Gerontology and the Study of Religion and Health: A Vital Role for a Social Science Melting Pot
Orrin R. Onken
Portland State University -- 1999
This study examines recent literature concerning religion, health and aging. Concluding that the bulk of modern research supports a finding that religion exerts a salutary effect on morbidity and mortality, the paper looks at the barriers to further research in the area and suggests that the disciplines of sociology and epidemiology offer the most promising institutional and theoretical avenues for future study. Finally, the paper comments upon the legal, social, and organizational difficulties facing policy makers attempting to harness and direct the positive health effects of religious involvement among the aging population.
In many American neighborhoods religious institutions exercise a near monopoly on the infrastructure of community life. To an extent that exceeds the combined efforts of all public and private competitors, churches control the buildings, the equipment, the kitchens, and the volunteer labor that make possible the weddings, funerals, anniversaries, and rites of passage that mark peoples roles in their community. Religious involvement, however, is more than theology, ritual, and potluck dinners. In the last decade, researchers have demonstrated that those who actively participate in religious activity are mentally and physically healthier than those who do not. This research raises several difficult questions in the field of gerontology.
Despite the prevalence of religion in America and the correlation between religious involvement and reduced morbidity, researchers have shied away from the both the scientific and public policy issues involved. This reluctance has stemmed from certain long-standing frictions between the religious and scientific communities -- frictions that are unlikely to disappear any time soon. The scientific communities, however, are not uniform in their attitudes toward religion. In a manner similar to the way individuals express themselves, the various disciplines that make up gerontology exhibit "personalities" that today make them more or less useful for looking at the relationship between religion and health.
This paper examines the problems that lie ahead in research and policy for those dealing with the salutary effects of religion upon the elderly. After a review of American religiosity and its relation to health, it suggests that sociology and epidemiology are the most promising of gerontology's constituent disciplines for helping policy makers work in this sensitive field. It then comments upon the legal, political and organizational obstacles hindering the transfer of scientific knowledge to those on the front lines of providing religion based social support and returning information from those front lines to researchers and academics.
The Salutary Effect of Religion on Health
An analysis of Gallup polls between 1992 and 1999 shows that thirty-eight percent of Americans over fifty years of age attend church at least once a week and seventy percent in that age group rate religion as an important part of their lives (Ehmann, 1999). Jeffrey Levin, the premier writer in the field of religion, aging, and health points out that 50% of those over 65 attend church at least weekly. Thus, the number of people attending church on any one Sunday is greater than the total number of Americans attending sports events during an entire year (Marwick, 1995). Not only is religion pervasive and influential in the United State, Levin argues, the bulk of research convincingly demonstrates that it is also good for us.
In Investigating the Epidemiologic Effects of Religious Experience, Levin (1994) describes his three-decade battle to push the issue of religion and health into the consciousness of the medical and social science communities. Although Levin has been rewarded for his labors in gerontology with many awards and several prestigious National Institute of Health grants, work in the field of religion and health still carries a patina of being on the fringe of legitimate research. Armed with skills honed during post-doctoral work in statistics and methodology Levin in 1996 reviewed the literature and concluded that there is ample empirical evidence of a salutary religious effect on morbidity and mortality. This protective epidemiologic effect appears " regardless of the religious measure used or the outcome under study, and this relationship (between religion and health) manifested in study populations regardless of age, sex, race, ethnicity, nationality, study design or the period of time during which the study was conducted." (Levin, 1996 p. 850)
Levin's conclusion has proven difficult to deconstruct. For instance, religious groups tend to discourage risk-taking behaviors and provide important social supports. Thus, health behaviors and social support seem likely intervening or confounding variables. When the numbers are adjusted, however, to account for these differences the protective effect of religion remains (Strawbridge, Cohen, Shema, & Kaplan, 1997). Similarly, early concerns about measuring religiosity, although not gone, have largely subsided due to the current prevalence of sophisticated multi-variable survey techniques (Keonig, Kvale & Ferrel, 1988; Williams, 1994). Alternative suggestions for the existence of decreased morbidity among religious groups have included heredity, that certain religious beliefs engender peacefulness, that religious ritual eases anxiety, and that the mere belief that religion is health enhancing enhances health. The most prevalent of assertions, however, is that religion imbues its adherents with certain coping skills that reduce the negative impact of life stressors (Koenig, et.al., 1988; Ai, Dunkle, Peterson & Bolling, 1998). Such coping skills do not, however, separate from their religious context and cannot be reduced to nonreligious forms of coping (Pargament, Smith, Koenig & Perez, 1998). Although alternative explanations cannot be completely discounted, for the time being it seems that the various elements found in religiosity combine in a somewhat unique way to inhibit the development of disease.
