2. Copyright  2005, Daniel E. Hall It Ain’t Necessarily So What a Family Physician Needs to Know Before Interpreting Studies on Religion and Health The Rev. Daniel E Hall, MD, MDiv Fellow in Religion and Health, DUMC Resident, General Surgery, UPMC Assisting Priest, Church of the Holy Family

3. Copyright  2005, Daniel E. Hall What You Need to Know 1.How to interpret the medical data about religion and health. 2.How to apply it ……Wisely In both lectures, I aim to challenge some assumptions and hopefully spark new insight.

4. Copyright  2005, Daniel E. Hall So what do we know about religion and health? Quite a lot, really. Over 2000 studies, some quite sophisticated Multidisciplinary field encompassing physical, mental and social health Strongest data demonstrates robust association between mortality and religious attendance.

5. Copyright  2005, Daniel E. Hall Examples: Lower mortality, longer survival (39 of 52 studies) Better immune function (5 of 5 studies) Lower blood pressure (12 of 14 studies) Less heart disease (11 of 16 studies) Purpose and meaning in life (15/16) Depression and its recovery (60/93) Suicide (57/68) Marital satisfaction and stability (35/38) Social support (19/20) Substance abuse (98/120) Handbook of Religion and Health (Oxford University Press, 2001)

6. Copyright  2005, Daniel E. Hall

7. The World According To George Gershwin “It ain’t necessarily so. The things that your liable to read in the bible… (aka NEJM, Harrison’s, Time) …..It ain’t necessarily so.”

8. Copyright  2005, Daniel E. Hall Empiricism What is religion? Try to define it. How would you measure it?

9. Copyright  2005, Daniel E. Hall History 15 Years ago: Poor Quality Today: toe to toe with other research Much more sophisticated –Design –Statistics –Controls –Explanatory pathways/mechanisms Koenig, et. al., Handbook of Religion and Health (Oxford University Press, 2001) McCullough, ME (1999) Research on religion-accommodation counseling: Review and meta- analysis. J of Counseling Psychology, 211-222. Levin, J. S., and H. Y. Vanderpool. 1987. Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Soc Sci Med 24(7):589–600.

10. Copyright  2005, Daniel E. Hall ICIHS Consensus Conference –1997, 1200 articles –2003, >2000 articles What was new? Not much. –The wider application of existing methodology generated more of the same kinds of findings. –Double edged sword of growing respect. As the field became a “field” less freedom and creativity in cracking new nuts.

11. Copyright  2005, Daniel E. Hall What do all those 2000 papers tell us? (On my most cynical day…) On the whole, “Religion” (poorly understood and even more poorly measured) has a small, robust, positive association with “health” (slightly better understood and measured).

12. Copyright  2005, Daniel E. Hall “Without attention to the epistemological matters of conceptualizing and operationalizing ‘religion’ in meaningful ways, no amount of methodological and analytical sophistication will be sufficient to generate meaningful findings” Levin, J. S., and H. Y. Vanderpool. 1987. Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Soc Sci Med 24(7):589–600.

13. Copyright  2005, Daniel E. Hall Conceptualizing Religion How can we do this better? Why is it important? –Impossible to interpret the medical literature without knowing how the study conceives its subject, and perhaps more importantly, how it measures that subject. –Healthy skepticism: It ain’t necessarily so.

14. Copyright  2005, Daniel E. Hall Measuring Religion? How has it been done so far?

15. Copyright  2005, Daniel E. Hall Religious Measurement Over 100 instruments exist Impressive depth and breadth Lots of valuable information

16. Copyright  2005, Daniel E. Hall Multidimensional Construct Organized Religiosity (attendance) NonOrganized Religiosity (private prayer, scripture reading) Intrinsic/Extrinsic Functional Measures –Spiritual Well Being –Coping History Spiritual Experiences Multidimensional Measures

17. Copyright  2005, Daniel E. Hall Duke University Religion Index (DUREL) 1.How often do you attend church or other religious meetings? 2.How often do you spend time in private religious activities, such as prayer, meditation or Bible study? 3.In my life, I experience the presence of the Divine (i.e. God). 4.My religious beliefs are what really lie behind my whole approach to life. 5.I try hard to carry my religion over into all other dealings in life. Koenig HG, et al. “Religion index for psychiatric research (DUREL).” Am J Psychiatry 1997;154:885-6.

