What is spirituality?

Spirituality has been defined in numerous ways. These include: a belief in a power operating in the universe that is greater than oneself; a sense of interconnectedness with all living creatures; and an awareness of the purpose and meaning of life and the development of personal, absolute values. Although spirituality is often associated with religious life, many believe that personal spirituality can be developed outside of religion. Acts of compassion and selflessness, altruism, and the experience of inner peace are all characteristics of spirituality. According to a 1997 survey of spiritual trends in the United States, 96 percent of Americans believe in God or in a universal spirit. Many Americans look to their spirituality to promote healing, especially in cases where medications and other treatments cannot provide a cure (like some chronic illnesses). In a 1994 survey of people hospitalized in North Carolina and Pennsylvania, 77 percent felt that their doctors should consider their spiritual needs.

Today, a growing number of studies reveal that spirituality may play a bigger role in the healing process than the medical community had previously thought. Since 1991, the National Institute for Healthcare Research (NIHR), a private, non-profit organization, has been reviewing studies of the influence of spirituality on health. The NIHR found nearly 30 studies that looked at spirituality's effect on the likelihood of dying from conditions such as respiratory disease, cancer, and heart disease. Most studies compared individuals who participated in religious activities to those who did not, and found that religious or spiritual people live longer. This effect was seen in both men and women from different ages, religions, ethnic groups, and countries.

How does spirituality influence health?

One reason spiritual and religious people tend to be healthy is that many religions encourage healthy lifestyles among their members. For example, Seventh-Day Adventists, a particularly healthy population, are instructed by their Church not to consume alcohol, eat pork, or smoke tobacco. In a ten-year study of Seventh-Day Adventists in the Netherlands, researchers found that Adventist men lived 8.9 years longer than the national average, and Adventist women lived 3.6 years longer. For both men and women, the chance of dying from cancer or heart disease was 60 and 66 percent less, respectively, than the national average.

But the health benefits of religion and spirituality do not stem solely from healthy lifestyles. Many researchers believe that certain beliefs, attitudes, and practices influence health. Qualities like faith, hope, and forgiveness and the use of social support and prayer have a noticeable affect on health and healing.

• Faith. A person's most deeply held beliefs strongly influence his or her health. Some researchers believe that faith increases the body's resistance to stress. In a 1988 study of women undergoing breast biopsies, the women with the lowest stress hormone levels were those who used their faith and prayer to cope with stress.
• Hope. Without hope—a positive attitude that a person assumes in the face of difficulty—many people become depressed and are more prone to illness. In a 35-year study of Harvard graduates, researchers found that those graduates who expressed hope and optimism lived longer and had fewer illnesses in their lifetime.
• Forgiveness. A practice that is encouraged by many spiritual and religious traditions, forgiveness is a release of hostility and resentment from past hurts. A 1997 Stanford University study found that college students trained to forgive someone who had hurt them were significantly less angry, more hopeful, and better able to deal with emotions than students not trained to forgive. Some researchers suggest that negative emotions, like anger and resentment, cause stress hormones to accumulate in the blood, and that forgiveness reduces this build-up.
• Love and Social Support. A close network of family and friends that lends help and emotional support has been found to offer protection against many diseases. Researchers believe that people who experience love and support tend to resist unhealthy behaviors and feel less stressed. In a study of a close-knit Italian-American community in Pennsylvania, researchers found that the death rate from heart attack was half that of the United States' average. Researchers concluded that the population was protected from heart disease by its strong social support network.
• Prayer. The act of putting oneself in the presence of or conversing with a higher power has been used as a means of healing across all cultures throughout the ages. Today, 76 percent of Americans believe that prayer is an important part of daily life. The healing power of prayer is widely accepted and is even beginning to influence the medical community. In a 1996 poll, one half of doctors reported that they believe prayer helps patients, and 67 percent reported praying for a patient. In a 1988 study at the University of California School of Medicine, patients in the coronary care unit that were prayed for had fewer deaths and required less medication and assistance than patients that were not prayed for. Dr. Herbert Benson, a Harvard cardiologist best known for his research on the health benefits of meditation, discovered that prayer produces changes in the body similar to the changes produced by meditation—metabolism, heart rate, and breathing slow, blood pressure drops, and brain waves become less active. Benson now believes that a person's belief system, what he dubs the "faith factor," promotes healing.

What illnesses and conditions respond well to spirituality?

Results from several studies indicate that people with strong religious and spiritual beliefs heal faster from surgery, are less anxious and depressed, have lower blood pressure, and cope better with chronic illnesses, such as breast cancer. One study at Duke University found that people who attend regular religious services tend to have increased immune function. In another study of 232 older adults undergoing heart surgery, those who were religious were three times less likely to die within the six months after surgery than those who were not. Not one of the 37 people in this study who described themselves as deeply religious died. Of course, the studies are not comprehensive and many people find help in spiritual resources for numerous conditions.

Can spirituality have a negative impact on health?

Some experts warn that religious beliefs can be harmful when they encourage excessive guilt, fear, and lowered self-worth. A researcher at Bowling Green State University in Ohio found that religious people who view humans as "sinners in the hands of an angry God" tend to be more depressed and anxious than religious people without such beliefs. It is also important to note that spirituality does not guarantee health. Members of some religions refuse medical treatment and rely solely on prayer for physical health—a practice that may result in illness and death.

Where can I find more information on spirituality and health?

To learn more about spirituality's role in health (including the latest research on this topic), call the National Institute for Healthcare Research at 301-984-7162, or visit their

Web site at www.nihr.org.

Supporting Research

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Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;159(15):1803-1806.

Gundersen L. Faith and healing. Ann Intern Med. 2000;132(2):169-172.

Harris WS, Gowda M, Kolb JW, et al. A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch Intern Med. 1999;159(19):2273-2278.

Krucoff MW. Mitchell W. Krucoff, MD: the MANTRA study project. Altern Ther Health Med. 1999;5(3):75-82.

Koenig HG. Spiritual healing and prayer. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:130-140.

Masek K, Petrovicky P, Sevcik J, Zidek Z, Frankova D. Past, present and future of psychoneuroimmunology. Toxicology. 2000;142(3):179-188.

Matthews DA. Prayer and spirituality. Rheum Dis Clin North Am. 2000;26(1):177-187.

Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med. 2000;132(7):578-583. 

Sicher F, Targ E, Moore D II, Smith HS. A randomized double-blind study of the effect of distant healing in a population with advanced AIDS. West J Med. 1998;169(6):356-363.