Religion and Psychological Well-Being:
Is There an Association?

by Vahid Payman

Surveying the moral landscape of the nineteenth century, Bahá'u'lláh, prophet-founder of the Bahá'í Faith, wrote: "The vitality of men's belief in God is dying out in every land." [1] The old religions, the dominant social and cultural force for so long, were now in decline. No longer holding sway over the thoughts and feelings of people around the world, their impotence had prompted Friedrich Nietszche, the German philosopher and contemporary of Bahá'u'lláh, to pronounce 'God is dead'.

Whilst the old religions have continued to lose influence during the twentieth century, nevertheless they remain important for many people, especially the elderly. And yet, for a phenomenon that has such a profound impact upon the individual, the interface between religion and mental health is a remarkably under-researched area. [2]

In spite of this, however, the universality of religion and its capacity to generate both good and evil prompts one to ask whether religion protects a person against psychological problems and whether it promotes mental well-being.

This paper will focus on studies conducted on the elderly and will attempt to answer four questions:

1. What is the prevalence of religious behaviour as a way of coping with difficulties in old age?
2. Is there a relationship between religiosity and psychological well-being?
3. What are the limitations of research conducted in this area to date?
4. What are the practical implications of such research?

Religion And The Founding Fathers Of Psychiatry

It is instructive to delve into the history of the debate concerning the impact of religion on psychological health.

Sigmund Freud, the founder of modern psychoanalysis, was a strong critic of religion. He thought that religious ideas had no basis in reality, that they were mere illusions which satisfied people's childlike wish for protection from the uncontrollable forces of nature. In fact, in Future of an Illusion, written towards the end of his life, Freud described religion as "the universal obsessional neurosis of humanity". Furthermore:

"...like the obsessional neurosis of children, it arose out of the Oedipus complex out of the relation to the father...If, on the one hand, religion brings with it obsessional restrictions, exactly as an individual obsessional neurosis does, on the other hand it comprises a system of wishful illusions together with a disavowal of reality, such as we find in an isolated form nowhere else but in amentia, in a state of blissful hallucinatory confusion." [3]

According to Freud, this denial of reality was an immature coping mechanism, and, like the obsessional patient who relinquishes his primitive defences with the help of his analyst, society would grow out of its need for religion with the aid of science.

In contrast, Freud's one-time pupil, Carl Jung, believed that religious faith was essential for well-being:

"Among all my patients in the second half of life - that is to say, over thirty-five - there has not been one whose problem in the last resort was not that of finding a religious outlook on life. It is safe to say that every one of them fell ill because he had lost that which the living religions of every age have given to their followers, and none of them has been really healed who did not regain his religious outlook." [4]

For Jung, the human psyche had always been "shot through with religious feelings and ideas", and, in a powerful broadside at his former mentor, stated: "Whoever cannot see this aspect of the human psyche is blind, and whoever chooses to explain it away, has no sense of reality... This father-complex (Oedipus), fanatically defended with such stubbornness and over-sensitivity, is a cloak of religiosity misunderstood." [4]

Similarly, for Erich Fromm, the humanist philosopher and psychoanalyst, the death of God had profound and grave consequences: "In the nineteenth century the problem was that God is dead; in the twentieth century the problem is that man is dead." [5] According to Fromm, a 'sane' society needed a system of myth and ritual to satisfy basic spiritual needs such as transcendence, orientation and belonging. Modern industrial societies had replaced such systems with the new collective neurosis of Having and Consumption. The consequence was a "society of notoriously unhappy, lonely, anxious, depressed, destructive, and dependent people who are glad when we have killed the time we are trying so hard to save." [5]

A Religious Perspective

"God is dead, but 50,000 social workers have risen to take his place." (Dr J.D. McCoughey, Australian Theologian)

Whilst psychiatrists and philosophers have argued over its pros and cons, the world's major religions have all taught the indispensability of religious life as the foundation for well-being. The youngest of these, the Bahá'í Faith, a religion now the second most widespread after Christianity, states that religion is the basis of human happiness. It reorients man to his true nature and to his God, promotes the cultivation of morals and virtues, develops discipline, and creates a pattern of order and stability for society:

"...universal benefits derive from the grace of the Divine Religions, for they lead their true followers to sincerity of intent, to high purpose, to purity and spotless honour, to surpassing kindness and compassion, to the keeping of their covenants when they have covenanted, to concern for the rights of others, to liberality, to justice in every aspect of life, to humanity and philanthropy, to valour and to unflagging efforts in the service of mankind...the purpose of these statements is to make it abundantly clear that the Divine religions, the holy precepts, the heavenly teachings, are the unassailable basis of human happiness..." [6]

