole. Furthermore, Sober and Wilson show in simple mathematical models, why one must transcend the realm of genes and 58

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individuals in order to understand the cultural dynamics of human societies. At the same time, empirical psychologists have shown, that human persons, as a matter of fact, tend to disgust cheaters and are often willing to sacrifice own benefits rather than allowing social cheaters to win their game. Both at group level as well as at the psychological level, there seem to be inclinations toward doing the good rather than just that which is of direct or indirect benefit to oneself. As is evident so far, sociobiology and evolutionary psychology have been concerned about explaining moral behavior, especially the possibility of altruistic and generous behavior (Post et al. eds. 2003). Why not extend this research program into the field of religious evolution, including the notion of God and ultimate reality? First steps have already been done. David Sloan Wilson has applied his method on the issue of religious evolution, using the development of Calvinism as one of his historical test-cases (Wilson 2003), and also many empirical studies of the psychology and spirituality of forgiveness have been presented (e.g., Worthington 2003). However, both the biological and the economic communities remain divided on the issue, as to whether the individualistic perspective is sufficient to explain social behavior, or one would need to understand cultural and religious evolution at the more complex level of group behavior and religious semantics. The field is thus ripe for new interventions. One possibility would to expand Sober and Wilson’s approach to the level of cognitive systems. It may well be that religions live and thrive around this globe not only because of the secular utility of religion for motivating self-sacrificing ethical behavior, but also by providing positive cognitive expectations (such as the triad of faith, hope, and love) vis-à-vis a world which is not easy to cope with otherwise. Religions, thus, may have positive fitness functions, not only by virtue of their ethical payoffs, but also by virtue of mental resources intrinsic to religious life. (Needless to say, such fitness improving capacities do not eo ipso suggest that religions are “approximate reality” in any philosophical sense: successful coping strategies do not imply the cognitive truth of these strategies, nor does evolutionary success detract from the plausibility of religious candidates for truth).

EVOLUTIONARY COGNITIVE SCIENCE OF RELIGION (CSR) Cognitive science is an umbrella term for the interdisciplinary study of human intelligence and representation. The field developed out of the computer sciences in the 1950s and spans today over disciplines such as philosophy, computer science, psychology, neuroscience, linguistics, and anthropology. Within this vast field, the idea of a cognitive of science of religion was inaugurated around 1990. A rather tightly knit group of scholars was formed around Pascal Boyer, E. Thomas Lawson, Robert McCauley, Harvey Whitehouse, Ilkka Pyysiäinen, Scott Atran, and Justin 59

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Barrett (overview in Visala 2009, chapters 1-3). They work on the problem how religious representations and behaviors are formed and transmitted according to a set of preestablished cognitive schemata in the human mind. Much research is today done in the context of empirical psychology, aiming to uncover the transcultural biases for religious belief, in particular for the intuitiveness of theism, given our evolved mindsets (Barrett 2004; Kelemen 2004). Such studies on the constrained set of ideas about God, gods, and spirits are probably going to increase over the coming years. Although it should be noted that psychological studies of this sort are in principle independent from the evolutionary explanations thereof, the CSR community is so far committed to what may be called a cultural Darwinism. The central assumptions are (largely taken over from evolutionary psychology) are the following: 1. 2.

3. 4.

Religious representations make use of the ordinary cognitive capacities of the human brain. The human mind is not a general purpose learning machine; rather the functioning of the human mind is massively modular in nature, so that specific modules are activated, which also lead to a constrained variety of religious representations. All faculties of the human mind have developed as a result of natural selection for specific adaptive purposes. Since the human species has lived in gather-hunterer societies for more than 99% of its existence, evolutionary CSR assumes that also modern human beings live and breathe in the mental schemata developed in hunter-gatherer societies.

To these general CSR assumptions can be added a set of more specialized hypotheses which can be tested by cross-cultural investigations: 1.

2.

3. 60

The idea of “supernatural agents” such as gods and spirits arise out of an innate inference mechanism in the human mind, which throughout evolution has learned to look out for traces of other minds and mental agencies (prey or predators). Ideas of God, gods, and spirit are thus the effect of the human mind’s “hypersensitive agency detection device” (HAAD), which looks for invisible agents behind empirical traces. “Minimally counter-intuitive concepts” (MCI concepts) are easier to transmit to other minds (and to new generations) than ideas that are either too mundane (hence uninteresting) or too paradoxical (hence implausible). For example, it is easier to remember and imagine a one-armed man than a normal two-armed man, or a man with no visible arms, legs, or face. It is easier to transmit and make plausible personalistic notions of supernatural agencies than more abstract or complex religious ideas.

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Hence, the Buddhist teaching of an impersonal Buddha-body is usually, in folk Buddhism, accompanied by innumerable personalized spirits, good or bad. Similarly the Christian idea of God as a three-personal community of love stands in need of doctrinal clarification and repeated catechetical instruction, whereas, simpler theistic ideas of God as Father or Mother are easier to transmit. The theological correctness maintained by scholars, priests, or monks are thus counteracted in popular piety by giving priority to one of the three Trinitarian persons (usually Christ), or by supplementing the Trinity with more approachable figures (such as Mary). Similarly, the nonanthropomorphic universe of Buddhism is standardly supplemented in public piety by a world of highly anthropomorphic ghosts and spirits. In what follows I focus on the assumptions underlying evolutionary approaches to CSR (Boyer 1994, 2001; Atran 2002; Pyysiäinen 2009). In his book with the ambitious title, Religion Explained: The Evolutionary Origins of Religious Thought (2001), Boyer offers a model for understanding how religious concepts, often counterintuitive and sometimes even exotic, have their natural place in the context of the ordinary workings of human brain. Religious concepts are natural both in the phenomenological sense that they emerge spontaneously and develop effortlessly, and in the naturalistic sense that also religious imagination belongs to the world of nature, by being naturally constrained by genes, central nervous systems and brains (Boyer 2001, 3-4). Fundamental to Boyer’s explanatory model is the distinction between concepts and templates (2001, 40-45). Concepts are general ideas referring to particular beings, whereas templates are more general schemes. The claim is that children as well as adults learn by subconsciously inferring that giraffes, even though they look very different from walruses, blackbirds, and mosquitoes, have a variety of common characteristics, because they are part of the same ontological category, the animal template. Animals have a body-plan, have a living place, they eat food, reproduce, and so on. Of course, a giraffe and the walrus look differently (long legs and neck versus a trunk), have different habitats (the savannah versus the sea), eat different things (leaves versus fish), and copulate in different ways. The information about these differences will have to be provided by the concepts, derived from empirical experience. But the template animal adds the information that all animals—from mosquitoes to elephants—live, eat, and reproduce. Templates can thus be perceived as aggregates of memory. By subconsciously using templates, we tacitly infer many things that we don’t observe but simply take for granted. The result is an inverted Kantianism, according to which the quasi a priori templates have accumulated through the a posteriori evolution of cognitive systems. According to Boyer, there are not many cognitive templates. The number is a question of definition, but the following may suffice: person, animal, plant, tool, artefact, natural object. Human beings will have a long-term acquaintance 61

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with each of these templates. Tools and natural objects don’t talk and don’t eat; persons do. Persons have memory and act according their past experiences, plants don’t. And yet, since the categories can be recombined new concepts can emerge, and the world of religion is full of such cases. Boyer mentions the examples of praying to statutes, of feeding mountains for an exchange of prey, and of special (potentially dangerous) ebony trees, which are able to recall the conversations of past generations. In effect, Boyer thinks that religious concepts came about by blending information coming from separate ontological categories, in particular the templates of natural objects and person. The hard core of Boyer’s theory of religion is now that religious concepts and imaginations are always marked by being counterintuitive in the concise sense of counteracting expectations raised by our template categories: “[R]eligious concepts invariably include information that is counterintuitive relative to the category activated” (Boyer 2001, 65). Observe that even though the world of religions certainly does involve oddities of many sorts (at least to outsiders), the mere fact that something is unexpected is not counterintuitive in Boyer’s technical sense. For example, imagining “a table made out of chocolate” or “a giraffe with six legs” certainly unsettles our ordinary knowledge but does not violate the ontological categories. The breach of expectations is here still at the level of concepts and natural kinds. However, to say that “the table felt sad, when the people left the room” breaks with our assumed information about what artefacts can do (Boyer 2001, 80-82). These examples, however, also show that religions are hardly satisfactorily defined by being contraintuitive (or counterontological, to be more precise). For so are also fairytales and science fiction stories. This is the so-called Mickey Mouse problem of CSR. What is, after all, the difference between pure fiction tales and religious stories that are taken to be more than fictional by religious minds? Boyer does not, it seems, provide us with a very distinctive understanding of the religious ideas that he nonetheless claims to have explained. Scott Atran even goes further by defining supernatural agents as being “counterfactual.” This may be the case, of course, but even so, the nonexistence of gods and spirits is not a good definition of their meaning. Evolutionary explanations of the repertoire of religious representation are here conflated with philosophical postulates about what is, and what is not. Atran, however, is keen to argue that religion is not to be defined by the presence of supernatural representations but also by the commitment of their protagonists and by the successful coping with perennial existential dilemmas. Atran’s definition of religion is as follows, “religion is (1) a community’s costly and hard-to-fake commitment (2) to a counterfactual and counterintuitive world of supernatural agents (3) who master people’s existential anxieties, such as death and deception” (Atran 2002, 4). Also Boyer is aware that religious concepts, in addition to being counterintuitive, have an existential importance. But again, also fairytales and science fiction stories may be existentially relevant. By religious concepts he mostly seems to understand 62

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simply the idea of supernatural beings such as gods, ghosts, and zombies or supernatural events, such as miracles, “a set of ideas concerning nonobservable, extra-natural agencies and processes” (1994, 5). The theoretical problem is here that the distinction between “natural” and “supernatural” is not relevant to all types of religious understanding (indeed, the Latin term supernaturalis was not coined until the ninth century AD). Empirically speaking, religion is not always about finding raced of an absent deity in salient experiences, but more often about seeing the presence of Gods or spirit within this world. “Respecting the dead” as part of the human community” as in Chinese, Japanese, or African culture, would, from the internal religious perspective, be to respect them as part of the natural world. The univocation of “supernaturalism” and “religion” in the CSR community has repercussions for CSR approaches to the concept of God. Let me again take my point of departure in Pascal Boyer’s work. Boyer starts out from the empirical observation that there are many conceivable, yet nonviable ways of thinking about God. Not all religious concepts can be equally successfully transmitted. Boyer mentions the example of a god watching us in every detail—but instantaneously forgetting about us; this is a notion nowhere found in the history of religion. Or think an omnipotent God existing only on Wednesdays. There are barriers to the wildness of religious imagination: any violation of a template will need to be specific, while at the same time preserving other features of the template (2001, 62). For example, when imagining God as a person, most believers violate the category of person by qualifying the template so that God is a person who is not limited to space and time, because God has no body. By contrast, it would be hard to go around with a religious message saying that God is an infinite person who has a body but no consciousness. The ontological category of personhood would here simply be eradicated. On the other hand, one can also enrich the concept of God by transferring specific knowledge claims gained from other source areas and applying them to God. One can, for example, use the tool template and praise God by saying, “You are the lamp that shines for my feet,” or the natural object template, and say, “The Lord is my rock.” Boyer is particularly interested in the pervasive role of personhood templates in religious thought. Throughout evolution, humans have survived by paying attention to differences, especially to salient features that can be treated as signs standing for something of importance. We are evolutionarily designed, as it were, to look for signs. Boyer here stands on the shoulders of Stewart Guthrie’s theory of religious anthropomorphism (Guthrie 1993, 2002). According to Guthrie and Boyer, we are bound to read events as signs indicating the activity of somebody. We therefore choose our perceptual bets neither randomly nor by probability, but according to their potential significance for our survival. What is significant for us is exactly living beings, either prey or predators, or those with whom we can communicate for some common purposes. 63

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Boyer also refers to Justin Barrett, who early on pointed to the aforementioned “hypersensitive agency detection device” (HADD): “Our evolutionary heritage is that of organisms that must deal with both predators and prey. In either situation, it is far more advantageous to overdetect agency than to underdetect it. The expense of false positives (seeing agents where there are none) is minimal, if we can abandon these misguided intuitions quickly. In contrast, the cost of not detecting agents when they are actually around (either predator or prey), could be very high” (Boyer 2001, 144). Gods and spirits can be (and certainly have been) perceived as predators that provoke fear and anxiety. But gods and spirits can also be seen as invisible partners with whom one can seek refuge, communicate, but also possibly exchange goods (2001, 146-150). What is distinctive for religious communication is here the fact that the communication with invisible partners is decoupled from the ordinary social exchange and thus offers a space for learning both social and self-reflective skills against a stable background, constituted by the relation to the Invisible Other (2001, 149). In other words, the pervasiveness and persistence of notions of a personal God (despite the criticisms coming from philosophers such as Spinoza or Fichte) can partly be explained by the naturalness of the mental module of agency detection, which is operative far below the threshold of reflection. And yet, as we shall see, agency detection may also produce a religious self-reflection about the extent to which personal features can be ascribed to God. Evolutionary CSR, here following evolutionary psychology, bases itself on fairly general reconstructions of the prehistoric human mind, an area in which archaeological scholarship is still guided by hunches, hypotheses, and gross generalizations. One of the difficulties for evolutionary CSR explanations is the assumption that religious thinking builds exclusively on the cognitive structures acquired in the preagricultural societies of gatherers and hunters. However, more reflected religious systems came about in the period of agriculture about 20 to 10 kyr ago, followed by the formation of states, cities, and alphabets as late as about 10 kyr to 1.500 years ago. As is well-known, the logic of monotheism emerged in these late cultures (most probably in Egyptian culture). The vastly important shifts in religious perception within cultural evolution are, unfortunately, not appropriately accounted for in CSR theories. It is, after all, a truism that self-reflective religious systems stand in need of religious instruction, whereas more simple personal concepts may emerge as a result of more “natural” (as opposed to “cultural”) maturation processes. But the same would be the case for other cognitive skills acquired in cultural evolution, such as literature, dancing, and music, not to speak of science. The more one wishes to address the highly regulated forms of religious life (for example, saying the Jewish Shema, reciting The Lord’s Prayer, or entertaining a Zen practice), the less evolutionary CSR is explanatorily relevant. 64

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This may also have repercussions for the relation between the empirical psychological studies of CSR and the evolutionary paradigm of CSR. It seems that even though evolutionary CSR may be strengthened by empirical work done on the psychology of memory among present-day human beings, Boyer and colleagues have yet to show how a theoretical reduction can be evidenced from religious practices and thought to the interplay between cognitive templates and people’s empirical imitations of reality (Gregersen 2006). It may be a result of this problem that one currently observes a certain competition between evolutionary CSR proponents and more psychologically oriented programs within CSR. Despite the label “evolutionary,” the CSR community has largely given up the claims of sociobiology that one would be able to specify the genetic basis of concrete cognitive behaviors. Boyer’s work refers in passing to the role of genes. Genes, however, are the only possible carriers, at an ultimate level, of the hardwiring of the brains, if any such hardwiring exists. Neither does evolutionary CSR point to any established causal theory about how cognitive systems and their mental modules relate to brain modules. Even if CSR proponents would argue that functional modules can operate on a variety of brain modules, the proximate causes of cognitive behavior would eventually have to be found in the neuronal structure of the brain, if any causal reduction of cognitive processes can be evidenced. In favor of evolutionary psychology, however, it should be noted that linkages between cognitive functions and brain processes are currently investigated by the neurosciences, and by virtue of advanced neuroscanners such as SPECT (single photon emission computed tomography) it is possible to identify the brain modules and even the trajectories of single electrons activated under religious experience. Current studies within neuroscience are thus consonant with some assumptions of evolutionary psychology, and may as evidence grows, offer a supplementary evidence to the CSR approach. Evolutionary SCR should therefore still be taken seriously as a potentially promising research program, even though Boyer and colleagues have not, as yet, offered what they claim to have offered: an “explanation” of religious thinking.

THE THEORY OF AUTOPOIETIC SYSTEMS (AST) I conclude this essay with the perspectives coming from autopoietic systems theory or the theory of self-productive systems. The general idea of self-organizing systems is sometimes prematurely equated with the notion of autopoietic systems. The difference is that while self-organizing systems combine great variability with internally regulated mechanisms or programs (as we saw in CAS), autopoietic systems produce new internal components, thus continuously producing new system-environment interactions. Creativity here resides neither in the internal schemata (as in CSR) nor in the reaction to the environment at large (as in behaviorism), but in the internal 65

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self-reproduction vis-à-vis a very specialized environment—each system (and subsystem) construing and constructing its “own” environment. While the concept of self-organization still retains the idea that systems are organized out of preestablished elements, the concept of autopoiesis more radically contends that the components themselves may be created only inside organized structures. Self-transformation extends not only to the organization of the whole organism but also to the specialized subsystems of the organism. It is only in a cell, for instance, that we meet the special arrangements of molecules that make up its membrane. Consider, for example, how the carvings of the brain (like physically engraved schemata) are produced in a kind of “topobiological competion” (Edelman 1992, 83), that recurrently reshapes the neurons and their interacting networks. Selection processes thus take place also in the brain, to the benefit of the brain’s overall plasticity and to the fitness improvement of the organism. In autopoietic systems, therefore, there is no separation between producer and produced. A cell’s being is given only by virtue of its internal dynamical operations. Hence, the system is not a substance definable prior to its operation—immune systems, for example, vary significantly in genetically identical twins. It is the internal functioning of the system that both determines whether or not the cell should build up new elements, and how the cell picks up (or ignores) specific elements of the external world (Maturana/Varela 1992/1987, 43-52). Taking the feature of complex adaptability seriously means taking seriously the pluralistic orders-and-disorders of nature. The world has many centers of control, and to each is assigned a certain process autonomy. Like other types of complexity theory, the theory of autopoietic systems presupposes a constitutive materialism (“there exist no other elementary particles than those known by the physical sciences—or in principle knowable by them”). However, what is important are not the singular objects (e.g., atoms or molecules), but the work cycles they perform within holistic and highly specialized networks. What matters is not the generic amount of matter’s physical energy, but the specific physical organization of matter. In this sense, information matters as much mass and energy (Davies and Gregersen eds. 2010). The pluralistic order-and-disorder has its ontological basis in the operational closure of the different systems themselves. That is, a system is not acting at the mercy of the environment, but is itself determining what is relevant, and what is not relevant, in the surroundings. Accordingly, there does not exist one objective environment, common to all systems, but there exist as many environments as you have adaptive systems. Autopoietic systems may react to their environments on all grades from negative feedback (balancing each other) to positive feedback (mutual enhancement). Eventually we face a continuous criss-cross interpenetration of different kinds of operational systems. Evolution seems to be driven by type-different autopoietic systems, sometimes competitive, sometimes symbiotic, sometimes in synergetic resonance, then in dissonance with each other. 66

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Elsewhere I have tried to formulate some of the basic principles of autopoietic systems as follows (Gregersen 1998, 338): 1. 2.

3.

4.

5.

Autopoietic systems are energetically open systems, dependent on external supplies. While autopoietic systems are energetically open, they are operationally closed. The closure of the system is even a precondition for the way in which the given system handles its openness vis-à-vis its environment. The cell, for instance, is open for energy supply only as long as the energy input does not break down its own membrane and internal structures. The self-reproduction of autopoietic systems is not necessarily tied to specific physical structures, since the structures may change as a result of the operations of the dynamical system. An immune system, for instance, does not always protect the frontiers that are under attack but may, instead, reproduce the system by forming new strategies of survival through structural self-transformations. Self-reproduction often happens through self-production. Also the elements of the autopoietic system are constituted by the system itself, by way of (selective) inclusion or exclusion. The membrane, for instance, only lasts as long as the cell-system lasts. Interpenetration between differently structured systems always takes place on the basis of the given system itself. In one system, the intrusion of a new chemical element makes no difference; in yet another, the consequences can be enormous. The causal effect is always codetermined by the system itself.

Let me just mention one example for how concepts of God can be elucidated through the idea of autopoietic processes: the Jewish and Christian concept of the “Kingdom of God” (Gregersen 2002). It is generally acknowledged in New Testament scholarship that the kingdom of God is not conceived as a place nor as a separate realm, but is simply the exercise of God’s reign in the world of creation in such an intense manner that God is perceived to be both present and revealed in particular mundane processes. Now, what are the similarities between the inherited idea of the kingdom of God and the theory of self-producing processes? First, there is a common awareness of the self-creative powers of nature. In the teaching of Jesus, the kingdom of God is likened to the scattering of a mustard seed on the ground which grows and sprouts while you are at sleep, you don’t know how: “The earth produces of itself ” (Mark 4:29, automatiké ). The reign of God is compared with the mustard that in antiquity was considered as weed. If this is so, it is the relentless will to existence that is compared with the kingdom of God—the same inconsiderate insistence that we 67

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see in beggars, or in the woman who lost a penny and went on searching until she finally found what she wanted (Luke 15:8-10). Second, the kingdom of God is related to open-ended possibilities. In Matthew, the kingdom of God is also called the kingdom of the heavens, whereby heaven is a symbol of those aspects of creation that are beyond our control and yet determine our existence. Speaking of the heavens as belonging to the kingdom of the God articulates the trust that even the powers of irruption and irregularity ultimately belong to God. The powers of disorder are not free-floating powers of an animistic sort (Welker 1999, 36-40). Thus, the notion of the kingdom of heaven both encapsulates the unity of the world of possibilities (heaven not being divine, but an integral part of God’s reign) and the multiplicity of new relevant possibilities (what the biologist of complexity Stuart Kauffman (1993, 1995) refers to as “adjacent possibilities”). Third, the idea of God’s reign addresses the fact that the world is construed as a series of openings or invitations. However, an invitation has to be received in order to reach the goal aimed for. The symbolic world of the parables is full of people who either accept the invitation or do not. Think of the parable of the king who invites to a wedding banquet, but his friends refuse to come, and the king then extends the invitation to the destitute on the street (Matt. 22:1-10). Or think of those who burry their talents rather than using them (Matt. 25:14-30). The choice of accepting or not accepting (or using the options or not using the options) exemplifies the formal features of autopoietic systems in so far as these are bound to adapt to their environments. To adapt or not to adapt, that’s the question. Yet one has to adapt to oneself in order to adapt appropriately to the environment. According to AST, operational closure precedes openness. Self-adaptation precedes adaptation to the environment. Accordingly, the one who is addressed by the parables will have to change his or her mental framework in order to catch the novel adjacent possibilities of the kingdom of God. For the same reason, the ontological status of the God’s reign is not, and cannot be, easy to determine. We hear that the kingdom is not a reality that can be observed, and yet it is said to be amongst us (Luke 17:21). The reason is simply that the adjacent possibilities of the kingdom of God have to be caught and taken up by human agents. If taken up, however, the internal structure of the human person is necessarily changed. The kingdom of God may be termed an objective-relational reality, in so far as it only occurs at the very moment when one enters into the relational networks elicited by the approaching kingdom. Accordingly, when Christians pray, “Thy Kingdom come,” they presuppose that the reign of God is not already here. There is not a ready-made design, a fulfilled reality imprinted on the structures of reality; rather the reign of God is in the process of coming to us. The kingdom is not of this world, and yet its efficacious presence can be depicted in scenes from everyday existence. As argued by the German theologian Michael Welker, “the reign of God is in a process of emergence.” As such it is similar to a 68

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surprise: “a surprising change of configuration is delineated that . . . requires new powers of self-organization” (Welker 1992, 509). Accordingly, the parables of Jesus consistently intertwine the awareness of the goodness of creation and the need for readjustment and redemption. The grace of God is graspable only in the creative zones between that-which-is (creation) and that-which-is-not-yet (the kingdom of God) by the exclusion of that-which-destroys creaturely co-existence (sin). The kingdom of God therefore presents itself in the fragile yet potentially fertile regimes between order and disorder. We thus find cross-fertilisations and co-adaptations on every scale: 1.

2.

3.

We have the interrelation of nature and culture (on the horizontal or spatial axis). Nature is not perceived as enslaved by laws but is consisting of autonomous agents in a constant process of self-productivity. Neither are human beings seen as exercising freedom at its fullest scale. Human beings are blind, unless they adjust their mental frameworks to the new possibilities of the kingdom. We also have the interrelation of the world of actualities and the world of possibilities (on the temporal axis). Unexpected chances for self-development emerge in the always critical system-environment interactions in which a restructuring of the human person is made possible. Finally, we have the interrelation between the finite realizations of order and the divine wellspring of unprecedented novelties (on the vertical axis). The concept of the kingdom of heaven specifies, within a highly complex network of images, the difference between self-productive processes that are resonant with God’s will and those who are not. A divine-humane economy of superabundance is articulated where more comes out of less in the highly ordered yet fragile zones of collaboration.

The sudden emergences of the kingdom of God are like seeing God in the fluids of a water drop. You both need to have the curved structure of the fluid drop “out there,” and you need to adjust yourself “internally” to seeing God in that fragment of reality. Nothing goes without the other. For in the world of autopoiesis, no adaptation happens without self-adaptation. The case of the semantics of the “kingdom of God” is but one example that shows how inherited religious concepts may be rearticulated through the insights of evolutionary thinking. Perhaps nature is not quite as brutal as we have become used to think. And perhaps cultural and religious evolution is not as separated from nature, as we have learned through a three-hundred-year-history of compartmentalization.

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CONCLUSION As we have seen above, computational complexity theory, however, is an umbrella term for a wide variety of studies on the formation, development, and propagation of patterns, some more general, some arising under specific organizational conditions. The field builds in particular on thermodynamics, information theory, cybernetics, and evolutionary biology, but also on economics, systems theory, and other disciplines (introductions in Waldrop 1992/1993; Johnson 2001). Not all forms of complexity theory are computational in nature, though. In the case of CSR, we saw a sort of thinking that is combinatorial in nature and asks how and why the transmission of religious representations tends to follow the same overall evolutionary trajectories cross-culturally. In the case of AST, we found a dynamical theory that is particularly fruitful when investigating the internal dynamics of specific religious systems and their repertoire of semantic possibilities. Since complexity studies consistently cross the boundaries between the inorganic and the organic, the natural and the cultural, the field is likely to influence the future dialogue between science and religion as two major cultural forces of the twenty-first century significantly (van Kooten Niekerk and Buhl eds. 2004).

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II. RELIGION, SPIRITUALITY, HEALING, AND HEALTH OUTCOMES

Chapter Four Strengths and Weaknesses in the Field of Spirituality and Health by David J. Hufford

PREFACE to the Revised Version This analysis was carried out under a contract from the Metanexus Institute in 2005 as part of the Templeton Advanced Research Project and published online at that time (www.metanexus.net/tarp/field.analyses.htm). The analysis was performed on a bibliography of approximately 2,000 publications assembled through an electronic search of Medline described below. Since that time, according to John Ehman’s “Annual Spirituality & Health Bibliographies of Medline-indexed Articles”4 almost 7,000 articles categorized under the subject headings of “Religion and Medicine,” “Religion and Psychology,” “Religion,” “Spirituality,” and “Pastoral Care” have been listed in (2005 through 2009). From those Ehman selected a total of 1,819 articles as “pertaining to spirituality & health,” and he notes that this sample is not exhaustive. This selection procedure is not focused specifically on “health outcomes,” as was my own search. With that narrowing, the numbers would be substantially lower. Nonetheless, it is clear that interest in spirituality and health among healthcare researchers and practitioners remains strong. I have not had the opportunity to update my “spirituality and health outcomes” search systematically since 2005. But I have followed the literature. The text that follows has been edited and revised from the original, based on my research and reading during the intervening years. Although progress has

4

Published by the Pastoral Care Department of the University of Pennsylvania Healthcare System at http://www.uphs.upenn.edu/pastoral/resed/bibindex.html.

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occurred on all fronts, the basic nature of the strengths and weaknesses of the field remain roughly the same as they were in 2005. This is not surprising when one considers how new scientific study of spirituality and health is, as illustrated by the following graphic:

Source: Chaplain John Ehman, Penn Presbyterian Medical Center (Philadelphia)

According to Index Medicus, prior to 1990 articles in Medline containing terms for spirituality and for religion in their titles averaged one hundred or less per year. This includes editorials and indexed letters to the editor. The number of actual studies was far less. During the following seventeen years there was roughly a fivefold increase in such titles, reflecting the growing interest in this topic within healthcare. But this volume is miniscule compared, for example, to the publications on psychological topics indexed in Medline. Today, a MedLine search for titles containing psychological terms, published between 2007 and the present, yields 68,515 citations, compared to 3,002 for spirituality and related terms. (And the references to spirit include references to volatile chemicals, “spirits,” such as a 2009 article on the “microextraction for the determination of volatile organic sulphur and selenium compounds in beers, wines and spirits using gas chromatography.”) As the field continues to grow, the rate of quality improvement is accelerating. Because the field is so new, most research to date has been basic rather than applied. Metrics for aspects of spiritual belief, practice, and experience have developed, but the research linking these factors to fitness and health is only beginning. There is a general consensus that such links exist and are clinically 74

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important, as indicated by mandates for the inclusion of spirituality as a topic in healthcare curriculum (e.g., American Association of Medical Colleges, American Board of Internal Medicine) and as an aspect of comprehensive patient care (Joint Commission on Accreditation of Healthcare Organizations—JCAHO). But the evidence base delineating these associations and developing practical applications is still in its infancy. During the first eighteen months, the original analysis was online. It was downloaded more than fifty thousand times, so it seems to have proven useful. We trust that this revised version will be of equal value.