It is important at this point to recognize what Levin does not say about health and religion. He does not say that religious involvement promotes healing. While some studies have found religious activity beneficial in recovery from acute illness (Ai, et al., 1998), at least one indicates that strongly held spiritual beliefs are associated with slower recoveries (King, Speck & Thomas, 1999). He does not say that generalized 'spirituality' or the holding of particular beliefs has a protective effect equal to that of religious association and practice. He does not rate religion as more important than other psycho-social factors. And finally, he makes no claims about superempirical or supernatural forces. Rather he finds only that religiosity is a protective factor in stemming tides of pathogenesis. This assertion by itself, however, turns out to have troublesome political, legal and research implications.
Resistance to Addressing the Connection between Religiosity and Health within the Social Science Community.
The academic and scientific communities, like other communities, establish over time certain institutionalized norms. These often-unwritten rules can have as much to do with the direction and nature of scientific research as do natural events, funding, social demands and the curiosity of scientists. In his influential small book on the subject, Thomas Kuhn described as "paradigms" the theories and structures that make and maintain scientific disciplines (Kuhn, 1962). Work outside of a current paradigm will not be 'science' for the purposes of the discipline being examined. For many in scientific fields any involvement with religion takes one out of the current paradigm and into a place where science cannot go. Thus the Council of the National Academy of Science writes in one of its booklets, "Religion and science are separate and mutually exclusive realms of thought, the presentation of which in the same context leads to misunderstanding of both scientific and religious belief" (Rioux & Barresi, 1997; p 411). This rather even-handed statement of the problem gets worked out for many on the rougher playing field of academic politics where matters related to religion seldom appear in leading journals.
One writer suggests that the dearth of sophisticated scientific social science work dealing with the enormous impact of religion on society and health is the "Anti-tenure Factor." The factor comes about in the case of religion and social sciences due largely to the fact that early efforts in the field were often biased and characterized by flawed research. Thus, not only did the researcher risk being associated with poor work, but he or she also lacked a firm base of prior research upon which to build. To do significant work in the area violated the unwritten rule that a person seeking a career in research do no more than one or two forays into "fringe" areas (Sherrill & Larson, 1994). In graduate schools, as in most groups, the unwritten rules are the most strictly enforced.
Another barrier for the researcher interested in religion and health arises from the fact that academia consists of an unrepresentative non-religious population. This population in small ways works to maintain that condition. In clinical psychology, for example, mock admissions processes have shown discrimination against graduate school applicants who report Christian beliefs. Similarly, a survey of introductory psychology books in the 1980's found that religion was cast in an unfavorable light despite studies at the time demonstrating a strong positive correlation between religiosity and mental health (Larson, Sherrill & Lyons, 1994).
Gerontology, interdisciplinary approaches and the personality of disciplines.