Furthermore, Shoghi Effendi, the Guardian of the Bahá'í Faith from 1921 to 1957, wrote compellingly of the consequences of irreligion both for the individual and for society:

"Human character is debased, confidence is shaken, the nerves of discipline are relaxed, the voice of human conscience is stilled, the sense of decency and shame is obscured, conceptions of duty, of solidarity, of reciprocity and loyalty are distorted, and the very feeling of peacefulness, of joy and of hope is gradually extinguished." [7]

Thus, 'peacefulness', 'joy', and 'hope', are replaced by agitation, despair and hopelessness, which form the basis of psychological problems from depression and suicide to drug addiction and violence.

There is, however, a note of caution insofar as religion can be manipulated and abused by leaders intent on power. Thus, religion can be either functional or dysfunctional, and the criterion by which this is measured is the degree to which religion promotes unity:

"...religion must be the cause of unity, harmony and agreement among mankind. If it be the cause of discord and hostility, if it leads to separation and creates conflict, the absence of religion would be preferable in the world." [8]

Religion: Psychological Benefits vs Harm

Schumaker [9] summarises the arguments proposed by various writers of the potential benefits and harms of religion to mental health. Some of the benefits suggested are:

1. That religion reduces anxiety by offering an explanatory model of personal and world events.
2. That it offers a sense of hope, meaning and purpose, resulting in emotional well-being.
3. That it provides a reassuring fatalism enabling one to better withstand pain and suffering. Such beliefs are echoed in the following words: "My calamity is My providence, outwardly it is fire and vengeance, but inwardly it is light and mercy." [10]
4. That religion provides solutions to situational and emotional conflicts.
5. That it resolves the problem of death through belief in an after-life.
6. That it provides a sense of power and control through association with an omnipotent force.
7. Religion encourages service to self and to others, as well as suppressing self-destructive practices.
8. That it promotes social cohesion.
9. That it offers a sense of identity, satisfies the need for belonging, and unites people around shared understandings.
10. That it provides a foundation for cathartic collectively enacted ritual.

Some of the proposed harms of religion include:

1. That it generates unhealthy levels of guilt.
2. Promotes low self-esteem by way of beliefs that devalue our fundamental nature.
3. Provides the foundation for the unhealthy repression of anger.
4. That religion creates fear and anxiety through threats of fear and punishment.
5. That it discourages a sense of internal control, rather placing excessive reliance on external sources of control, and thus fostering dependency, conformity and suggestibility.
6. It inhibits sexual expression.
7. That religion is divisive and promotes intolerance of 'sinners'.
8. That it instils paranoia of malevolent forces threatening one's moral integrity.
9. That it interferes with rational and critical thought. [9]

Given the plausible nature of many of these arguments, it is useful to view religion as a phenomenon with the potential to exert either positive or negative effects. The concept of 'functional' and 'dysfunctional' religions, briefly mentioned previously, is a useful classification, developed by Spilka11. Functional religion contains meanings that promote a person's freedom and potential for development, whilst dysfunctional religion involves meanings "that lead to dogmatism, restrict thought and limit freedom and opportunity, distort reality, separate people, and arouse fear and anxiety." [11]

Definitions

(a) Religion

In "Psychoanalysis and Religion," [12] Fromm describes religion as "...a system of ideas, norms, and rites that satisfy a need that is rooted in human existence, the need for a system of orientation and an object of devotion."

Whilst Fromm's definition is useful in a general sense, research in the area of religion is hampered by the difficulties associated in attempting to define such a multidimensional phenomenon. There are endless modes of religious expression and many studies deal with only one or a few dimensions of religiosity.

Glock [13] offers a five part definition: (i) ideological (the person's belief system); (ii) intellectual (knowledge about scriptures); (iii) ritualistic (overt institutional actions); (iv) experiential (direct knowledge of ultimate reality through religious experiences); (v) consequential (the secular effects of the above).

Allport and Ross [14] pass beyond external behaviours into the realm of experience and motivation. They describe those who are 'extrinsically' motivated as opposed to those 'intrinsically' motivated. The extrinsically religious "uses" his religion for personal gain and holds his beliefs lightly and selectively. The intrinsically motivated, in contrast, "lives" his religion and integrates his beliefs into daily life. Hoge [15] has developed a ten-item scale of intrinsic religiosity that is both validated and practical for clinical application.