LEXICAL PROLOGUE The difficulty of clearly and concisely stating the distinctions and relationships between spirituality and religion runs through the field of spirituality, religion, and health and necessarily through this analysis of the field. The issue will be dealt with in some detail below. But even to begin this essay requires the establishment of a simple and noncontroversial convention for the use of the terms. The following definitions will get us started, although they do not solve the basic terminology problem, Spirituality = According to the New Shorter Oxford English Dictionary (1993) spirituality means “the quality or condition of being spiritual” and spiritual means. 1. Of, pertaining to or affecting the spirit or soul” (p. 2990). Religion = the community, institutional, aspect of spirituality; a spiritual organization Thus spirituality is the more general term, it includes religion, and spirituality is a core aspect of religion. This does not deny that there are “spiritual but not religious” individuals or that extrinsically religious people may not be especially spiritual. For ease of reference, I will use “S/R” to indicate the broad domain, and I will use S/RH to indicate the “field of spirituality, religion and health.”

ASSIGNMENT For this review, I was asked to discuss the state of the field of S/RH, including successes but emphasizing current limitations, key problems, methodological shortcomings of current research and related issues relevant to moving the field forward. This greater emphasis on problems should not be taken to indicate fundamental flaws in the field. Considering its abrupt and recent emergence as a field, S/RH has a remarkable track record. 75


METHOD OF THIS REVIEW This review began with the assumption that most S/RH studies published through 1999 were identified by Koenig et al. in their Handbook of Religion and Health, given their very thorough search strategy (2001, 6) which had yielded approximately 1,600 references. (Although a small number of references from the year 2000 are included in their bibliography, it seems that the cutoff for thorough coverage was the end of 1999.) To supplement this material, in February 2005 several searches of Ovid MEDLINE were carried out to identify health outcome studies involving spirituality and/or religion for the year’s 2000 to the present. These searches combined the search terms “health outcome” OR “pregnancy outcome” OR “exp treatment outcome” OR “Outcome Assessment (Health Care),” with either “spirituality OR Spiritual Therapies” or “religion.” The spirituality and the religion searches were carried out separately. The “spirituality and health” search yielded a total of 323 references. The “religion and health” search yielded 219. Of the total of 542 references, 103 were duplicates, leaving a set of 439 references on spirituality and/or religion and health outcomes, indexed on MEDLINE for the years 2000 through February 2005. These were compared to Koenig et al.’s bibliography, and no overlap was found. Further examination showed that the results from the “spirituality” search had included 111 hom(o)eopathy references. A separate search of these references located no use of either “spiritual” or “religious” terms in the titles or the abstracts, so these were deleted, leaving 328 references. An additional 30 references lacking specific religion or spirituality references were culled, including several referring to traditional African healing practices without specific spiritual references, another topic included by MEDLINE under Spiritual Therapies. Several additional references without explicit spirituality or religion content were found on further examination, including several acupuncture studies. These were also removed, leaving a set of 287. Materials already in my files, results from several tightly targeted additional searches (e.g., “spirituality or religion and health”), plus selected references from Koenig et al.’s The Handbook of Religion and Health (2001), and Kenneth L. Pargament’s Religious Coping (1997) were then added manually to complete the set. It is clear that this strategy does not locate every relevant study. However, it does compile materials that may be said to define the core of the field. The problems involved in searching for all relevant work are discussed below under weaknesses of the field (especially Scope and Informatics).

BACKGROUND A powerful relationship between spirituality and health has been assumed by most societies through history. But in the late nineteenth century, this changed in the Western world. The emergence of modern scientific medicine was accompanied by the abandonment of vitalism and an explicit and intentional disentanglement 76

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from religion. The growing acceptance of the idea of antipathy between science and religion, urged on by polemics such as Draper’s History of the Conflict Between Religion and Science (1874) and White’s A History of the Warfare of Science with Theology in Christendom (1896), encouraged the idea that religion had no appropriate place within medicine. By the time that American medical schools had been reformed along scientific lines, following the Flexner Report in 1911, and medical research in the modern sense had begun to take shape, religion and spirituality had been either expunged from medical attention or neatly submerged as a variety of psychopathology within the new field of psychoanalysis (Hufford 2003b). When religion was discussed within medicine, it was typically as a problem, as in the beliefs of Jehovah’s Witnesses about blood transfusions as an obstacle to good care. But the S/RH connection was resurgent in the United States by the 1960s, as neo-Pentecostalism and the Charismatic Movement grew in influence (Harrell 1975). By the mid-1970s, spiritual healing had a firm place within virtually every Christian denomination. In response to these changes in the larger society, growing consumer pressure, and the implicit connection of spirituality with the emerging interest in “complementary and alternative medicine,” medicine’s relationship with religion and spirituality had become a central issue in medical research and practice by the 1990s. These historical and social factors that have produced the current interest in S/RH are more than the necessary precursors to scientific research on the topic. They are an integral part of what that research must investigate and come to understand. Research on the relationships among religion, spirituality, and health has grown dramatically over the past decade. It is clear from the literature that many in research, in health care, in the public, and in government, believe that important positive connections have been established and should be vigorously studied. It is also clear that others are unconvinced and even hostile to the subject. It is not surprising that such a deeply felt subject should be controversial when it makes its way into a field such as medicine. Nor should it be surprising that such a complex topic as spirituality and religion, having been left out of scientific inquiry for so long, should prove difficult to study with the methods of science. Yet there actually can be no serious question about whether religion and spirituality have important connections to health. Religious teachings, values, and beliefs are powerful influences for many Americans regarding reproductive health, end-of-life decisions (just consider the Terri Schiavo case that culminated in 2005!), and behaviors such as smoking and drinking alcohol. Sickness and injury immediately elicit prayer and the fundamentally religious question “Why me?’ from a majority of Americans, as they have for people around the world throughout history. Survey data have made it very clear that these connections are salient and important to most Americans. For example, a poll of American adults conducted by Princeton Survey Research Associates and published in the March 31, 1997 issue of Newsweek found that 87% believe “that God answers prayers,” 82% “ask for health or success for a child or family member when they pray,” and 79% say God answers prayers for healing someone with an incurable disease. 77


The question is not whether connections between spirituality and health exist but rather what are those connections and what are their effects. While some of the basics of religion may be metaphysical, the connections between religious behavior and health are empirical. Empirical questions are subject to scientific inquiry, and empirical questions with high value in society that have bearing on mortality and morbidity should be studied scientifically.

CRITICISMS AND RESISTANCE As S/RH has emerged and become a robust area of research and publication within mainstream academic circles and in the peer-reviewed literature, there has developed a substantial backlash. Just as some were dissatisfied with the predictions of religion’s demise in modernity and its absence from serious public discourse, others found those developments good and hopeful for humankind and the current changes maddening. It should be no surprise to find that there are diverse and strongly held views on religion and related topics. I have put this comment here, because it is hard to know whether to consider the vigorous resistance a strength or a problem for the S/RH field. One often wishes the disputes were less partisan and more civil, but we should be glad that strong opinions are expressed and can be responded to. The resistance that prevented research on S/RH was a bad thing. But now that the field has emerged and found substantial support, resistance can have a salutary effect. Both pro and con positions call for scrupulous scholarship and critical thinking. I have intentionally omitted reference here to examples of what I would consider “backlash” simply because it seems healthier not to separate these reactions from the rest of the discourse through which we hope to achieve a better understanding of this fundamental aspect of human behavior.

PROBLEMS AND NEEDS IN SPIRITUALITY, RELIGION, AND HEALTH RESEARCH Scope and Boundaries of the Field The greatest strength of the S/RH field is the fact that it arises from and reflects powerful cultural forces in American society, and this is also a source of some of the field’s major problems. Neither religion nor spirituality died out in America during the twentieth century, despite confident predictions of its demise, and Christianity faced the twenty-first century as a major force in the modern world. The other religions of the world, both the world religions and “local religions,” are also showing great vigor. A part of this process has involved the reconnection of health care with spirituality. Historically related on intimate terms and then intentionally divorced as 78

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modern biomedicine developed in the latter half of the nineteenth century, the two domains seem to be engaged in a process of reconciliation. The process has not been led by either medical or religious authorities but rather by popular demand. This dramatic change in attitude and its broad popular support have allowed researchers who value religion and spirituality to pursue research and publication that twenty years ago would have cost them their careers, as pointed out by Sherrill and Larson in their 1994 essay, “The Anti-Tenure Factor in Religious Research.” This popular demand has powerful political dimensions and has allowed rapid changes from the National Institutes of Health to university faculties to the process of peer review in scientific and medical journals. Whether one applauds this shift (many do) or abhors it (as many others do), it is an undeniable and intensely interesting fact of contemporary life. Such a dramatic contradiction of social science predictions deserves study. The question cannot be whether spirituality and health should be studied, but must rather be how the topic should be studied. The current configuration of the S/RH field reflects powerful social forces in contemporary America. The rise of religion’s salience in American culture allowed those with strong religious commitments an increased voice in public life outside their congregations. This is as true, obviously, of other areas of American life, for example politics, as it is of American health care. In itself this is a good thing as suggested by Stephen L. Carter’s provocative work The Culture of Disbelief: How American Law and Politics Trivialize Religious Devotion (1993), and in medicine this change has brought to light influential but unexamined aspects of health behavior. But just as in other domains of American life, these changes in medicine are shaped by forces of social and cultural construction that are largely invisible to those affected (consider the different impacts in politics and the academic world). These changes have been sudden and dramatic, and the S/RH field has not had an opportunity to develop a rich and critical interdisciplinary discourse. The result is a field that is limited to a few specialties, particularly medicine (speaking broadly, with a special emphasis in psychiatry, primary care, oncology, cardiology, and gerontology) and psychology, and that tends to tacitly incorporate the particular religious and spiritual commitments of investigators and their critics in what are intended to be scientific discussions. The S/RH field is selectively focused on mainline Protestant Christian religion. It emphasizes the idea of spiritual interventions, but it has carried out primarily epidemiological and other observational research that is difficult to use in the development of specific clinical uses. It has ignored the spiritual and religious interests of large segments of American society in order to remain within what can only be called the most conventional aspects of this new and scientifically unconventional topic. And it has not sought out collaborative intellectual relationships with researchers in obviously relevant fields such as religious studies, the history of religion, and the history of medicine, anthropology, philosophy, linguistics, and a variety of other disciplines that could be of great assistance to the field. This does not seem to be an intentional exclusion, and it must be said that it has taken those in these related fields 79


a long time to notice the S/RH developments that should have caught their attention at least a decade earlier. Perhaps most surprisingly, the S/RH field has not emphasized collaboration in research and practice with the one discipline that has always labored to understand and deliver S/R “interventions” in health settings, chaplains. This all reflects the sudden, dramatic, and unexpected nature of these social and cultural changes. In the sections that follow, I will touch on some of the more obvious lacunae in the S/RH field, gaps that must be filled for the field to mature. NOTE: For the longer sections below, I have provided a brief summary of the argument at the beginning. Scholarship SUMMARY: Because of the rapid emergence of S/RH as a field, beginning primarily within medicine and psychology, and because disciplines that have traditionally studied religion have not systematically studied issues in terms of relevance to health, S/RH lacks a broad, interdisciplinary base of scholarship. Because of the great cultural and linguistic complexity of S/RH in American society, this lack of scholarship has created serious problems. Many of these are reflected in the “shape” of the field, which entirely omits topics that are conceptually important to the goals of S/RH research.

The field of S/RH research is quite new, less than two decades old, but growing rapidly. The study of religion, of course, has existed since ancient times and is well represented in several contemporary fields. But those fields, such as theology, religious studies, and the sociology and the history of religion have paid relatively little attention to healing, almost none to other issues of direct clinical relevance. Ironically, the recent surge of interest in spirituality and health has come not from the disciplines that have historically studied religion, but rather from medicine and psychology, disciplines that either ignored or stigmatized the topic in the past. The result is a field of inquiry that, unlike medicine or the sciences, has almost no scholarly infrastructure. Scholarship, though by definition not science in itself,5 is essential to a mature scientific field, especially in the life sciences. Such disciplines as ethics and history do not simply use health data to develop their own methods and theories. The work of such disciplines directly shapes and supports the work of the sciences

5

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Scholarship is a complex term. I use it here in its most conventional sense as referring to work in “the humanities” (DeVinne et al. 1982, 1098, “scholar”), or “orig. esp., in the classics, now in languages, literature, or any non-scientific subject” (Brown 1993, 2713).

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they study. In the twentieth-century medicine evolved along with such fields as the history of medicine, philosophy of medicine, bioethics, and medical sociology. This scholarship has been formative and was necessary to the maturity of the field. For example, medical research and practice have been changed forever by the development of the doctrine of informed consent, a concept rooted in legal and historical context and articulated in its modern form in the 1960s. Partly in response to the revelations of the Nuremberg War Crimes Trials, informed consent affected research design and was further refined after the public revelation of what has been called “the Tuskegee Syphilis Study.” Such concepts as clinical equipoise and the inclusion of the patient’s view (often largely shaped by religious beliefs and values) in the analysis of risks and benefits, have engaged scholars in both the humanities and the social sciences. And the work of those scholars has shaped medical research and practice in important ways. The maturity of the field of medicine cannot be separated from the scholarship of the humanities and social science fields that comprise its intellectual surround. Today physician scholars, like physician scientists, are increasingly important. Physicians and Ph.D. scholars are colleagues and collaborators, and their disciplines productively engage one another. Ironically, scholarship in the field of S/R and health is scarce, even though it was scholarly research that gave spirituality and health much of its initial impetus. The systematic analyses of religious variables in psychiatric journals by Larson et al. in 1986 and Craigie et al. in 1988 helped to simultaneously establish the importance of religion in the health literature and the inadequacy of its past treatment. But since that time, scholars in relevant fields have continued to pay little attention to spirituality and health, and spirituality and health researchers have made little progress in broadly incorporating sophisticated scholarship into the field. This should be understood as a natural consequence of the abrupt emergence of the field within medicine, not a criticism of the individuals involved. Nonetheless, those scholars who have studied and written on S/RH topics should receive more attention than they have (for example, Dossey 1993, 1999, 2000; Frohock 1992; Fuller 1989, 2001; Gardner 1983). Language: Defining Spiritual, Religious, and Psycho-spiritual SUMMARY: The S/RH field has experienced major problems in defining and distinguishing religion and spirituality. These problems result from the lack of a solid base of relevant scholarship and difficulty in coming to terms with those core aspects of spirituality and religion that led so many academics to predict its demise: a focus on the reality of spirit—as opposed to simply “a higher power” or matters of “ultimate concern.” The persistent use of ambiguous, universalizing definitions, mainly patterned on those taught by Christian existential theologians, notably Paul Tillich, reflects a kind of tacit theological commitment

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common in the academic community in general. This problem is deeply entrenched and creates immense difficulties for theory and research. For that reason, it receives extra attention here.

Difficulties in dealing with the meaning of the terms religion and spirituality comprise a serious weakness in the S/RH field. To the extent that these core terms are not used appropriately and consistently, the field will face serious shortcomings in validity and coherence. This weakness arises directly from the lack of scholarly infrastructure noted above. For example, in Larson, Swyers, and McCullough’s (editors) Scientific Research on Spirituality and Health: A Consensus Report (1997) the “Definitions of Religion and Spirituality” section begins with the following statement: An immediate consensus among Panel members was the need to ground definitions of religion and spirituality in scientific and historical scholarship. (p. 15)

But of twenty-one panel members, judging from the contributors list, only one had a humanities appointment (holding an endowed chair of liberal arts) and one was a sociologist. The remainder held medical or psychology appointments. The panel members are excellent researchers, but that does not make them linguists, historians, or philosophers. The resulting definitional criteria suffer from a lack of broad, interdisciplinary scholarship. The resulting definitions center on “a search for the sacred.” The term “sacred” refers to a divine being or Ultimate Reality or Ultimate Truth as perceived by the individual” (p. 21). Religion is understood to possibly involve “non-sacred goals” such as “meaning” in a primarily sacred seeking context plus “the means and methods of the search” validated and supported by a group. As George et al. say, while approving of them, they are “highly abstract definitions that do not lead to straightforward operationalization” (2000, 105). In the Handbook, Koenig, Larson, and McCullough further develop the concepts from the Consensus Report, giving the following definitions: Religion: Religion is an organized system of beliefs, practices, rituals, and symbols designed (a) to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality) and (b) to foster an understanding of one’s relationship and responsibility to others living together in a community. Spirituality: Spirituality is the personal quest for understanding answers to ultimate questions about life, about meaning and about relationship to the sacred or transcendent, which may (*or may not) lead to or arise from the development of religious rituals and the formation of community. (2001,18)

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At this point the problem of abstractness and difficulty of operationalizing have not been solved! There has been a great deal of agonizing over these two terms in the field. It has been recognized that usages in published work are inconsistent, even within the writings of single authors. It has been suggested that due to recent changes, religion has come to be viewed too narrowly while the meaning of spiritual has become “fuzzy” (Zinnbauer et al. 1998). Definitions of the terms have been called “vague and contradictory” (Egbert 2004, 8). There have been complaints that the meanings of each has changed over time (Pargament 1996; Zinnbauer 1997). The central problem is one that occurs regularly when scientific fields appropriate natural language terms. Natural language is inherently ambiguous. Meanings shift, expand, and contract as words travel in different speech communities. For words employed as technical terms, this is a problem. Medicine could not use the words virus and bacteria in the loose, overlapping senses that these technical terms have acquired in ordinary speech. But when the words originate in natural language, and where, as in S/RH, the intent is to understand human behavior through language-based methods (surveys, interviews, et cetera), the issue is different. To the extent that operationalized definitions meet the conceptual criteria of investigators they often lose the meanings that they have in ordinary speech. The result is equivocation and loss of validity. The S/R literature often seems to suggest that investigators are seeking the correct meaning of these terms with the assumption that their colloquial usages are somehow incorrect, mistaken like colloquial use of “virus” to mean “germs” in general. But for naturally occurring language, the only correct meanings are those found in customary usage, and the correct meaning, as Emblen concisely points out, “depends on how the ambient community commonly uses the terms” (Emblen 1992, 41). Community meanings are discovered through lexical6 research, which is based on the observation of substantial numbers of naturally occurring usages. Although some of the published literature includes studies of personal meanings of terms (especially Zinnbauer et al. 1997), I have not found a single lexical study in the S/RH literature. Zinnbauer et al. asked a diverse sample of Pennsylvanians to define spirituality and religiousness and to choose the degree to which respondents would apply each term to themselves, using a 5-point Likert-type scale (551-552). The sample, though diverse, is not representative of any specifically identifiable speech community. More importantly, this method, though interesting, is not lexicology. It does not analyze a corpus of naturally occurring speech. Compare the results of

6

Lexicology is the branch of linguistics that studies vocabulary, the meaning of words derived from observations of their usage; lexicography is the discipline that creates dictionaries, describing the findings of lexicology..

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asking the average person for a definition of any word in ordinary speech with those of inferring meaning from a sample of actual usage. There is often a relationship, but there is no reliable and consistent unity of meaning. Giving definitions is not an ordinary speech act, and words laden with strong emotional and cultural connotations are those that are most difficult for speakers to accurately define. One need only compare the effort of giving a definition of a term such as love to the task of analyzing naturally occurring uses of the word to understand the difference. Efforts to arrive at an appropriate definition of spirituality have been most common in the nursing literature (e.g., Emblen 1992; Dyson 1997; Narayanasamy 1999). Several of these have involved the analysis of a corpus of usage by authors of published papers. For instance, Unruh et al. (2002) reviewed the usage of the word spirituality in a variety of disciplines. The investigators inferred the inherent definitions in a variety of published works on spirituality and then analyzed usages thematically. This approach is a kind of lexical research, but it investigates the usages of professionals as expressed in the peer-reviewed literature. Such studies describe the meanings of “experts.” But what is needed for validity in studies of patient populations is specifically the meanings of nonexperts. This lexical research is more difficult, since a corpus of research articles is more easily obtained than is one of the naturally occurring speech of ordinary speech communities. One problem that the expert meanings display is the incorporation of a great deal of description into their definitions, and this is what renders them so complex and abstract. Definitions for use in quantitative research should state minimum characteristics that are always true of what is being defined. Descriptions note aspects of defined things that are often but not always true. Mammals are defined by being warm-blooded vertebrates. They may be described as typically living on land—but some, such as whales, do not. Descriptors are generally probabilistic in this way. The descriptive material is not only unnecessary at the point where definition is needed, it misleadingly bundles theory and interpretation into definition, and this creates bias. For example, the definitions of the Consensus Conference and the Handbook noted above both use the term ultimate in their definition of religion. This comes from the definition of religion used by the famous theologian Paul Tillich: “the object of ultimate concern” (1952). But what if a man is a member of the Methodist Church, but he is more concerned with the well-being of his family or the good of his country or perhaps even football than the divine or anything else connected with his church? Would we say that Methodism is “not his religion?” If you ask him his religion, he says “Methodist” or perhaps “Christian.” Do we say he is wrong because he doesn’t care enough? Maybe he cares quite a bit, but just not ultimately. In a similar vein, some authors have suggested that while God is a key element in S/R, religion “is whatever an individual takes to be of highest value in his/her life” (Dyson 1997, 1183). This takes a long step away from what is meant by God, and by implication spirituality and religion, in the speech of most Americans, reminiscent though it is of AA’s “higher power.” When we say, “Money is Smith’s God,” we are speaking metaphorically. 84

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Defining spirituality as a “quest” encounters the same problem. If a woman has found the sacred and rests comfortably within that, perhaps feeling at home, is this no longer her spirituality? Are only “seekers” spiritual? It seems right to apply ultimacy descriptively to religion and questing to spirituality, but they do not belong in a definition that will be used in attempting to elicit information from samples whose understandings derive from colloquial usage. The odd thing about the inconsistency, vagueness, and worry by investigators over these terms is that they do have consistent, concise meanings in ordinary speech, and they relate to one another in a perfectly ordinary way. We are accustomed to pairs of words such as learning and education or health and medicine, where the former word identifies a broad domain, and the second word refers to an institutional aspect of that domain. We know that not everything in education is about learning, and not everything in medicine is about health. In each case there are also financial issues, characteristic social roles, and so forth. Not all learning happens in schools, and not all health behavior takes place in clinics or hospitals. Spirituality and religion stand in the same relation, not all spirituality is to be found within religious frameworks, and religions include more than spirituality. Fortunately, very thorough and authoritative lexical research has been done on spirituality and religion, as on most commonly used English words (Hufford and Gucklin 2006). According to the authoritative New Shorter Oxford English Dictionary, the meaning of these words has been stable for centuries. Spirituality has two sets of meanings, both originating in late Middle English. The first, now archaic, refers to the clergy and ecclesiastical property. The second, still the common meaning is “the quality or condition of being spiritual; regard for spiritual as opp. to material things” (Brown 1993, 2990). The word spiritual means “1. Of, pertaining to or affecting the spirit or soul, esp. from a religious aspect” (1993, 2990). And spirit means “1. The animating principle in humans and animals. 2. The immaterial part of a corporeal being. 3. A supernatural, immaterial, rational or intelligent being, usu. regarded as imperceptible to humans but capable of becoming visible . . . as an angel, demon, fairy, etc.” (1993, 2989), also dating to Middle English. When spirituality refers to something else, it is by metaphorical extension to other intangible and invisible things, such as ideas, as in “team spirit” or the “spirit of democracy,” or as in seventeenth-century chemistry and anatomy where the “animal spirits” that move through the nerves are a class of highly refined, invisible particles analogous to those emitted by volatile liquids such as alcohol—thus, “wines and spirits.”7 Religious refers to those community institutions such as Buddhism, Christianity, Judaism, and Islam that are based on spirituality: religions. Spirituality, then, properly depends on diverse beliefs that are controversial in the modern world (the

7

See, for example, the Rousseau’s account of Thomas Willis’ neurology (Rousseau 1990, 107-146).

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existence of the soul and its nature, theological debates, etc.). This presents several difficulties for the study of spirituality and health. One is the question whether the study of spirituality requires the belief that “spirits exist?” Another is that the determination of whether some state or event is spiritual is inevitably subjective, and different subjects will come to different conclusions on this with regard to what appear to be the same circumstances. The most common response to the “belief problem” has been to follow the pattern of Christian Existential theology in making definitions that are more modern (secular) and less doctrinally specific. Notably, Paul Tillich (1886-1965), among the most influential of twentieth-century theologians, “defines spirit as the unity of power and meaning . . . spirit appears fully only in humanity, in freedom, self-transcendence, morality, rationality, creativity, selfhood” (Thomas and Wondra 2002, 92). This leads to an equally broad definition of spirituality as the sum of all the uniquely human capacities and functions: self awareness, self transcendence, memory, anticipation, rationality (in the broadest sense), creativity, plus the moral, intellectual, social, political, aesthetic, and religious capacities, all understood as embodied (Thomas 2000, 16).

Such universalizing definitions make all humans and all human behavior (or at least all good human behavior) spiritual. This is, understandably, one of the most common theological positions in the United States, and it is the most common theological stance for most modern academics. But that is a matter of personal commitment, not science. For research, it renders the term useless. The Tillich influence is clear in the following definition by Christina Puchalski, M.D., of George Washington University, a leader in spirituality and health: I see spirituality as that which allows a person to experience transcendent meaning in life. This is often expressed as a relationship with God, but it can also be about nature, art, music, family, or community—whatever beliefs and values give a person a sense of meaning and purpose in life. (Puchalski 2000, 129)

Another example is the widely used FACIT-SBI, which focuses on purpose and meaning in life, peacefulness, and taking comfort in faith. Research that employs such definitions lose specificity and divergent validity and conflate psychology, religiosity, and spirituality. They also fail to refer directly to what the population at large means by the term, and they are, therefore, lacking in ecological validity. These conceptual difficulties are reflected in the common complaint that discussions of the importance of spirituality suggest that very spiritual people are somehow “better” than others, or that one must be spiritual to be moral, 86

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ethical, compassionate, etc. These complaints are legitimate when the definition of spirituality is universalized as in Tillich’s approach. At best, one would have to say that those complaining really are spiritual but don’t know it. Using the definitions in common usage simplifies both research design and the interpretation of results. The distressed patient who feels an illness is punishment by God (a spirit) is referring to a kind of “spiritual distress.” If they have been cut off from valued opportunities for worship and for pastoral care (institutional sources of spiritual support), they have a religious (and spiritual) problem. It does not matter whether the investigator assumes that all such distress is “really” psychosocial in origin. Calling the distress spiritual should not commit us to a theory about the ontological status of the human soul! And whether such distress is ever objectively distinguishable from other anguish is an open empirical question. The meaning, for the patient, is spiritual and religious, and that is where our understanding of its causes and remedies has to begin.

PSYCHO-SPIRITUAL THE INTERSECTION OF THE SPIRITUAL WITH BEHAVIORAL DOMAINS Whether spirit in the common usage is real or not, clearly that which is referred to as spiritual has some interaction with that which is psychological. For many devoutly spiritual persons, psychology originates with spirit; it is spirit that reasons, spirit is the mind that inhabits the brain. For the reductive materialist, spiritual talk is naïve psychology just as “mental talk” is naïve neuroscience. This is part of the appeal in Tillich’s equation of the spiritual with the core human capacities; it is open to either the devout or the dismissive interpretation. But for empirical research, these debates are not usually relevant. When they are relevant; e.g., intercessory prayer research, they are to be settled empirically if possible or to be left open if not. Arguably all behavioral domains interact, and the spiritual can be seen as a kind of behavioral domain. Scientific knowledge and practical applications of spirituality must begin with the core meaning of spirituality, locate that within particular traditions, and then associate those meanings with outcomes in other domains. This must be so, because the outcomes of scientific interest are, presumably, not spiritual outcomes per se given the traditional meaning of the term. Being saved, feeling the presence of God, reducing one’s karmic debt, or approaching enlightenment are spiritual outcomes. Even if some such outcomes are real, they seem beyond scientific reach. But being less depressed, being more optimistic, recovering more quickly from surgery, being less likely to divorce, use illicit drugs or smoke tobacco are empirically available to study. They are not “spiritual outcomes” in themselves, but they are health outcomes that seem, in many studies, to be associated with 87


spiritual variables such as holding spiritual beliefs, engaging in certain kinds of spiritual activities, or having certain kinds of spiritual experiences. This is the intersection that I suggest we call psychospiritual. This avoids the problem, frequently criticized, of conflating spiritual and psychological variables, but rather it specifies the interaction of these different kinds of variables. Because spirituality, for those who embrace it, is potentially relevant to all aspects of life, there are a great many psychospiritual outcomes available for inquiry. Research has established strong links between spirituality and physical, psychological and medical health (Ai et al. 1998; Helm et al. 2000; Williams and Larson 1991; Koenig, McCullough, et al. 2001; Koenig, Pargament, and Nielsen 1998), most of them positive but some of them negative, depending on the specifics of belief and practice (Koenig, Pargament, and Nielsen 1998). Many of these outcomes are at least in part attributable to the behavioral and social ramifications of spirituality. The influence of spirituality on diet, and therefore nutritional fitness, is another very important topic ranging from vegetarianism to the doctrines of health-conscious religious groups such as Seventh-day Adventists.

