Culture, spirituality, religion and health: looking at the big picture

Human health has multiple sources: material, social, cultural and spiritual. We are physical beings with material needs for nutritious food, clean air and water, and adequate shelter, as well as physical activity and sleep. We are also social beings who need families, friends and communities to flourish. We are cultural beings — of all species, we alone require cultures to make life worth living. And we are spiritual beings, psychically connected to our world.

In this article I make some broad observations about the cultural expression, or translation, of the spiritual, especially through religions, and how this can affect health. The article draws on a background in the social determinants of health and wellbeing, especially cultural influences.1-3 It is not a review of the research literature on religion and health (which is covered in other articles in this supplement). It reflects a belief that cultural change can be usefully studied at a large scale of global influences affecting entire societies, and not just at the small scale of culture as local knowledge shaping the daily lives of individuals and groups (the approach favoured by anthropologists).3,4

Cultures are about how we think the world “works”: the language, knowledge, beliefs, assumptions and values that shape how we see the world and our place in it; give meaning to our experience; and are passed between individuals, groups and generations. Spirituality is a deeply intuitive, but not always consciously expressed, sense of connectedness to the world in which we live. Its most common cultural representation is religion, an institutionalised system of belief and ritual worship that usually centres on a supernatural god or gods.

My main purpose is to illustrate how macrocultural factors such as materialism and individualism can affect the expression of the spiritual, including religion, to influence health and wellbeing.

Religious belief and practice enhance health and wellbeing, although aspects of this relationship are contested. The psychological literature suggests that the benefits to wellbeing flow from the social support, existential meaning, sense of purpose, coherent belief system and moral code that religion provides.5-8 All these things can be found in other ways, although perhaps less easily; religions “package” many of the ingredients of health and wellbeing to make them accessible to people. This has been their social function.

All in all, wellbeing comes from being connected and engaged, from being suspended in a web of relationships and interests. This gives meaning to people’s lives. Many of the sources of wellbeing are interrelated, the relationships between sources and wellbeing are often reciprocal, and one source can compensate, at least partly, for the lack of another.

People can find meaning in life at a variety of levels.9 Close to their personal lives, there are things like jobs, family, friends, interests and desires. Many people today find meaning in the pursuit of personal goals. There is also the level of identity with a nation or ethnic group, and with a community. At the most fundamental, transcendent level, there is spiritual meaning. Spirituality represents the broadest and deepest form of connectedness. It is the most subtle, and therefore easily corrupted, yet perhaps also the most powerful. It is the only form of meaning that transcends people’s personal circumstances, social situation and the material world, and so can sustain them through the trouble and strife of mortal existence.

History suggests that a measure of both balance and stability in meaning in life is crucial to personal wellbeing and social cohesion. A lack of meaning beyond the personal increases people’s vulnerability. When too much meaning is attached to things that are fragile, transient or ephemeral, disappointment and failure become more likely. But the imbalance can also be in the other direction, with the search for meaning and belonging ending in the total subjugation of the self — in, for example, religious fundamentalism or nationalistic fanaticism.

Many sources of psychological wellbeing are also related to physical health, including longevity. For example, socially isolated people are two to five times more likely to die in a given year than those with strong ties to family, friends and community.10 Wellbeing itself appears to have a central role in these associations, improving health through direct physiological effects on the immune and neuroendocrine systems and by influencing diet, exercise, smoking, drinking and other lifestyle behaviours.2

The complex nature of the relationship between religion, health and wellbeing lies behind a continuing debate among researchers about religion’s health effects. Some argue that the association is not robust and may depend upon unknown confounders and covariates.11 Others believe that no such association should exist once all mediating variables are taken into account.12

It is just this complexity of causal pathways that allows the “intrusion” of other social and cultural factors, so modifying religion’s influences on health. Furthermore, the mainly statistical correlations on which the associations between religion and health are based barely scratch the surface of the role of spirituality. Its nature is mysterious and elusive, making it extraordinarily difficult for science to define and measure. Tacey, who has written extensively on spirituality, argues that “spirit” plays a crucial but largely unacknowledged role in wellbeing, and that secular societies have not understood its meaning, nor recognised its capacity to nurture and transform.13,14

Durkheim’s notion of social integration provides a tradition within sociological theory for understanding the link between social conditions and ill health.15,16 Social integration (of which social support is a by-product) involves the interplay between two antagonistic aspects of human existence — the individual and the social. Integration is optimal when the two sides are in balance, and part of this balance requires constraining human needs. Durkheim emphasised the role of social institutions such as the family and religion in binding individuals to society, in keeping “a firmer grip” on them and drawing them out of their “state of moral isolation”.17

Two powerful cultural factors that work against spirituality in Western societies today are materialism and individualism, especially in combination. I have written about their influence on health elsewhere.1-3,9 In promoting the importance in life of money and possessions, materialism is a cultural antagonist of the spiritual, hindering or distorting its expression. Historically, individualism was concerned with freeing the individual from social regulation, including by the Church. But, as sociologists have noted, it is a two-edged sword: the freedom we now have is both exhilarating and disturbing, bringing with it both new opportunities for personal experience and growth and the anxiety of social dislocation. The hazards of individualism are growing as it becomes increasingly associated with the belief that we are independent of others.