Gerontology has often been cited as one field where there are fewer institutional barriers to research on the health effects of religion. Consequently, gerontologists have been at the forefront of methodologically advanced work in the area (Sherrill and Larson, 1994). One reason for this success relates to the organizational structure of the discipline. Being interdisciplinary, practitioners and researchers are more able to pick and choose what disciplinary methods and norms they want to import into the field. A second reason lies in the fact that not only have older people in this century traditionally engaged in religious activity more than the young, but new longitudinal studies suggest that even today's young will turn more to religion as they age (Argue, Johnson & White, 1999). Thus the problem of religion and health confronts gerontologists more bluntly than it does those researchers in associated departments. Extracting meaning and eventually policy from the statistics regarding religiosity in the elderly may well, however, require theory taken from gerontologists' constituent disciplines. In doing so, the gerontologist must be mindful that each of the associated fields of study has a history and personality that can make it more or less helpful in guiding and interpreting current gerontological research.
Psychology and Psychiatry
At the turn of the century William James brought psychology to religion in the classic Varieties of Religious Experience, (James, 1902) but the wedding of the two turned out to be short lived. Despite the great importance of religion in the lives of American's, psychology still gets the modern "low-ball" award for the percentage of dissertations and publications dealing with the issue (Larson et al., 1994).
One of the oft-cited reasons for this state of affairs in psychiatry is the residue of Freud casting of religion in a negative and even psychopathological light (Sherrill & Larson, 1994). Outside of psychoanalytic studies where Freudian roots are less pronounced, psychology has struggled with its role in the sciences as well as its theoretical foundations. Roger Smith (1999) in a recent history of psychology and the social sciences observes that psychology in the universities has become preoccupied with methodology to the extent that the field is defined more by its methods than its subject matter. For many of these researchers measurement and quantification have taken the place of explanation and identification of causes. Thus, the difficult and obscure vocabulary associated with statistical methodology has become the linguistic currency of the field.
In short, both the history and the current state of psychiatry and psychology suggest that the fields do not have the type of disciplinary personalities that will make them widely useful in the study of religion and its effects on an aging population. Although gerontology lacks the historical prejudice against religion that one finds in psychology, the study of aging has already absorbed some of that discipline's tendency to value collections of information over explanation (Bengston, Rice, and Johnson, 1999). Looking to psychology for help in this particular project would probably exacerbate this trend.
Medicine and Geriatrics
In the last couple decades medicine has become more accepting of religion as a component of good health. Recent studies have found correlation between religiosity and the reduced instance of a variety of pathological conditions. (Mitka, 1998; Walsh, 1998) Nevertheless, the allopathic approaches that still dominate the medical field impose some limitations on the discipline's usefulness in studying religion and health.
Medical research tends to approach health problems from the tri-part perspective of a doctor, a patient and a disease. Thus, practitioners want to know what they should do and what they should instruct a patient to do within the social and ethical boundaries that define the doctor-patient-disease relationship. Arguably, religious matters lie outside those boundaries in much the same way as economic status and marital status. One commentator summarizes the doctor's ethical dilemma as follows:
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 would join such factors as socioeconomic status and marital status, already well established as significantly associated with health. Although physicians may choose to engage patients in discussions of these matters to understand them better, we would consider it unacceptable for a physician to advise an unmarried patient to marry because the data show that marriage is associated with lower mortality. 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. (Sloan, Bagiella & Powell, 1999 p 667)
Medicine is likely to be a continuing contributor to the study of religion and health in our aging populations. However, to the extent that the work is framed by the current social structures surrounding doctor and patient the work may have limited range and reduced usefulness in designing social or research policies. Gerontologists will need to pay attention to what is coming out of the medical field while remaining cognizant of its limitations.
Ever since Emile Durkheim (1915) demolished the idea that religion is a holdover from primitive explanations of natural phenomena, sociology has been a major force in the study of religion and society. Today, it is one of the few fields even willing to volunteer for the job of examining religion, health and aging (Ellison & Sherkat, 1995). Further sociology, has provided the measurement techniques for tackling the multidimensional nature of religiosity (Williams, 1994). Sociological approaches have, however, been subject to criticism. The first is the reverse side of the problems inherent in medical research; sociological conclusions provide little in the way of clinical usefulness. The second is that the study of religion within the field of sociology has become a sub-specialty that is hesitant to emerge into the wider ranging rough-and-tumble politics of academic social sciences (Sherrill & Larson, 1994). Despite these problems, sociological studies will probably continue to inform gerontological inquiry into issues of aging and religion for some time to come.
