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COPYRIGHT 2001 JAI Press, Inc.
1. Introduction
In recent years, research in a broad range of disciplines has turned attention to how religion and spirituality influence different aspects of physical and mental health (Ellison, 1991; Koenig, 1994; Levin, 1994). Matthews, Larson, and Barry (1993) have identified a "faith factor," referring to the consistent manner in which research has shown religion to have a positive influence on overall health. A similar line of work has highlighted the importance of religion and spirituality as resources for coping with stressful life events (Chang, Noonan & Tennstedt, 1998; Pargament, 1998; Pargament et al., 1990; Picot, Debanne, Namazi & Wykle, 1997).
The present study sought to further clarify the connections among religion, spirituality, and significant life events by examining a group of Alzheimer's disease caregivers and a matched comparison group of noncaregivers. How is it that religion and spirituality improve health or help people cope with life events? A "true-believer" would argue that "prayer works" and that God has taken favor on them. This type of response can meet with great skepticism and resistance from both the practitioner and scientific communities. Indeed, as noted by King and Dein (1998), many practitioners have held long-standing negative views of religion, in particular, because of its propensity to induce guilt among fallible followers. They have viewed religion as part of the problem of emotional distress, not as part of the solution. Researchers have not traditionally examined the role of religion or spirituality in the human condition because of a similarly historic tension between science and religion. Ironically, by employing the scientific method, both practitioners and clinicians can objectively examine the relationships among religion, spirituality, and well-being and gain important insight into the underlying nature of these relationships.
2. Religion and spirituality defined
Part of the tension between religion and science is the often ambiguous or ill-defined terms of religion and spirituality. Writers even at the forefront of research in this area will use the terms interchangeably, which can contribute to confusion when interpreting study results. Religion and spirituality are defined here in the following ways. Religion is a particular doctrinal framework that guides sacred beliefs and practices in ways that are sanctioned by a broader faith community. It is a system of beliefs and practices that helps structure how people worship. Spirituality refers to beliefs and practices that connect persons with sacred and meaningful entities beyond themselves. These beliefs and practices often create and sustain a personal relationship with a supreme being as defined according to one's own beliefs, and give meaning and purpose to life. Although they are not mutually exclusive, religion emphasizes a communal type of worship and spirituality emphasizes a personal or meditative worship experience.
Moreover, this study proposed as a specific construct to help explain the connection between religion, spirituality, and well-being a condition under which spiritual and religious beliefs and practices have a positive impact on health outcomes. The Reconciled Life Perspective (RLP) refers to the extent to which individuals have reconciled their spiritual and religious beliefs and practices with adverse events in their lives. Those with a strong RLP do not feel abandoned by a supreme being, but rather draw on this entity for support. They do not expect that they will be protected from traumatic life events because they adhere to a particular religion or spiritual practice or belief. The study proposed that strong religious and spiritual beliefs and practices are effective adaptation resources if persons have a strong RLP, i.e., they are beneficial if persons do not feel abandoned by their faith when adverse events occur. As a first step, this study sought to begin to clarify the RLP construct. On-going research initiatives, led by the author, are seeking to take the next steps by linking a RLP to positive health and well-being outcomes.
3. Impact of religion and spirituality on well-being
Religion played an important role in the scholarly writings of early sociologists. Durkheim (1951) argued that religion served both a social and a mental health function. Not only was religious participation an important social activity, but also those who adhered to religions with clear lines of unquestioned religious authority were less likely to commit suicide than individuals who followed religions that offered a less defined authority structure. James (1958) articulated different aspects of religion noting that it may have beneficial or deleterious effects on individuals. The "healthy soul" has fully integrated religious beliefs into his or her lifestyle, and has a positive view of religious and spiritual beliefs. The "sick soul" has an undue focus on the guilt associated with failing to measure up to certain standards of a particular religion. The "sick soul" also would include persons who feel abandoned by their religion or who are disappointed that their lives have not measured up to their expectations.
Contemporary research, like the work of Koenig (1994), has identified two key reasons why religion, in particular (though one could add spirituality), may play an important role in overall well-being. First, religion provides a framework for understanding why, in the words of noted rabbi and author Harold Kushner, "bad things happen to good people." A religious belief system can offer a rationale for why pain and suffering exist. Second, many religions foster the hope in an "afterlife" that will transport followers to a utopian existence after they die. Current difficult circumstances are manageable if viewed as temporary burdens before an eternal reward. Levin (1994) adds another somewhat less mystical explanation for the link between religion and health. Some religions, e.g., Mormonism, promote lifestyles (no smoking, no drinking) that, in turn, have a positive impact on health.
4. Religion and spirituality and coping
The work of Pargament et al. (Pargament, 1998; Pargament et al., 1990) has extensively focused on religion and coping. He has called for an incorporation of the religious dimension into research on coping because of the consistency with which he has found persons to rely on their religious practices during times of stress and crises. Furthermore, Pargament (1990) has identified ways in which religion can play a role in coping. For one thing, religion may play a role in a coping ritual. For example, most funerals have a religious component that seeks to comfort the bereaved. Religious or spiritual involvement also may prevent potentially risky coping behaviors, such as alcohol use or drug abuse.
A specific coping behavior associated with both religion and spirituality is prayer. Bearon and Koenig (1990) highlight the importance of prayer during sickness. They found that among an elderly population, the use of prayer as a supplement to medical care was common, though the practice of prayer did vary by religion and education. The respondents did not express an expectation that God played an active role in health and illness, but, nevertheless, most prayed about health concerns on a regular basis.
Interestingly, Reed (1994) has noted that spirituality, which in this context may or may not include a religious element, should be viewed differently than as an ad hoc coping resource only to be called upon when life approaches an overwhelming state. Rather, she argues that spirituality might be "better understood as a basic human phenomenon, sustained throughout...
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