ETHNOCENTRISM AND HISTORICAL DISTORTIONS It is sometimes suggested that spirit(s) comprise a Western category and that some traditions, Buddhism being an often cited example, lack the concept. But as long as the definition of spirit is kept simple, this is not a valid criticism. The concept of reincarnation in Buddhism may not involve a concept analogous to the Western idea of a soul in some of its versions, but it nonetheless does involve something invisible and intangible that is a kind of essence of the person that reincarnates. Part of the complexity of this topic is that its point of reference, spirit(s), is contested. The investigator can neither observe spirit nor assume that it exists. But that should not be a unique problem. The field has shown the ability to investigate belief in an afterlife and the consequences of that belief, such as its influence on death anxiety (e.g., Alvarado 1995), without having to take a stand for or against the reality of the afterlife. Religions are institutions organized around the idea of spirit. With this simple definition, the criticism that religion, like spirit, is a culture-bound Western term does not hold up. Scholars have occasionally claimed that Buddhism is not a religion, sometimes on the basis that it is not theistic. Even apart from the fact that much of Buddhist belief and practice around the world does involve gods, clearly Buddhism is an institution organized around such ideas as reincarnation and Nirvana, and it teaches practices that affect the intangible part of the human, the part that progresses or degenerates, the part that approaches enlightenment and Nirvana. Buddhism does fit our definition of religion. 88

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The simple definitions of spirituality and religion work cross-culturally, they certainly encompass the domains that S/RH research seeks to address. They are what most English speakers mean when using the words. Despite the simple definitions, these concepts are multidimensional, and they have many aspects that can be explored. The description of the beliefs, values, and behaviors involved in religion and spirituality is an enormous task. And if one accepts these definitions as referring to a concept that underlies the behaviors of interest in this field, then that does not mean that each survey question about spirituality or religion needs to use the word, any more than every question in a health assessment needs to use the word health. Spirituality under this definition could, for example, be readily explored among people who state sincerely that they “are not spiritual,” just as surely as we could inquire about a person’s affection for his country even if he insisted he was not a “patriot.” Concerns about the difference between spirituality and religion often include the historical assertion that the distinction itself is new. George et al., for example, say that “it is only recently that spirituality began to acquire meanings separate from religion” (2000, 103). The source they cite concerning the forces that pried spirituality loose from religion is Philip Sheldrake’s book Spirituality and History (1998), in which he gives as the basic meaning of spirituality “the theory and practice of the Christian life” (pp. 40-41). This example illustrates why, during times of religious conformity, spirituality—understood as correct or orthodox spiritual belief and practice—would be coterminous with, if not identical to, religion. The development of religious dissent and pluralism lead to a multiplication of spiritual views that, seen from within any orthodox religious framework, will seem eccentric at best and perhaps not “authentically spiritual.” But the idea that spirituality as separable from religion is new in America is simply wrong. As Robert Fuller points out, in the late 1600s, less than one-third of colonist adults were church members, and by the time of the Revolutionary War this had dropped to about 15%. Hector St. John de Crèvecoeur wrote that “religious indifference is . . . at present one of the strongest characteristics of the American people” (cited in Fuller 2001, 13). Nonetheless, the colonists were avidly spiritual in their orientation, engaging in astrology, divination, folk healing practices that were fundamentally spiritual, decried by colonial clergy as wicked and heretical and influenced by the Freemasons (most of the men who signed the Declaration of Independence were Masons) and Rosicrucianism. And during the nineteenth-century movements from Transcendentalism to Mesmerism, New thought and spiritualism flowered in the United States (Fuller 2001, 13-44; see also Butler 1990). Spiritual language was widely used in all of these discourses. And many eighteenth- and nineteenth-century Americans clearly were “spiritual but not religious,” as that phrase is used today. This is important to establish, because there is very evident bias in the S/RH literature toward conventional, mainstream religion. Dismissing the “spiritual but not religious” position as a current (“New 89


Age”) fad distorts what is actually a strong and historically deep spiritual tradition that has been associated with progressive philosophies since before the American Revolution (Schmidt 2005). Here are three potent examples: 1.

2.

3.

Thomas Jefferson (1743-1826), the third president of the United States (1801-1809) and principal author of the Declaration of Independence was a deeply spiritual religious nonconformist. About his own religion he said, “I am of a sect by myself, as far as I know” (Sheridan 1983). Ralph Waldo Emerson was ordained in 1829 and became the junior pastor of Boston’s Second Church (Unitarian). He resigned this post in 1832, going on to launch Transcendentalism, a movement that sought an idealized spiritual state founded on the individual and avoiding the dogmas of established religions. On the occasion of his death, the Dial for May 1882 (Vol. III Chicago) published a brief essay on Emerson. Praising his battle against both the “theoretical materialism” of science and “the practical materialism” of society, it said that “Emerson was the prophet of spirituality. This was the meaning of the Transcendental movement.” In 1893, Swami Vivekananda introduced Hinduism and Yoga to American society through his appearance at the World’s Parliament of Religions at Chicago in 1893. Adopting a traditionally Hindu openness to all religions as paths to God he was, and continues to be, called the prophet of spirituality.

This strand of unchurched American spirituality is what Sydney Ahlstrom has called “harmonial piety” (1972), and its message, summarized by Fuller as being that “spiritual composure, physical health, and even economic well-being are understood to flow from a person’s rapport with the cosmos” (2001, 51) is readily recognizable in today’s “spiritual but not religious” as well in a number of religious messages. This history, in contrast to the common historical assertions made in discussions of S/R terminology, should raise the concern that to some extent the tension between the terms reflects the diversity of theological points of view among investigators and implicit biases for or against religious orthodoxy. I will return to this below, in connection with the S/RH field’s lack of attention to minority religious views. S/RH and Complementary and Alternative Medicine (CAM) SUMMARY: Both S/RH and CAM research have recently emerged among health researchers from a history of neglect, marginalization, and stigma, and both currently strive with considerable success for legitimacy. Basically, all S/R health interventions (not all S/ RH practices) fit the conventional definition of CAM. The best

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quantitative studies of CAM utilization show strong associations between CAM use and use of prayer. Studies of why patients use CAM indicate that a spiritual point of view is among the strongest reasons. Most CAM practices show a variety of affinities to both spirituality and religion. Both S/RH and CAM researchers are engaged in studies of the prevalence, distribution, and health impact of the practices that they are investigating. And both groups are working toward the appropriate integration of the practices they study into clinical medicine. Yet there is a clear and apparently intentional divide between the two research domains. For example, in Koenig et al.’s Handbook of Religion and Health the mention of Eisenberg’s survey research summarized below mentions only the figures on the use of prayer and call the survey topic “unconventional therapies (UT)” citing only the 1993 study which uses unconventional in the title and not the 1998 study which employs the term alternative medicine. The index entry is under “unconventional.” There is only one entry under “alternative medicine,” and this leads one to the statement that public demand for “psychosocial-spiritual care that is not being met by traditional sources . . . has opened the door to a whole host of charlatans and alternative medicine practitioners” (5). Neither the affinities nor the antipathies between these areas are new in America. They are readily traced back to colonial days (Fuller 1989, 2001). Clearly this situation is itself an important area for future social science investigation, and some resolution is of great importance.

The fields of S/RH and CAM are clearly concerned with domains that overlap extensively, yet the fields are populated by distinct communities of investigators who often do not even cite one another and who sometimes show an actual antipathy toward each other’s approaches. This is a serious weakness with important consequences. The first large quantitative study of CAM was Cassileth et al.’s “Contemporary Unorthodox Treatments in Cancer Medicine” (1984). The study, centered on University of Pennsylvania’s oncology clinic, found a surprisingly high rate of utilization of unconventional treatments by Penn’s patients. The study utilized seven treatment categories, one of which was “spiritual,” and of 378 patients, 100 received spiritual treatment (p. 108). The next large quantitative studies were carried out by David Eisenberg et al. at Harvard in 1990 and again in 1997. These two studies (1993, 1998) asked about utilization of 16 well-known varieties of CAM during the past year. The category “Spiritual healing” (by others) received positive responses from 4.2% of respondents in 1990 and 7.0% 1997. “Self prayer” for an illness within the past twelve months got 25.2% positive responses in 1990 and 1997 35.1% in 1997. 91


The inclusion of prayer and spiritual healing reflects the standard definition of CAM that has been implicit since the early 1980s and explicit at least since Eisenberg’s first study and reinforced by the conclusions of an NIH panel in 1995: The broad domain of complementary and alternative medicine (CAM) encompasses all health systems, modalities, and practices other than those intrinsic to the politically dominant health system of a particular society or culture. CAM includes all practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being (O’Connor 1997, 60).

Exclusion from conventional biomedicine is the one defining characteristic shared by all of the modalities that have come to be referred to as CAM. But another element shared by almost all is a strong undercurrent of spirituality. This is even true of many forms of what are ordinarily considered material modalities, such as herbalism. From the traditional Chinese medicine (TCM) understanding of herbal treatments as operating through Qi as well as biochemistry to folk herbalism found in many parts of the United States, the meaning, selection, preparation, and use of botanical medicines is consistently associated with explicitly spiritual concepts. For example, herbalist Norma Meyers says that after 15 years of observing the plants, I have come to believe that herbs work not so much because of biochemistry and nutrition as because of energy fields . . . I have two beliefs that have grown out of feeling the energies of the herbs. The first is that these plants were made by the same Creator that made you and me. I was not a religious person when I first came into contact with the plants. But because of their influence on me I have now become a religious, spiritual person (Conrow and Hecksel 1983, 193-95).

The relationship of “energy” and spirituality in this quote is also common, suggesting the resonance between vitalist theories and spiritual ideas evident in most CAM traditions (e.g., the TCM concept of Qi, the ki of Reiki, Daniel Palmer’s “Innate Intelligence” in chiropractic, the “energetic” aspect of homeopathy, the “human bio-field” of therapeutic touch, and many others). In 1998, John Astin published in JAMA a study addressing the question of “Why Patients Use Alternative Medicine” (Astin 1998). Based on a national sample, this study concluded that the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine

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but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life (1548).

The “holistic philosophy of health” that strongly predicted utilization was “the health of my body mind and spirit are related, and whoever takes care of my health should take that into account” (1551). A second predictive factor obviously associated with spirituality was the statement, “I have had a transformational experience that causes me to see the world differently than before” (1551). The most recent and best data on the strong association and overlap between the S/RH domain and CAM utilization is found in Barnes et al.’s “Complementary and Alternative medicine Use Among Adults: United States 2002.” This study was based on interviews with 31,044 adults, using data from the 2002 National Health Interview Survey (NHIS), conducted by the CDC and the National Center for Health Statistics. It used a more open-ended strategy than the Eisenberg studies, not restricting CAM to the 16 common categories most surveys have used. The study found that when prayer was included, 62% of the sample had used CAM within past 12 months. When prayer was excluded, 36% had. Among the most common varieties of CAM used, five were explicitly spiritual in nature: personal prayer for health (43%), prayer by others (24.4%), participation in prayer group for one’s own health (9.6%), meditation (7.6%), yoga (5.1%). The other five, natural products (18.9%), breathing exercise (11.6%), chiropractic (7.5%), massage (5.0%), and diet-based therapies (3.5%), are often associated with religious and spiritual ideas and groups (e.g., the strong association of Seventh-day Adventism with natural products and diet). Overall, regarding prayer the study concluded that “About 45% of (English-speaking, American) adults used prayer specifically for health concerns during the past 12 months” (Barnes 2004, 6). McCaffrey et al.’s study of prayer for health concerns, also published in 2004, showed further connections between CAM and spiritual practice. That study concluded that an estimated one third of adults used prayer for health concerns in 1998. Most respondents did not discuss prayer with their physicians . . . users reported high levels of perceived helpfulness. (Abstract, p. 858). CAM therapies were associated with increased use of prayer for health concerns. By strength of association these therapies were herbal medicine . . . relaxation techniques . . . guided imagery . . . self-help techniques . . . folk remedies . . . energy therapy . . . and chiropractic (McCaffrey 2004, 860).

One reason for the tendency for S/RH researchers to avoid CAM relates to the salience of “spiritual but not religious” CAM modalities. Therapeutic touch (TT) 93


is a good example. TT, developed in the 1970s by Dolores Krieger, a professor of nursing at New York University, further illustrates this connection and its relevance to issues in the S/RH field. Krieger began studying with spiritual/psychic healer Dora Kunz who perceived “subtle energies” around living beings and believed that they all possessed an innate healing ability. Kunz had studied Oskar Estebany, a Hungarian healer who used laying-on-of-hands and “felt he was a channel for the spirit of Jesus Christ.” Estebany believed his healing was a special gift, but Krieger did not agree. She roughly equated his “healing energy” with qi, Reiki (Japanese), prana (Sanskrit) and other spiritual healing ideas from around world, and developed the specifically nonreligious healing practice that she called therapeutic touch (Krieger 1979). “I became convinced that healing by the laying-on of hands is a natural potential in man, given at least . . . the intent to help heal another, and a fairly healthy body (which would indicate an overflow of prana)” (Krieger 1975, 786). Prana is a Hindu term for Brahman, for the life force and breath, and it is an important concept in yoga. Further evidence of the spiritual and religious ramifications of TT can be seen in some of the opposition to it. For example, Dónal O’Mathúna, Ph.D. (professor of bioethics and chemistry, Mount Carmel College of Nursing, Columbus, Ohio), wrote a negative assessment of TT in the Physician’s Guide to Alternative Medicine (American-Health-Consultants 1999) based on scientific issues, but in the Journal of Christian Nursing, he wrote that the use of TT is wicked and offensive to God because “the Evil One has great powers at his disposal. TT introduces practitioner and patient to a spiritual realm forbidden by God.” Although formal religious healing practices fit comfortably within the CAM definition, the attention of the CAM field seems largely focused on “spiritual but not religious” healing practices such as therapeutic touch, Qigong, Reiki, and so forth. These are the spiritual health practices that the S/RH field largely avoids in favor the religious practices of mainstream Western religious institutions. The contrast between this preference and that found in the S/RH field is readily evident in the comparison between the chapters on spiritual healing found in two popular textbooks on CAM. In Novey’s Clinician’s Complete Guide to Complementary/Alternative Medicine (2000), the “Spiritual Healing and Prayer” chapter is written by psychiatrist Harold Koenig, a leading researcher in the S/RH field. Koenig discusses prayer and epidemiological evidence that religious behavior, such as Bible reading, have positive health effects. The interventions he mentions (“Office Applications,” p. 133) are “prayer and pastoral counseling” and possible support for the patient’s religious or spiritual beliefs. Apart from one reference to a study of Buddhist meditation, the chapter concerns Christian belief and practice. The interpretations that Koenig explicitly favors are those that he calls “local naturalistic” rather than “supernaturalistic” (130-131). 94

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Wayne Jonas and Jeffrey Levin’s textbook, Essentials of Complementary and Alternative Medicine (1999), provides a sharp contrast to Koenig’s approach. Seven of the twenty chapters devoted to particular CAM approaches include spiritual aspects: ayurvedic medicine, Native American medicine, Tibetan medicine, holistic nursing, spiritual healing (Daniel Benor), qigong, meditation and mindfulness. Chapter 21, “Spiritual Healing” is written by Daniel J. Benor, M.D., begins with Benor’s own definition of spiritual healing: “the systematic purposeful intervention by one or more persons aiming to help (an)other living being (person, animal, plant, or other living system) or beings by means of focused intention, by touch, or by holding the hands near the other being, without application of physical, chemical, or conventional energetic means of intervention” (p. 369). The same definition is given in the book’s Glossary. The Glossary further defines spiritual energy as “the cosmic or universal vital force that originates beyond the material level and gives life to physical organisms (p. 583). Religion is not defined in the glossary. In Appendix A, the list of organizations under “Spiritual Healing” includes just four: Barbara Brennan School of Healing, Healing Touch International, LeShan Healing, and Nurse Healers—Professional Associates International, Inc. but no religious healing organizations. The five suggested readings are Benor’s healing Research Vols. I-IV, Brennan’s Hands of Light (1993), Gerber’s Vibrational Medicine (1988), LeShan’s The Medium, The Mystic and the Physicist (1974), and The Qigong Institute’s Qigong Database. Benor’s overview of spiritual healing is focused on subtle energies (including such as Riechenbach’s odyle and Reich’s orgone energy, p. 372). Religion’s role in spiritual healing is discussed historically, but current religious healing is largely absent. Terms such as Charismatic and Christian Science do not appear in the index or Glossary. This book is interesting to compare to the Novey book in this regard. Koenig’s chapter on spiritual healing in the Novey book is devoted entirely to conventional religious healing. A variety of other spiritual approaches is covered in other chapters but is not accessible under spiritual in either the index or the table of contents. In the Jonas and Levin book, in contrast, religious approaches are absent, and it is, roughly speaking, “spiritual but not religious” modalities that are emphasized. Clearly a major source of the division between the S/RH and CAM fields is the contentious division between religion and health and spirituality and health. This is an interesting cultural clash among investigators, apparently reflecting personal commitments as much as anything else since many have similar professional training. But the conflict is unfortunate because it smuggles personal theological commitments into the scientific discourse and prevents the logical integration of these overlapping fields. 95


Dramatic S/R Experiences and Health SUMMARY: During the past thirty years, research on dramatic spiritual experiences, such as mystical experiences and “near-death experiences,” has grown rapidly. Much of the research has been carried out by psychologists and physicians (e.g., Moody [MD], Ring [psychologist], Sabom [MD], Greyson [MD], van Lommel [MD]). Historically, such experiences have been related to medicine by being consistently assimilated to psychiatric symptomatology (Hufford 1985, 2005, 2008a, 2008b). Contemporary research has challenged those assumptions of pathology and has shown new associations with health: (1) some of these experiences are triggered by serious health events, often in medical settings (e.g., near death experiences), and (2) positive impact on emotional health (Rees 1970, 1971; Kass 1991; van Lommel 2001). Yet S/RH research tends to ignore these experiences in favor of more ordinary, daily spiritual experiences (Fetzer 1999). This leaves another gap in the field that parallels the preference for religion over spirituality outside the religious context and avoidance of unconventional topics, even when those topics are receiving serious investigation with studies published in peer-reviewed journals.

In 1975, sociologist Andrew Greeley published remarkable findings concerning dramatic spiritual experiences of Americans, findings that were headlined “A Nation of Mystics” in some newspapers. Greeley’s survey, carried out by the National Opinion Research Center, employed a full national probability sample (N = 1,460) with in-home interviews. One of his questions asked, “Have you ever felt as though you were very close to a powerful spiritual force that seemed to lift you out of yourself?” (35% said “yes”). Greeley used the Bradburn psychological well-being scale (1969) to assess association between these experiences and emotional health and found a strong and positive relationship. My own research (Hufford 1985) has shown that Greeley’s “mysticism question” is effective in identifying near-death experiences (NDEs). The following year, Raymond Moody’s book Life after Life introduced the term “near-death experience” (NDE) and launched a substantial stream of study, much of it carried out by physicians, which linked these experiences to spiritual transformation and psychological health effects (see, for example, van Lommel, 2001 in the Lancet; and the Journal of Near-Death Studies, passim). Greeley also asked, “Have you ever felt that you were really in touch with someone who had died?” 27% said yes, and this response was also strongly associated with better emotional health. This followed an important turning point in grief literature. In 1971, Dewi Rees, MD, published a study in the British Medical Journal showing that compellingly real experiences of a “visit” by the deceased spouse are very common among the bereaved, that they appear normal and are 96

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associated with healthy resolution of grief. By the mid-1970s, these experiences had become well-known in the grief literature. They are obviously spiritual experiences and are often transforming for those who have them (Rees 2001). NDEs and the bereavement “visits” are just two of the spiritual experience categories that are logically appropriate for S/RH study, but that have been largely ignored. The fact that both experiences (and several others) have a clear history of having been used to diagnose serious psychiatric disorders—but have now been shown to be associated with better psychological health (Hufford 1982, 2008a, 2008b)—should be of special interest to researchers! In 1991, Kass and colleagues, published in an article in the Journal for the Scientific Study of Religion titled “Health Outcomes and a New Index of Spiritual Experience,” in which they presented new instrument which they called Index of Core Spiritual Experience (INSPIRIT). The instrument utilized Greeley’s mysticism question and explicitly referred to “near-death experiences.” It linked scores on INSPIRIT, in a sample of medically ill patients, to emotional and medical outcomes. In the Handbook (Koenig 2001) INSPIRIT receives a brief paragraph noting its correlation with religiousness, but there is no discussion of the health implications of the experiences tapped by the instrument. The Handbook also has a section on “Measures of Mysticism” (507-508; Hood 1975; Levin 1993; Mathew 1995) but again discusses the three instruments noted only in terms of their use as indications of religiosity and/or spirituality. This seems to assume that such experiences are a product of belief, but much of the current data suggests the opposite, that these experiences shape and change belief. The Handbook has few other references to spiritual experiences, and where there are such references, they do not refer to the kind of intense experience discussed above. For example, in a section of “Religion and Immune Function” the study cited which investigated “religious experience” used watching a film about Mother Teresa as the “religious experience” (288). The documented relationship of intense, even mystical, spiritual experiences to health should make them of great interest in S/RH research, but that is not the case. Literature searches in PYCHInfo and MEDLINE for the fifteen-year period since the Kass article introduced INSPIRIT in conjunction with health outcomes yielded only six studies (Dedert 2004; Springer 2003; Hodges 2002; Baider 2001; McBride 1998; VandeCreek 1995), although there were thirteen dissertations. My initial searches on S/RH yielded only three references to “spiritual experience.” Two of those referred to “the experience of being religious,” and one used the Fetzer-NIA instrument with its Daily Spiritual Experience subscale. The Fetzer-NIA Daily Spiritual Experience section states that it is intended to “assess aspects of day-to-day spiritual experience for an ordinary person, and should not be confused with measures of extraordinary experiences (such as near-death or out-of-body experiences) which may tap something quite different and have a different relationship to health outcomes” (11). The instrument does not contain any 97


measures for the extraordinary experiences, except for the ambiguous “Have you had a religious or spiritual experience that changed your life?” (68) The ambiguity of this item is underscored by the authors’ comment “The origin of these items [about life changing experience] is unclear . . . Researchers disagree about what these items measure,” but they do go on to state that “further research regarding . . . life-changing religious/spiritual events is highly recommended” (66). My analysis of the literature strongly supports their statement! Minority Religions Including Roman Catholicism, the “Spiritual But Not Religious,” and “Folk Religions” SUMMARY: It is widely recognized that the S/RH literature is focused on mainline denominations of Protestant Christianity. This has deflected attention from several areas of importance in health research: the ancient and vigorous Roman Catholic tradition of liturgical healing and healing through the intercession of the saints; and most S/RH researchers have shown a negative bias toward the health ideas and practices of the “spiritual but not religious,” and the S/RH issues in “folk religion.” Taken together, these trends underemphasize the S/RH beliefs and values of more than half of all Americans!

It is not surprising that Protestant Christianity receives most of S/RH researchers’ attention. Christianity is the dominant religion in the United States, and Protestants are the largest religious group, generally reported as somewhat more than 50% of the entire population. However, the practice of aggregating most non-Catholic Christians under the heading Protestant is questionable, resulting in a category that is very diverse demographically and doctrinally. If the specifics of S/R belief are important (and if the entire domain is important the specifics seem likely to be also), then the collective categories of Christian and Protestant should be disaggregated. When this is done, one finds that Catholics are the largest group, at about 24% compared to Baptists, the next largest denomination, at about 16% (Adherents.com, 2005 [accessed]), making Catholicism the largest religious group in America. CATHOLICISM: Catholicism has the longest continued tradition of spiritual healing and commentary on medical practice of any branch of Christianity in the world. Its theology and traditions of practice are very distinct. And since the development of the Charismatic movement in Catholicism in the late 1950s, Catholicism also includes most of the healing practices found in other Christian denominations. Catholicism is also recognized as having exerted major influence in a number of medical policy areas such as reproductive health and end-of-life care. Catholics are often included in epidemiological studies, but studies of distinctively Catholic healing practices, such as pilgrimages linked to devotion to the saints, 98

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are largely absent from the S/RH literature. My MEDLINE searches yielded only four references citing Catholicism (Kemkes-Grottenthaler 2003; Latkovic 2001; Panicola 2001; Ryan 2003), and none of these referred to distinctive Catholic spiritual practices. Although the Handbook (Koenig 2001) has numerous entries under Catholicism, it mentions pilgrimage, a major and well-known aspect of Catholic healing practice, only five times. Four of these five references marginalize or stigmatize the practice. The first is in the historical timeline referring to Lourdes (46), another is under “faith healing” referring to pilgrims at Lourdes as “desperate” (55), and a third is in connection with two “debunking” books on religious healing (Rose 1971; Nolen 1974) (64). But then, remarkably, there are two mentions of the only study of Catholic pilgrimage noted in the book, Morris’s 1982 study, which, using the Beck Depression Inventory, found that a group of chronically ill pilgrims to Lourdes went from “mild depressive symptoms to virtually no symptoms” at ten-month follow-up (132, 152). Millions of Americans and others visit healing shrines in the Americas and Europe every year, and there is a large literature on pilgrimage in the social scientific study of religion and among religion scholars. The differences between “faith healing,” and these Catholic practices are substantial. My own ethnographic work on pilgrimage suggests that the majority of pilgrims find support in coping with illness, and many explicitly deny that they are primarily concerned with the possibility of a miraculous physical healing (Hufford 1985b). Yet even Pargament’s excellent book on religious coping (1997) has only a single reference to Catholicism and coping, and that involves Catholic Charismatic practice. The rich and varied healing practices of Catholics offer a major opportunity for S/RH research, but have as yet received very little attention. SPIRITUAL BUT NOT RELIGIOUS: To return to the prevalence of spiritual viewpoints in America, I have already noted that Catholics are about 24% of Americans, and Baptists, the next largest denomination, are about 16%. Surveys estimate those who say they are “spiritual but not religious” in the range from 20% (Blum 2001) and 30% (Gallup-Organization 2001), and 33% (USA/Gallup Poll 2005), making the spiritual-but-not-religious either the largest spiritual group in America, or second only to Catholicism. It has been suggested that this group is a mere hodgepodge of uninformed opinions, defying analysis. It has also been assumed that this group represents a recent development in American spirituality. I have already discussed the historical depth of this viewpoint in America above. Historians and religious studies scholars have also shown that within this group there are consistent themes and shared values (Batson 1976; Ahsltrom 1972; Fuller 1989, 2001). Despite the salience of the spiritual-but-not-religious group in America, the S/RH literature tends to disparage this viewpoint. The Handbook refers to this form of spirituality as “unmoored spirituality” in contrast to “spirituality moored to an established religious tradition” (18). The authors subdivide spirituality categories in a way that results in a low estimate of this group’s size and illustrates it with 99


references to crystals, astrology, and Shirley MacLaine (19). And George et al. in 2000 stated that so long as most individuals do not distinguish between religion and spirituality [DH: I have already presented data showing that most do.], separating these concepts operationally will be impossible. Of course, we can study individuals who report that they are spiritual but not religious—there are a few studies of this kind (e.g., Legere 1984; Roof 1993). But such studies will not generate distinct, broadly applicable measures of religiousness and spirituality. (In theory, we could also study individuals who describe themselves as religious but not spiritual, but research suggests that the numbers of such persons are too small for meaningful analysis.) (104).

