The field of religious studies, itself drawing on multiple disciplinary orientations, conceptualizes the link between health and religion – or religious traditions – in two primary ways. The first focuses on the interpretation, or exegesis, of primary texts with content related to healing. The second addresses lived phenomena involving practices and worldviews with direct and indirect bearing on the health of individuals and communities.
Any discussion of religion and healing must include questions of ultimate meaning and various understandings of the sacred or divine, afterlife or reincarnation, cosmological explanations of human suffering, and multifaceted models of what it is to be human. Explanatory models of illness often identify deeper reasons for suffering (e.g., a test or punishment from God or other sacred force, an opportunity to emulate specific paradigms of suffering), which may reinforce right or moral health behaviors; or which may require specific religious actions to redress. Theological diversity within a tradition may inflect health worlds differently; in many parts of Latin America, liberation theologians promote public health and welfare by confronting structural violence, while other Christians turn to faith-healing practices and post-death salvation to the neglect of structural and public health issues.
Illness itself may be not only a category afflicting an individual, but also a group, and may include the effects of structural forms of intergroup violence. Healing interventions may require religious rituals of different kinds. Rituals intended to effect healing may be formal and performed by elite specialists, like a priest (Sp. cura, one who heals) or shaman; they may be home-based, undertaken by laymen or laywomen. These practices vary depending on the gender, social class, racial or ethnic background, immigrant status, or other social variable of patient identity, their social networks, and the practitioners whose help they seek. Outcomes may be intangible, sometimes occurring after death. Although physical cure may stand out as evidence of the power of the practice, it is far from the only result sought – a core difference from other kinds of outcome and efficacy criteria. Various scholars and religious reformers have argued that Islamic ablutions, Hindu purity regulations, Jewish kosher laws, and other religious practices have their origins in, or at least may be rationalized as, health promotion movements, but such explanations do not address the symbolic meaning these practices now hold in their practitioners’ daily lives. Moreover, insofar as various medicine systems intersect deeply with religious traditions – Tibetan or Ayurvedic medicine being only two examples – the Cartesian dualism of the very categories religion and health fails to do justice to the complexity and interdependence of religious and health worldviews.
Biomedical Approaches
Biomedicine approaches the relationship between religion and healing from a number of perspectives. The first involves the religiously informed bioethical dilemmas that arise in relation to medical decision making, sometimes in relation to religiously based prescriptions or prohibitions of actions or substances. The most routinely cited are the rejection of blood transfusions by Jehovah’s Witnesses and of biomedical interventions by practitioners of Christian Science. In such cases, religion is represented primarily as an unscientific obstacle to biomedical therapies, and not as a source of healing in its own right.
Some of these bioethical debates are driven by the impact of technological innovation, rather than ethics informing the development of technology. Rather than reflecting the pluralism within religious traditions, bioethics tends to present traditions as having generic and normative ideals for correct action, rooted in the interpretation of authoritative sources. This focus bypasses accounts of the customized, lived ways in which individuals and communities actually integrate authoritative rulings (to the extent they are aware of them) with other factors, when making ethical decisions in particular social and personal contexts.
Another approach focuses primarily on quantifiable health outcomes and on the less tangible factor of religious coping in the face of illness or other forms of suffering. Although individual biomedical physicians may craft a host of personalized ways to integrate their religious lives with their medical practice, biomedicine as a discipline has resolutely distanced itself from religion, which has been framed as antithetical to science. Yet not all researchers have accepted the mutual exclusiveness of the two domains. Some have applied medical research models to the impact of religiosity on health, in the hope that by employing standards of research and evidence most familiar to, and accepted within, biomedical culture, their colleagues may become less reluctant to acknowledge and build on links between the domains.
This undertaking has posed the challenge of formulating an operationalized definition of religiosity that can be articulated through scales. Many such scales have focused on religious affiliation or membership, religious participation or attendance at formal services, private religious practices (e.g., prayer, meditation, reading sacred literature), and religious coping in response to difficult circumstances. Critics argue that few of these scales truly represent religious pluralism, reflecting instead the often Christian orientation of their designers. Such scales are well suited for the study of some Christian communities, but fall short when investigating most other religious traditions. Alternate approaches might, for example, focus on ritual, the observance of prohibitions and prescriptions, and other dimensions of practice.
Medical literature, professional education, and policy initiatives have increasingly taken note of cultural and, occasionally, religious pluralism. Transcultural psychiatry, for example, represents an attempt to critique biomedical disease categories and apply medical anthropological insights into illness experiences that often have religious or spiritual dimensions. Medical anthropological, ethnographic, and cross-cultural studies regularly include analysis of religious healing practices. Here, however, sociological, political-economic, or psychological models of religion tend to prevail, many of them relatively reductionistic.
Biomedical approaches have also examined ways in which religiosity may serve as a protective factor against negative health outcomes. Examples include ways in which religious communities may help individuals internalize healthy lifestyle choices and provide external sanctions for violating norms. Religious coping strategies and patterns of mutual economic and social support likewise receive attention. Some links between various indicators and specific coping strategies have been suggested, but variables of social location, types of health problem, as well as the diversity and changeability over time of religious orientation limit their predictive value and generalizability. Critics often challenge the design of such studies and argue that few clinicians have adequate training to serve in the capacity of spiritual advisor or counselor, particularly in the face of growing religious pluralism.