Theology and Pastoral Care
Religious studies such as theology and pastoral care are done outside the social sciences and outside the organizational structures that govern most academic inquiry. While those who work in the field are separated somewhat from the academy their front line practitioners constitute the enormous 'hidden' health care system. Unfortunately, religious theorists and counselors have been slow to address the particular challenges of old age, preferring instead to interpret the problems of the elderly using standard, widely applicable metaphors. Only in the last couple of decades has the literature of theology and pastoral care begun to address the particular needs of the elderly (Kimble, 1995). The barriers to using the experiences of pastoral care practitioners come from both widely differing language norms and organizational separation. Bridging the gap between those who speak the language of religion and those who speak the language of social science can present a variety of problems. In addition, pastoral care workers operate within church hierarchies rather than those of government or the academy. Extracting information from deep within those religious organizations and then getting it through the prejudices and disciplinary jealousies of the social sciences can be more far more of a challenge than most researchers want to face.
In the nineties, Levin and other leaders have strongly suggested that epidemiology is most capable of providing the conceptual ground for research into religion, aging and health (Levin, 1996). Based in phenomenology moreso than traditional theory, epidemiology considers religion to be a demographic factor along the lines of sex and age. Thus, when early epidemiologists mapped the cholera epidemic in London to the Broad Street Pump, they were not necessarily suggesting that the pump caused the bacterial disease. Instead, they were offering a statistical correlation. Sometimes, however, effective policy does not require thorough clinical knowledge of the disease mechanism, as closing the Broad Street Pump eventually demonstrated.
Levin argues that epidemiology allows a more thorough look at the process of health and disease in a selected population by examining the life of disease from the presymptomatic through acute stages to the final return of equilibrium. Thus, one may be able to identify what factors are pathogenically or salutarily important at different stages. The importance of this for gerontologists approaching questions of religion and health is that religiosity seems to flex its salutary muscle prior to the appearance of illness. In short, religious people do not get sick as often or as severely. If this is the case, the policy concerns are then quite different from those that might arise if religion were either a cure or an aid in recovery.
Epidemiology's strength, however, is also its weakness. Its atheoretical language -- terms like risk ratio, confidence intervals, morbidity, and mortality -- holds little meaning for those used to the language of religion or those accustomed to the language of the other sciences. Levin makes powerful claims for epidemiology, but acceptance is likely to be slow to come on many fronts.
Implications and Recommendations
The Scientific Study of Religion and Aging
Religion, like religiosity, is a multifaceted phenomena with philosophical, behavioral, cultural, and epistemological components. The concept of health is similarly complex and is as dependent upon the cultural or disciplinary orientation of the researcher as it is upon the subject of study. Thus, research in the area of religion and aging will continue to breed controversy as outlooks collide.
Kuhn's concept of scientific change as a quasi-political process caused a controversy that has yet to truly resolve. Scientists objected on the ground that the knowable nature of physical reality exempted them from Protagoras's observation that "Man is the measure of all things." Theologians claim a similar exemption due to the knowable nature of God. It is a recipe for trouble. While people who engage in most types of human endeavor are satisfied to be useful and helpful, both parties to this particular conflict are unwilling to settle for mere usefulness. Instead each claims a methodological highway to truth, and in doing so stakes out boundaries that have proven difficult to traverse even when the rewards of doing so might be a healthier and happier society.
Language Barriers in Disciplinary Conflict
Entering a new field of endeavor involves new activities, new social structures, and often a new language. For the neophyte, the language of the social sciences can seem distant, jargonistic and harsh. Even after one has learned enough to make the vocabulary ones own, the various disciplines under the general penumbra of social science have different dialects that separate its members as distinctly as the language of worship separates Christians from Jews. Translating information from psychology to medicine has its problems. Translating from the religious to social science can border on impossible.