Morality is an important dimension of religious belief and practice. Values provide the framework for deciding what is important, true, right and good, and so have a central role in defining relationships and meanings.2,9 Consistent with what is known about wellbeing and with Durkheim’s ideas about social integration, most societies have tended to reinforce values that emphasise social responsibility and self-restraint and discourage those that promote self-indulgence and antisocial behaviour. Virtues are concerned with building and maintaining strong personal relationships and social affiliations, and the strength to endure adversity. Vices are about the unrestrained satisfaction of individual desires, or the capitulation to human weaknesses. Individualism and materialism reverse these universal virtues and vices, thus weakening one of the core social functions of religion, one which is central to health and wellbeing.

We see the consequences of the cultural impact of materialism and individualism on religion, and its embodiment of the spiritual, at many levels: the decline of mainstream Christianity in Western countries; the rise of “New Age” beliefs, which are often individualist and consumerist; and the counter-trend towards increasing religious fundamentalism, wherein strict adherence to the literal truth of sacred texts means too much power is ceded to religious authorities.

However, cultural influences do not just change the external “shape” of religion. Cultural messages can create tension, conflict and confusion within individuals when they run counter to religious beliefs and teachings, making it harder to integrate religion into their lives.18,19 This, in turn, can lead to change and compromise within religions, including a greater tolerance of consumerism and self-gratification, so removing any need to choose between “God and Mammon”.

In other words, for all the health benefits it can confer, religion is no panacea. For example, Americans stand out from the people of other developed nations in the strength of their religious belief and observance.20 While, generally speaking, the importance of religion declines with increasing income, the United States is the exception — an island of religiosity in a sea of secularism in the developed world. Yet the US compares poorly on many social indicators, including life expectancy, crime, poverty and inequality.21

Americans’ religiosity has not protected them from the rise in youth suicide, one of the most dramatic adverse health trends in Western nations over the past 50 years (but now improving in many of the countries that saw the largest rises). At least part of the explanation can be found in an analysis a colleague and I carried out of the cultural correlates of youth suicide in developed nations. There was no correlation between suicide and the importance young people attached to God in their lives, but strong, positive correlations with several different measures of individualism, including young people’s sense of freedom of choice and control over their lives.22

If social integration is central to health, religion is one important means, but only one. And its effectiveness in this regard may depend on the ways religious belief is explained and practised. While Durkheim emphasised the role of institutions in integrating individuals into society, and so setting limits and giving direction, cultures as a whole can serve a similar role, both directly and through their effects on social institutions. They can affect the expression of the spiritual, including through religion.

Cultures can “hollow out” the spiritual content of religion and fill it, instead, with other things, including materialism, nationalism and fanaticism. Another metaphor is of religion as a vessel or jug, the spiritual contents of which can become spoiled or adulterated by other belief systems. Religion can still function as a source of social support and meaning under these circumstances, and provide incentives to lead a healthy lifestyle. However, my contention here is that when spirituality withers, religion’s social value is diminished because its transcendental dimension is lost or distorted. Religions can be made so rigid and sclerotic by inertia, bureaucracy, politics and corruption that they become self-serving institutions lacking any higher purpose; worse, they can become potent ideologies of oppression and abuse.

Nevertheless, the spiritual impulse remains strong, and there is also evidence that, between the “old Church” and the New Age, new expressions of spirituality are emerging that transcend, rather than confront, the powerful individualising and fragmenting forces of modern Western culture. As Tacey says of this “spirituality revolution”, the new spirituality is “existential rather than creedal”. “It grows out of the individual person from an inward source, is intensely intimate and transformative, and is not imposed upon the person from an outside authority or source.”13

Religion serves humanity best when it embodies and expresses the spiritual as purely as possible, with only a limited influence of institutional and political agendas. The Jewish prayer book, Gates of prayer, captures what religion, as an expression of the spiritual, offers:

Modern Western culture, with its emphasis on personal consumption and self-gratification, betrays this ideal — at considerable cost to health and wellbeing. The restoration of a stronger spiritual dimension to life will be important in turning around this situation.