18. Copyright  2005, Daniel E. Hall Critique Valuable information: Absolutely –Psychometrically advanced and well-validated –MD approach isolates potential “pathways” Tendency to over-generalize –Particularly in popular press –“religion” is good/bad for your health Near exclusive reliance on self-report Little or no attention to the specific context of religious belief or practice –Existing approaches lump together widely divergent worldviews

19. Copyright  2005, Daniel E. Hall Context is Critical Existing measures assess “religiousness-in general” –True for both global assessments and functional measures—most instruments are context-free. Locate subjects on a continuum of intensity from “very religious” to “not at all religious”. Driving question: How are “religious” people different than “secular” people. Assumption: It doesn’t matter what you believe, so long as you DO believe.

20. Copyright  2005, Daniel E. Hall Religiousness-in-General

21. Copyright  2005, Daniel E. Hall Religiousness-in-General This approach supported by some polls Favored by the rising preference for “spirituality” as something more generic and universal than “religion”. But it doesn’t describe the religious landscape Lumps together widely divergent worldviews and belief systems Intensely religious Jews, Muslims, Unitarian Universalists are analyzed in the same group.

22. Copyright  2005, Daniel E. Hall The Religious Landscape

23. Copyright  2005, Daniel E. Hall Civil Religion Content of Civil Religion Nominal Theism Minimalist moral order American way of life Limited specificity—not a traditional religion “Cultural Christianity” Biblical metaphors adapted to national myth –Washington::Moses –Lincoln::Christ Liturgical calendar: –Thanksgiving, President’s Day, Memorial Day, etc Bellah, R. N. (1967). "Civil Religion in America." Daedalus: Journal of the American Academy of Arts and Sciences 96(1): 1-21.

24. Copyright  2005, Daniel E. Hall Confounding Findings: End of Life Decision-making

25. Copyright  2005, Daniel E. Hall What does this mean? Measure specific faith traditions But…. Spirituality is in vogue American Gladiators of Religion –My God is better than your God

26. Copyright  2005, Daniel E. Hall How to redeem the existing measures? (pun intended) Perhaps the existing measures are actually better understood as measures of SECULARITY. What do I mean by that? –Precision

27. Copyright  2005, Daniel E. Hall Precision: Measures of Secularity

28. Copyright  2005, Daniel E. Hall Hitting the Target

29. Copyright  2005, Daniel E. Hall Secularity and Health The existing research may better be understood as demonstrating a small, but consistent health liability for those who approach the world from a deliberately secular worldview. Yes, this is a bit inflammatory…but I think it is a more accurate interpretation.

30. Copyright  2005, Daniel E. Hall Deep Breath One or two questions before we move on

31. Copyright  2005, Daniel E. Hall Live and in Pay Per View A one night engagement only WWF SMACKDOWN! Weber v. Aquinas (Worldview Wrestling Federation)

32. Copyright  2005, Daniel E. Hall Conceptualizing Religion How did we come to assume “religion” as such exists? Once, there was no “secular”. The concept of religion is only 300 years old Concurrent with “modernity” –Nominalists, Renaissance, Enlightenment Presumes the “objective” perspective from “nowhere”. Hall DE, Koenig HG, Meador KG. Conceptualizing "religion": How language shapes and constrains knowledge in the study of religion and health. Perspectives in Biology & Medicine. 2004;47(3):386-401.

33. Copyright  2005, Daniel E. Hall Of Cocoa, Frosting and Cake Dominant paradigm for religion as an optional frosting added to the vanilla cake of generic human experience. Weber, Durkheim, Eliade, Wm James Predicated on “generic human experience” Predicated on the Enlightenment epistemology called Foundationalism

34. Copyright  2005, Daniel E. Hall Foundationalism Foundation of “universal” knowledge Accessible to all people Lock away particular, individual convictions Empirical observation and the application of reason Extremely powerful at answering particular types of questions. Part and parcel with modernity But it wasn’t always so.

35. Copyright  2005, Daniel E. Hall The Bad News Foundationalism is dead or dying Objectivity doesn’t exist Living through a revolution of epistemology Trust, not proof, plays a much larger role in our systems of knowledge than we like to admit.

36. Copyright  2005, Daniel E. Hall Cultural-Linguistic Contingency If we can’t have proof, what is left? Knowledge is contingent on the cultural- linguistic context in which it is meaningful Electrons that are looked at Chocolate cake is not the same thing as vanilla cake with chocolate frosting Ingredients are the same All the difference in the order of mixing

37. Copyright  2005, Daniel E. Hall Unmediated Knowledge This is the way scientists are trained to think This is the way our culture is trained to think

38. Copyright  2005, Daniel E. Hall Unmediated Knowledge But it just isn’t possible

39. Copyright  2005, Daniel E. Hall Mediated Knowledge None of us are a blank slate All knowledge is mediated through some interpretive lens Sunrise is different for: –Aquinas –Copernicus –Einstein

40. Copyright  2005, Daniel E. Hall Mediated Knowledge However, the lens is often invisible—hidden by unconscious assumptions Yet, nonetheless, the lens constrains both the possible questions and the possible answers Degree of certainty is contingent on how much we trust the lens.