The bias against “unmoored spirituality” appears linked both to problems defining the terms spirituality and religion and to the disconnect between S/RH and CAM research noted above. The practices of the spiritual-but-not-religious are often those linked to CAM in the literature. But it is important to note that many of the core spiritual practices of this group are also found among church members, constituting a sort of “folk religion” level that has always existed within congregations despite the best efforts of clergy. Based on my own fieldwork and a careful examination of survey data, it seems certain that some who self-identify as spiritual-but-not-religious attend some variety of services regularly, and some would even indicate a denominational affiliation or preference if asked (Pew 2009). FOLK RELIGION AND HEALTH: Folk religion is comprised of “unofficial” religious belief and practice, the religion of congregation members as distinct from the religion of theologians and clergy. Folk religion is found both within all religious institutions, and also among people who are not formally affiliated with any specific religion. It is not the peculiar property of any particular demographic (Yoder 1974), and it should all be of interest in S/RH. Nonetheless, most scholarly attention has been focused on immigrant communities. The religious and health beliefs of ethnic minorities and new immigrants currently receive substantial attention in the medical and nursing literature and training in cultural competence has been mandated for medical education. A recent editorial in The New England Journal of Medicine noted “pronouncements by the Institute of Medicine and the American medical Association, among other organizations, that cultural competence is necessary for the effective practice of medicine,” and that religion, of course, is an aspect of culture (Betancourt 2004). All works about diverse cultural groups written for health professionals include prominent attention to the religious dimension and the closely related “folk medical” practices of each group. One of the most noted recent publications on the topic of 100

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cultural diversity and health care was Anne Fadiman’s The Spirit Catches You and You Fall Down: A Hmong Child and Her American Doctors, and the Collision of Two Cultures (1997), which focuses on tragic medical outcomes that center on differences in spiritual belief between the parents of the patient and her doctors. This case, which is factual, is similar to several other cases that have gained prominence in the national media over the past ten years. Cross-cultural research on religion and health comprises a long-standing research domain in anthropology that could be an important area of S/RH collaboration, especially since much of the work has focused on the operation of religious healing traditions such as the Afro-Cuban santeria and curanderismo(a) as a mental health resource within certain neighborhoods (Baez 2001; De Cupere 2001; Forman 2000; Gomberg 2003; Hunt 2000; Luna 2003; Najm 2003; Padilla 2001; Trotter 2001; Tsemberis 2000). Yet my S/RH search in MEDLINE yielded only one article published since 2000. In the Handbook there is almost no mention of these religious groups, and where they are noted the references are implicitly negative. This is an area of S/RH that clearly has health consequences, that requires both study and the development of ethically sound interventions, and that is supported by most major medical and nursing education organizations. It is not necessary to consider these religious beliefs and practices as positive forces in health, although cultural competence would suggest that we ought not assume the opposite either! But whether their effects are a net positive or negative value regarding health outcomes, there is no doubt that they do have such effects and that those effects are investigable. Yet this topic has received almost no attention in the standard S/R/H literature. Description The S/RH field suffers from several gaps in description. The specific beliefs of S/R groups and their particular effects on health have received cursory treatment. Beliefs tend to be described globally (e.g., “belief in God”), and in general, though often included in survey instruments, belief has not received much attention as a specific variable. For example, George et al. note that the Fetzer/NIA conference group that developed the Fetzer/NIA multidimensional measurement “did not recommend” religious/spiritual belief “as particularly important for understanding the links between religion/spirituality and health” (2000, 106). Although the relationship of prayer to various health measures has frequently been investigated, the S/RH literature devotes little attention to the specifics of prayer belief and practice, although there is solid social science research that suggests the scope, variety, and importance of the distinct forms (Poloma and Gallup 1991). Also, the very high prevalence among Americans of the belief that healing prayer is effective (e.g., the Princeton poll published in the March 31, 1997, in Newsweek found 101


that 87% believe “that God answers prayers,” 82% “ask for health or success for a child or family member when they pray,” and 79% say God answers prayers for healing someone with an incurable disease) has elicited little attention among S/ RH investigators. Clearly, beliefs about the efficacy of prayer comprise a major perceived resource among American patients, and the impact of that belief must influence both decision-making and coping. Certainly a great deal of religiously motivated noncompliance with medical regimens stems in part from these beliefs, and there is good reason to associate these beliefs with coping behaviors also. But the specific beliefs themselves and the ways that patients arrive at and maintain those beliefs have received very little attention in the S/RH literature. The Fetzer/ NIA instrument section on “Beliefs” has seven questions, and all but one (“Do you believe there is life after death?”) are general, largely metaphysical beliefs (e.g., “God’s goodness and love are greater than we can possibly imagine,” 1999, 32). Although several studies have supported the connection of specific beliefs to mental health (e.g., Alvarado 1995; Schafer 1997), the description and utilization of specific beliefs in an understudied area in S/RH. Quality of life (QOL) is a kind of medical outcome that might be expected to be especially open to S/R effects, and QOL is a topic that requires a combination of quantitative and qualitative approaches by definition. QOL studies in S/RH are beginning, especially among cancer patients (Brady 1999; Carlson 2003; Demierre 2003; Tate 2002), but QOL has not yet received the attention that it deserves. The lack of belief description is related to the lack of ethnographic, qualitative, and historical work within the S/RH literature, because these forms of scholarship are heavily committed to description. When such methodologies are noted in the contemporary S/RH literature, it is typically assumed that their usefulness is largely for the generation of hypotheses (e.g., Koenig et al. 2001, 482). Although they are useful in this way, they are also very helpful in extending and clarifying the findings of quantitative studies and as studies in their own right (Press 2005). Often called the “mixed method” approach, this would be enormously helpful in S/RH! Assessment of S/R in Health Settings If the spirituality-religion-health connections, whatever they may be, are to have clinical importance, then some information about the patient’s S/R will have to be elicited. This much should be noncontroversial. If a patient is a Jehovah’s Witness, it is important to know that. And if they are, it will be important to know whether they accept the denomination’s total rejection of blood and blood products or, as for some patients, whether they reject only whole blood, or whether they are undecided. If a patient wishes support from a member of the clergy but is not a current member of any religious denomination, it is important to know that. Given that it has been documented that most American patients want S/R issues raised at appropriate times (Ehman 1999; MacLean 2003), and that physicians rarely raise 102

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them (Monroe 2003), it seems that the development of an efficient, sensitive, and effective means of S/R assessment is a pressing need. Furthermore, the JCAHO and the Committee on Accreditation of Rehabilitation Facilities (CARF) have now mandated spiritual assessments for health care institutions. Spiritual assessment has been widely discussed and practiced in nursing for years. In fact, in the United Kingdom , “the view that nurses should be competent to assess the spiritual needs of patients . . . is so widely accepted that it is expressed as a requirement for registration (UKCC 2000)” (Draper 2002, 1). Given the amount of time and effort that has been put into developing S/R measures for research, it seems that the resources for developing reliable and valid assessment tools are readily available. For these reasons, it is surprising to see how little rigorous development has taken place! Although the Handbook (Koenig et al. 2001) discusses clinical applications for doctors, nurses, and others, including taking a religious history (441-447), the discussion seems to assume some that assessment is linked to some degree of spiritual intervention. This ranges from “Support or Encourage Religious Beliefs” (441-442) and “View Chaplains as part of the Health Care Team” (442) to “Be Ready to Step in When Clergy Are Unavailable” (442-443)” to “Use Advanced Spiritual Interventions Cautiously” (443). But it seems that no research is cited that directly relates to assessment itself, as opposed to patient’s interest in spiritual intervention or the care provider’s willingness to raise spirituality as a topic. For clinical use, it would seem that some aspect of “spiritual need” should be a feature of assessment, but neither term appears in the index of the Handbook, and my combined MEDLINE searches yielded only five references to “spiritual need” or “spiritual distress,” only one suggested an assessment tool, but it offered only an educational framework for such a tool (Narayanasamy 2004. ASSET). Most of the assessment tools that have been published in the S/RH literature have not been tested (e.g., Anandarajah, HOPE 2001; Galek 2005), although most authors’ publishing assessment tools seem to hope for research on them. Puchalski (2000) states that she has trained “roughly 4,000” people in one-and-one-half- to two-hour workshops in the use of her FICA spiritual assessment tool. She also says that she has instruments for the evaluation of the various aspects of the FICA, but “we’re just beginning those studies” (Puchalski 2000, 134-135). However, my 2005 MEDLINE search on Puchalski found no reports of studies evaluating this tool. The importance of rigorous research on the proposed assessments is underscored by Koenig’s comment that “simply taking a spiritual history is often the intervention” (2001, 30), and others have suggested the same thing (e.g., Puchalski 2000, 2004). These are strong empirical claims, and only systematic research can evaluate them. This aspect of S/RH would benefit from a closer association with the instrument development efforts described above. The development of S/RH assessment would also benefit from being linked to the current efforts to develop cultural assessments, of which S/R assessment would seem to be a logical part. 103


Personnel: Who Should Provide Attention To S/R In Health Settings? The issue of who should provide S/RH assessment and/or “intervention” in health care settings has been a subject of some controversy. Nurses have generally assumed that this is at least at times a nursing task. Some nurses have called this assumption into question (Draper 2002, 1), while others have vigorously defended it (Swinton 2002). The same is true now in medicine, as illustrated by the responses to Anadaraja’s publication regarding his HOPE assessment tool (Anandarajah 2001). In the same issue of American Family Physician, Harold Koenig endorsed the role of the physician in doing spiritual assessment, stating that “while providing spiritual advice or direction is best left to the chaplain or the patient’s clergy, the spiritual assessment should not be left to others” (2001, 30). Also in the same issue of AFP, Richard Sloan and Emilia Bagiella argue that “the absence of compelling empiric evidence and the substantial ethical concerns raised suggest that, at the very least, it is premature to recommend making religious and spiritual activities adjunctive to medical treatments” (Sloan 2001). It seems intuitive that the issue of who delivers any sort of assessment or intervention (and in what role) will make some difference in the activity’s impact. Furthermore, there is a substantial history now both of faith-based organizations delivering biomedical health care (Westberg 1984) and of a variety of providers delivering S/R assessment and “interventions.” It is surprising, therefore, that so little research has been done on the question of who can and should deliver which S/RH activities. There has been some evaluation of health programs operated by or through faith-based organizations. A literature review conducted in 2004 described twenty-eight such programs that reported effects and found evidence to support their effectiveness (DeHaven 2004). However, given the number and variety of such programs, much more research is needed. The Parish nursing concept, initiated by Rev. Granger Westberg, combines health care with spiritual orientation, and there are now at least hundreds of parish nurse programs around the country. And yet my combined MEDLINE search found only a single reference to Parish nursing, and the Handbook states that “there is almost no research on how successful parish nurse programs have been” (Koenig et al., 2001, 475). Of course, chaplains have the longest record of providing spiritual interventions. Modern hospital chaplaincy dates from the 1920s when Clinical Pastoral Education (CPE) started in a mental hospital in Worcester, Massachusetts, largely through the work of Anton T. Boisen and Richard C. Cabot. As Sloane, van der Creek, and several colleagues recently noted in a letter to the New England Journal of Medicine in 2000, CPE-certified chaplains are present in health care specifically to provide such spiritual care as is needed. Chaplaincy practice is the primary “spiritual 104

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intervention” found in the American health care system, so we might have expected S/RH research to be heavily focused on Chaplaincy, but it is not. In 1987, Elisabeth McSherry, M.D., called “appropriate measurement and research” critical for “patient care and chaplain department survival” (McSherry 1987, 3, 10-11). In 2001, Koenig, Larson, and McCullough described the financial pressures and dwindling support for hospital chaplaincy programs and stated that systematic research is necessary to reverse this trend (451-453). They called for the efforts of chaplains to be supplemented by “outside institutions to provide expertise on study design, project operation, and data analysis” (453). Both McSherry and Koenig et al. call for the development of modern, valid, and appropriate measurement techniques. And yet my combined MEDLINE S/RH search from 2000 to the present yielded only twenty-five references to chaplains. Among these twenty-five chaplaincy references, nineteen were from a single special issue of the Journal of Health Care Chaplaincy. Most of these noted the need for chaplaincy to “become more scientific,” but also expressed concern that this could lead to what one author called “ministry by the numbers” (Millspaugh 2002). Many expressed concern for an overreliance on quantitative research methods, posing the question for chaplaincy of “What actually constitutes acceptable evidence, who decides, and why?”) (Swinton 2002). The challenge, as described by W. J. Baugh, is to answer this question: “Are there true definable outcomes that can be validated when our primary task is dealing with matters of the heart and soul?” (2002, 11) The remaining six articles came from other issues of that journal or one other pastoral care journal. Although four of these articles make reference to the “discipline for pastoral care giving” (“a discipline-based, outcome-oriented model for chaplaincy”; Lucas 2001), none report actual studies utilizing this model or any other objective research tool. Judging from these articles and other work with chaplains, there is a legitimate concern for qualitative and ethnographic research to balance quantitatively oriented research tools and designs. Resistance within the profession, which must partially account for the lack of research in the field, suggests that sensitive and chaplain-specific tools, complemented by sophisticated qualitative research methods (the mixed method approach), are needed. Since chaplains are trained religious professionals who are already located in many health care settings, who have accreditation and certification procedures in place, and who work as liaison to other clergy in the community, they ought to be the first line for providing spiritual assessment and interventions. There are not enough chaplains to provide all of the S/ RH care for which patients have expressed a desire, but rigorous outcomes research showing that chaplaincy care is effective would be a crucial step in increasing their numbers. It seems, therefore, that the lack of such research is a glaring omission in the S/RH field. 105


Informatics Information science, or informatics, is of enormous importance in today’s scientific fields. The high volume of research publications, the growing interdisciplinary links, and the rapid rate at which new information is developing, coupled with new methods of digitally storing, organizing, and retrieving that information in relational databases, have placed informatics at the center of scientific work. Informatics is a kind of scholarship and relies heavily on additional scholarship from many fields. Spirituality and health as a field has largely relied on existing informatics structures, such as MEDLINE, and these are inadequate for the organization and accessioning of this unique body of materials. Efforts to work within this structure have resulted in ad hoc conceptualizations and nomenclature that further impede a coherent picture of the topic. As the searches done for this analysis have shown, MEDLINE attempts to act on the difference between spirituality and religion, but the attempt fails because the distinction and the apparent boundaries of the spirituality category are not yet developed in a coherent and valid manner. For example, in MEDLINE “homeopathy” and “Medicine—Traditional African” are included under spiritual therapies. But in the articles returned in my 2000-2005 search, none of the homeopathy articles and very few of the African articles included any explicit spiritual reference. It is certainly true that much traditional African medicine has spiritual roots. It is also true that the vitalism implicit in homeopathy has a resonance with spiritual ideas. But that does not make it useful to equate these terms with “Spiritual Therapies.” Another problem is the inclusion of “Faith Healing” as the sole religious healing reference under Spiritual Therapies. This is another indication of the need for greater linguistic and cultural sophistication. At the same time that much extraneous literature was returned in my S/RH searches, many pertinent items were omitted. In part, this is because inclusion of periodicals in MEDLINE is based on overall medical relevance, and many of the journals that publish S/RH studies do not publish enough other studies relevant to medicine to qualify for inclusion. MEDLINE is helpful but not adequate for spirituality-religion-health-outcomes searches or general S/RH searches. Similar problems exist in the other major informatics source for the field, Koenig et al.’s Handbook of Religion and Health (2001). Although this is the most complete reference work available on the literature of spirituality and health, its organization and access tools are inadequate. For example, the 1,600-plus studies located for the Handbook are listed in a bibliography and also listed in an appendix by health outcome, with a concise characterization of design and a numerical score for study quality (pp. 513-589), but there is no way to directly locate any of them in the text of the book. There is no author index, and the bibliography does not carry any indication of where in the book each listed publication is 106

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discussed. It is necessary to use chapter titles and visually scan the text in the effort to locate citations. So the commentary in the book is accessible more as in a textbook than a reference work. Similarly, Pargament’s thorough treatment of the psychology of religious coping (1999) is organized as a textbook rather than a reference work. The Handbook also illustrates some of the language problems noted above that arise when science is decoupled from scholarship, in this case inappropriate word usage implicitly advancing controversial views. In discussing a study of bereavement behavior, the authors say that “the most prevalent belief expressed in the study was spiritualism (the belief that there is a spirit that occupies the body and that leaves the body at death)” (342). This definition is simply wrong in a very misleading way. Spiritualism, the practice of systematically communicating with the spirits of deceased persons, often through mediums, is found in many cultures around the world and enjoyed considerable popularity in the nineteenth century in the United States and Europe. Although several kinds of spiritualism are common in the United States, spiritualism is still a highly stigmatized practice except in a few communities where it is a part of folk religious practice (e.g., Haitian Voodoo, Cuban Santeria, and Puerto Rican Espiritismo). Although a variety of forms of spiritualism are popular throughout Latin America, combining nineteenth-century European spiritualist teachings (Kardecism), with indigenous religions, the traditions of enslaved Africans, and Catholicism, most Christian teaching in the United States rejects spiritualism as contrary to Divine Law. The Handbook definition is not simply mistaken, it serves to stigmatize one of the most widely held spiritual beliefs in the world, a belief common to the vast majority of Christians: the belief in a human soul and afterlife. Ironically, the most widespread spiritualist religions in the United States, primarily found among Caribbean immigrants, are almost entirely absent from the Handbook! The point is not the validity of the authors’ implicit theological point, but rather the way in which word usage carries a great deal of hidden freight. As these examples show, the meanings of words, implicit and explicit, are central to the conduct of valid research and analysis. Because the field of spirituality and health lacks a well-established scholarship that carefully attends to language, these debates over basic spirituality issues lack conceptual clarity and focus. The solution is to recognize the language of spirituality and health as a major aspect of the field itself and to ground an understanding of that language in a rigorous empirical manner, utilizing the expertise of those disciplines that have studied such issues over the past century. While an area of research in its own right, such language work is also crucial for the development of a solid, coherent, and accessible informatics infrastructure for the field. Priority needs to be given to the development of S/RH databases and bibliographies, including the concordances and other tools that such an enterprise entails. 107


STRENGTHS OF THE FIELD OF SPIRITUALITY AND HEALTH RESEARCH By characterizing the following eight areas as strengths of the field, I mean that in each domain serious investigators have produced a substantial body of published work, that methods are becoming more rigorous, and that generally the field is moving in the right direction. I do not mean that in any of these areas the field is fully mature, but that is not to be expected in such a relatively new area of research. Publication Trends The strength of the field at present is perhaps best shown by the fact that between 1990 and the year 2000, the number of references in a 1-year search of MEDLINE rose almost 5-fold (from 50+ to 250+) for spiritual and spirituality and roughly doubled (from 300+ to 700+) for religion and its cognates. The increase was such that MEDLINE began adding more journals in the subject area (as a result, subsequent increases are not comparable). Similar increases have occurred in the general literature. A search of Gale’s Onefile, by 5-year intervals from 1985 through 1999, showed for religion a rise from 2,211 (1985-1989) to 6,497 (1995-1999), and for spirituality from 323 to 929. “Across the board . . . surveys confirm a remarkable rise in spiritual concern” (Gallup and Jones 2000, 27) During the 1990s, special spirituality and health sections or editions of scientific journals appeared, including the American Journal of Physical Medicine and Rehabilitation, Annals of Behavioral Medicine, the Journal of Contemporary Criminal Justice, the Journal of Health Psychology, the Journal of Marital and Family Therapy, Psycho-oncology, and Twin Research. Substantial publication in a broad array of peer-reviewed journals is the mark of a maturing field, and this has been achieved by spirituality and health. There is no doubt that medical researchers, physicians, nurses, and the general public have a strong and growing interest in spirituality and health. This publishing activity includes a variety of materials from editorials to original research to reviews and metaanalyses and practice recommendations. The bulk of the research is comprised of epidemiological studies relating Protestant Christianity to a variety of health outcomes. Cross-sectional studies still comprise the greatest part of the literature, but a growing number of longitudinal, prospective, and even experimental studies are now being produced. Physical Health and S/R Associations Are Supported by Improved Study Design and Evaluation The field has reached the point at which reviews of the literature, some of them quite sophisticated, are helping to assess trends. In 2002, Townsend and colleagues published a review of “all RCTs published from 1966 to 1999 and 108

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all non-RCTs published from 1996 to 1999 that assessed a relationship between religion and measurable health outcome” (Townsend 2002, 429). Excluding studies that dealt with “non-religious spirituality, ethical issues, coping, well-being, or life satisfaction” the authors concluded that “religious activities appear to benefit blood pressure, immune function, depression, and mortality.” (The exclusion of “non-religious spirituality” is typical of the literature and is one of its weaknesses.) This generally supports the conclusions of the very large review that forms the basis of The Handbook of Religion And Health (Koenig et al. 2001). George and colleagues, in the same year, reviewed research on the relationship of religious involvement “with better physical health, better mental health, and longer survival,” paying special attention to the role of “health practices, social support, psychosocial resources such as self-esteem and self-efficacy and belief structures, such as sense of coherence” (George 2002, 190) and the ability of these mediating factors to account for the variance observed. They concluded that these psychosocial factors do not by themselves account for all of the effects reported. The following year, Seeman and colleagues examined potential biological mediators and reached a similar conclusion in a review that added experimental studies of meditation (Seeman 2003). In the same special issue of American Psychologist, Powell et al. carried out a review that excluded all studies that lacked controls for potential confounders, which were cross-sectional, that employed inadequate measures (either S/R or health), that lacked statistical analysis, or that utilized cohorts previously reported on. In this conservative review that graded the studies for design and required multiple supports for the hypotheses considered, the authors concluded that “in healthy participants, there is a strong, consistent, prospective, and often graded reduction in risk of mortality in church/service attenders. This reduction is approximately 25% after adjustment for confounders. Spirituality protects against death largely mediated by the healthy lifestyle it encourages . . . there are consistent failures to support the hypotheses that religion or spirituality slows the progression of cancer or improves recovery from acute illness . . . The authors conclude that church/service attendance protects healthy people against death” (Powell 2003, 36). The rigor of this review is important in that it begins to provide specificity and discrimination among the various hypotheses entertained in the field. The lack of support for the effect on cancer progression is especially important given widespread speculation on this subject for at least several decades, both within medicine and among the public. Neither the positive nor the negative conclusions can be considered definitive, and the review calls for more rigorously designed studies. But it is important that the body of studies and the methods developed for assessing them has progressed to this point of specific, if tentative, conclusions. A further strength in the current literature is the appearance of some well-designed studies that go beyond the Judeo-Christian tradition. This not only adds diversity and better grounds for generalization of findings, it also supports research on interventions, such as yoga and meditation, that are more amenable to experimental design than 109


are church attendance or self-prayer. Examples are Mindfulness Meditation in the treatment of psoriasis (Kabat-Zinn 1998), yoga for carpal tunnel syndrome (Garfinkle 1998), and Transcendental Meditation in the treatment of mild hypertension in a sample of African American males (Schneider 1995). The addition of more specific biological health measures is another indication of maturation in the field. For example, changes in salivary cortisol as a stress marker were measured in response to Transcendental Meditation among cancer patients (Carlson 2004; Carlson 2003), and in relation to measures of spirituality and religion among HIV patients (Ironson 2002). In 1999, a conference on psychoneuroimmunology and religion was held at Duke University, and out of that conference, The Link between Religion and Health: Psychoneuroimmunology and the Faith Factor (Koenig 2002) was published, further advancing the concept of biological markers of stress and immune system function. One final aspect of methodology in the field that I consider a strength—although many others consider a great weakness—has been the willingness to undertake systematic study of the belief that intercessory prayer can affect health through pathways currently unknown to science. Although first investigated by Francis Galton in 1883 in his Inquiries into Human Faculty and Its Development (277-294), it was not until the 1960s that a blinded and controlled trial, albeit with small numbers, was attempted (Collipp 1969). Almost another twenty years passed before cardiologist Randolph Byrd tried such an experiment with reasonably large numbers of subjects (Byrd 1988). With subsequent studies (Harris et al. 1999; Aviles et al. 2001; Krucoff et al. 2001; Cha et al. 2001, among others) has come growing controversy. Criticisms have ranged from statistical issues and ethical challenges (Sloan 2000; Sloan 2001; Sloan 2001; Sloan 2002; Sloan 1999), to implicit theological objections (Chibnall 2001), to accusations of fraud in one case. The criticisms are interesting, reflecting as they do the highly charged emotional and cultural issues touched on by such studies, and the statistical challenges have scientific merit but not are not definitive. Why, then, count these studies as a strength of the field? Because beliefs in the efficacy of prayer, apart from conventional psychological pathways, are beliefs that make an empirical claim. The metaphysical dimensions of such claims (e.g., divine intervention) may be beyond scientific inquiry, but the claim that when prayers are uttered certain things become more likely is an empirical claim that must be investigable. And given the very widespread public belief in intercessory prayer as capable of operating by spiritual as well as other means, it seems reasonable and an indication of open-mindedness in the scientific community that some researchers will give the subject a try and that some editors and peer reviewers will look thoughtfully at the results. The results of such studies will always be subject to some constraints on interpretation. This is especially true for the typical designs employed so far. In particular, the studies “apply prayer” in ways that seem quite different from actual practice, and they do not give enough descriptive information for one to fully evaluate the intervention. There is a basic 110

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asymmetry in this problem: these limitations would only detract from negative, not positive, findings. This has been acknowledged in some of the studies reporting no effect. For example, in 2006, Herbert Benson and colleagues published the “Study of the Therapeutic Effects of Intercessory Prayer (STEP) in Cardiac Bypass Patients” in the American Heart Journal. This was a large multicenter study that enrolled 1,802 subjects. The study employed a complex, three-arm design, and it found no benefit for intercessory prayer in terms of complication rates for the CABG surgery. But in conclusion the authors granted that the finding that intercessory prayer, as provided in this study, had no effect on complication-free recovery from CABG may be due to the study limitations . . . Private or family prayer is widely believed to influence recovery from illness, and the results of this study do not challenge this belief. Our study focused only on intercessory prayer as provided in this trial and was never intended to and cannot address a large number of religious questions, such as whether God exists, whether God answers intercessory prayers, or whether prayers from one religious group work in the same way as prayers from other groups (942).

This is a prudent and rigorous position for the study authors to have taken. Together with the other studies, though, it does raise the question of why there have not been efforts to more carefully study prayer for healing as it actually occurs in the community. Nonetheless, it seems possible in principle to develop sufficiently rigorous designs such that a robust positive effect would be detectable if present. This is what I see as a strength, a bold willingness to experiment with novel efforts to bring together science and religion. Even the controversy indicates strength, and we should watch with interest to see whether advocates of these experiments can produce compelling results. We shouldn’t expect single definitive experiments that change all minds at once, but we are already seeing the evolution of thought on the subject, pro and con, and that is a good thing for intellectual inquiry. Mental Health and S/R Despite Larson’s early work on religious variables and mental health included in psychiatric journals but not commented on (Larson 1986; Larson 1992), research in S/R and mental health has not kept pace with physical health studies, or has tended to be subsumed within studies of coping, well-being, life satisfaction, and so forth. For example, in a (nonsystematic) review article based on data extracted from the review of 1,600 studies done for The Handbook of Religion and Health (2001), Koenig, Larson, and McCullough state that “nearly 850 studies have been conducted in medically ill patients or older persons with chronic disabilities,” and they conclude that “religious 111


involvement appears to enable the sick, particularly those with serious and disabling medical illness, to cope better and experience psychological growth from their negative health experiences, rather than be defeated or overcome by them” (Koenig 2001). In contrast to the literature on S/R and mental health among the physically ill, Koenig et al. (2001) found only sixteen studies involving religion and severe mental illness (216-217). Of those only two were clinical trials and both involved small numbers (28 and 20). As important as the mental health of the physically ill and disabled is, this approach leaves a gap in the literature. As Corrigan et al. note, while numerous studies relate “religiousness and spirituality with health and well-being, far fewer studies have examined this phenomenon for people with serious mental illness” (Corrigan 2003, 487). However, studies are now beginning to address S/R in the context of serious psychiatric illness (Baetz 2002; Corrigan 2003). It should also be noted that the numerous publications throughout the twentieth century suggesting strong religious belief as either a sign of or risk for psychotic illness (for example, Dittes 1971; Clark 1981; Watters 1992) have now been subjected to the same kind of careful review and criticism as positive religion and health studies are, and as a group they have been shown to be scientifically weak, inconsistent with other findings (for example, Wilson 1998), and lacking in valid causal attributions (Koenig 2001, 156-165). Coping Kenneth Pargament’s The Psychology of Religious Coping: Theory, Research and Practice (Pargament 1997) reviews the psychology of religion literature on coping behaviors and places them within a rich setting of theory and practical application. Although religious coping does not always involve explicit health outcomes, a review of the studies summarized in the book reveals that the largest category of challenges to coping that have been studied is comprised of illness, injury, disability, and death. That, together with the fact that ability to cope is a mental health parameter, makes religious coping a central domain of religion and health research. Pargament’s book documents a wide array of research that predicts and describes ways of religious coping, and in his chapter on “Religion and the Outcomes of Coping,” he summarizes the research as follows: “The sizes of the religious effects of most research studies are fairly modest . . . (But) In the majority of studies, across diverse groups dealing with diverse problems, religious coping emerges as an important predictor of adjustment” (p. 312). Coping is a complex construct. In a sense, anything one does that helps (or is intended to help) deal with a problem could be considered coping, but such a definition would render the concept almost meaningless from a research perspective. Methods for the study of coping vary, but many of them involve either asking subjects how they cope or having them choose from a list of coping strategies. These methods make it difficult to distinguish between varying meanings of the 112

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term (the lexical dimension) and varying ways of trying to adapt/adjust to difficult circumstances. It is not surprising, then, that rates of religious coping show wide variation depending on the research design used. Koenig and colleagues in The Handbook of Religion and Health state that reported rates vary from “1% to 42% (depending on the population and the part of the world in which the subjects live)” (2001, 79). Nonetheless, the quantity and variety of religious coping indicates that the use of religious and spiritual ideas and behaviors is a widely used method of trying “get through” difficulties, and that people believe that it helps. In the review based on the literature search done for the Handbook (2001), Koenig et al. conclude that “when people become physically ill, many rely heavily on religious beliefs and practices to relieve stress, retain a sense of control, and maintain hope and their sense of meaning and purpose in life. Religious involvement appears to enable the sick, particularly those with serious and disabling medical illness, to cope better and experience psychological growth from their negative health experiences, rather than be defeated or overcome by them.” Although circumstantial, the research evidence suggests that these efforts are often effective. Religious coping and health continues to be a popular topic in spirituality and health research. In the 287 relevant citations yielded by my combined MEDLINE searches from 2000 to 2005, 25 deal with some aspect of coping. Some of these studies are beginning to delineate differences in religious coping styles that align with different groups. For example, in a study of chronic pain patients, Dunn and colleagues found that “older women and older people of minority racial background reported using religious coping strategies to manage their pain more often than did older Caucasian men” (Dunn 2004, 19). Instrument Development (Within Christianity) David Larson, in his 1986 review of religious variables in the psychiatry literature (Larson, 1986) found that fewer than 3% of his sample of more than 2,000 quantitative studies used a religious measure as a central variable, and only one of these employed a multidimensional, statistically valid questionnaire. This despite the fact that even in 1986 there existed a substantial number of important religion and spirituality instruments. And even when religious or spiritual measures have been shown to have strong predictive value, they were generally reported without discussion. Since that time, there has been a dramatic increase in the use or religious and spiritual variables in health research, for both mental and physical health, and in the development of such measures specifically tailored to use in a health setting. Because the problematic distinction between religion and spirituality is central to spirituality and health research, the intrinsic/extrinsic religiosity (I/ER) measures in Allport and Ross’s classic religious orientation scale (ROS) (Allport 1967) has been of continuing importance in the field. I/ER does not map perfectly on the spirituality-religion distinction, but it is clearly related, so spirituality and religion measures have been 113


consistently influenced by the ROS and efforts to refine its distinctions (Burris 1999), including the development of new I/ER measures (Egbert 2004, 9-11). Hoge’s intrinsic religious motivation measure (IRMS) is an early variant on the ROS and continues to be influential and used in health research. For example, Sherman and Simonton (2001) have found it reliable and valid in health related research. In their chapter on measurement methods, Koenig et al. (2001, 495-510) describe dozens of instruments relating to various aspects of religiosity (e.g., religious belief, religious affiliation, organizational religiosity, religious well-being, spiritual well-being, and spiritual involvement, among others). Hill and Hood (1999), in their Measures of Religiosity, provide even more. Not all of these instruments are equally valuable, and all reflect to some extent the ongoing developments in terminology in the field. As long as there is uncertainty about the meanings of religion and spirituality, measures of those concepts will face validity problems. But the use of these scales in health research will be a part of the solution to that problem. The greatest difficulty, therefore, is the fact that so many researchers in spirituality and health do not use existing, tested instruments. Not all studies require formal instruments, but many do and those would benefit from familiarity with the tools that have been established for their reliability, consistency, validity, and psychometric properties. Several recent instruments deserve specific mention with regard to health outcomes research. The Duke University Religion Index (DUREL) is a brief, 5-item scale that has one item each for organization and nonorganizational religiosity and three for intrinsic religiosity (Koenig 1997). In a study of cancer patients, the three intrinsic religiosity questions were found to be reliably related to IR on Hoge’s IRMS (Sherman 2000). The Index of Core Spiritual Experiences (INSPIRIT) is a broader measure that still relates well to intrinsic religion measures (Kass 1991). One of the most important recently developed instruments is the Fetzer-NIA measure (Fetzer 1999). First published in 1999 and reprinted in 2003, this set of scales was developed by a group of prominent social scientists engaged in spirituality and health research (Idler 2000). The scales are contained in an 88-page booklet available free from Fetzer or downloadable from the Internet. It contains long and short forms, with explanation, background, and discussion for 12 dimensions: Daily Spiritual Experiences, Meaning, Values, Beliefs, Forgiveness, Private Religious Practice, Religious/Spiritual Coping, Religious Support, Religious/Spiritual History, Commitment, Organizational Religiousness, and Religious Preference. It also includes a brief combined version of the scales, the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) with a total of 38 items. According to the new preface in the 2003 reprint, more than 3,000 copies had been distributed, and 80% of recipients had rated the instruments as useful. The most popular subscales, according to the preface, are the Religious/Spiritual Coping and the Daily Spiritual Experiences Scales (DSES). Of special importance is the fact that an abbreviated version has been included in the general Social Survey of the National Opinion Research Center (Idler 2003). The breadth, widespread use, and easy availability of 114

