[Montse Esquerda, Angela Lopez-Tarrida, David Lorenzo, Margarita Bofarull]. Since the dawn of history, science and belief are destined to a permanent dialogue, since both are centred on the human being, who tries to assign sense and meaning to the events that occur, both those that happen to him or herself and those that happen around him or her.
Considering this close relationship, we reflect on how beliefs can be seen as determinants of health in the same way as other types of psychological or social factors such as culture or the environment. This is questioned through a reflection based on the considerations of authors such as Cassell or Frankl, and on relevant scientific research that has reliably demonstrated the positive impact that beliefs have on health.
Religion, Spirituality and Medicine, a long, shared history
Religion and medicine share a long and complex history, as well as a complex present. There is not necessarily a conflict between them. Since ancient times, medicine has been linked to the beliefs of human beings and to some of the great questions of humanity, such as illness, suffering and death. These have been spaces of coexistence, controversy and questioning both in the world of medicine and in the world of religion.
An evolution can be seen from the time when the answers to these great questions used common elements in both worlds: illness as divine punishment or even as (demonic) possession, and the figure of the doctor, healer, priest or shaman. Some cultures still maintain the absence of division, without distinguishing between science and belief.
The development of medical science, of the knowledge of the human body and its functioning in terms of anatomy, physiology, pathophysiology and, in recent decades, genetics, has gone from milestone to milestone resituating the fields and attributions, reaching a dissociation between the medical field and that of religious and spiritual beliefs. The biological model of approaching the human being has led to a reductionism of its multidimensional nature, forgetting the unity of the person.
In recent times, beyond this progressive dissociation of spheres, religious beliefs have even been considered as enemies of health. The great masters of suspicion, Freud, Nietzsche or Marx considered religions to be dangerous because they fostered infantile and immature aspects of the person.
This view of the philosophers of suspicion may still survive to some extent in the world of medicine, coexisting with a more positivist view that only what is scientific (empirical) and objective is part of the world of medicine.
But surely one of the most frequent attitudes is that religion and spirituality belong to an independent world outside the health environment; in other words, their existence in the field of health is recognised, but they are understood to be differentiated from each other, without influence or relationship, and therefore are not considered in care. It would be a position of absence or lack of linkage.
But in between these two perspectives, a new view of the relationship between religious or spiritual beliefs and health is emerging. Between the recalcitrant belligerence, in which belief is set against reason, and the quiet presence, which places it outside the scientific realm that inhibits it or removes belief from the person in clinical care, a new view of the relationship between belief and health has emerged in recent decades.
Could we speak of beliefs as spiritual determinants of health?
Social determinants of health are defined as those economic and social conditions that establish individual and group differences in health. Social determinants of health include factors such as place of residence, access to education, employment, housing conditions, or cultural factors. These determinants are given by place of birth, geographic or social factors that “condition a person’s life”. They can be expressed in the well-known sentence “your postcode is more important for your health than your genetic code”.
In view of this, we asked ourselves whether there are similarities between these determinants and beliefs, which have the same influence, i.e. whether there are aspects of these religious/spiritual beliefs and practices that determine or condition better health and which depend on whether a certain dimension of these beliefs and practices has been fostered or educated.
We will try to identify those healthy elements that we can attribute to spirituality and/or religiosity:
- Spiritual and religious beliefs are related to more positive coping styles of coping with adversity, such as better management of stress and anxious aspects associated with illness and ageing. Coping styles are a set of cognitive and behavioural strategies that a person uses to manage internal or external demands that are perceived as excessive for the individual’s resources. These coping strategies may be more or less appropriate or adaptive, but they mediate a person’s response to a situation.
- Most religions promote a range of positive emotions that can improve adjustment to illness and even the prognosis of illness: well-being, altruism, compassion, forgiveness or gratitude. Such emotions would be associated with a better response to illness.
Adherence to a lifestyle related to religious beliefs, as occurs in the Anglo-Saxon sphere, may be related to improved lifestyle habits (less alcohol consumption, smoking, more social relations, etc.). - The quality of life improves in people who have spiritual and/or religious practices among their life habits, as well as their well-being. Belonging to a religion usually also entails belonging to a community, and the mere fact of belonging to and feeling part of a community has positive effects on health, both physical and mental. According to some studies, the mere factor of participating in a social environment would already be healthy.
- Internal locus of control is higher in people with religious beliefs, which facilitates adjustment to illness. Locus of control refers to the degree to which people feel they are in control of what happens in their lives, from a routine event to a dangerous situation. This factor can be internal, considered a protective factor for emotional and physical symptoms; and external, referring to a predictor of illness. Thus, depending on whether they have an internal or external locus, people cope with life events in different ways.
- Meaning and hope are key elements for positive coping with negative aspects of life. For Frankl, the dimension of meaning is fundamental, mainly what he calls the “final or ultimate meaning”, and he relates the meaning of suffering to the meaning of life. Frankl said, “Man’s search for meaning is not a clever title for a book. It is a definition of being human. The human being is a seeker of meaning” (Frankl, 1999, p. 112).
The anthropology of health speaks of three aspects of illness: disease, illness and sickness. Disease refers to the biological, physiological or technical side of illness. Illness reflects the subjective experience of disease, i.e. how the individual, based on the conceptual parameters of his or her own culture and thinking, interprets, lives and experiences the disease from which he or she suffers. Sickness means or expresses the social and political aspect of the illness, how it influences the sick person’s relationship with others, with society, with the body politic, etc. (Bouché, 2001, Comelles and Hernáez, 1993, Helman, 2001). Spirituality plays a relevant role in all of them, but especially in the illness aspect.
Without being completely exhaustive, we believe that these are the fundamental elements linked to religious beliefs and practices. However, both the spiritual and religious dimensions do not develop in isolation, but are strongly influenced by the social environment, and are therefore partly socially determined. That is, depending on the geographical area, country, community or family, there is a greater likelihood of developing beliefs and of these beliefs being healthy.
Medicine’s approach to care in this dimension is showing the limitations of approaches that tend not to take into account this area of the person, as well as its complexity. The health professional-patient relationship is a relationship based on trust and, within this framework of proximity, it can be difficult not only to assess beliefs, but also the extent to which the health professional can or should promote healthy beliefs.
The concept of holistic health incorporates very positive features, but a multidimensional model of care has not been developed, or perhaps it is simply that there are many aspects of the health model that are beyond healthcare or even the realm of medicine, such as the belief system, which could both enable a healthier lifestyle and a more positive adjustment to illness and suffering.
As Siddartha Mukkerjee, an American oncologist, comments:
“It’s easy to make perfect decisions with perfect information. Medicine, on the other hand, asks you to make perfect decisions with imperfect information. My medical education taught me a lot about data, but little about the spaces that exist between these data. I am learning that there are lots and lots of spaces. The profusion of data masks a much deeper and more important problem: the need for reconciliation between knowledge (certain, fixed, perfect, concrete) and clinical wisdom (uncertain, fluid, imperfect, abstract)”.
In order to provide holistic and comprehensive care to people, it is essential to learn how to integrate data and spaces between data. Acknowledging and accommodating religious and spiritual beliefs, as modulators of the response to illness or as healthy elements, implies and generates a broader and more comprehensive view of care in health professionals.
This post is an excerpt from an article published in Razón y fe (January-April 2023).