Spirituality, religiousness, and health: from research to clinical practice.

There are several high-profile and controversial topics in medicine today (cloning and stem cell research come to mind). A less well known yet controversial area receiving increasing federal and private funding is spirituality, religiousness, and health. Attention to topics of spirituality, religiousness, and health has increased substantially in medical and graduate school curricula, clinical practice, and research (1–3). Of the many interesting aspects of this phenomenon, perhaps the most remarkable is the observation that medical science, the field of inquiry that initially separated mind from body (e.g., the ghost from the machine) (4), now finds it compelling and perhaps even necessary to reexamine relationships among spirit, mind, and body. The number of empirical studies on spirituality, religiousness, and health has proliferated in the scientific literature. Using the keywords religion and health and spiritual/spirituality and health, a Medline search from the year 1975 to the present reveals a striking trend, especially in the last 5 to 6 years (Figure 1). In recent years, every major medical, psychiatric, and behavioral medicine journal has published on the topic. In 1999, the National Institutes of Health Office of Behavioral and Social Sciences Research created an expert panel of scientists to critically examine this growing body of literature. Usually, such an increase in interest and publications on a topic follows a new discovery, such as that of a novel gene; the development of a new medical instrument; or perhaps a more sensitive and reliable assay. This is obviously not the case in this instance because spirituality and religion have been relative constants of cultures. The word spirituality did not even appear in Medline until the 1980s. Reasons for this relatively dramatic increase likely include the growing field of complementary and alternative medicine as well as one of the more unpalatable characteristics of managed care: the impersonal nature of assessment and treatment. There have been efforts on numerous fronts, the impetus for a majority of which originated from patients themselves, to bring acknowledgment of the “whole person” back into medicine (5). The impetus for this special issue of Annals of Behavioral Medicine arose from a panel presentation1 on spirituality, religiousness, and health at the annual meeting of the Society of Behavioral Medicine, held in March 2000 in Nashville, Tennessee (6). Six of the eight articles are from members of the Society, and two were solicited from nonmembers. As indicated by the special issue title, the articles cover topics of relevance to research (including reviews of the existing literature and methodologies and an examination of new instruments) and to clinical practice. Carl E. Thoresen and Alex H. S. Harris present an overview of the field, examine evidence, and address possible mechanisms that may underlie the potential effects of religious and spiritual factors on health outcomes. The authors also discuss implications for health care professionals. Richard P. Sloan and Emelia Bagiella present a critical review of the literature linking religious involvement and health outcomes. The authors call into question the methodological soundness of these studies and illuminate a tendency of review articles to rely on inappropriate secondary sources. These articles serve to advance the field by calling into question the prior tendency of “uncritical positivism” when reporting research findings (7). Three articles address the critical issue of the development and testing of instruments. As in any field of research, true progress can only be built on the foundation of valid and reliable data. These instruments have been designed for topics of spirituality, religiousness, and health among healthy and chronically ill populations. They have had to address some rather basic and difficult questions as well. Exactly what spirituality is, for example, has been a vexing issue in the literature and somewhat of a stumbling block (8,9). Concepts such as sense of peace, faith, compassion, religious behavior, and belief in God have needed to be addressed and incorporated into definitions of spirituality and religiousness. Other challenges have included determination of the most appropriate way to assess religiousness and spirituality in respondents from different religious traditions and how to assess spirituality without the use of terms typically of a religious nature.