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this instrument(s) makes it of great importance for spirituality and health research. I would agree, though, with Koenig et al. (2001, 506-507), that this otherwise very good instrument is weakened by the incorporation of a variety of items that are questionable as religion or spirituality measures including some, such as feelings of peace and harmony, that can directly indicate mental health. This virtually ensures some level of apparent association between spirituality as measured by this instrument and mental health. This kind of problem is characteristic of the conceptual difficulty of separating distinctively spiritual characteristics from psychological characteristics, as discussed above in connection with definitions and the idea of the psychospiritual domain. Because no single instrument can be fully suited to all samples, it is a strength of the field that new measures are being developed (or revised) for use in particular populations. For example, Lukwago and colleagues have published a set of brief scales to measure collectivism, religiosity, racial pride, and time orientation in urban African American women (Lukwago 2001) that includes both borrowed and new scales, and Jagers and Smith published a twenty-item measure specifically oriented to African Americans, which Egbert et al. suggest may be useful in health-related studies (Egbert 2004). Instruments for other groups are also being developed. For example, Mokuau and colleagues have tested a revised version of the Fetzer/NIA BMMRS in a native Hawaiian population (Mokuau 2001). Instruments for specific disease groups are also being developed. For example, the Santa Clara Strength of Religious Faith Questionnaire (SCSORF) (Sherman 2001) is a reliable and valid measure for cancer patients that has been evaluated in well-defined samples of breast cancer patients and healthy young adults and shows good retest reliability and internal consistency for IR, OR, and NOR. In 2002, Meraviglia et al. published a prayer scale adapted for people with cancer which was tested in a sample of 32 people with a variety of cancers (Meraviglia 2002). Also, in 2002, Ironson et al. published the Ironson-Woods SR Index (Sense of Peace, Faith in God, Religious Behavior, and Compassionate View of Others) for use with HIV/AIDS patients in a study in which aspects of the measure were correlated with a variety of health-related factors including longevity, less distress, and lower cortisol levels. Existing instruments are also being evaluated with regard to specific diseases. Sherman et al. tested the DUREL instrument in two groups of cancer patients and found good internal consistency. Comparison to other measures showed good convergent and divergent validity, and the authors concluded that the DUREL (which they called DRI) is useful with cancer patients (Sherman et al. 2000). The ongoing development of more specific instruments evaluated in appropriate samples and extending beyond the general population is an important indication of the strength of the field. A persistent problem in instrument development results from the language/terminology problems discussed above. When inadequate definitions of spirituality and religion are employed, the validity of measures suffers. 115


CONCLUSION In the early 1990s, when the initial uptick in spirituality and health began to receive attention, many assumed that it was a fad. The modern idea that the rapid advances and growing influence of science would erase spiritual belief, at least in the mainstream population, still had some traction. At precisely the same time, the interest in what was then generally called “alternative medicine” was also receiving new public attention, and the reaction was similar. There had already been studies (beginning with Cassileth’s in 1984) that strongly suggested connections between these two developments and indicating that they were mainstream social trends rather than mere current fashions. But by 2005, when I completed the first version of this field analysis, it had become clear these trends are strong, that they involve all segments of society, and that they have penetrated medical research, practice, and education in very substantial ways. Changes in the editorial and peer review processes are potent indicators of this, as suggested by this literature review. In the five years since the first version of this review, these trends have continued, the literature has expanded, and the quality of research has continued to improve. No one should underestimate the significance of this. These changes fly in the face of the vast bulk of social science and humanities thinking regarding spirituality in the modern “disenchanted” world. Practically all academic predictions regarding the relationship of science and religion are contradicted by the current situation. Spirituality/Religion-and-Health is a very important subject not only because of its practical application in healthcare, but also what it can tell us about being human in the twenty-first century. Faced squarely with an open, inquiring mind, the current state of spirituality and health offers an opportunity to reexamine some very old and apparently very inaccurate assumptions dating from at least the Enlightenment. The idea of a bright line separating science and spirituality/religion, with reason on one side and emotion-dominated faith without reason on the other, has proven to be a stereotype that produced a self-fulfilling prophecy. And as usually happens with such stereotypes, its power seems to be eroding in the face of evidence. At the same time, the current situation invites a serious reconsideration of spirituality and religion themselves. As the cultural diversity of the country continues to increase, we need to give up the romantic notion of “American religion” as a homogeneous monument to one brand of Christian orthodoxy, “the faith of our fathers.” It is now clear that the inextricable connection of spirituality and health never was severed, and that the diverse pluralism of American spirituality, both “churched” and “unchurched,” has been a part of the dynamic fabric of American society from colonial times. Modernity is not what we thought it was, and one need not be “postmodern” to acknowledge that. One need only be observant.

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Chapter Five Spirituality, Religion, and Health: A Skeptic’s View

by Richard Sloan While the literature on religion, spirituality, and health has improved since our first review in 1999, a great deal remains to be accomplished. This review addresses current problems in the field and makes recommendations for activities worth pursuing, not worth pursuing, and about an important clarification of the aims of such research.

CURRENT PROBLEMS IN THE FIELD Paucity of Evidence The most thorough review of the empirical evidence is that of Powell et al. in 2003. This review is vastly superior to the voluminous but highly questionable Handbook of Religion and Health by Koenig et al. (2001). We have shown, for example, that the Handbook overestimates by a considerable margin the number of studies that support the proposition that religious involvement is associated with beneficial health outcomes (Sloan and Bagiella 2002). In the Powell et al. review, nine hypotheses about the connection between religion and health were evaluated. Powell et al. concluded that only in the case of studies of attendance at religious services and mortality was the evidence persuasive. In all other cases—that religion or spirituality protects against cardiovascular disease, against cancer mortality, that deeply religious people are protected against death, that religion or spirituality protects against disability, that religion or spirituality slows the progression of cancer, that people who use religion to cope with difficulties live longer, that religion or spirituality improves recovery from acute illness, and that being prayed for improves physical recovery from acute illness—the evidence was at best equivocal. 117

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It is true that studies of religious attendance and mortality are the strongest of the lot but even so, there are significant problems with them. These problems include self-selection (Bagiella, Hong, and Sloan 2005; Norton, Sloan, and Bagiella 2005), residual confounding (Sloan, Bagiella, and Powell 1999), measurement error in the self-report of attendance (Hadaway, Marler, and Chaves 1993; Presser and Stinson 1998), and data dredging (Smith and Ebrahim 2002). Most of these problems characterize the field as a whole, too. Heterogeneity of Findings Even among studies that are well conducted and show effects of attendance on mortality, there is considerable heterogeneity in the findings. For example, Hummer et al. found that after adjusting for confounders and covariates including functional status and social connection, frequency of religious attendance was inversely associated with mortality in a study of over 21,000 subjects (Hummer, Rogers, Nam, and Ellison 1999). However, the protective effect was entirely absent for patients with cancer and only marginally significant for patients with heart disease, the two diseases that account for the bulk of deaths in the United States. Omen and Reed found that in a community sample of 1,931 affluent, largely white adults over age 55 in Marin County, California (Oman and Reed 1998), religious attendance was associated with reduced mortality in multivariate model (RR = 0.76, 95%; CI = 0.62, 0.94), an effect seen for both men and women. However, when they used a different measure of attendance and added individual items representing various types of social engagement, the risk ratio rose to 0.81 (95% CI = 0.81, 1.00), and the model retained museum or art gallery attendance (RR=0.81, 95%; CI = 0.63, 1.04) as a marginally significant effect. In contrast to the main finding of Oman and Reed, the Tecumseh Community Health (House, Robbins, and Metzner 1982) and Alameda County studies (Strawbridge, Cohen, Shema, and Kaplan 1997), frequency of attendance at religious services was inversely associated to mortality, but after control for all relevant covariates, this relationship held only for women. In contrast, for men but not women in the Tecumseh study, frequency of attendance at meetings of voluntary organizations was associated with reduced mortality, while religious attendance was not (House et al. 1982). In a study by Schoenbach et al. (1986), the effect of religious attendance on mortality was seen primarily for white men only. In the Duke cohort (N = 3968) of the EPESE study, the effect of religious attendance was significant in the multivariate model, but in the full model, the effect for men achieved only marginal significance (RR=0.83, 95%; CI 0.69-1.00) (Koenig et al. 1999). In the New Haven EPESE cohort, no such association was found (Idler and Kasl 1992), but more generally, social and productive activities were associated with reduced mortality (Glass, de Leon, Marottoli, and Berkman 1999). 118

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Residual Confounding A broader problem with the religious attendance literature is the inability of studies conducted to date to tease apart attendance from more general efforts to remain active in one’s community. While this is difficult, it is not in principle impossible, and evidence from several community studies suggests that this distinction is important. For example, in the New Haven cohort of the EPESE study, attendance at religious services was not associated with future mortality, but engagement in community and social activities was, suggesting that the broad category of remaining active in older age more generally is the operative factor. Such engagement could mean attendance at religious services but could also include volunteering at schools or literacy programs, going to the public library, or working in a community center. Some studies, while showing associations between religious attendance and reduced mortality, do so from the perspective that religious attendance is one of many indices of social engagement. For example, in a cohort of 15,938 subjects, aged 55 or older, enrolled in the National Health Interview Survey, attendance at religious services in the past two weeks was inversely related to mortality but so were attending shows, movies, and concerts, socializing with friends and neighbors, visits with relatives, and volunteerism (Rogers 1996). Not surprisingly, analysis of a subset of these data restricted to participants aged 70 years and over showed the same findings (Goldman, Korenman, and Weinstein 1995). Measurement Issues One of the central concerns of this literature is a lack of specificity of religion and spirituality, the putative “independent” variables in these studies. A similar, although not identical problem arises for the outcome variables. No scientific inquiry can proceed without rigorous specification of the variables in question. The difficulty in clearly defining independent and dependent variables no doubt contributes significantly to the paucity of evidence described above. One would assume that religion, in contrast to spirituality, is easier to specify, and although this may be so in principle, in practice difficulties have arisen. Independent Variables In the literature examining the health correlates of religious involvement, there are almost as many different definitions of religious involvement as there are studies. A great many studies have examined self-reported attendance at religious services as an index of involvement. Other have assessed self-reported prayer, reading the Bible or other religious texts, listening to religious radio, or watching religious TV. Others studies have addressed denominational differences, e.g., Christians vs. 119

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Jews, Protestants vs. Catholics, Seventh-day Adventists vs. residents of New York City. Still others have operationalized religiosity as the degree of orthodoxy within a given religion, e.g., orthodox vs. reform vs. nonreligious Jews. Such diversity of definitions of religiosity has an advantage and a disadvantage. From a measurement perspective, if these different ways of operationalizing religiosity resulted in consistent results, we would be increasingly confident that they all tap into an underlying construct of religiosity. In the absence of such consistent findings—the current state of the evidence—such definitional inconsistencies lead more to confusion than clarity. This may be why studies of religious attendance and mortality—in which both the independent and dependent variables are relatively unambiguous—are the strongest of the studies on religion and health. But even in this case, there are significant measurement problems. Presser and Stinson have demonstrated a significant self-presentation bias in studies of religious attendance and mortality that employ interview methods, either in person or by phone (Presser and Stinson 1998). They suggest that during such interviews, specific questions about church attendance are understood by many participants as asking whether or not the participants are good Christians. In the interpersonal setting of the interview, questions about religious attendance—“How often do you attend religious services? More than once/week? Once/week? Once or twice/month?”—engage a self-presentation bias that leads participants to inflate their estimates of church attendance. The alternative method of data collection—time use estimation—asks participants about the activities they engaged in during the past week with no reference to any particular activity. For example, participants are asked what they did at 9 a.m. on last Monday? . . . 10 a.m. on Monday? . . . and so on throughout the entire week, including Saturday and Sunday, when participants could report attendance at religious services. Presser and Stinson showed that time use estimation leads to a substantial reduction in self-reported attendance at religious services, compared to interview methods that ask specifically about how often the participants attended services. Hadaway et al. have similarly demonstrated such overestimation (1993, 1998). The problem is worse still with definitions of spirituality. Recognizing this lack of clarity, Larimore et al. attempt to provide some guidance, endorsing what they refer to as “positive spirituality,” which “involves a developing and internalized personal relationship with the sacred or transcendent” (2002, 71). Positive spirituality, to be encouraged by the physician, is characterized by “honesty, self-control, love, joy, peace, hope, patience, generosity, forgiveness, thankfulness, kindness, gentleness, goodness, faithfulness, understanding, and compassion” (p. 71) as means toward better mental and physical health (Larimore et al. 2002). These values are virtues to be sure, but we have no evidence that they are associated with better health. And questions should arise about whether it is the business of physicians to promote them, regardless of their merits as a whole. Suggesting that it is the business of physicians to make recommendations about the values that their patients hold represents and arrogant and unwarranted extension of the role of a doctor. 120

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In contrast to this list of virtues, Miller and Thoresen, in a review article, report that in popular usage, “spirituality” is distinguished from material reality and as such, refers to the transcendent, something beyond the self (2003). Anandarajah and Hight agree. They assert that “world’s great wisdom traditions suggest that some of the most important aspects of spirituality lie in the sense of connection and inner strength, comfort, love, and peace that individuals derive from their relationship with self, others, nature, and the transcendent” (2001, 87). According to a draft report of a consensus panel on spirituality in medical education, spirituality transcends rituals, dogmas, institutions, and religions. It refers to the striving for meaning, growth, development, transcendental experience, and ultimate hope that keeps humans going. This definition agrees in general with that of Anandarajah and Hight. Studies that use the popular FACIT-SWB (for spiritual well-being) instrument generally are consistent with this definition of spirituality. The FACIT-SWB operationalizes spirituality as consisting of two factors: a sense of meaning, peace, and purpose in life and faith (Brady, Peterman, Fitchett, Mo, and Cella 1999). “The Spiritual Index of Well-Being” (Daaleman and Frey 2004) takes an entirely different view of the term. This index is a 12-item scale consisting of two subscales assessing self-efficacy and “life scheme” with the latter reflecting a sense of self-directedness. This is spirituality as Horatio Alger, the great American striving for accomplishment. In the SWIB, there is nothing about transcendence, nothing about other directedness. Spiritual well-being consists in knowing what you want and believing that you can get it. Because definitions of spirituality that appear in the literature are more diverse and less well established than definitions of religiosity, it is extremely difficult to draw conclusions about whether spirituality is associated with health outcomes. Outcome Variables In the case of the outcome variables in the literature on religion and spirituality and medicine, the problem is not that the variables are poorly defined, but rather that they vary widely from study to study. Again, the Powell et al. review is informative. In the nine hypotheses they identify, the following outcome variables appear: mortality, protection against CVD, cancer mortality, disability, cancer progression, and recovery from acute illness. The Handbook of Religion and Health has a great many chapters, each devoted to a different outcome variable. Among those variables are hypertension, cardiovascular disease, cerebrovascular disease, cancer, disability, pain, health behavior, immune system dysfunction, depression, suicide, marital instability, delinquency, substance abuse, and schizophrenia. And within each of these chapter headings, there are multiple outcome variables. And within each of these categories, there are multiple variants. For example, the chapter on cardiovascular disease cites studies that examine improved functioning, adherence to treatment, and diminished 121

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health concerns a year after cardiac transplantation, length of stay in ICUs, length of stay in the hospital, pain medication required, arrhythmic events, blood pressure, functional status, disability, and blood lipids. This variety of outcome variables results in part from the different interests of investigators. Nevertheless, the enormous variety makes it difficult to come to general conclusions about associations with religiosity. What are we to say if, for example, one study showed that attendance at religious services was associated with lower blood pressure, while another failed to show any relationship between frequency of prayer and blood lipids? The Sharpshooter’s Fallacy and Related Problems In many cases, individual studies will measure many of these variables. A problem produced by this strategy is the likelihood that if enough outcome variables are measured, one certainly will achieve statistical significance. This is the problem of multiple comparisons that arises from the failure to adjust the level of significance for the number of statistical tests conducted.6 Physicist Robert Park has referred to this as the “sharpshooter’s fallacy’: the sharpshooter empties the six gun into the side of the barn and then draws the bull’s-eye. An excellent example of this problem is provided by a study of Koenig and colleagues (1998) in which well over one hundred outcome variables were measured. Such a strategy guarantees that some of the variables collected will achieve a level of statistical significance unless alpha levels are adjusted downward. Such analytic behavior falls well short of what is methodologically acceptable for hypothesis testing. The only appropriate stance to take regarding such fishing expeditions is that they are exploratory investigations: any associations that achieve a 0.05 level of significance should then be tested as hypotheses in new datasets with appropriate control for multiple comparisons. A related problem, not often easy to detect, is that in the large datasets very often used in these studies, it is possible to cut the data in a great many ways before conducting analyses. So for example, Helm et al. (2000) reported that among a sample of the elderly who were not functionally disabled, private religious behavior, e.g., reading the Bible, watching religious TV, prayer, was associated with reduced mortality. Because in the entire sample, no such relationship between private religious behavior and mortality existed, one must wonder why the authors decided that dichotomizing the data on functional status was crucial. More likely, they cut the dataset in multiple ways, e.g., by sex, race, education, etc., until a “significant” finding emerged. The absurd conclusion they drew—that private religious behavior protects only those who engage in it for a lifetime—is consistent with this view. After all, how did Helm and his colleagues know that those already disabled did not also have such a habit of private religious behavior? 122

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Reliance on Datasets Designed for Other Purposes Many of these problems arise directly from the use of large datasets that contain information on religious activities and beliefs and health variables but were designed for other purposes. This encourages a practice referred to as “data-dredging,” in which investigators, now aided by the availability of powerful computers, conduct analysis after analysis until something “emerges.”

FAILURE TO ADEQUATELY CONSIDER ETHICAL AND THEOLOGICAL ISSUES At least three significant ethical problems arise in connection with attempts to link religious activities to health outcomes: manipulation, invasion of privacy, and causing harm. Manipulation Health professionals even in these days of consumer advocacy retain influence over their patients by virtue of their medical expertise. This threat to patient autonomy was raised most recently by Cassell in the New England Journal of Medicine (2005). When doctors depart from areas of established expertise to promote a nonmedical agenda, they abuse their status as professionals and violate the implicit norms of the physician-patient relationship. Some physicians apparently believe that they should inquire into the patient’s spiritual life in the service of making recommendations that link religious practice with better health outcomes. Is it really appropriate, as Matthews et al. (1998) recommend, for a physician to ask patients what he or she can do to support their faith or religious commitment? Privacy A second ethical consideration involves the limits of medical intervention. If religious or spiritual factors were shown convincingly to be related to health outcomes, they then would join such factors as socioeconomic status and marital status (Sorlie, Backlund, and Keller 1995), already well established as significantly associated with health. While physicians may choose to engage patients in discussions of these matters to better understand them, we would consider it unacceptable for a physician to counsel a single patient to marry because the data show that marriage is associated with lower mortality (Sorlie et al. 1995). This is because we generally regard financial and marital matters as private and personal, not the business of medicine, even if they have health implications. There is an important difference between “taking into account” marital, financial, or religious factors and “taking them on” as the objects of interventions. 123

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Causing Harm A third ethical problem concerns the possibility of actually doing harm. Linking religious activities and better health outcomes can be actively harmful to patients, who already must confront age-old folk wisdom that illness is due to their own moral failure (Gould 1981). Within any individual religion, are the more devout adherents “better” people, more deserving of health than others? If evidence showed health advantages of some religious denominations over others, should physicians be guided by this evidence to counsel conversion? Attempts to link religious and spiritual activities to health are reminiscent of the now discredited research suggesting that different ethnic groups show differing levels of moral probity, intelligence, or other measures of social worth (Gould 1981). Because all of us, devout or profane, ultimately will succumb to illness, we should avoid the additional burden of guilt for moral failure to those whose physical health fails before our own.

THE AIMS OF RESEARCH ON RELIGION AND HEALTH Beyond the empirical issues, there is a broader issue to be addressed: given the significant place that religion holds in the United States and the substantial ethical issues that arise in connection with religion and health, what, precisely, is the larger objective of studies that seek to examine connections between religious practices and health? In other areas of biomedical research, studies, either epidemiological or experimental, attempt to illuminate underlying pathophysiological mechanisms in a way that leads to development of new treatments. To take the example of studies that repeatedly show relationships between depression and heart disease, the aim of most researchers is to identify the pathophysiological mechanisms so that new interventions can be developed. Such interventions might involve treatment of depression or treating mechanisms in the causal pathway. If this analogy seems inappropriate, consider that Koenig et al. have commented that if religious beliefs and activities really help the patient to be physically or mentally healthier, then “this finding has major implications for our struggling health care system” (2001, 5). Others suggest that by implementing religious practices in medicine, management of chronic disease may be improved (King, Mainous, and Pearson 2002), and health care costs can be reduced (Pearce et al. 2002). Harris et al. (1999) recommend introducing prayer into medical practice. Larimore et al. (2002) encourage physicians to bring religion and spirituality into their clinical practices. In the case of depression and heart disease, this approach makes sense, and the path to therapeutic interventions is plausible. It is far from clear that this is 124

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the case with religious involvement and its putative health effects. The analogy to treating depression—treating insufficient religious devotion, were this shown by the epidemiological literature to be associated with poor health—is highly problematic. While physicians can treat depression with pharmacotherapy or psychotherapy, not only is there no parallel treatment for low religious devotion, but it would be ethically impermissible for physicians to make recommendations that their patients engage in religious behavior of one sort or another. Alternatively, again following the case of depression and heart disease, a physician might attempt to intervene at the level of the mechanism in the causal pathway, e.g., enhanced platelet reactivity or reduced autonomic regulation of the cardiovascular system, to reduce the risk associated with heart disease, without addressing the depression at all. In a parallel fashion, if there were solid evidence that religious devotion were associated with lower risk of a specific disease and the intervening mechanisms were clearly understood, a physician might intervene at the level of these mechanisms without making recommendations about religious beliefs or behavior. On the surface, this might be ethically permissible, but religious involvement would be reduced to a marker rather than a mechanism.

AREAS OF RESEARCH NOT WORTH PURSUING Neuroimaging Studies Recently, Andrew Newberg, a neurologist at the University of Pennsylvania, has conducted neuroimaging studies of meditation and demonstrated that this practice leads to differences in regional cerebral blood flow. In itself, there is nothing objectionable or, for that matter, very interesting about this finding since there are blood flow differences in the brain that correspond to virtually all human activity including writing about, or reading about, research studies on religion and health. What is objectionable about this is the implication that there is something special about the religious experience because it has neurophysiological underpinnings. According to his Web site, Dr. Newberg claims that neuroscience can elucidate the nature of mystical experiences, their importance in human evolution, and why the abiding need for a concept of God is imperative for the survival of the human species (http://www.andrewnewberg.com/default.asp). Identifying areas of the brain that light up during prayer or meditation has little value and almost certainly is not worth the resources such studies consume. Not only are they wasteful, but they trivialize the religious experience by suggesting that it is nothing more than increased activity of a region of the brain. 125

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Assessing the Impact of Distant, Intercessory Prayer As indicated above, most studies of religion, spirituality, and health are observational in nature and as such, cannot control exposure to the religious activities or attitudes thought to be associated with health benefits. In such studies, confounding and self-selection become significant problems. In contrast to these observational studies, research on the impact of distant, intercessory prayer (IP) permits random assignment to treatment conditions and double-blind assessment of outcomes. Unfortunately, these advantages over epidemiological studies of religion and health are more apparent than real. Significant problems characterize all aspects of these studies. At the level of the treatment variable, the inability to understand the characteristics of prayer make it impossible to determine with certainty the degree of exposure to the putative therapeutic agent, a problem which does not exist in randomized controlled trials. At the level of the outcome variables, there is a different type of uncertainty: the inability of IP researchers to specify the outcomes likely to be influenced by IP leads to a shotgun approach that violates standards of statistical analysis. Finally, the absence of a persuasive mechanism linking IP to outcomes has led to assertions about the revolutionary nature of the IP “findings” that are greatly overstated and fail to appreciate the nature of true scientific revolutions. These limitations demonstrate that further study of IP is not justified. Studying Mechanistic Pathways Any theory about how religion and spirituality might influence health should specify the intervening pathways. However, presenting a laundry list of potential physiological mediators, e.g., IL6, elevated BP, increased behavioral sanctions against risk behavior, is not sufficient. Even a sophisticated list of potential mechanisms is premature. Efforts to understand mechanisms must wait until there is solid evidence of an association between religious involvement and health outcomes. As Powell et al. have demonstrated, only in the case of religious attendance and mortality does the evidence reach this level. And even in this case, as discussed above, serious questions arise.

WHAT IS WORTH PURSUING? The most obvious direction for this literature is to conduct a relatively definitive study of what appears to be the strongest findings to date: the link between attendance at religious services and mortality. As an observational study, such a project can never be free of the potential biases of self-selection and confounding. 126

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But a new, well-designed study can do more to address these concerns than previous studies that have relied on existing databases designed for other purposes entirely. Thus, a study designed from the start to investigate this matter can address the concern about self-presentation bias associated with interview methods that Presser and Stinson (1998) have identified by employing time use estimation. It could address the potential confound associated with a more general inclination to engage in socially productive, community activities suggested by Cohen (2002). It could address the issue of assessing the differences in the availability of religious and community resources to participants as a way of teasing apart whether reduced mortality is associated with a more general interest in social engagement or a more specific interest in religious involvement. Such a study has another advantage: an unambiguous outcome variable.

CONCLUSIONS Even a well-conducted study is only a means for understanding the elements of religious involvement that promote health. Because of the substantial ethical problems identified above, it can never be the basis for active introduction of religious activities in clinical medicine. A parallel activity must address the general aims of such an inquiry and, more generally, of studies that attempt to determine the health correlates of religious involvement. Explicit recognition of the limits of such studies, regardless of their findings, is required. These limits pertain to activities of medical clinicians and relate to the bioethical imperatives associated, among other things, with threats to the religious freedom of patients. That is, the principle of patient autonomy requires that clinicians recognize the power of their role as medical expert and assiduously avoid coercive or manipulative actions related to religious activities. This restriction also is related to a recognition that physicians lack expertise in religious matters and that the clinical setting is one in which they are required to limit their attempts to influence patients to the medical matters in which they possess expertise. Recommending an antibiotic for pneumonia is not manipulative in this setting; recommending, either explicitly or implicitly, that a patient attend religious services is. Recognition of the bioethical principle of nonmaleficence requires that in the clinical setting, physicians avoid causing harm. And although not specifically a bioethical principle, a dose of humility is required. Increasingly, physicians are called upon to consider the importance of spirituality in the lives of their patients. Physicians not only are encouraged to probe deeply into the spiritual lives of their patients, but also to function as arbiters of appropriate and inappropriate spiritual beliefs (e.g., Anandarajah and Hight 2001; Larimore 2001; Larimore et al. 2002). As such, the roles of physician and clergy 127

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become conflated and physicians are asked to become guides to the spiritual lives of their patients, an astonishingly arrogant assumption of responsibilities for which they have no training whatsoever. The bitter irony of this stance is that as physicians choose to spend time exploring matters of spirituality with their patients, an activity for which they have no qualifications, they will have even less time to attend to basic recommendations about disease prevention, which is not only within their domain of expertise and within the practical limits of their interactions with patients but also is their responsibility.

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Chapter Six The Cognitive Neuroscientific Study of Religion and Spirituality by Andrew Newberg With the rapidly expanding field of research exploring religious and spiritual phenomena, there have been many perspectives regarding the validity, importance, relevance, and need for such research. There is also the ultimate issue of how such research should be interpreted with regard to epistemological questions. The best way to evaluate this field is to determine the methodological issues that currently affect the field and explore how best to address such issues so that future investigations can be as robust as possible and make this body of research more mainstream. It should also be mentioned at the outset that the overall study of religious and spiritual phenomena requires at its root an analysis of very complex, very compelling, and very subjective experiences. Hence, the field of cognitive neuroscience offers one of the most important fields of study to explore such phenomena. It is unfortunate that various perspectives regarding this research are often uninformed or misinformed regarding the nature and potential results of such research. Perspectives range from the highly religious to the highly materialistic with concerns from “writing off ” religious experience on one hand to being unimportant on the other. These criticisms miss several major issues such as the challenge to cognitive neuroscience for exploring arguably some of the most complex mental phenomena human beings have. With many current studies on emotion, laughter, morality, and happiness being reported almost daily, there should also be substantial information regarding complex human experiences vis-a-vis the study of religious and spiritual phenomena. Furthermore, it is a great challenge to science to develop appropriate definitions, measurement tools, and methods in order to study such phenomena. The results from these studies will also provide important mechanistic data that may help elucidate any potential health effects, positive or negative, that are associated with religion and spirituality. 129

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The religious and spiritual perspectives also stand to gain tremendously from this interaction since the results might help toward a new and deeper understanding of these phenomena. This research may also lead to a better understanding not only of specific types of experiences but also of a wide range of phenomena that pertain to religion including love, altruism, charity, forgiveness, worship, theology, and epistemology. However, it should be stated that such leaps must be made carefully, fully acknowledging the dynamic relationship between science and religion. While some of these applications are still far off, the potential benefits should be obvious. This paper will review four dimensions of this area of research with a critical perspective on methodology and statistical analysis. The four dimensions as they relate to the neuroscientific study of religious and spiritual phenomena are (1) appropriate measures and definitions, (2) subject selection and comparison groups, (3) study design and biostatistics, and (4) theological and epistemological implications.

