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BOOK REVIEW |
Director of Academic Affairs, AARP 601 E Street, NW Washington, DC
Religious Influences on Health and Well-Being in the Elderly, edited by K. Warner Schaie, Neal Krause, and Alan Booth. Springer Publishing Company, New York, 2004, 320 pp., $46.95 (cloth).
The Link between Religion and Health: Psychoneuroimmunology and the Faith Factor, edited by Harold G. Koenig and Harvey Jay Cohen. Oxford University Press, New York, 2002, 304 pp., $42.50 (cloth).
There has recently been an upsurge of popular interest in the idea that religion can have a positive impact on health. Writers from many disciplines have joined physicians and scientists in announcing news that comes as a surprise to the secular mind: Empirical data show that religious belief is correlated with good health. It's an idea with huge implications for gerontology. But it is also a claim that raises a host of unanswered questions. Why does religion have this positive impact? What explanatory mechanisms are at work? What might be the practical implications for health promotion? The scientific search for causal explanations has led to fascinating inquiries into biofeedback, mind–body medicine, and other exotic topics. Two outstanding anthologies bring together some of the best research on religion, health, and aging, and both are volumes by investigators of the highest academic qualifications. Harold Koenig and Harvey Cohen have edited The Link between Religion and Health: Psychoneuroimmunology and the Faith Factor, and K. Warner Schaie, Neal Krause, and Alan Booth have edited Religious Influences on Health and Well-Being in the Elderly.
Why do these books, and this burgeoning field of inquiry, come to visibility at the present time? What does this new attention to religion, health, and aging say about us in the field of gerontology and also about American attitudes toward faith, age, and well-being? Answering those questions demands that we look beyond methodology and appreciate why the recent attention to religion, health, and aging captures our attention at this historical moment and what it may suggest about the future of America as an aging society.
The Religion of Healthy-Mindedness
"Religion is good for your health" is a message we Americans have heard many times before. Christian Science, New Thought, New Age movements, and endless forms of alternative medicine have all played variations on this familiar theme (Schoepflin, 2002). We recognize immediately what philosopher William James, more than a century ago, called "the religion of healthy-mindedness" (James, 2002). Americans believe in science, and we also believe in religion. So why shouldn't the two be connected?
More deeply, Americans remain inheritors of a Calvinist Ethic that delivers another not-so-subtle message: True faith will be rewarded by well-being in this world. This link between Protestant morality and healthy living is an old story in American life. Historian Thomas Cole has argued that the original Calvinist vision of aging brought an integral perspective incorporating both loss and the hope of redemption (Cole, 1992). By contrast, the Victorian successors to Protestant moralism shifted to a dualistic message in which anyone who lived a virtuous life could maintain health into advanced age (achieve "successful aging"). Late-life illness, then, becomes a signal of a life not well lived. As more of us in middle age join the ranks of the worried well, we hear the dualistic message with increasing attention and interest. When your old college roommate is diagnosed with Parkinson's disease or cancer, there's a temptation to answer the question "Why do bad things happen to good people?" by replying, uneasily, "Well, maybe they weren't quite good enough. ..." (But then, what about the ones who get lung cancer but never smoked?) In any case, if we are subscribers to the gospel of Successful Aging we will be more inclined to take up jogging and exercising, to wolf down antioxidants, maybe to go to church services, too. These efforts to "cover all the bases" are a postmodern version of Pascal's wager about belief in God; if we're acting under uncertainty, we have more to gain (and little to lose) by accepting religious belief. ("Hey, you never know.") William James would not have been surprised.
Again and again the American soul tries to reinvent science as faith, or faith as science. But we have more trouble dealing with old age. "This is no country for old men," wrote W.B. Yeats in "Sailing to Byzantium." The Irish poet might just as well have had America in mind. Today there are more members of the American Academic of Anti-Aging Medicine than there are board-certified geriatricians. And why not? Geriatrics, after all, tries to adapt to old age, but anti-aging medicine aims to eliminate it altogether. True, faith in anti-aging medicine is not quite acceptable in scientific or academic circles. But then again, religion also seemed embarrassing to the secular academic mind until recently. In the past decade, programs of alternative and holistic medicine have made inroads in some of the nation's venerable temples of orthodox medicine: Harvard, Columbia, Stanford, and other places, too. With support from the Templeton Foundation, serious discussions about religion and science now take place, even while the White House announces new faith-based initiatives for domestic policy. On all sides, the walls come a tumblin' down.