(b) Mental Health

Concepts of mental health or well-being can be defined in a negative sense, as in the absence of illnesses such as depression or anxiety disorders. Alternatively, well-being can be measured by looking at positive characteristics of health. Maslow's studies of 'self actualised' people are useful in defining some of these characteristics: e.g. joy, wisdom, creativity, humour, peak or mystical experiences. [16] However, such concepts can be value laden and therefore bias the results of religion's perceived influence on mental health. For example, Humanist Psychologists' emphasis on autonomy, self-determination and emancipation from external sources of control as indicators of psychological health conflict with monotheistic religious concepts such as submission to the will and laws of God.

Religiosity and Mental Health in Old Age

As mentioned previously, research in the area of religion and mental health is rare. Nevertheless, there are pockets of activity around the world. This paper will focus on work done amongst geriatric populations, especially that of Koenig and others at the Centre for the Study of Aging and Human Development, Duke University, North Carolina.

(i) Prevalence

A number of studies suggest that religious behaviour is a common way of coping with difficulties in old age. Koenig and others [17] studied 100 adults aged 55-80, looking at their coping responses during three unpleasant and stressful life events. Unlike earlier studies which tended to look at poor, African-American women, the researchers chose a stratified, random sample of 50 men and 50 women, all white and all of middle or upper class. Respondents were asked how they had coped, and what they did or thought that stopped them from giving up. 45% reported that religion had helped them during one or more of the three stressful events. Women (58%) were more likely to do so than men (32%). The three most common forms of religious coping behaviours, accounting for 74% of those reported, were (1) Trust and Faith in God, (2) Prayer, and (3) Help and Strength from God. Thus, cognitions played a more important role than organised activities. The main limitation of this study, as with others conducted in North Carolina, was its representativeness. North Carolina is part of the American "Bible-Belt", where religious practice is common, and so there is doubt about the extent to which the results of this study are representative of other parts of the country.

In a study of 200 randomly selected low income women aged over 65, Conway [18] gave participants lists of possible coping mechanisms to stressful events in the past year. Of the 80 participants (46 African-American, 34 white), Prayer was the most commonly listed 'action oriented' coping response (91% of participants), followed by Consulting a Health Professional. Of the cognitive coping responses, the two commonest thoughts used by participants were: "I'm better off than a lot of people" and "thinking of God or your religious beliefs" (86%). This was in contrast to the thought, "I think that a professional will get me through the situation", reported by only 25%. When asked, "Who assisted You?", God was the most common response (85%), followed by a Professional (78%). The sample being studied was biased towards African-Americans (greater than 50%, compared to less than 20% in the general population) and the results may reflect to some extent the fact that African-Americans have had less access to medical services in the past and so relied more on religion to help them through difficult situations.

(ii) Association between religion and mental health

Studies conducted on the relationship between religion and mental health have tended towards a small positive correlation between the two. Mental health indicators used have been scales of well-being, life satisfaction, morale and the like, as well as psychiatric concepts of depression and anxiety. Dimensions of religion measured are religious attitudes and beliefs (intrinsic) and external religious activities (extrinsic).

Koenig and colleagues, [20] in a study of 836 elderly adults from Illinois and the mid-West, tested the hypothesis that religious activities and attitudes correlate with morale. The adults came from five community groups: an outpatients clinic, a Senior's lunch programme, members of Conservative Protestant Churches, a Jewish Seniors' lunch programme, and a group of retired Dominican and Franciscan nuns. Participants were given questionnaires with measures of morale, subjective coping, organisational religious activities (ORA) such as prayer groups and Bible classes, non-organisational religious activity (NORA) such as private prayer and devotional reading, and intrinsic religiosity (IR). Subjects were also assessed on known confounding variables of degree of social support, health, and financial status.

Results showed significant and moderately strong correlations between NORA, ORA, IR, and morale, subjective coping. Specifically:

ORA and Morale (r= 0.26), subjective coping (r=0.14)
NORA and Morale (r= 0.16), subjective coping(r=0.12)
IR and Morale (r= 0.24), subjective coping (r=0.12).

After controlling for health, social support, financial status, sex and age, correlations were reduced but remained moderately strong and highly significant. For persons 75 years and older, religious variables contributed more to the variance in well-being than any other variable, except for health.

Although correlations ranged only between 0.10 - 0.30, the authors commented that other variables such as social support and financial status rarely correlate with well-being at strengths above 0.30. The main limitation of this study was its cross-sectional nature, which excludes any conclusions about causality. It remains unclear whether religion generates morale or whether those with high morale are attracted to religion.