One of the persisting issues in the study of religion and health among elders has been the question whether the salutary effect of religion is due to behavior or belief. This question is presented as one legitimate for social science research. At the same time, Catholics and Protestants have been negotiating a peace on the question of "justification by faith." That theological question concerns whether the core of religiosity lies in behavior or belief. Thus, two very similar questions occupy the time of two very different cultures, each choosing to proceed without the experience and expertise of the other. It is always difficult to determine whether language barriers are the cause or result of social friction, but in either case those barriers present considerable difficulty for any policy maker attempting to integrate the experience of the churches with scientific research results in addressing health issues among the elderly.
Gerontology may well be the default home for studies of religion and health for many years to come. Much research remains to be done, particularly in the area of religious coping methods. Two recent papers point in promising directions. Rioux and Barresi (1997) asked research subjects to rate types of experience, including religious experiences, on numerous affect terms, eventually concluding that scientific experience leans toward the self and self-control while religious experience tends to have balanced self-directed and other-directed affect components. Meanwhile, Kenneth Pargament, one of the emerging leaders in the field, has identified many methods of religious coping and made attempts to identify which of these in combination produce the greatest salutary effect on health (Pargament, et al., 1998). Both avenues of research show promise for understanding the mechanisms that give religiosity its protective effect.
Policy options in the area of religion, health and aging are limited by both law and the fierce independence of many religious organizations. Thus, connecting government-funded social services with religious organizations is seldom a viable option. This state of affairs requires policy planners to think outside the idea that social policy is solely a government function and, instead, direct their attentions toward how religious organizations can use current research to improve their own elder care services.
The line in the sand for any policy maker addressing issues of religion and health is that government funded social services cannot constitutionally entangle themselves with religious organizations and religious organizations normally cannot, according to their own governing principles, turn over institutional decision making to government agencies. The legal battles that have occurred over religion in government schools, government in religious schools, and other church-state entanglements establish several areas where health policy simply cannot go. Churches cannot be used as a conduit for government funded social services. Government cannot require religious behaviors as a condition of receiving public benefits. And finally, government cannot advocate religious practices or beliefs.
The constitutional limits on church-state entanglement require research oriented policy makers dealing with the religion-health connection to step away from their natural relationship with government programs and into the "hidden" health care system operated by the churches. Doing this may require immersion in unfamiliar organizational structures and an unfamiliar language. If, however, they can make the transition from the highly centralized and status-driven organizational structures of the university or government agency to the more decentralized and populist structures of modern churches they may be able to nudge those organizations toward more effective eldercare practices.
Congregations and pastoral care professionals would be well served in their efforts to address elder needs by work done in the academic field of gerontology. Yet they are unlikely to come to the universities and agencies for such help if it is offered in a strange and condescending language. Pastoral care practitioners in the pulpit and in the pews are not necessarily resistant to help in addressing elder issues. They simply resent the help acting like the boss.
The road to methodologically sound studies of religion and health has been marked by biased research, philosophical conflict, and social prejudice. As the millenium ends, however, the numbers are in and it appears clear there is a significant connection between religious practice and better health. What this means for researchers in the constituent disciplines that make up gerontology is far less clear. For medical practitioners it probably means very little. For policy makers taking a sociological or epidemiological stance, the correlation may point toward useful health-enhancing policies among the aged.
Implementation of health policies that recognize the salutary effect of religion and the greater occurrence of religiosity among older Americans face significant legal and institutional hurdles. The Constitution prevents the churches being transformed into providers of government services. In addition, churches are not amenable to having non-members direct pastoral care policy in regard to the aged or anything else. Thus, policy makers may have to enhance their prestige in religious organizations by learning the terminology of pastoral care, eliminating prejudice against church members in their ranks, and granting greater social legitimacy to the hidden social programs that elder church members have come to rely upon.
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