It is inevitable that the field of aging would come to reflect this new ethos of reconciliation among science, medicine, and religion. In the first decade of the 21st century, the gospel of Successful Aging has joined the "Good News" chorus, preaching a message of personal responsibility for health and old age. Rowe and Kahn (1999), in their landmark book, promoted an optimistic vision of aging, assuring us that genetics (fate) is only a minor player in the drama of well-being in later life. Freedom, not fate, is the American ideal, so why shouldn't aging itself become a form of voluntary action? Like Horatio Alger contemplating the life course, we want to believe that our destiny is in our own hands. But that message could be discouraging if we insist on too much personal responsibility: for example, hitting the gym every day or eating less or any of the other sensible practices urged on us by right-thinking proponents of public health. Like the zealots who want to ban smoking everywhere, there is a whiff of fanaticism among contemporary members of the health police. Recall that St. Augustine condemned the Pelagian heresy whose proponents insisted on too much personal responsibility for individual behavior. "No salvation outside the church" became the doctrine of the day, offering a potent argument for going to church on Sundays. In every generation religion needs its rational argument, but the language of the argument changes with the times.
Scientific Support for Faith
Koenig and Cohen also want to offer a powerful argument for religious participation, but they must make their case in the language of science, not religion. They want to find naturalistic explanations for phenomena long shrouded in mystery or miracle. Though sympathetic to the "faith factor," Koenig and Cohen display minds open toward both science and religion, but always as members in good standing of the Church of Science. Thus, Koenig and Cohen acknowledge negative as well as positive effects that religion can have on health during the life span. They start with the undeniable correlation between faith and positive health outcomes, but they are concerned to find theoretical models and to explore alternative psychological and physiological mechanisms by which religion might influence health. Contributors to their volume offer a range of articles summarizing recent research on faith and its impact on the use of health services and health care compliance.
The fundamental explanatory pathway explored in this book is summed up in the concept of psychoneuroimmunology, an idea long familiar from the early work of Hans Selye (1978) and other pioneers of mind–body medicine, and documented more recently by investigators in mind–body medicine (Benson, 1997). Chapters in the Koenig and Cohen volume examine this idea in relation to the immunology of cancer, wound healing, HIV/AIDS, autoimmune diseases, and the endocrine system. Although solidly grounded in medicine and physiology, their book also includes chapters that examine Eastern and Western religions, the importance of social networks, and the broader implications of psychoneuroimmunology for society and culture. In sum, Koenig and Cohen have produced a book that reflects the multidisciplinary aspiration of gerontology at its best.
But if their ecumenical spirit is impressive, we should also be on guard for the implicit message conveyed in this book. Psychoneuroimmunology represents the response of science to problems that led Descartes into his famous dualism of mind and body. Oddly enough, scientific inquiry requires its own kind of faith, in this case, a repudiation of dualism in favor of comprehensive explanation for why the mental and physical dimensions of the human being interact in startling ways. In short, psychoneuroimmunology opens a "back door" for religious ideas, but only insofar as these can be registered in the monistic framework dictated by neuroscience. It is not the only approach possible. Indeed, there are eminent philosophers from Immanuel Kant to John Searle who would have a very different approach to the phenomena purportedly "explained" by PNI (as psychoneuroimmunology is dubbed by insiders). Have we then adopted a new monistic faith in place of an older dualism? What are the theological implications of this agreement to let all questions be resolved by the rules of the laboratory? If we allow religion to be supported by science, will we find that we have accepted reasons that are, ultimately, not relevant to religion at all?
Theory and Practice
These questions deserve reflection as we turn to Schaie, Krause, and Booth's collection of articles focusing on the impact of religious institutions, practices, and organizations on the health and well-being of older people. The challenge here is the same that stimulated the rise of PNI: namely, we know that older adults who are religious tend to enjoy better physical and mental health than others, but we don't know why. Alternative explanations abound and it's hard to do controlled clinical trials in which "religion" appears as an independent variable. We need explanations, argues Neal Krause, because what do know suggests that "research on religion may be used to help improve the quality of life of our aging population." In other words, the starting point is not just better theories, but practical steps to improve the lives of elders (practice, not theory alone).
