As a Jesuit priest who practices medicine, I must say that some of the more tiresome moments in my career have been encounters with reporters who want to do a “little story” on spirituality and medicine. Some go well, with insightful questions and good dialogue. Too often, however, the camera does a close-up on the reporter who, in a breathy voice and with way too much facial expression, asks: “And now, Dr. Sheehan, tell me: How many people have you cured by your prayer?” I have not been smart enough to answer: “More than you and I will know.”
For those people who, like the reporter, are hoping for something sensational and a bit weird, Harold Koenig’s book will be a disappointment. For those who are intrigued by the potential connections between religious faith, maintaining health and recovery from illness, Medicine, Religion, and Health provides a down-to-earth, matter-of-fact and carefully reasoned review of the topic. Koenig’s explicit goal “is to explore and make sense of some of the recent research on religion, spirituality, and health.” In focusing on this goal, he is not asking about the theological dimensions of the link between spirituality and health; that task will be covered in a volume on which he is currently working. Koenig is focusing on a review of research and looking at links between faith and health outcomes.
The author, as would be expected in a book that is meant as a popular review of the scientific literature, is methodical and careful in presenting his findings. He introduces the topic by defining spirituality and religion and considering how the definitions are important in research but perhaps a bit less important in day-to-day practice. In preparing to relate the results of research, Koenig stresses that in our current aging society, where health care costs are skyrocketing, carefully considering new approaches to health care interventions, like the impact of spirituality and religion, is not simply intrinsically interesting but could provide major savings and improvements in health care delivery. Having provided definitions and a compelling reason for interest in the results, he then reviews the topic of known and potential mechanisms by which the mind influences the body. Then comes a series of chapters that look at specific areas where research has been conducted on the links between religion and health.
Koenig gives evidence of beneficial outcomes where religion is a factor in general health, longevity, mental health, endocrine and immune function, cardiovascular disease and diseases related to stress and behavior. What I find attractive about Koenig’s review is that he is not making an argument on exactly how religion influences these health-related outcomes, but is looking at the evidence that health outcomes are influenced. Especially useful for those who might question the strength of the connections that Koenig presents is the careful explanation of confounding and explanatory variables in determining causality in scientific studies. If the good outcomes are simply the result of confounding variables, then it is not faith or religion that makes the difference. If, however, there is something associated with religious belief or faith that explains the result, then there is a causal link. Koenig argues well that much of the criticism of results that he highlights is based on a lack of attention to what may be an explanatory variable versus a confounding variable.
As might be expected, much of this book is fairly detailed. It is written at the level of an intelligent non-scientist reader: it makes some demands on the reader and provides good instruction in return. For a more casual reader, I would recommend the final chapter on clinical applications of the research that has been presented. Once again, Koenig continues his no-nonsense style in listing seven common-sense reasons why clinicians should pay attention to the links between religion and health. He then discusses appropriate ways to work with patients that engage their beliefs while not alienating individuals who do not believe or whose beliefs differ from the clinician. Especially important is his discussion for clinicians about the importance of engaging the faith community and recognizing the skills and talents that trained hospital chaplains can bring to bear. A physician referral for a patient to a chaplain can be a crucial move in facilitating the patient’s well-being.
As someone who has felt that religious faith and a person’s spirituality influence people’s approach to illness and health, but who has been underwhelmed by the research with which I was familiar, this book is of great value. It makes me understand that my personal experience has been confirmed in a number of studies, that the research is not explaining exactly what is happening, that there is plenty of not so good research, but that this area needs further attention. Keonig’s final word sums up what I felt on completing this book. “Thus, both a solid research base and common sense argue that the religious and spiritual beliefs of patients are linked in one way or another to their health and well-being. Learning to respect the power of these beliefs and utilize them to speed the patient’s healing and recovery of wholeness…should be a priority for modern medicine and health care.”