MEASUREMENT AND DEFINITION OF SPIRITUALITY AND RELIGIOUSNESS One of the most important issues related to the measurement of religious and spiritual phenomena has to do with correlating subjective and objective measures. For example, if a particular type of meditation reduces blood pressure or is associated with changes in cerebral metabolism, it is critical to know what was actually experienced by the individual. Subjective Measures In some sense, the most important measures of religious and spiritual phenomena are those that pertain to the subjective nature of the experience. When any person has a religious or spiritual experience, they can usually try to describe it in terms of various cognitive, behavior, and emotional parameters. Furthermore, a person will usually define the experience as “spiritual” which distinguishes the experience from others, which are regarded as “nonspiritual.” The issue of measuring the subjective nature of these phenomena is akin to opening the mysterious “black box” in which something is happening, but it is not immediately observable by an outside investigator. The problem becomes more difficult when trying to compare experiences across individuals and across cultures. A spiritual experience for a Jew may be vastly different than a spiritual experience for a Hindu. Furthermore, there is likely to be a continuum of experiences ranging from barely perceptible to absolutely mystical (d’Aquili and Newberg 1993). The question for any researcher is how to qualitatively ascertain the subjective component of such experiences. Is there a way to quantify and compare these subjective feelings and thoughts individuals have regarding their spiritual 130

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experiences? It is difficult to develop adequate scales to measure spirituality and religiousness. Many existing scales are difficult to find in the literature especially when they are reported in nonscientific journals that are not typically cited or referenced in literature reviews (Larson, Swyers, and McCullough 1998). A number of attempts have been reported in the literature to develop a self-reporting scale that measures the subjective nature of a particular religious or spiritual phenomenon. The book Measures of Religiosity (Hill and Hood 1999) provides fertile grounds for various scales and questionnaires that assess everything from a person’s feeling of commitment to awe to hope to the direct apprehension of God. Some have been assessed for validity and reliability, which is critical if these scales are to have any use in future research studies. Testing the validity implies that the results return information about what the scale is supposed to measure (Patten 2000). For example, a valid scale of a feeling of hopefulness would ask questions regarding the amount of hope a person has. If this scale did not address hope, but rather happy emotional responses, it would not be a valid measure of hope. Reliability assesses whether the scale when given to the same person at different time points yields roughly the same results (Patten 2000). While it is important to assess the reliability and validity of scales, this is particularly problematic with regard to religious and spiritual phenomena. The reason for this difficulty is the problem with defining these terms. If someone defines spiritual as a feeling of “awe” and another defines it as a feeling of “oneness,” what types of questions should be used to assess spirituality? A questionnaire that asks about feelings of awe might not truly be measuring spirituality; and therefore, until clear and operational definitions of spirituality and religiousness can be determined, there will always be the potential problem of developing valid scales. Reliability is also a problem since spirituality and religiousness can be very consistent or widely variable within an individual. Thus, they might subjectively feel differently at different time points; and therefore, the reliability of any scale with the intention to measure spirituality is always problematic. Another problem with individual scales is whether they are useful across traditions and cultures. For example, many of the scales that are referenced in Measures of Religiosity are Christian-based and, therefore, may not be useful for evaluating Jewish or Buddhist perspectives. Fortunately, there are other scales, which either have a more universal quality or at least can be modified to accommodate other perspectives. However, this might bring into question the validity and reliability of such scales in different contexts. There is another interesting problem with scales that attempt to measure the subjective nature of spiritual or religious phenomena. This arises from the fact that most scales of spirituality and religiousness require the individual to respond in terms of psychological, affective, or cognitive processes. Thus, questions are phrased: How did it make you feel? What sensory experiences did you have? What did you think about your experience? On one hand, such measures are very valuable to individuals interested in exploring the neural correlates of such experiences 131


because psychological, affective, and cognitive elements can usually be related to specific brain structures or function. However, the problem with phrasing questions in this way is that one never actually escapes the neurocognitive perspective to get at something that might be “truly” spiritual. It might be suggested that the only way in which an investigator can reach something which is truly spiritual would be through a process of elimination in which all other factors—i.e., cognitive, emotional, sensory—are eliminated through the analysis, leaving only the spiritual components of the experience. In other words, the most interesting result from a brain scan of someone in prayer would be to find no significant change in the brain during the time that the individual has the most profound spiritual experience. As described above, part of the problem with developing adequate measures is ensuring that they measure what they claim to measure. A subjective scale designed to measure the degree of an individual’s religiosity needs to focus on the things which make someone religious. However, this first requires a clear definition of religiousness and spirituality. Furthermore, these definitions must be operationalized so that any measure or study can have a firm-enough grasp to actually measure something (Koenig 1998; Koenig, McCullough, and Larson 2001). To that end, it is important to avoid narrow definitions that might impede research and also to avoid broad definitions that cannot be measured. For example, definitions of religion that pertain to a single God would eliminate almost two billion Hindu and Buddhist individuals from analysis. On the other hand, a definition of religiousness that is too broad might end up including many bizarre experiences and practices such as cults or devil worship. One final issue, which is related to problems with definitions, is that there are so many approaches to religious and spiritual phenomena that it is often difficult to generalize from one study to another. Some scholars have pointed out that one type of meditation practice may be very different from other types, or one type of experience might be substantially different than other types (Andresen 2000; Andresen and Forman 2000). It is certainly critical to ensure that any study clearly states the specific practices, subpractices, and traditions involved. Furthermore, changes in the brain associated with one type of meditative practice may not be specifically related to a different type of practice. Of course, the dynamic nature of this body of research may also provide new ways of categorizing certain practices or experiences so that one can address the question regarding whether different types of meditation truly are different, or are only experienced to be different. Objective Measures Objective measures of religious and spiritual phenomena that pertain to the neurosciences include a variety of physiological and neurophysiological measures. Recent advances in fields such as psychoneuroendocrinology and psychoneuroimmunology address the important interrelationship between the brain 132

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and body. Any thoughts or feelings perceived in the brain ultimately have effects on the functions throughout the body. While this can complicate measures as well as introduce confounding factors, this integrated approach allows for a more thorough analysis of religious and spiritual phenomena (Newberg and Iversen 2003). Several types of measures which have already been reported in the literature include measures of autonomic nervous system activity. These are the most common approaches to specific religious and spiritual practices such as meditation or prayer. A number of studies have revealed changes in blood pressure and heart rate associated with such practices (Sudsuang, Chentanez, andVeluvan 1991; Jevning, Wallace, and Beidebach 1992; Koenig, McCullough, and Larson 2001). It is interesting that the actual changes may be quite complex, involving both a relaxation as well as an arousal response. Early work by Gellhorn and Kiely (1972) developed a model of the physiological processes involved in meditation based almost exclusively on autonomic nervous system (ANS) activity, which, while somewhat limited, indicated the importance of the ANS during such experiences. These authors suggested that intense stimulation of either the sympathetic or parasympathetic system, if continued, could ultimately result in simultaneous discharge of both systems (what might be considered a “breakthrough” of the other system). Several studies have demonstrated predominant parasympathetic activity during meditation associated with decreased heart rate and blood pressure, decreased respiratory rate, and decreased oxygen metabolism (Sudsuang, Chentanez, and Veluvan 1991; Jevning, Wallace, and Beidebach 1992; Travis 2001). However, a recent study of two separate meditative techniques suggested a mutual activation of parasympathetic and sympathetic systems by demonstrating an increase in the variability of heart rate during meditation (Peng et al. 1999). The increased variation in heart rate was hypothesized to reflect activation of both arms of the autonomic nervous system. This notion also fits the characteristic description of meditative states in which there is a sense of overwhelming calmness as well as significant alertness. Also, the notion of mutual activation of both arms of the ANS is consistent with recent developments in the study of autonomic interactions (Hugdahl 1996). Measures of hormone and immune function have more recently been explored especially as an adjunct measure to various clinical outcomes (O’Halloran et al. 1985; Walton, Pugh, Gelderloos, and Macrae 1995; Tooley, Armstrong, Norman, and Sali 2000; Infante et al. 2001). Thus, if a hypothetical study showed that the practice of meditation results in reductions in cancer rates, then it might be valuable to measure the immunological and hormonal status of the individuals to determine the physiological basis of the effect. Certain cancers are related to abnormalities in immune (i.e., leukemia or lymphoma) or hormonal function (i.e., breast and prostate cancer). It is also important to note that alterations in various hormones and immune functions may be related to specific changes in brain function. Further, this interaction can be bidirectional. Thus, certain brain states may enhance hormonal status, but these hormonal states may in turn affect brain function. This 133


can particularly be observed in women with premenstrual syndrome, but there are other circumstances in which various neurohormones can alter emotional, cognitive, and behavioral states. Neurophysiological changes associated with religious and spiritual states can be obtained through a number of techniques that each has its own advantages and disadvantages. In general, the primary requirement is that the methodology evaluates functional changes in the brain. However, there are many ways of measuring such functional changes. Early studies of meditation practices made substantial use of electroencephalography (EEG) that measures electrical activity in the brain (Banquet 1973; Hirai 1974; Hebert and Lehmann 1977; Corby, Roth, Zarcone, and Kopell 1978). EEG is valuable because it is relatively noninvasive and has very good temporal resolution. In other words, the instant that an individual achieves a certain state, the EEG should change accordingly. For this reason, it has continued to be useful in the evaluation of specific meditation states (Lehmann et al. 2001; Aftanas and Golocheikine 2002; Travis and Arenander 2004). The major problem with EEG is that spatial resolution is very low so that any change can only be localized over very broad areas of the brain. Another problem is that analysis can be difficult because of the extensive amount of recordings that are made during any session. However, EEG may be particularly valuable to include in studies employing functional imaging techniques since the EEG may help to signal certain states or, at the very least, ensure that the individual being studied has not fallen asleep. Functional neuroimaging studies of religious and spiritual phenomena might become one of the most important techniques since the results have physiological, clinical, and potentially philosophical relevance to the issues related to such phenomena. To date, brain imaging studies have utilized positron emission tomography (PET), single photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI). In general, such techniques can measure functional changes in the brain in pathological conditions, in response to pharmacological interventions, and during various activation states. Activation states have included sensory stimulation (i.e., vision, auditory, etc.), motor function and coordination, language, and higher cognitive functions (i.e., concentration) (Newberg and Alavi 1996). The changes that can be measured include more general physiological processes such as cerebral blood flow and metabolism, in addition to many aspects of the neurotransmitter systems. For example, the serotonin, dopamine, opiate, benzodiazepine, glutamate, and acetylcholine systems have all been evaluated in a number of brain states (Newberg and Alavi 2003; Warwick 2004; Kennedy and Zubieta 2004). While functional neuroimaging studies have contributed greatly to the understanding of the human brain, they each have their own advantages and limitations with respect to evaluating religious and spiritual phenomena. Functional MRI primarily measures changes in cerebral blood flow. In general, this is a valid method for measuring cerebral activity since a brain region that is activated during a specific task will experience a concomitant increase in blood flow. This coupling 134

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of blood flow and activity provides a method for observing which parts of the brain have increased activity (increased blood flow) and decreased activity (decreased blood flow). Functional MRI has several advantages. Functional MRI has very good spatial resolution and can be coregistered with an anatomical MRI scan that can be obtained in the same imaging session. This allows for a very accurate determination of the specific areas of the brain that are activated. Functional MRI also has very good temporal resolution so that many images can be obtained over very short periods as short as a second. Thus, if a subject was asked to perform ten different prayers sequentially while in the MRI, the differences in blood flow could be detected in each of those ten prayer states. Finally, fMRI does not involve any radioactive exposure. The disadvantages are that images must be obtained while the subject is in the scanner and the scanner can make up to one hundred decibels of noise. This can be very distracting when individuals are performing various spiritual practices such as meditation or prayer. However, several investigators have successfully utilized fMRI and have performed the study by having subjects practice their meditation technique at home while listening to a tape of the fMRI noise so that they become acclimated to the environment (Lazar, Bush, Gollub, Fricchione, Khalsa, and Benson 2000). The MRI noise can also affect brain activity, particularly in the auditory cortex. Functional MRI also relies on a tight coupling between cerebral blood flow and actual brain activity, which, while a reasonable assumption, is not true in all cases. Well-known examples in which brain activity and blood flow are not coupled include stroke, head injury, and pharmacological interventions (Newberg and Alavi 2003). However, a detailed evaluation of this coupling in all brain states has not been performed. One final disadvantage is that at the present moment, fMRI cannot be used to evaluate individual neurotransmitter systems. PET and SPECT imaging also have advantages and disadvantages for studying religious and spiritual phenomena. The advantages include relatively good spatial resolution for PET (comparable to fMRI) and slightly worse for SPECT imaging. PET and SPECT images can also be coregistered with anatomical MRI, but this must be obtained during a separate session, and therefore, matching the scans is more difficult. PET and SPECT both require the injection of a radioactive tracer, so radioactivity is involved, although usually this is fairly low. Depending on the radioactive tracer used, a variety of functional parameters can be measured including blood flow, metabolism (which more accurately depicts cerebral activity), and many different neurotransmitter components. The ability to measure these neurotransmitter systems is unique to PET and SPECT imaging. Such tracers can measure either state or trait responses. It should also be mentioned that some of the more common radioactive materials such as fluorodeoxyglucose (that measures glucose metabolism) can be injected through an existing intravenous catheter when the subject is not in the scanner. This allows for a more conducive environment for performing practices such as meditation and prayer. This tracer becomes “locked” in the brain during the injection period, and the person can then be scanned after 135


the person has completed their practice, but still measure changes associated with the practice (Herzog 1990-1991; Newberg, Alavi, Baime, Pourdehnad, Santanna, and d’Aquili 2001). A major drawback to PET and SPECT imaging, in addition to the radioactive exposure, is that these techniques have generally poor temporal resolution. Depending on the tracer, the temporal resolution can be as good as several minutes and as bad as several hours or even days. PET or SPECT would be very difficult to use in order to study ten different prayer states in the same session. However, two or three states might be measured in the same imaging session if the appropriate radiopharmaceutical is used (Lou, Kjaer, Friberg, Wildschiodtz, Holm, and Nowak 1999). The result of this discussion is that depending on the goals of the study, various neuroimaging techniques might be better or worse. There are other more global problems that affect the ability to interpret the results of all functional imaging studies. The most important of which is how to be certain what is actually being measured physiologically and how it compares to various subjective experiences. There are already potential problems addressing what a particular scan finding means in terms of the actual activity state of the brain. For example, it is not clear what will be observed if there is increased activity in a group of inhibitory neurons. Would that result in increased or decreased cerebral activity as measured by PET or fMRI? The bigger problem is trying to compare the physiological changes observed to the subjective state. With regard to religious and spiritual experience, it is not possible to intervene at some “peak” experience to ask the person what they are feeling. Therefore, if a person undergoes fMRI during a meditation session and they have a peak experience, how will the researcher know which scan findings relate to it? In addition, there are typically a number of changes in the brain with varying degrees of strength. It is not clear what degree of change should be considered a relevant change (i.e., 10%, 20%, etc.). From a statistical perspective, analyzing images has a number of problems including how to compare images across subjects and conditions and how to take into account the problems of multiple comparisons both in terms of activation states and also in terms of individual brain regions. A program called statistical parametric mapping (SPM) has been developed which can be used to evaluate various images and works by normalizing the images, coregistering the images, and then analyzing them pixel by pixel for significant changes (Friston, Holme, Worsley, Poline, Frith, and Frackowiak 1995). This is a very conservative statistical approach because of the problem with multiple comparisons, and therefore subtle changes may be missed. Of course, the question still arises as to whether changes observed which are not significant in SPM are still clinically relevant. Furthermore, in the study of religious and spiritual states, it may be important to evaluate subjects on an individual basis since such states may be highly variable phenomenologically across subjects. In spite of these limitations, neuroimaging studies have been successfully utilized to evaluate specific spiritual and meditative practices. There are currently six known studies which have spanned the different neuroimaging techniques 136

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(Herzog 1990-1991; Lou, Kjaer, Friberg, Wildschiodtz, Holm, and Nowak 1999; Lazar, Bush, Gollub, Fricchione, Khalsa, and Benson 2000; Newberg, Alavi, Baime, Pourdehnad, Santanna, and d’Aquili 2001; Kjaer, Bertelsen, Piccini, Brooks, Alving, and Lou 2002; Newberg, Pourdehnad, Alavi, and d’Aquili 2003). Interestingly, there appears to be some coherence of their findings with the frontal lobes, parietal lobes, thalamus, and limbic system appearing to be related in network associated with such practices. It may be that the variety of different types of practices activates a network of brain structures in relatively similar ways. It is also interesting that there do seem to be some differences that correlate well with the variations among the approaches. One study also measured changes in the dopamine system and found increased activity during meditation-related practices (Kjaer, Bertelsen, Piccini, Brooks, Alving, and Lou 2002). Thus, the level of complexity of our understanding continues to improve as more studies are performed. Future studies will certainly be necessary to more thoroughly evaluate the neurophysiological changes that occur in the brain during various religious and spiritual phenomena.

SUBJECT SELECTION AND COMPARISON GROUPS Another interesting methodological issue in the study of religious and spiritual phenomena is to determine who are the most appropriate subjects to study and who should represent the comparison group(s). The issue of whom to study with regard to religious and spiritual phenomena depends somewhat on the definition of the phenomena. Obviously, if a researcher wanted to evaluate physiological changes during meditation, there would be thousands of different possible groups to consider studying. It is important to determine which elements of a particular practice or experience are of most interest. The more specific a researcher wants to be in terms of the phenomena, the more focused will be the subject group. For example, if a researcher wanted to study the physiological effects of the rosary, the group would have to consist of those individuals who practice the rosary. If the focus is on feelings of unity, there may be many different practices that could be chosen, or perhaps the study group will consist of individuals from many different backgrounds. An important issue in this regard is the level of expertise or proficiency of the individuals being studied. In the case of meditative practices, there could be varied results between novice, experienced, and master-level individuals. These differences could be related to whether more novice individuals can perform the practice in a manner that is similar to their usual level of practice while under the scrutiny of the researcher. For example, the noise of an MRI scanner may result in a novice not being able to perform their practice of meditation adequately while a more experienced individual may have less of a problem with the distraction. Thus, the difference observed might be related to the fact that one of them successfully performed the practice rather than true differences between the practices. It is 137


also important to select individuals that have similar socioeconomic and health backgrounds. If Franciscan nuns are less likely to smoke, then their brain scans might differ from a group of other individuals who do smoke. The other major issue in terms of subject selection relates to the comparison or control groups. One possibility, which is frequently employed in functional neuroimaging studies, is that the individual acts as their own comparison. Studies of various meditative practices typically compare the meditation state to the subject’s own baseline waking state. Others have suggested that a more appropriate comparison would be a state in which they are doing a task that is similar but has no specific spiritual meaning. For example, one study explored whether different mantras (some spiritual some not) have different effects on the brain electrical activity during meditation (Telles, Nagarathna, and Nagendra 1998). Another issue with regard to using subjects as their own comparison involves excluding other factors that are part of the practice. Thus, a practice that involves burning incense would be better to compare to a baseline state in which incense is also used. Otherwise, the primary change observed would be in the olfactory regions of the brain and may have nothing to do with the spiritual practice. Similarly, if a practice requires the eyes to be open (i.e., reading prayers), then the baseline state should have the subject with their eyes open, or possibly even reading nonreligious texts. Some studies have looked at such differences and have found distinctions in cerebral activity depending on whether a subject was reading a religious or nonreligious text (Azari 2001). Other types of practices might also be used as comparisons including artistic and creative practices, athletic events, or cognitive and visuospatial tasks. Comparison groups could be other practitioners in the same tradition, but with different levels of expertise or practitioners in other traditions in which similar practices are performed. These groups might help to determine longitudinal effects of various spiritual practices, but factors such as age and health might interfere with the interpretation of such studies. Placebo groups are another important problem with the study of religious and spiritual phenomena. It is not clear what a placebo would represent in many cases since most people who are spiritual know whether or not they are actually performing their spiritual practice. Placebo groups in this case more likely will represent other tasks that resemble the spiritual one but are lacking the specific spiritual content. Thus, if reading a prayer is going to be studied, then reading a nonreligious text would represent a reasonable comparison group.

STUDY DESIGN AND BIOSTATISTICAL ANALYSIS Based on the above review of the existing literature and the proposed operational definition of spiritual experience, there are at least seven neuroscientific paradigms which can readily contribute to the initial operationalization of spiritual experience 138

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(Larson, Swyers, and McCullough 1998). These seven paradigms include (1) the neurophysiology of spiritual interventions; (2) spiritual interventions associated with psychopharmacological agents; (3) drug-induced spiritual experiences; (4) neuropathologic and psychopathologic spiritual experiences; (5) spiritual experiential development in infants, children, and adolescents; and (6) physical and psychological therapeutic interventions. After these study designs are considered, the biostatistical issues with such studies can be reviewed. The Neurophysiology of Spiritual Interventions The first paradigm involves an experimental spiritual intervention such as prayer or meditation with concomitant measures of a psychological- and spiritual-dependent evaluation. This will help to define and delineate the nature of the spiritual intervention itself. These psychological and spiritual measures can then be compared to simultaneously derive neurobiological parameters, such as electroencephalographic activity, cerebral blood flow, cerebral metabolism, and neurotransmitter activity. Such measures can be performed with state-of-the-art imaging techniques including positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI). Body physiological scalar parameters such as blood pressure, body temperature, heart rate, and galvanic skin responses (that measures autonomic nervous systems activity) can also be measured. Other body physiological parameters such as immunological assessments, hormonal concentrations, and autonomic activity should also be included to complete a thorough analysis of the effects of spiritual interventions. Altering Spiritual Interventions The second existing paradigm that might be employed to investigate spiritual experience from a neuroscientific approach uses pharmacological agents or other interventions in an attempt to alter spiritual interventions. Using this paradigm, a previously measured spiritual practice will be compared to the same practice with the addition of some intervention. For example, studies might attempt to show the effects of an opiate antagonist on the strength of the subjective experience of meditation or prayer. Preliminary studies (on one or a few subjects) of this type have shown no effect on EEG patterns during meditation when subjects were given either anopiate or benzodiazepine antagonist (Sim and Tsoi 1992). The effects of transcranial magnetic stimulation, other pharmacological agents, or even surgical procedures (performed for other purposes) could be evaluated. However, it is clear that more extensive studies measuring a number of neurophysiological parameters are required. Other agonists and antagonists may be utilized to determine their ability to augment or diminish spiritual 139


experiences. In addition, the exploration of various pharmacological agents on spiritual interventions may help to delineate the role of different neurotransmitter systems. Such studies also offer the possibility of measuring dose responses in terms of spiritual interventions. Drug-Induced Spiritual Experiences A third paradigm that might be employed utilizes those people whose use of hallucinogenic agents has resulted in intensive spiritual experiences. Since it has long been observed that drugs such as opiates, LSD, and stimulants can sometimes induce spiritual experiences, careful studies of the types and characteristics of drug-induced spiritual experiences, perhaps utilizing modern imaging techniques, may help elucidate which neurobiological mechanism are involved in more “naturally derived” spiritual experiences. Some studies related to the use of such hallucinogenic agents have already been performed (Vollenweider, Leenders, Scharfetter, Maguire, Stadelmann, and Angst 1997; Vollenweider, Vontobel, Hell, and Leenders 1999; Vollenweider, Vontobel, Oye, Hell, and Leenders 2000); but a more extensive study of such agents, particularly in relation to religious and spiritual experiences, is required. Comparing this paradigm to naturally occurring spiritual phenomena may allow for a better distinction of pathologic and nonpathologic spiritual experiences. There are obvious ethical and legal considerations with studies such as these (although studies outside of the United States may be more possible). However, subjects who have had pharmacologically induced spiritual experiences can be studied using radioactive analogues of such agents as a means of determining the concentration of receptors and their agonists. Another related approach would be to study the effects of drug withdrawal on spiritual experience. However, there are no reports in the literature of such findings. Neuropathologic and Psychopathologic Spiritual Experiences A fourth paradigm would utilize patients with various known neuropathologic and psychopathologic conditions. Neurological conditions, including seizure disorders, particularly in the temporal lobes, brain tumors, and stroke, have been associated with spiritual experiences or alterations in religious beliefs. For example, temporal lobe epilepsy has been associated with hyperreligiosity and religious conversions (Bear 1979; Bear and Fedio 1977). Psychiatric disorders such as schizophrenia and mania also have been associated with spiritual experiences and religious conversions. Delineating the type of pathology and the location of that pathology will aid in determining the neurobiological substrate of spiritual experience. Thus, neuropsychiatric disorders can be an effective tool for the neuroscience of spiritual experience. 140

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Research on pathological conditions has classically been used to elucidate the normal functions of biological systems. Spiritual experiences in psychiatric and neurological disorders may be central to the identification of largely nascent neurobiological systems that subserve “normal” spiritual experience. This presents a crucial distinction to the historic psychiatric implication that spiritual experience is an expression of psycho- or neuropathology. This provides a framework in which normal spiritual experience can occur in pathological and normal conditions and pathologic spiritual episodes might occur in individuals with or without psychopathological disorders. However, care must be taken to avoid referring to spiritual experience only in pathological terms or associated with pathological conditions as well as not reducing spiritual experiences only to neurophysiological mechanisms. Spiritual Experiential Development There has been a fairly extensive literature regarding the developmental aspects of religion and spiritual experience (Fowler 1981; Tamminen 1994; Oser 1991). These reports consider the overall development of spiritual experience from infancy through adolescence and into adulthood. There is also consideration of the necessary neurocognitive developments for spiritual experience to arise. For example, a more primitive form of undifferentiated faith may occur in infancy while the more complex aspects of spiritual experience which include cognitive, cultural, and affective components usually requires growth into adulthood (Fowler 1981). Most of these analyses of spiritual experiential development are grounded in psychology. However, neuroscience may be able to utilize these findings and compare them to the development of various brain structures and neurocognitive processes. This may help elucidate which brain structures and functions are required for various components of spiritual experience. The developmental approach can also be viewed from the end-of-life perspective. For example, alterations in spiritual functions may be associated with diffuse neuropathological conditions (e.g., dementia). Furthermore, it may be useful to study alteration in spiritual functions that are associated with decrements in neurocognitive functions as well as decrements in physical health. Physical and Psychological Therapeutic Interventions There are a large number of ongoing studies that have explored the therapeutic effects of meditation, stress management, prayer, and other related interventions for various psychological and physical disorders including anxiety disorders, hypertension, coronary artery disease, cancer, and the human immunodeficiency virus (Kabat-Zinn 1992; Carson 1993; Levin 1989, 1994; Miller 1995; Leserman 1989; Zamarra 1996; Massion 1995; Schneider 1995). While these studies focus 141


on the effects of the intervention on various disease parameters, it maybe possible to “piggyback” onto these studies to include measures of spiritual experience and well-being. Utilizing measurement scales already available in the literature, it may be possible to determine the relationship of spiritual experiences and well-being to the intervention as well as to the progression of the disorder. Performing high-quality studies is essential to demonstrating the relationship between spirituality and health especially in light of the various criticisms that have been raised regarding methodological issues with these early studies (Sloan, Bagiella, and Powell 1999; Sloan and Bagiella 2002). Statistical Analysis Issues In terms of statistical analysis, there are several issues that arise in the study of religious and spiritual phenomena. To begin with, religious and spiritual phenomena are frequently very complex with many different components. As mentioned above, these components can be both subjective and objective. In order to account for this variety of components, there are frequently a number of variables that must be factored into the statistical analysis. Thus, simple statistical comparisons will frequently oversimplify the findings and may miss important covariates that may have significant contributions to the findings. Every effort should be made to perform statistical analyses in studies of religious and spiritual phenomena with the same rigor and complexity as other biomedical studies. To this end, it is imperative that well-qualified statisticians are utilized to evaluate data from these studies in order to ensure the highest quality of such research. Another problem that may be somewhat unique to religious phenomena is the interindividual differences that may be beneficial to evaluate. For example, in our research study of Tibetan Buddhist meditators, we asked each participant to practice the same type of meditation for the same amount of time. In this way, the data were easier to pool for group analysis. However, we may have missed important interindividual differences related to the strength and depth of the meditation practice, the specific experiences an individual may have had, and whatever unique techniques each person may utilize as part of their practice. Unfortunately, statistical analysis becomes more limited in evaluating interindividual differences, especially when the focus is on physiological measures in the brain or body. Future development of analyses that can better explore such interindividual differences could be highly beneficial to this field.