Krause of course acknowledges that it's probably not possible to come up with a single grand model of religion, health and aging (he'll settle for "theories of the middle range"). The topic is simply too big and we need a multidimensional approach. So the editors of this collection offer theoretical and pragmatic principles leading them to examine specific domains of religion. The chapters in the book focus on church attendance and denominational preference, prayer, religious coping responses, forgiveness, lifecourse issues, and the role of socioeconomic status and race. A large collection, indeed. Other topics, such as gender and the negative side of religious involvement, are not explored in this volume. But the editors have carved out a huge range of different domains and they use a compelling "dialogical" approach to make for lively reading. They have commissioned reviews of major topics written by recognized subject-matter specialists and then they have invited discussants to respond to these articles. We get to hear from experts like Ellen Idler, Jeff Levin, and Kenneth Pergament, and then hear from a range distinguished commentators, followed by a capstone chapter on religion and health in life course perspective, by Linda George and co-authors. All in all, a real academic feast.
Two Cheers for Religion and Science
But when all is said in done, one is left with a nagging question: Will all the new empirical illumination of religion, health, and aging do what the editors seem to want? Will it give us better strategies to improve the lives of elders? Some years ago, when the interest in religion and health first came to public prominence, the Christian Century magazine published an editorial, wondering whether this new-found enthusiasm for religion as a tool for health promotion might not be a misplaced enthusiasm. For the earliest Christians, after all, faith was not a ticket to health and longevity but a risk factor for early martyrdom.
Can religion ever be what some would call an "intervention" to promote health and well-being? A growing number of people seem to think so, and the changing face of religion is one reason why. Over the past few decades, says sociologist Alan Wolfe (2003), American religion has become more individualistic and less doctrinal, more practical and purposeful. Aging baby boomers are approaching religion in their pragmatic way, as part of a "spiritual marketplace" (Roof, 2001) in which we look for a payoff in the form of better health. Is it surprising that alternative medicine guru Larry Dossey (1997) would claim that "prayer is good medicine?" Or that practitioners will eagerly adopt questionnaires for "spiritual assessment?" The walls come a tumblin' down, all right, but in this new era of good feeling between science and religion, we may find that to gain acceptance by the guardians of the temple of science, we have adopted restricted terms of engagement permitting religion to enter the public square of academic and medical life. True, some prophetic voices have arisen in opposition. For example, Harriet Mowat, writing in Albert Jewell's (2003) Aging, Spirituality, and Well-Being, presents a sharp indictment of the way in which our worship of successful aging has supplanted, or perhaps corrupted, a more traditional spiritual view of the purpose of human existence. Well-being, after all, cannot be equated with good health or else we lose the entire message of religion: "What profiteth a man to gain the whole world if he loses his own soul?"
Today, more voices within the health care system are being raised to ask whether medicine as a profession has not begun to lose its soul. If religion, in turn, allows itself to be justified in terms derived from a commodified "health-industrial complex," then what will remain of the prophetic voice that could be raised in criticism? Perhaps the vogue for religion and health is a sign of progress. After all, two decades ago, empirical investigation of religion and health was less fashionable than now. "You've come a long way, baby" as the commercial jingle used to say. But have we then come to a point where we find ourselves moving in a spiritual marketplace where prayer is justified as medicine and a good (successful) old age is defined as defeat of illness by whatever tools, including religion, may be at our disposal?
These are questions of a philosopher who muses about gains and losses, hidden agendas and unforeseen consequences. But perhaps we should step back from these musings and look at the bigger picture. Why not acknowledge, with gratitude, that we in gerontology have achieved something good, which the wider body politic in America today has not. Just think for a moment about the role of religion in the public sphere today, and what comes to mind is an endless culture war (school prayer, stem cells, abortion, and so on), pitting citizens against one another with an erosion of civil, let alone rational, dialogue. On the contrary, what we find in both volumes reviewed in this essay is exactly the opposite: the quiet progress of science and reason, respectful attention to claims of faith and the spirit, a dialogue among investigators of very different points of view. Without suppressing differences, we in gerontology may have achieved something that could be a lesson for the wider body politic: bringing religion into the public sphere without divisiveness.
Civic discourse is not a small achievement. Those who are inheritors of the Enlightenment must find ways of allowing back into the light a world of faith that has for too long lived in the shadows, certainly for science and medicine, perhaps for academic life in general. We should welcome this "return of religion" but we should not banish our doubts about what this return may mean for us all. The life of faith and the life of doubt both need one another, now and for years to come.
References
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