In an offshoot of the above study, [21] decreased intrinsic religiousness in elderly women correlated with chronic anxiety (p<0.05).

In the First Duke Longitudinal Study of Aging, 272 volunteers were followed for 18 years and degree of religious attitudes and activities were correlated with longevity, happiness, usefulness and personal adjustment, with controls for age, sex and occupation. Results showed that religion was not related to a longer life, that religious attitudes (eg. "Religion is the most important thing to me", "Religion is a great comfort") were not significantly related to happiness, but significantly related to feelings of usefulness (r= 0.16) especially in those engaged in manual occupations (r= 0.24), and to adjustment in those from non-manual occupations (r= 0.24). Religious activities (eg. church attendance, reading Bible) were significantly related to happiness (r= 0.16), especially men (r= 0.26), those over 70 (r= 0.25), and significantly related to usefulness (r= 0.25), especially manual occupations (r= 0.34), and those over 70 (r= 0.32). They also were significantly related to adjustment (r= 0.16), especially manual occupations (r= 0.33) and males (r= 0.28). Correlations increased over the 18 years of observation and the authors concluded that, not only does religion play a significant role in personal adjustment for many older persons, but as people age, religion becomes increasingly important.

Furthermore, Beckman and Houser [23] demonstrated positive correlations between religiosity and well-being in widowed women, both with children (r=0.22, p<0.05) and without children (r= 0.27, p<0.05).

Some studies have shown no or insignificant relationships. In a longitudinal study over 8 years of mostly Mexican-American Catholics, [24] there were small, insignificant correlations between church attendance and life satisfaction, and little change over 8 years. Tellis-Nayak [25] found weak to negligible relationship between religiosity and (i) well-being, and (ii) anxiety about death.

Conclusion and Discussion

Studies conducted to date in the area of religion and mental health suggest that religious behaviours, both public and private, are commonly used by the elderly in the face of difficult life events. The extent, however, to which these studies are representative is questionable given that the samples have been recruited from populations or subgroups in which religion traditionally has been well represented.

Furthermore, whilst there have been studies showing no correlation between religiosity and well-being in later life, the general consensus is that of a positive, albeit weak, correlation. In addition, there are no studies showing a significant negative association. [2] However, one must consider the possibility of a bias in the literature where studies are excluded because of a lack of positive findings.

There are a number of possible explanations for the weak correlations. [2] A 'dilutional' effect may be occurring because of inaccurate measurement of religious attitudes and behaviours. For example, crude measures of religiosity, such as denomination, might allow the majority of less committed members of a denomination to dilute the effect of a committed religious faith on mental health. Another possible reason is that people may turn to religion at times of mental distress and so this would also dilute the positive effects of religion on those who have been devoted believers for many years. Longitudinal studies are needed to control for this effect. Furthermore, religion tends to be more prevalent in the lower classes, where, for other reasons, there is a higher incidence of anxiety and depression. Religion, therefore, may be acting as a buffer against social and financial deprivations and more studies are needed controlling for these confounding variables. Finally, 'dysfunctional' religions may contribute to mental disturbance and thus cancel the positive effects of 'functional' religions.

Clinically, the research described in this paper highlights the need for health professionals to be aware of the importance of religion as a coping strategy in the elderly. Counselling and psychotherapy can take advantage of these strategies. For example, patients can be supported in their beliefs, encouraged as far as possible to participate in religious activities, and referrals made to religious professionals.

It is also worth speculating on the long term mental health consequences of irreligion on an aging population. Whilst there are problems with definition, there is evidence that irreligion has been increasing in most societies of the world for at least the past one hundred years. [26] Although one cannot draw any conclusions on causality in the studies mentioned in this paper, nevertheless if religion does indeed provide protection against depression and anxiety, will there be a dramatic rise in the incidence of mental illness in the near future? And if the traditional religions are no longer able to satisfy people's spiritual yearnings, will this allow 'dysfunctional' religions to exert greater influence on the naive and the credulous?

Finally, an important area for further research is to investigate the mental health and sense of well-being amongst other religious groups. The research presented in this paper has concentrated on followers of the Judaeo-Christian tradition. It would be worthwhile to extend these investigations to members of other religions, in particular the Hindu, the Buddhist, the Muslim and the Bahá'í faiths. If religion is to be judged by its fruits, then it would be of interest to know whether the models of personal and community life offered by such religions contribute to psychological well-being.

References