THEOLOGICAL AND EPISTEMOLOGICAL IMPLICATIONS One of the most ancient problems of philosophy is, “How do we know that the external world corresponds, at least partially, to our mental representation of it?” The 142

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question of what is “really real” has been considered, with various answers, since the time of the pre-Socratic Greek philosophers in the West. Preoccupation with this question is even older in Eastern religio-philosophical traditions. In considering the neuroscientific approach to religious and spiritual phenomena, one can ponder whether epistemological issues can actually be addressed. With regard to this issue, a number of researchers claim that because there is a neurobiological correlate of a religious phenomenon, there is nothing more to that phenomenon. While this interpretation may ultimately be accurate, that a neurobiological correlate exists does not specifically refer to the causal mechanism of such phenomena. In other words, if the brain activity changes during a mystical communion with God, it is not clear whether the brain activity caused that experience or responded to that experience. Even situations in which certain religious states are induced by pharmacological agents do not necessarily detract from the spiritual nature of these states. Shamanic practices in which various substances are ingested to aid in the spiritual journey are not viewed as less real or less spiritual because of the use of these substances. On the other hand, use of such substances alone does not typically result in profound religious experiences. It is clear that the specific context in which various practices and experiences arise is also crucial to the spiritual nature of those phenomena. However, in reconsidering the epistemological question from a neuroscientific perspective, a term sometimes referred to as “neuroepistemology,” how reality is experienced in the brain, results in a complex paradox (Newberg, d’Aquili, and Rause 2001). For example, the three most common criteria given for judging what is real are the following: 1. 2. 3.

The subjective vivid sense of reality. Duration through time. Agreement intersubjectively as to what is real.

Each of these can be related to specific brain functions. But it may be demonstrated that all three of these criteria determining what is real can be reduced to #1 above—the vivid sense of reality. For example, the sense of duration through time depends on the structuring of time in baseline reality. It appears that the ability to have a sense of time, or more properly duration, is structured by the brain. Alteration of the function of parts of the brain that subserve temporal ordering, for any reason, results in a significant distortion of the perception of time in a number of ways. Most dramatically, during various spiritual practices and states, there is no sense of time or duration while the person is in that state. It becomes obvious that time and duration are not absolutes and derive their perceived qualities from brain structuring. Hence, it begs the question to derive the reality of baseline reality from one of the qualia, in this case time, which is itself structured by baseline reality (the brain). This same critique applies to any appeal for the 143


reality of objects which depend on characteristics of baseline reality the perception of which is known to be structured by the brain. The third criterion for the reality of entities, i.e., intersubjective validation, again arises from begging the question. The “subjects” who agree or disagree about entities being real are themselves only images or representations within the sensory-cognitive field of the analyzing subject-philosopher. Thus, it is unfortunately true that any person analyzing his or her own experience must start out, at least, as a naive solipsist. These analyses could continue ad infinitum. Suffice it to say that we are satisfied that each and every criterion of the reality of entities collapses into the first, i.e., the vivid sense of reality. If we are forced to conclude that reality is ultimately reducible to the vivid sense of reality, then what are we to make of religious and spiritual states that appear to the experiencing subject as more real than baseline reality, even when they are recalled from within baseline reality? If we take baseline reality as our point of reference, it seems that there are some states of reality that appear to be inferior to baseline reality and some states of reality that appear to be superior to that of baseline reality when these states are recalled in baseline reality. And this is the crucial point. These different experiences of reality appear more real than baseline reality when recalled from baseline reality. Thus, individuals almost always refer to dreams as inferior to baseline reality when they are recalled and discussed within baseline reality. The same is true of psychotic hallucinations—after they are cured by phenothiazines or other psychotropic medications. A person having emerged from such a psychotic state will recall it as psychotic. The same cannot be said, however, of many religious and spiritual states which appear to be “more real” than baseline reality and are vividly described as such by experiencers after they return to baseline reality. This is true of a number of such states including absolute unitary states (Newberg, d’Aquili, and Rause 2001), cosmic consciousness as described by Bucke (1961), certain trance states, hyperlucid visions (usually of religious figures, religious symbols, and dead persons), and near-death experiences (Newberg and d’Aquili 1994). So real do these experiences appear when recalled in baseline reality that they often alter the way the experiencers live their lives. Studies have actually been performed on this topic with near-death experiencers. Those who have had the core experience clearly behave more altruistically, more kindly, and with greater compassion toward other human beings than they showed before the experience (Ring 1980). Furthermore, there is a marked tendency for near-death experiencers not to fear death. And these beneficial changes do not persist for just a short period of time after the near-death experience but seem to persist for many years or even a lifetime. Again, if it is true that all of the proposed criteria by which reality is judged to be real can be reduced, in the last analysis, to the vivid sense of reality, then we have no choice but to conclude that in some sense, these states, and especially absolute unitary states or pure consciousness, are, in fact, more real than the baseline reality of our everyday lives. And the word “real” here is not used in a poetic or 144

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metaphorical sense. It is used in the same sense as in the utterance “this rock or this table is real.” Suffice it to say that when one approaches questions of reality from a neuroscientific perspective, “reality” becomes a very slippery concept, often manifesting itself in profoundly counterintuitive ways to the scientist, philosopher, or mystic.

CONCLUSION While the neuroscientific evaluation of religious and spiritual phenomena has advanced considerably since some of the initial studies that were performed over thirty years ago, this field of research is still in its early stages. There are many unique methodological issues that face this field in addition to the potentially more problematic barriers of funding and academic stature. However, pursuit of such projects may ultimately pay large dividends both for science and religion. From the religious perspective, the results of such studies may help toward a better understanding of the human experience of religion. These studies enhance human knowledge of how spiritual and religious pursuits affect the mind, brain, body, and behavior. From the scientific perspective, such research may shed new light on the complex workings of the human brain as well as the relationship between brain states and body physiology. Finally, addressing methodological and statistical issues can enhance both fields since such issues may result in improved scientific and statistical techniques and also contribute to theological and philosophical dialogue. Overall, this integrated field of neuroscience and religion should be an important area of scholarship for the twenty-first century and beyond.

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III. RELIGION, SPIRITUALITY, AND HUMAN FLOURISHING

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Chapter Seven The Psychology of Spirituality and Human Flourishing by Robert Emmons The Metanexus Institute seeks research projects that scientifically explore the link between religion and spirituality and the virtues and human strengths that reflect humanity’s highest aspirations and noble qualities including, but not limited to, creativity, purpose, perseverance, gratitude, prayer, awe and wonder, personal responsibility, love, honesty, joy, humility, and generosity. This document provides a review and analysis of recent successes in the field, with an emphasis on current limitations, key problems to be overcome, and suggested areas of focus for future research. A selected, annotated bibliography of key studies is included. One of the primary criteria in the evaluation of proposals is methodological innovation. New and generative methodological approaches that advance the science of spirituality are encouraged. The overall objective of the research initiative is to take research on the human spirit to new levels of scientific sophistication and significance. In addition to basic research, groundbreaking, transdisciplinary approaches for suggesting practical strategies for maximizing human flourishing are encouraged.

BACKGROUND After a period of relative dormancy, the psychology of religion and spirituality has recently reemerged as a full-force, leading-edge research area that has contributed new knowledge, data, and professional activity to the rest of psychology (Emmons and Paloutzian 2003). This is apparent upon examination of the recent trends in the publication of textbooks, journal articles, presentations at professional meetings, teaching courses in the psychology of religion, the establishment of new journals, books on clinical and health issues, and the development of psychology of 149

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religion research that interfaces the theory and topics of the mainstream discipline. During the past twenty-five years psychology of religion material has appeared with increasing frequency in high-end journals. It has emerged as a strong research enterprise whose topics interface almost all areas of psychology, whose scholars produce an impressive body of research, whose research will further develop internationally and cross-culturally, and whose importance is only going to increase. An increasing amount of research is being done with novel, creative methods, both quantitative and qualitative; but more of it is needed. Other new and innovative methods must be developed and exploited. An increasingly vigorous area of research is human virtue. The study of virtue, at the nexus of the psychology of religion, personality psychology, moral philosophy, and the psychology of emotion, is making a comeback in psychology (Emmons and Paloutzian 2003). Partly responsible for this resurgence is the positive psychology movement (Seligman and Csikszentmihalyi 2000) which has sought to systematically classify human strengths and virtues into a comprehensive taxonomy (Peterson and Seligman 2004). Concepts such as forgiveness, love, hope, humility, gratitude, self-control, and wisdom appear as highly prized human dispositions in Jewish, Christian, Muslim, Buddhist, and Hindu thought and are affirmed universal principles in world philosophies and ethical systems. Basic research as well as interventions to cultivate these virtues is well under way. Yet there is much hard work that lies ahead. In the next section of this paper several promising areas are identified that could be the focus of efforts to open new horizons in the study of religion, spirituality, and human flourishing. These areas help to frame a consideration of where the field is and where it should be going.

PRIORITY CONTENT AREAS 1.

Neuroscience

There is now a recognized role for brain imaging in the study of human religious and spiritual phenomena. The capacity for spiritual experiences of awe, gratitude, love, hope, and other areas of foci within this initiative is inseparably connected to the architecture of the mind-brain. With rapid advances in the development of techniques to measure brain activity, neuroscience approaches to the human spirit are receiving increasing attention. The hemodynamics of blood and oxygen flow or glucose metabolism in the brain as revealed by positron emission tomography (PET) or functional magnetic resonance imaging (fMRI) suggests that spiritual practices such as meditation and prayer involve increased activity in frontal brain structures, as well as those other brain areas that form a system to regulate and focus attention. There is also evidence that prayer involves increased activity in brain regions known to be involved in the production of language (Newberg, Pourdehnad, 150

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Alavi, and d’Aquili 2003). Much of the existing work is based upon the study of either extreme religious states or highly developed prodigies. Further work needs to be done in the study of more common, normal, everyday religious experiences, states, and behaviors. A number of interesting and empirically tractable questions can be envisioned. For example, what brain regions are activated or deactivated by the religious experiences of awe, gratitude, praise, and worship? Is there a unique pattern of activation for these or for particular forms of prayer? What are the appropriate tasks to activate the mental and emotional processes associated with these spiritual states of consciousness? How are individual differences in spiritual strengths related to brain function? While the potential of brain imaging research to elucidate neural mechanisms underlying religious and spiritual phenomena is tremendous, the pitfalls are equally significant. As the more humble neuroscientists readily admit, brain imaging is not the “Holy Grail” because the brain image itself as revealed by imaging techniques has little bearing on the psychological or spiritual significance of the image (Cacioppo et al. 2003). Therefore, careful analytic frameworks must guide the design and interpretation of research in this area. One must have clearly articulated hypotheses concerning which components of spiritual experience might be responsible for which variations in brain activation. Development and advances in the neuroscience of the spirit will likely emerge from a transdisciplinary perspective in which cognitive neuroscientists team up with theologians, social scientists, and scholars and scientists in allied fields. 2.

Developmental Science: Childhood and Adolescence

A recent commentary on spiritual development concluded “the pursuit of things spiritual or religious represents a hidden and unclaimed core dimension of human development . . . It is time for psychology to claim and honor spiritual development as a core developmental process that deserves equal standing in the pantheon of universal developmental processes” (Benson 2004, 50). The field of spiritual development is rapidly gaining legitimacy and attracting the interest of scholars from multiple disciplines and diverse contexts (Benson, Roehlkepartain, King, and Wagener 2005; King and Boyatzis 2004). A rich body of scientific scholarship already exists, but Metanexus envisions that this research initiative will help to shape and build the future of this field. A developmental approach would assess antecedents, social correlates, and consequences of spiritual strengths and virtues. There is a rich history of developmental research on prosocial behavior, altruism, empathy, and perspective taking, but not from an explicitly religious perspective (Boyatzis 2005). What is the developmental trajectory, say, of gratitude, humility, or a sense of purpose? When do such qualities first appear? What would constitute valid, age-appropriate measures of these and related virtues? What are the socialization and induction mechanisms that 151


parents employ to cultivate these behaviors in children? What parenting processes (e.g., communication, conflict resolution) or styles are associated with gratitude, humility, and a sense of purpose? To what degree are these virtues individually or jointly predictive of positive outcomes such as school success, overall well-being, service, resiliency, health behaviors, and less risk taking? 3.

Developmental Science: Adulthood and Aging

Developmental studies need not be limited to childhood and adolescence. There is a need for basic research on spirituality, religion, and flourishing across the life span, from young adulthood through old age (McFadden 1999). Thanks to recent efforts, the field of religious gerontology is becoming well developed, particularly in the area of spirituality, religion, and mental and physical well-being. The major thrust of this work has been to examine the association between religious involvement and mental health including depression and dementia. This work is vital, but it should not preclude the study of strengths and virtues and the roles that these play in understudied outcomes in religious gerontology, including positive emotions, activity level, resilience, healthy aging, and a deceleration of the aging process. Research incorporating religious contexts and institutions is highly desirable. For example, how might religious professionals and others who work with elderly people and their families (administrators, social workers, counselors, nurses, physicians, and recreation and rehabilitative therapists) within the context of religious institutions utilize information gleaned from basic research on spirituality and religion to maximize flourishing in later life? 4.

Measurement

Measurement is fundamental to scientific progress. The value of any subsequent research hinges on the ability to accurately measure relevant constructs. Major advances in scientific disciplines are typically preceded by major breakthroughs in measurement methods. Measurement has proven to be a challenge in the area of spirituality, and therefore, instrument development remains a high priority for the future. A careful investment in the development of assessment tools and statistical techniques would serve to catalyze high-level scientific advances. New and innovative measurement methods (i.e., going beyond self-report inventories) are especially needed. Because human strengths are invariably entangled with culture, biology, and consciousness, there is a multiplicity of avenues by which these states may be studied. Thus, a full range of investigative strategies are needed. Studies that measure multiple interacting variables through either correlational or experimental methodological designs are especially desirable. The virtues and human strengths of creativity, purpose, perseverance, gratitude, prayer, awe and wonder, personal responsibility, love, honesty, joy, humility, and generosity are 152

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necessarily interdependent. Most prior research has examined these in isolation from each other, obfuscating the mutually dependent and interactive nature of various aspects of spiritual functioning. 5.

Cultural Psychology

Cultural psychology has demonstrated the strength of culture in influencing the perceptions, construals, thoughts, feelings, and behaviors of its members (Lehman, Chiu, and Schaller 2004). Therefore, it is desirable that research draw from multiple cultures and religious traditions. There are cultural variations in what aspects of spirituality are valued. Yet there are also psychological universals—invariant patterns of thinking, feeling, and acting that are unaffected by cultural context. In this vein, it is important for future research to develop a deeper understanding of the complex connections between cross-cultural differences in spiritual processes and universals in these. Concepts such as purpose, wisdom, creativity, awe, and transcendence are filtered through culture. To what degree do these different aspects of the human spirit contribute to human flourishing across cultures? The tension between the search for human universals and the discovery of differences between people from distinct cultures cannot be ignored if research on the human spirit is to make significant forward strides. For further views on the interaction between culture and religion, interested readers are referred to the cutting-edge empirical research and theoretical articles in the Journal of Cognition and Culture. 6.

Mental Health and Illness

Both basic as well as what National Institutes of Health calls “translational” research on issues related to religion, spirituality, and human flourishing are encouraged and needed. The term “translational” refers to the task of translating or applying basic discoveries to problems in the realms of mental and physical health or education. The federal government and many private foundations are committed to identifying and reducing mental and physical illness and enhancing education. Therefore, it is desirable that proposals have potential to leverage assets from these other sources. In this context, a vital research question is which strengths and virtues, either singly or in combination, confer resilience to psychiatric illnesses? Resilience refers to individual differences in susceptibility. The possession of certain strengths and virtues may be a key factor in why some people do not develop depression or anxiety disorders or recover faster from these. A recent study found that social religiosity and thankfulness were associated with reduced risk for both internalizing (e.g., depression) and externalizing (e.g., antisocial personality) disorders (Kendler et al. 2003). What are the mechanisms by which these and other characteristics reduce the incidence and severity of disorders? 153


7.

Intervention Studies

Closely related to issues in mental health and illness is the need for research on interventions that are designed to cultivate human strengths and virtues. Within the positive psychology movement, several interventions designed to increase happiness and well-being have been developed. Rigorous tests of these using large-scale, random assignment placebo-controlled studies are a priority. What evidence-based interventions are most effective with which populations, and why? Studies are needed with children, adolescents, young adults, elders, and persons with psychological or physical disabilities. What interventions might foster a deep sense of meaning and purpose, joy, humility, perseverance, generosity, and personal responsibility? Mind-stretching work is required to identify the most appropriate outcomes and their rigorous measurement in these interventions and to disseminate these in the widest possible way. 8.

Religious and Spiritual Contexts

As Metanexus seeks research projects that scientifically explore the link between religion and spirituality and the virtues and human strengths that reflect humanity’s highest aspirations and noble qualities, research that explicitly incorporates spiritual and religious variables and processes is especially welcome. For example, research on understanding what spirituality looks like in different contexts—in different religious traditions and nonreligious traditions—would be helpful. As another example, consider emotion. In what ways do sacred or spiritual emotions such as gratitude, awe, hope, joy, and reverence differ from natural variations of these emotions? They vary widely across cultures and are highly sensitive to disciplined formation; they are strongly associated with sets of beliefs about the nature of the universe and human nature and are often a response to verbal communication. They are associated with ritual and in many traditions (Roberts, in press). Religion provides context and direction for emotion, and the influence of religious systems on emotional experience and expression is considerable. In what ways do religious traditions, as cultural and linguistic systems, form and evoke sacred emotions, and through what means? The study of positive emotions is a major trend in contemporary affective science (Fredrickson 2001), and future research should consider the many ways in which the psychology of religion can contribute to a growing understanding of positive emotions and the functions of positive emotions in people’s lives. 9.

Methodological and Data Analytic Strategies

What research approaches are most likely to advance knowledge? Inasmuch as spirituality is a dynamic process, ever-more sophisticated approaches to data analysis are needed. Latent growth curve modeling has been applied to understand individual 154

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differences in the course of spirituality over time (e.g., Brennan and Mroczek 2002) and hierarchical linear modeling techniques, which allow within-subject analysis, to examine relationships between daily spiritual experience and daily pain (Keefe et al. 2001). Longitudinal, cohort-sequential designs to study change are an appropriate research strategy when one wishes to examine developmental changes in religious and spiritual behavior. Intraindividual variability can be studied using latent growth curve models that incorporate dynamic elements. Researchers are encouraged to avail themselves of the latest cutting-edge techniques. It is hoped that a focus on these will better equip researchers to understand the dynamics of spirituality and human flourishing. Many important advances have been made in research methodologies, and the incorporation of these newer methodologies into the broadening areas of inquiry will lead to a much richer psychology of religion and spirituality in the future. Innovative research must employ innovative methodologies, and researchers are encouraged to continue to take varied and diverse approaches for exploring religious and spiritual processes related to human flourishing. Methods culled from experimental research on the cognitive bases of religion approach are promising (Barrett 2004) as are measurement methods that go beyond direct, conscious self-reports, such as implicit attitude measures (Fazio and Olson 2003). At the same time, ethnomethodological- and phenomenological-oriented methods should not be ignored. Different methods complement one another, and their incorporation is likely to be an important key to advancing the field. 10. The Need for a Multilevel Interdisciplinary Paradigm If we have learned anything, it is that a single, sectarian approach is incapable of yielding comprehensive knowledge of phenomena as complex and multifaceted as spirituality. A multilevel interdisciplinary paradigm (MIP) is required to anchor the study of spirituality and human flourishing strongly in the biological sciences and in the social and clinical sciences. Allied fields contributing to the MIP include evolutionary biology, neuroscience, anthropology, cognitive science, theology, and philosophy as a generalized cross-disciplinary approach to critiquing and sharpening the assumptions of science. This paradigm recognizes the value of data at multiple levels of analysis, while making nonreductive assumptions concerning the value of spiritual and religious phenomena. Nonreductive implies that spiritual or religious phenomena cannot be accounted for solely in terms of existing psychological, social, or biological constructs and processes. Appropriated wisely, the MIP will yield new and scientific ways to talk about the human spirit (Emmons and Paloutzian 2003). Behind the MIP is the assumption that information from various disciplines and levels of analysis has something to contribute to our understanding of religious and spiritual phenomena and that ultimately, this information can be integrated into 155


a larger, coherent whole. For a science of the human spirit to flourish, a critical mass of ideas and knowledge must be developed that can serve as the springboard that will stimulate research that either extends one topic or supports cross-topic collaboration (Paloutzian 2005). In its most visionary form, the MIP would foster integrative lines of research, theory, and practice in pursuit of the ultimate goal of understanding human flourishing. Research within each level of analysis is of course still critical, yet integrative research should be a priority for the future, as the MIP is not a passing trend.

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Chapter Eight Our Natural Spiritual Religious Inclinations and the Nature of Unselfish Love by Stephen Post The integrated hypotheses explored in this analysis of religion and spirituality and human flourishing are these three: first, human nature appears to include a powerful spiritual and religious inclination toward worshipful union with a presence in the universe that is higher than our own; second, a fully flourishing individual and society must make room for spirituality and religion (i.e., spirituality organized around group worship, rituals, symbols, and acculturation) in their salutary forms; third, these salutary forms can be described in terms of the degree to which they result in unselfish love of others, centering on our shared humanity, rather than on some small fragment of humanity. This is not to suggest that human beings cannot prosper to a significant degree when the spiritual-religious inclination (henceforth, SRI) is inhibited, nor is it to suggest that spirituality and religion cannot be destructive when they elicit human arrogance, intolerance, and resultant conflict. Indeed, we must not forget that those individuals who, through SRI, achieve a love for all humanity without exception (e.g., Gandhi and Sadat) are too often murdered by those whose “groupish” spirituality is threatened by such universal equal regard. This analysis will address these three themes above and then turn to an annotated bibliography of current research on SRI in relation to unselfish love for a common humanity, without which SRI may not contribute to human flourishing. The core scientific questions regarding SRI and human flourishing, or so I will argue herein, must be these: 1. 2.

How does spiritual and religious experience enhance the human capacity for a life of unlimited “exceptionless” love? What is the relationship between perceptions of perfect divine love and expanded love in the life of the individual and across a society? 157

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How do religious rituals and practices at their best increase the total amount of love energy in society and in the world?

THEME ONE: THE STAYING POWER OF SRI All major world religions teach that spirituality at its best brings blessings such as serenity, the release of unselfish love, well-being, happiness, health, and societal benefits. There are, however, many occasions when SRI is manifested in ways that are destructive to self and society because it intensifies loyalty to a small fragment of humanity rather than to the whole. All successful spirituality and religion, argues Holmes Rolston III, points toward the universal goal of exceptionless love, albeit through some necessarily particular system of beliefs and symbols, and therefore allows conflicts to be resolved in an ultimate context of universal love rather than of ultimate hate. In both its creative (love for all) and destructive (love for some) forms, SRI is extremely strong at the dawn of the twenty-first century despite the powerful twentieth-century currents of secular existentialism, Freudianism, behaviorism, and Marxism. It is so strong that we might just as well ask if the sun could more easily be plucked from the sky than the human sense of a creative higher presence be much diminished. Observation of contemporary and historical human experience makes plausible the hypothesis that human nature has evolved in such a remarkable way as to be turned toward a presence in the universe that is higher than its own. While we may never completely demonstrate the existence of such a Creative Presence through either scientific studies or philosophical argument, from the dawn of recorded history to the present the human perception and worship of such has not abated, and this may be proof enough. Is there an essential inclination toward a Creative Presence? Can this be demonstrated empirically? For most people, a sense of cosmic purpose is essential for personal meaning—and it is a serious matter to lose the sense that the universe has a purpose. Human beings seem to have evolved a capacity to sense a Creative Presence that they perceive is a way out of despair and meaninglessness. This persistent turning of human nature is now the subject of various explanatory models. Pascal Boyer, for example, advances an argument for the permanence of a religious inclination that is grounded in sociology and evolutionary psychology. His Religion Explained challenges the positivist’s assumption that belief in a Creative Presence could be set aside in the human future (Boyer 2001). Andrew Newberg describes the ways in which the human brain appears “hardwired” for spiritual and religious experiences in his work entitled Why God Won’t Go Away: Brain Science and the Biology of Belief (Newberg, d’Aquili, Rause, and Cummins 2001). David Sloan Wilson, in Darwin’s Cathedral: Evolution, Religion, and the Nature of Society, argues from the evolutionary biological perspective of group selection that a 158

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human society is like a competitive organism in which religion is a biologically and culturally evolved adaptation that enables the society to function as a communitas or internally altruistic unit—an adaptation that includes the element of out-group hostility, making exhortations to universal love of all humanity without exception both necessary and challenging (Wilson 2002). Harold Koenig and colleagues, in their comprehensive Oxford Handbook of Religion and Health, rigorously critique the methodology of 1,200 separate scientific studies on the relationship between religion and health, rank them according to their reliability, and conclude that a sufficient number of very high-quality studies allow for the generalization that spirituality and religion contribute to psychological and physical flourishing (Koenig, McCullough, and Larson 2001). Dean Hamer, in the highly controversial The God Gene: How Faith Is Hardwired into Our Genes, argues that spirituality and religion are so evolutionarily salutary that there is a behavioral genetic aspect to this deep human inclination (Hamer 2004). While views of human nature vary, especially with regard to what is essential or inessential to it, these scientific works demonstrate with varying degrees of success that SRI is very deeply engrained in human nature. This may explain why positivistic pronouncements of a new secular age never come true. The law of nature, which includes SRI, eventually buries its persecuting undertakers—whether in the Soviet Union or in China. This growing scientific appreciation for the permanence of spirituality and religion in Homo sapiens does not imply that the alternative secular image of the human is entirely implausible or that it lacks thoughtful defenders or deserves respect. Within the wide spectrum of perspectives on human nature, however, no one can seriously deny that SRI is widely manifest and that the arguments made to encourage us to act contrary to this tendency have been relatively ineffective in the real world. The inclination appears too deep in human nature to be widely impeded by those who would wish to do so by philosophical argument. Indeed, one of the twentieth century’s most celebrated atheist philosophers, Anthony Flew, acknowledged in December of 2004 that the facts of the cosmos logically presume a higher creative being. Spirituality and religion are as significant as ever in human history, or more so, and take increasingly diverse forms. They appear inextinguishable. It can only be hoped that their beneficent manifestations will come to exclude all maleficent ones—a hope that pertains to all other forms of human expression. The great majority of human beings—although respectfully, not all—seem to want communion with the Creative Presence, however variously interpreted and symbolized, and their own creativity and sense of purpose are often dependent on this communion. SRI is essential to human nature but is generally most beneficial and good when linked with universal love. SRI resonates with the classical idea of Homo religiosus. It does not have to rest on a set of absolutely incontrovertible scientific facts about human nature but rather emerges from the weight of human experience and history. Epistemological appeal to 159


experience, attentive to both the historical and the contemporary features of human expression and culture, is reasonably persuasive of an ineradicable spirituality often ensconced in the ritual, belief, and practice of formalized religion. Were spirituality and religion to disappear from the world, as Comte, Freud, Marx, and others long ago had predicted, the appeal to human experience and history would result in a different conclusion about human nature. But their positivist predictions have never become reality. Epistemological rootedness in human experience is essential to the Aristotelian tradition and, in this context, demands recognition of the perennial prevalence of religious expression in the narrative of human history (Dombrowski 1997, 96-123). If human nature were devoid of SRI, we would not be inclined to ask questions of ultimate meaning and ultimate reality in a context that takes this Creative Presence into consideration, and the annals of human philosophical and theological thought would be filled with very different subject matter than they are. In this sense, the fact that we trouble to think so often and so deeply about the God question hints that on some existential level we intuit such a divine presence. Many people see about them the overwhelming beauty of the earth and of the universe, which inclines them to suppose that artistry involves a Creative Presence. St. Paul wrote that “ever since the creation of the world his eternal power and divine nature, invisible though they are, have been understood and seen through the things he has made” (Romans 1:20). We appear inclined to speculate ontologically, metaphysically, and theologically; and this is what one would expect from a creature with an innate worshipful tendency. In moments of severe illness, for example, we seem widely inclined to ask questions like “How can a good god allow bad things to happen to good people?” The pervasiveness of such speculation across cultures and times hints at an essential human tendency rather than a purely cultural artifact, although culture is surely influential. We do see periods in which certain intellectual circles set these sorts of speculations aside. But as Huston Smith argues, questions about ultimate reality and ultimate meaning are grounded in humanness and resist abolition: Wherever people live, whenever they live, they find themselves faced with three inescapable problems: how to win food and shelter from their natural environment (the problem nature poses), how to get along with one another (the social problem), and how to relate themselves to the total scheme of things (the religious problem). If this third issue seems less important than the other two, we should remind ourselves that religious artifacts are the oldest that archeologists have discovered. (Smith 2001, 11)

Smith writes that religious world views include the sense that “human beings are the less who have derived from the more” (Smith 2001, 34), which means that they are not perceiving themselves as “the more that has derived from the less” (Smith 2001, 35). In our modern world, continues Smith, science has presumed to 160

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answer by denial all metaphysical or “big picture” spiritual questions (Smith 2001, 45). It has created an antimetaphysical world in which even the philosophers “tend to assume that scientists are in a better position to see the whole of things than they themselves are” (Smith 2001, 49). Smith describes a modern “tunnel” that attempts to suppress “big picture” thinking: the floor is scientism, the left wall is higher education, the roof is the media, and the right wall is the law. But the human rational inclination to raise metaphysical questions cannot be suppressed, argues Smith, and it now increasingly explodes through the tunnel. Indeed, considerable numbers of scientists are themselves now asking metaphysical questions.