41. Copyright  2005, Daniel E. Hall Multiple Lenses More than one lens shapes our knowledge of the world. Physician Scientist Husband/Father American Woman/Man Black/White

42. Copyright  2005, Daniel E. Hall Compound Lenses Both the number and the order of the lenses matter.

43. Copyright  2005, Daniel E. Hall Why does this matter? “Religions” function like one of these lenses. Religion as “worldview”: –“A comprehensive, self-referentially complete interpretation of the human condition that does not require reference to any external narrative or tradition.

44. Copyright  2005, Daniel E. Hall What is religion? Not defined by its ingredients. Chocolate cake v. Vanilla & chocolate frosting Not a set of beliefs Virgin birth, Resurrection, Holy Spirit, etc Not a set of experiences Mystical communion with the divine Sense of God’s love, etc Religion is the framework of meaning that binds together various beliefs and experiences in distinct relationships.

45. Copyright  2005, Daniel E. Hall So What? Five implications for the scientific study of religion and health.

46. Copyright  2005, Daniel E. Hall 1-Secularism is not objective No intrinsic privilege over other rational worldviews Frosting/Cake model distorts religion Outside looking in Forces religion into secular categories Better to study from “the inside” of the unique cultural-linguistic tradition Science  Secular

47. Copyright  2005, Daniel E. Hall 2-Measure fluency not content Learning a worldview (or religion) is like learning a foreign language Grammar and syntax are not enough Must also have skill putting it together: fluency Religious belief and experience are not enough….must also be fluent Measurement requires some assessment of “performance” by someone else who is fluent

48. Copyright  2005, Daniel E. Hall 3-“Spirituality” is not a universal language Spirituality:Religion::Linguistics:Language Textbook in linguistics  Shakespeare’s Sonnet XII Spirituality-in-General is about as useful as Esperanto Individualized Expressions of Religion Sheila and private languages Religion-in-General like a meta-analysis without primary data.

49. Copyright  2005, Daniel E. Hall The Religious Landscape

50. Copyright  2005, Daniel E. Hall 4-Religion isn’t a “therapy” Therapeutic model of faith Is religion “good for your health?” Implication that doctors might “prescribe” faith. Problematic from both theological and methodological perspectives. Will the “effect” be the same if people “get” religion in order to live longer? “Idolatry “ of “replacing God with a personalized, manipulable sense of well-being.” Changing a worldview is both methodologically and ethically problematic. Conversion rare Proselytism inappropriate If not a therapy, then what is it? Shuman, J. J. and K. G. Meador (2003). Heal Thyself: Spirituality, medicine, and the distortion of Christianity. New York, Oxford University Press.

51. Copyright  2005, Daniel E. Hall Worldview as demographic risk factor Like Japanese men and gastric cancer, there may be patterns of disease, specific to particular worldviews, that are relevant to healthcare. Goal isn’t so much to intervene as it is to better understand risk factors and guide appropriate care.

52. Copyright  2005, Daniel E. Hall 5-Worldviews may have consequences Dangerous and threatening Challenge entrenched belief and power Meaningful findings will require asking these dangerous questions in a responsible way. MacIntyre A. Whose Justice? Which Rationality? Notre Dame, IN: University of Notre Dame Press; 1988.

53. Copyright  2005, Daniel E. Hall What do all those 2000 papers tell us? (On my most cynical day…) On the whole, “Religion” (poorly understood and even more poorly measured) has a small, robust, positive association with “health” (slightly better understood and measured).

54. Copyright  2005, Daniel E. Hall A Fork in the Woods? Steps to the next level Different Questions Better Answers Will require attention to the Levin’s epistemological challenges of conceptualizing and operationalizing “religion” in more meaningful ways. Don’t have the answers, but these are some first steps

55. Copyright  2005, Daniel E. Hall Conclusions Religion and Health: It ain’t necessarily so… (or at least not how we once thought) Applying the scientific method to the study of religion has unique challenges Be careful as you try to interpret findings from studies written by authors who may or may not think this carefully about epistemological and conceptual challenges of “religion”.

56. Copyright  2005, Daniel E. Hall Questions?