SRI AND HUMAN FLOURISHING Those who wish to deny the connection between SRI and flourishing make the common observation that religion is sometimes distorted through frenzied appeal to malicious human emotions, including hatred, arrogance, thanatos, insular tribalism, and a resistance to scientific progress. It is true the religion sometimes brings out the very best in human nature and sometimes the very worst, including mass suicide and terrorism. Hence the appeal of John Lennon’s lines in “Imagine.” Yet few of the critics of religion would wish to extend such critique to spirituality. Moreover, while the major world religions do not always achieve their ideals, they often successfully inculcate hospitality to the stranger, love for all humanity without exception, and characterize ultimate reality in terms of unlimited love. The solution to the recurring problem of religion’s ability to tap into violent emotions and out-group hatreds is not to be found in the erroneous Enlightenment myth that SRI can somehow be set aside as inessential, like taking off clothing before a shower. The only answer rests in challenging people of all faiths within the context of their particular sacred narratives to abide by the spiritual ideal of limitless love for all humanity. SRI is fundamentally enhancing of psychological well-being and moral progress when it is not held hostage by group loyalties that demonize outsiders or by the malicious view that those who conceptualize God in ways that differ from “my” own should not be equally respected. In 1932 Anthropologist R. R. Marett first suggested that Homo sapiens would better be designated Homo religiosus (Marett 1933). Spiritual-religious concerns are present among the earliest evidences of human behavior, and we know of no human societies over the entire course of history that are devoid of such concerns. Spiritual and religious human expression dates back to at least 60,000 BCE (Mithen 1996), indicating that it can be respected for its staying power alone. Whatever continuities exist between human beings and other advanced species, we alone pray and worship. History, experience, and the very readiness to raise metaphysical questions at least point in the direction of a Creative Presence. If human nature really is turned toward God like a flower toward the sun, one can intelligently surmise that 161


this inclination arose evolutionarily in response to some objective and attracting feature of the universe that contributes significantly to human advantage. While this is indeed a highly speculative transposition, moving us quickly into the area of metaphysical speculation on the nature of God and ultimate reality, it is scientifically odd to think that complex inclinations (a) evolve without some real selective benefits to the species or (b) without some objective referent. Two analogies may be useful here. The God tendency would be like the turning of a sunflower. As the sun rises, the sunflower turns to the east, and as it journeys west across the sky the flower follows it. The sunflower has evolved this way because it gets a flow of benefit from being sun-pointed. So the spiritual instinct turns us toward the Creative Presence. This instinct is like the wick of a lamp. It can burn dimly or brightly by turning the wick down or up, and in some the flame can be extinguished. Yet the wick remains. Thus wrote St. Augustine in his Confessions, “Man is one of your creatures, Lord, and his instinct is to praise you” (Bk. 1, 1). However forgetful of the Creative Presence, the instinct remains and memory can be rekindled. It is often rekindled in the context of group worship, replete with sacred symbols and rituals (Underhill 1991). Classical Natural Law Central to this analysis is the classical natural law concept that SRI expression is the outgrowth of an essential human propensity that is far from irrational, that is salutary, and that cannot be long inhibited without incidence of revolt or a generalized failure in individuals and society to most fully thrive. This is not to suggest that the person in whom the religious impulse is inhibited cannot live a good and moral life—in some instances a life more laudable than those religious counterparts who manifest harmful absolutisms and destructive intolerance. Nevertheless, without wishing to deny the above ambiguity, I would concur with the words of John Hick, for the human being is “a religious animal,” and in its highest expression, this spirituality reorganizes the self’s priorities and elevates it (Hick 1999, 3). The ancient idea of natural law identifies those human “goods” (ends, pursuits, inclinations) without which human flourishing is improperly limited. As Leo Strauss argued, classical natural law began with the ideal of a good life defined as “life in accordance with the natural order of man’s being, the life that flows from a well-ordered or healthy soul” (Strauss 1953, 127). “Human flourishing” is meant to render the Greek eudaimonia (usually translated as “happiness,” but a better word would be “excellence”) more accurately. Natural law makes two presuppositions: there is an ultimate end of human life (flourishing) and there is a greater-than-human lawgiver, whether that lawgiver be the providential order of the universe or God. Classically, communion with a Creative Presence has been central to the natural law notion of true flourishing, and the cosmos is understood as unfolding toward such communion as its highest purpose. 162

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In order to confirm the existence of a natural law morality, one has only to look at the basic goods in which societies invest and around which institutions are established and structured. Hospitals, schools, housing, playgrounds, museums and concert halls, and places for worship come immediately to mind. These basic goods are universal. To better explicate the theory of natural law, I turn here to some of its modern interpreters. One of the modern defenders of natural law ethics is John Finnis of Oxford University. What does he believe are the universal features of human well-being? The first of seven basic human goods, “corresponding to the drive for self-preservation, is the value of life” (Finnis 1980, 86). He refers to medical schools, road safety laws, famine relief efforts, and the like as empirical evidence. The universal transmission of life through procreation and the rearing of children also establishes the human good of life itself. The second human good is knowledge, pursued not just instrumentally, but for its own sake (Finnis 1980, 87). While the noninstrumental pursuit of knowledge may reflect the ideals of an Oxford professor, knowledge for social and economic purposes is a universal human good. People need to take care of themselves and of others; to do so, they need some craft, trade, or other means of procuring necessities. A case can also be made for knowledge for its own sake, indicating the nonreducible feature of this human good. The third human good is play: “A certain sort of moralist analysing human goods may overlook this basic value, but an anthropologist will not fail to observe this large and irreducible element in human nature” (Finnis 1980, 87). Is there a culture in which toys of some sort are unheard of, in which children play no games, in which some form of sport does not exist? A fourth human good is aesthetic experience. While many forms of play are occasions for aesthetic experience, Finnis argues that beauty is not an indispensable aspect of play; the experience of beauty need not involve one’s own activity. The fifth basic human good is sociability and friendship. A sixth good is practical reasonableness, “the basic good of being able to bring one’s own intelligence to bear effectively (in practical reasoning that issues in action) on the problems of choosing one’s actions and lifestyle and shaping one’s own character” (Finnis 1980, 88). This good includes the good of freedom. The final good is religion: Misgivings may be aroused by the notion that one of the basic human values is the establishment and maintenance of proper relationships between oneself (and the orders one can create and maintain) and the divine. For there are, always, those who doubt or deny that the universal order-of-things has any origin beyond the “origins” known to the natural sciences . . . (Finnis 1980, 89)

But Finnis argues persuasively that people do wish to bring their actions into harmony with “that transcendent other and its lasting order,” even if they struggle in this effort and cannot ultimately achieve this harmony (as would be the case 163


with Sartre) (Finnis 1980, 90). It is this dialectic between the imperfect world and the transcendent order that makes religion necessary and valuable in public life and in the public square. The Contribution to Public Life Religion in public life has been deemed by Rorty as a “conversation-stopper,” and sometimes it is. However, it is also our most significant conversation-starter. On August 28, 1963, Martin Luther King Jr. stood before the Lincoln Memorial and spoke of “all God’s children” participating in the American dream: When we let freedom ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all God’s children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of that old Negro spiritual, “Free at last! Free at last! Thank God almighty, we are free at last!”

This religious content was not just rhetoric for the sake of emotional engagement. As Richard Neuhaus writes, many public commentators ignored or trivialized the religious conviction underlying King’s words and works because “in recent decades we have become accustomed to believe that of course America is a secular society. That, in the minds of many, is what is meant by the separation of church and state” (Neuhaus 1984, 80). When one announcer covering King’s memorial service described him as “the son of a minister,” he was reflecting the belief that religion “must be kept at one remove from the public square, that matters of public significance must be sanitized of religious particularity” (Neuhaus 1984, 98). Yet Dr. King had remarked, “They aren’t interested in the why of what we’re doing, only in the what of what we’re doing, and because they don’t understand the why they cannot understand the what” (Neuhaus 1984, 98). The point here is that Dr. King believed in human freedom and justice not merely because these were his values; because these are, as he perceived and felt them, the values and purposes of the Creator of us all, King was willing to speak for them, to act on them, and ultimately to die for them. His entire world of thought and action was based on the notion of agape or unlimited love, including the tradition of nonviolent resistance that was passed onto him from his mentors (L. E. Carter 1998; King 1963). The “why” giving rise to the “what” of which King spoke is nicely represented at the international level in the thought and life of Dag Hammarskjöld. Here the relationship between the public servant and the inner religious self is well manifested. When he was killed in a plane crash over Africa in 1961, “the whole world knew that it had lost one of its most dedicated and invaluable public servants” (Van Dusen 1967, 3). As Henry P. Van Dusen continues, Hammarskjöld’s leadership 164

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as secretary general transformed the United Nations “from a forum of prolix and often ineffectual talk into an instrument of action by the Community of Nations for the safeguarding of peace and the furtherance of world order” (Van Dusen 1967, 4). Like Lincoln and King, his religious sensibilities (which were issued in the publication of his spiritual classic entitled Markings) and his remarkable political abilities matched exactly the needs of the hour. Hammarskjöld wrote of his religious grounding in all that he did: In the faith which is God’s marriage to the soul, you are one with God, and God is wholly in you, just as, for you, He is wholly in all you meet. With this faith, in prayer you descend into yourself to meet the Other, in the steadfastness and light of this union, alone before God, and that each of your acts is an act of creation, conscious because you are a human being with human responsibilities, but governed, nevertheless, by the power beyond human consciousness which has created man. (Van Dusen 1967, 150)

Hammarskjöld was another of the many truly great public servants who, with tremendous statesmanship born of a desire to be effective for an urgent purpose higher than his own, did so much for so many. His sense of spiritual calling in public life separated him from the despised political opportunist. Ronald F. Thiemann writes that “religious voices should be welcomed into the pluralistic conversation of democracy as long as they agree to abide by the fundamental values of this republic: a commitment to freedom, equality, and mutual respect” (Thiemann 1996, 173). Throughout American history, the religious convictions of the American people have shaped and enhanced social changes. Lincoln brought his religious convictions about human equality directly into his public rhetoric and actions. Reverend King and Rabbi Abraham Joshua Heschel publicly addressed the problem of racism on the basis of Christian and Jewish ethical traditions. Working within the boundaries of respect, pluralism, and respect for the views of others, religious people are an integral part of moral progress in countless areas of public life. As Stephen L. Carter points out in his Massey Lectures at Harvard University, a pronounced feature of the religious voice is its willingness to be somewhat subversive of the reigning moral and political assumptions of the day in order to achieve progress (S. L. Carter 1998b). Carter writes, Our most famous progressive examples of this subversive aspect of the religions are the abolitionist movement and the civil rights movement, both of which were largely inspired by the shared meanings of religious communities that were sharply different from the meanings that the larger society in those days proposed; both of which changed the nation quite radically for the better; and both of which give the lie to the constitutional

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canard that there is something wrong, or even something suspicious, about religious argument in American political life. (S. L. Carter 1998b, 28)

So while religion should promote civility in public discourse and political debate, it would be unfortunate if it became too civilized to assert a prophetic voice against the power of injustice. One of Stephen L. Carter’s most useful contributions in the academic conversation about the nature of discourse in the public square is his discussion of civility (S. L. Carter 1998a). He defends the place of religious argument in public debate and of civility in such debate between those who differ. He laments the loss of civility in public debate and politics and sees religion as they key to its reconstruction: The key to reconstructing civility, I shall argue, is for all of us to learn anew the virtue of acting with love toward our neighbors. Love of neighbor has long been a tenet of Judaism and Christianity, and a revival of civility in America will require a revival of all that is best in religion as a force in our public life. Only religion possesses the majesty, the power, and the sacred language to teach all of us, the religious and the secular, the genuine appreciation for each other on which a successful civility must rest. (S. L. Carter 1998a, 18)

His general argument is that secularists have not done well over the last decade in creating an atmosphere of political civility and that any hope for a rebirth of civility will begin with the purposeful commitment of religious participants to the principle of neighbor love. Perhaps it would be useful to provide a context in which SRI is clearly associated with human flourishing. This is often evident in the relationship between SRI and benevolent love within the community of a shared humanity.

SALUTARY SRI AND EXCEPTIONLESS (“UNLIMITED”) LOVE The great and lasting religious traditions of the world do in various symbolic ways associate the Creative Presence with unlimited love, a term that I borrow from the writings of Sir John Templeton, and by which he means “total constant love for every person with no exception” (Templeton 2000). Reflection on the human condition suggests strongly that unlimited love is not a human possibility, nor has it ever been so. Yet some exemplary persons do seem to manifest degrees of such unlimited love through their experiences of participation in the Creative Presence toward which we are all to some extent inclined. 166

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Unlimited love is resonant with the idea of agape, an ancient Greek word that describes an unselfish, warm, and accepting form of love that was appropriated by early Christianity. Judaism, for example, in Psalm 119, speaks of the hesed or “steadfast love” of God. Buddhism speaks of karuna, meaning compassionate love. One finds rough equivalents of the ideal of divine unlimited love across the major spiritual and religious traditions. Moreover, the consensus between these traditions is that in various ways that need to be better understood, human beings can connect with this source of love and in this way be elevated. Exactly how to best harness the power of unlimited love deserves further research and study. What is it, then, toward which Homo religiosus is inclined? Toward a higher Creative Presence in the universe that is characterized by an abiding, personal, and affective affirmation of the value of all of our lives. By participating to various degrees in this Creative Presence, we too can affirm the value and even sacredness of the existence of all others, leading to expressions of unlimited love in compassion, care, communion, and forgiveness. We share in a divine love that acknowledges for all others their absolutely full significance that, because of egoism, we otherwise acknowledge only for ourselves. This migration at the center of our being toward all others in their full and equal value is the core element in unlimited love, and it is the fruit of spiritual and religious experience through which communion with a Creative Presence brings such love into the world. For the vast majority of us who only participate in unlimited love to some very small extent, the fact that such love is a perceived reality in the universe provides immense solace and comfort. Those who freely shape their lives around the ideal of divine unlimited love, as manifested in compassion, care, forgiveness, and justice, are as much citizens of the republic as those who shape their lives around other experiences, beliefs, and values. Far from being menaces to the commonweal, such persons are more likely the salt of the earth and should be free to contribute to the human good across all the domains of public and private life.

CORE SCIENTIFIC QUESTIONS Let us repeat the core scientific questions, then, regarding SRI and human flourishing, in the context of the above discussion: 1. 2. 3.

How does spiritual and religious experience enhance the human capacity for a life of unlimited “exceptionless” love? What is the relationship between perceptions of perfect divine love and expanded love in the life of the individual and across a society? How do religious rituals and practices at their best increase the total amount of love energy in society and in the world? 167

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Harrington, A., ed. (1997). The Placebo Effect: An Interdisciplinary Exploration. Cambridge: Harvard University Press. Haught, J. (2006). Is Nature Enough? Meaning and Truth in the Age of Science. New York: Cambridge University Press. Hollinger, D. A. (1996). Science, Jews, and Secular Culture: Studies in Mid-Twentieth-Century American Intellectual History. Princeton: Princeton University Press. Kaptchuk, T., Finniss, D., Miller, F., and Benedetti, F. (2010). Biological, Clinical, and Ethical Advances of Placebo Effects. Lancet 375 (9715), 686-695. Koenig, H. G., McCullough, M. E., and Larson, D. B. (2001). Handbook of Religion and Health. New York: Oxford University Press. Marsden, G. M. (1996). Soul of the American University: From Protestant Establishment to Established Nonbelief. New York: Oxford University Press. Pals, D. L. (2006). Eight Theories of Religion (Second ed.). New York: Oxford University Press. Polanyi, M. (1958). Personal Knowledge. London: Routledge and Kegan Paul. Preus, J. S. (1996). Explaining Religion: Criticism and Theory from Bodin to Freud. Atlanta: Scholars Press. Sharpe, E. J. (1986). Comparative Religion: A History (Fifth ed.). Chicago: Open Court Publishing. Smith, J. Z. (1982). Imagining Religion: From Babylon to Jonestown. Chicago: University of Chicago Press. Smith, J. Z. (2004). Relating Religion: Essays in the Study of Religion. Chicago: University of Chicago Press. Sternberg, E. (2001). The Balance Within: The Science Connecting Health and Emotions. New York: W. H. Freeman. Taylor, M. C., ed. (1998). Critical Terms for Religious Studies. Chicago: University of Chicago Press. Wilson, E. O. (1998). Consilience: The Unity of Knowledge. New York: Knopf. 172

10. References Chapter One: Stark Albright, William Foxwell. [1940] 1957. From the Stone Age to Christianity. Garden City, NY: Doubleday. Bader, Christopher, and Paul Froese. Forthcoming. “Images of God: The Effect of Personal Theologies on Moral Attitudes, Political Affiliation, and Religious Behavior.” Barnes, Michael Horace. 2000. Stages of Thought: The Co-Evolution of Religious Thought and Science. Oxford: Oxford University Press. Beattie, John. 1966. “Ritual and Social Change.” Man 1:60-70 Bellah, Robert N. 1964. “Religious Evolution.” American Sociological Review 29:358-74. Burrow, J. W. [1871] 1903. Primitive Culture. London: John Murray. Caird, Edward. 1899. The Evolution of Religion. Glasgow: James Maclehose and Sons. Davie, Grace. 1994. Religion in Britain Since 1945. Oxford: Blackwell. Durkheim, Emile. [1912] 1995. The Elementary Forms of the Religious Life. New York: Free Press. —. [1897] 1951. Suicide. Glencoe, IL: The Free Press. —. [1886] 1994. Review of Part VI of Herbert Spencer, The Principles of Sociology, in W. S. F. Pickering, Durkheim on Religion. Atlanta: Scholars Press:13-23. 173


Frazer, James G. [1922] 1950. The Golden Bough. New York: Macmillan. Freud, Sigmund. [1912-1913] 1950. Totem and Taboo. New York: W. W. Norton. Herberg, Will. 1960. Protestant-Catholic-Jew. New York: Doubleday. Kallen, Horace M. 1951. “Democracy’s True Religion.” Saturday Review of Literature 34 (July 28): 6-7. Lee, Robert. 1960. The Social Sources of Church Unity. New York: Abingdon Press. Needham, Rodney. 1972. Belief, Language, and Experience. Chicago: University of Chicago Press. Price, S. R. F. 1984. Rituals and Power: The Roman Imperial Cult in Asia Minor. Cambridge: Cambridge University Press. Sperber, Dan. 1975. Rethinking Symbolism. Cambridge: Cambridge University Press. Stark, Rodney. 2003. For the Glory of God. Princeton: Princeton University Press. —. 2001a. One True God: Historical Consequences of Monotheism. Princeton: Princeton University Press. —. 2001b. “Gods, Rituals, and the Moral Order.” Journal for the Scientific Study of Religion 40:101-120. Stark, Rodney, and Roger Finke. 2000. Acts of Faith: Explaining the Human Side of Religion. Berkeley: University of California Press. Stark, Rodney, and Charles Y. Glock. 1968. American Piety. Berkeley: University of California Press. Swanson, Guy E. 1960. The Birth of the Gods. Ann Arbor: University of Michigan Press. Tylor, Edward Burnett. [1871] 1958. Religion in Primitive Culture. New York: Harper. Williams, J. Paul. 1952. What Americans Believe and How They Worship. New York: Harpers. 174

11. References Chapter Two: Wilson (Annotated) Atran, S. (2002). In Gods We Trust: The evolutionary landscape of religion. Oxford, Oxford University Press. Analysis of religion as a by-product of cognitive adaptations that evolved in ancestral environments, primarily in a nonreligious context. Atran, S., and A. Norenzayan (2005). “Religion’s evolutionary landscape: Counterintuition, commitment, compassion, communion.” Behavioral and Brain Sciences in press. Summary and update of Atran (2002), followed by commentaries and reply. Aunger, R. (2002). The Electric Meme. New York: Free Press. Perhaps the most thorough analysis of the meme as a useful concept for thinking about cultural evolution. Boyer, P. (2001). Religion Explained. New York: Basic Books. Analysis of religion as a by-product of cognitive adaptations that evolved in ancestral environments, primarily in a nonreligious context. Boehm, C. (1999). Hierarchy in the Forest: Egalitarianism and the Evolution of Human Altruism. Cambridge, MA: Harvard University Press. An account of the genetic and cultural evolution of human ultrasociality, from our closest primate relatives to large-scale human sociality. Bowles, S. (2003). Microeconomics: Behavior, institutions, and evolution. Princeton, NJ: Princeton University Press. A treatise by an economist at the forefront of transdisciplinary research that includes traditional economics, evolutionary biology, psychology, and anthropology. 175


Carniero, R. (2003). Evolution in Cultural Anthropology: a critical history. New York: Westview Press. A review of the history of cultural evolution, from before Darwin to the present, with a focus on the emergence of large-scale society. Deacon, T. W. (1998). The Symbolic Species. New York: Norton. A highly original and interdisciplinary attempt to show that humans are (nearly) unique in their capacity for symbolic thought. Diamond, J. (1997). Guns, Germs, and Steel. New York: Norton. A panoramic history of worldwide cultural evolution from the origin of agriculture to the present. Diamond, J. (2004). Collapse: How societies choose to succeed or fail. New York: Viking. An analysis of how past civilizations have failed and what modern civilizations must do to share a similar fate. Fehr, E., and S. Gachter (2002). “Altruistic punishment in humans.” Nature 415:137-140. Experiments that reveal the human propensity to punish social transgressions, even without the prospect of indirect benefits. Fehr, E., and U. Fischbacher (2003). “The Nature of Human Altruism.” Nature 425:785-791. A review of human altruism that represents the best of contemporary interdisciplinary research. Gintis, H. (2000). Game Theory Evolving. Princeton, NJ: Princeton University Press. A treatise by an economist at the forefront of transdisciplinary research that includes traditional economics, evolutionary biology, psychology, and anthropology. Gintis, H. (2003). “Towards the Unity of the Behavioral Sciences.” Santa Fe Institute Working Paper #03-02-015. An article-length account of contemporary interdisciplinary studies of human sociality. Gintis, H., S. Bowles, et al., eds. (2005). Moral sentiments and material interests: the foundations of cooperation in economic life. Cambridge, MA: MIT Press. A treatise by two economists at the forefront of transdisciplinary research that includes traditional economics, evolutionary biology, psychology, and anthropology. Henrich, J. (2003). “Cultural group selection, coevolutionary processes and large scale cooperation.” Journal of Economic Behavior and Organization 53:3-35. An article-length account of modern research on cultural evolution, including commentaries.

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Henrich, J., R. Boyd, et al. (2004). Foundations of human sociality: economic experiments and ethnographic evidence from fifteen small-scale societies. Oxford, UK: Oxford University Press. A unique interdisciplinary study in which a single set of experiments drawn from the field of experimental economics was administered to small-scale societies around the world. Koppl, R., ed. (2005). Evolutionary psychology and economic theory. Greenwich, CN: JAI Press. A recent volume exploring the interface between evolutionary and economic theory, including the nature of large-scale human social organizations. Nisbett, R. (2003). Geography of thought: How Asians and Westerners think differently, and why. New York: Free Press. A popular book that summarizes current research on cognitive processes as a product of cultural evolution, but a leader in this field. Odling-Smee, F. J., K. N. Laland, et al. (2003). Niche Construction: The neglected process in evolution. Princeton: Princeton University Press. An attempt to think about evolution as a coevolutionary process in which organisms change their environment, which in turn changes the properties of organisms. Pagel, M., and R. Mace (2004). “The cultural wealth of nations.” Nature 428:275-278. A brief account of how human cultural diversity exhibits the same patterns as biological diversity. Poggi, G. (1978). The development of the modern state: a sociological introduction. Stanford, CA: Stanford University Press. This short history of the emergence of state-level society doesn’t mention evolution by name but clearly implicates multilevel cultural evolutionary processes. Richerson, P. J., and R. Boyd (2004). Not by genes alone: how culture transformed human evolution. Chicago: University of Chicago Press. The most recent and perhaps most balanced and accessible account of the contemporary field of cultural evolution. Sober, Elliott, and David S. Wilson (1998). Unto Others: The Evolution and Psychology of Unselfish Behavior. Cambridge, MA: Harvard University Press. A book-length treatment of multilevel selection theory in relation to human behavior and cultural evolution.

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Sosis, R. (2004). “The adaptive value of religious ritual.” American Scientist 92:166-172. An example of contemporary, theory-driven empirical research on religion from an evolutionary perspective. Teilhard de Chardin, Pierre (1959). The phenomenon of man. New York: Harper. An early attempt to integrate evolution and religion that portrayed evolution as progressive with mankind at the forefront. Tomasello, M. (1999). The cultural origins of human cognition. Cambridge, MA: Harvard University Press. An attempt to understand the roots of human cultural evolution through the study of our closest primate relatives and human child development. Wilson, D. S. (2002). Darwin’s Cathedral: evolution, religion, and the nature of society. Chicago: University of Chicago Press. Analysis of religion as primarily a product of between-group selection, in contrast to the by-product of interpretation of Atran and Boyer. The diversity of views among evolutionary biologists studying religion points out the need for a balance between hypothesis formation and testing. Wilson, D. S. (2004). “The New Fable of the Bees: Multilevel selection, adaptive societies, and the concept of self-interest.” Advances in Austrian Economics 7:201-220. An article-length treatment of how multilevel selection, and not self-interest, accounts for all forms of ultrasociality. Wilson, E. O. (1998). Consilience: The Unity of Knowledge. New York: Knopf. A general plea for the unification of knowledge.

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12. References Chapter Three: Gregersen Alexander, J. McKenzie (2009). “Evolutionary Game Theory,” www.plato.stanford. edu/entries/game-evolutionary, visited March 31, 2010. Alexander, R. D. (1987). The Biology of Moral Systems. New York: De Gruyter. Atran, Scott (2002). In Gods We Trust: The Evolutionary Landscape of Religion. Oxford: Oxford University Press. Axelrod, Robert (1990). The Evolution of Cooperation. London: Penguin. Axelrod, Robert (1997). The Complexity of Cooperation: Agent-Based Models of Competition and Collaboration. Princeton: Princeton University Press. Bak, Per (1997). How Nature Works: The Sciences of Self-Organized Complexity. New York: Oxford University Press. Barrett, Justin L. (2004). Why Would Anyone Believe in God? Walnut Creek, CA: AltaMira Press. Brams, Steven J. (1983). Superior Beings: If They Exist, How Would We Know. Game-Theoretic Implications of Omniscience, Omnipotence, Immortality, and Incomprehensibility. New York: Springer Verlag. —. [1984] 2002. Biblical Games: Game Theory and the Hebrew Bible. Cambridge, MA: MIT Press.

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Christoffersen, L., Hans Raun Iversen, Hanne Petersen, and Margit Warburg, eds. (2010). Religion in the 21st Century: Challenges and Transformations. Aldershot: Ashgate. Cowan, George A., David Pines, and David Meltzer eds. ([1994] 1999). Complexity: Metaphors, Models and Reality Cambridge, MA: Perseus Books. Davies, Paul, and Niels Henrik Gregersen, eds. (2010). Information and the Nature of Reality: From Physics to Metaphysics. Cambridge: Cambridge University Press. Deacon, Terrence (1997). The Symbolic Species: The Co-Evolution of Language and the Brain. New York: W. W. Norton. Depew, David J., and Bruce M. Weber, eds. (2003). Evolution and Learning: The Baldwin Effects Reconsidered. Cambridge, MA: MIT Press. Edelmann, Gerald (1992). Bright Air, Brilliant Fire: On the Matter of the Mind. New York: Basic Books. Gell-Mann, Murray (1994). The Quark and the Jaguar: Adventures in the Simple and the Complex. New York: W. H. Freeman. Gardner, M. (1970). “Mathematical Games: The Fantastic Combinations of John Conway’s New Solitaire Game ‘Life,’” Scientific American 223 (4), 120-23. Gregersen, Niels Henrik (1998). “The Idea of Creation and the Theory of Autopoietic Processes.” Zygon: Journal of Religion & Science 33 (3), 333-67. Gregersen, Niels Henrik (2002). “Beyond the Balance: Theology in a Self-Organizing World.” In Design and Disorder: Perspectives from Science and Theology, eds. Niels Henrik Gregersen and Ulf Görman, London-New York: T & T Clark-Continuum, 53-92. Gregersen, Niels Henrik, ed. (2003). From Complexity to Life: On the Emergence of Life and Meaning. New York: Oxford University Press. Gregersen, Niels Henrik (2005). “Living with Complexity: A Cellular Automaton Model of Religious Transformation.” Studies in Science and Theology 10. Lund: Lund University, 185-203.

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ANNOTATED BIBLIOGRAPHY: PREPARED BY ROBERT EMMONS Cacioppo, J. T., Berntson, G. G., Lorig, T. S., Norris, C. J., Rickett, E., and Husbaum, H. (2003). Just because you’re imaging the brain doesn’t mean you can stop using your head: A primer and set of first principles. Journal of Personality and Social Psychology 85, 650-661. [neuroscience] Required reading for anyone planning on conducting brain imaging research on spirituality. Four simple principles are provided (well, not so simple) that serve as guidelines for thinking about the neural bases of psychological processes, including religious and spiritual phenomena. The authors conclude that (a) complex aspects of the mind and behavior will benefit from yet a broader collaboration of neuroscientists, cognitive scientists, and social scientists and (b) social psychologists bring important theoretical, methodological, and statistical expertise to this interdisciplinary enterprise. Damon, W., Menon, J., and Bronk, K. C. (2003). The development of purpose in adolescence. Applied Developmental Science 7, 119-128. [purpose] This article offers a new operational definition of purpose that distinguishes it from meaning in life in an internalistic sense, and it reviews the existing psychological studies pertinent to the development of purpose during youth. The article identifies a number of urgent questions concerning how—and whether—young people today are acquiring positive purposes to dedicate themselves to and, if so, what the nature of today’s youth purposes might be. Purpose as a motivator of good deeds and galvanizer of character growth is stressed. Danner, D., Snowdon, D. A., and Friesen, W. V. (2001). Positive emotions in early life and longevity: Findings from the nun study. Journal of Personality and Social Psychology 80, 804-813. [sacred emotions; love; gratitude] This is one of the most important of the last five years. Handwritten autobiographies from 180 Catholic nuns, composed when participants were a mean age of twenty-two years, were scored for emotional content and related to survival during ages seventy-five to ninety-five. A strong inverse association was found between positive emotional content in these writings and risk of mortality in late life (p

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