Religion and Mental Health

Int. J. Appl. Psychoanal. Studies 7: 102–115 (2010)

Copyright © 2010 John Wiley & Sons, Ltd DOI: 10.1002/aps

International Journal of Applied Psychoanalytic Studies

Int. J. Appl. Psychoanal. Studies 7(2): 102–115 (2010)

Published online 12 March 2010 in Wiley InterScience

(www.interscience.wiley.com) DOI: 10.1002/aps.240

Religion and Mental Health:

Theory and Research

JEFF LEVIN

ABSTRACT

This article provides an overview of psychiatric and mental health research on religion.

First, conceptual models of religion and of mental health used throughout this literature

are described. Second, published empirical research in this fi eld is summarized,

including fi ndings from epidemiologic, clinical, and social and behavioral investigations.

Third, promising theoretical perspectives for understanding a putative religion–

mental health connection are elaborated. These are based on respective behavioral,

biological, psychodynamic, and transpersonal interpretations of existing research

fi ndings. Copyright © 2010 John Wiley & Sons, Ltd.

Key words: religion, spirituality, mental health, psychiatry, research

INTRODUCTION

Recently, the idea of a “religion–health connection” (Ellison & Levin, 1998) has

gained traction among clinicians, due to a growing body of research. Literature

reviews (e.g. Levin & Chatters, 1998) and academic (Koenig, 1998a; Koenig,

McCullough, & Larson, 2001) and popular (Levin, 2001) books have focused

attention on social, behavioral, epidemiologic, and clinical research papers that

total in the thousands. These studies explore the impact of religious indicators

on psychiatric and mental health outcomes in population, community, and

hospital samples: rates of mood disorders, such as depression and anxiety; levels

of psychological distress, using numerous assessment instruments; dimensions of

psychological well-being, such as life satisfaction and happiness; patterns of selfdestructive

behavior, including the addictions; and mental health care utilization.

The weight of evidence, on average and across studies, suggests that religion,

however assessed, is a generally protective factor for mental illness.

Until now, most scientifi c effort has been devoted to accumulating empirical

evidence. Less effort has gone to stepping back and asking, “But what does this

mean?” Data alone do not increase understanding of a topic without theoretical

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models that help us make sense of said data. Such perspectives are akin to lenses

that enable us to “see” fi ndings that might not fi t into our scientifi c worldviews

and thus be cast aside or disparaged. Identifying perspectives to explain and

interpret fi ndings on religion and mental health is thus important and timely,

especially as supportive fi ndings have been misinterpreted – on both sides of the

issue. That religion might have something to say about mental health, for good

or bad, has been a sensitive and contentious issue within psychiatry, dating to

Freud, as familiarity with the history of psychiatry attests.

A case in point: the 1994 revision of the American Psychiatric Association

(APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), which

added a new diagnostic category (V62.89) termed “religious or spiritual problem.”

In earlier versions (e.g. DSM-III-R), the sole references to religion were as a sign

of psychopathology – as features of cases exemplifying cognitive incoherence,

catatonia, delusion, magical thinking, hallucinations, or schizotypal disorders

(Larson et al., 1993; Post, 1992). Once this oversight was dissected, the new

construct was rolled out in the DSM-IV, defi ned broadly as a circumstance

whereby “the focus of clinical attention is a religious or spiritual problem”

(American Psychiatric Association, 1994, p. 300). Examples include loss of faith,

conversion-related problems, and questioning of faith or values. This new category

signifi es that psychiatrists have become sensitive to the idea that certain

expressions of faith, where “distorted or disrupted rather than inherently so”

(Levin, 2009, p. 91), may be sources of certain kinds of psychological distress

(Turner, Lukoff, Barnhouse, & Lu, 1995).

The years since have seen a sustained increase in research on religion and

mental health. The time is right to step back and evaluate where we are and

what we know about the relation between these two constructs. Accordingly,

this paper tries to explain and interpret observed associations from behavioral,

biological, psychodynamic, and transpersonal perspectives. Each perspective

suggests ways to make sense of fi ndings and each helps to place fi ndings into a

larger context that may enable a better understanding of etiology and more

effective treatment.

HISTORY AND CONCEPTUAL MODELS

As religion and health research has gained acceptance in psychiatry and psychology,

a misperception has arisen that such studies are a new development.

Not so. Nor is this a novel topic for these fi elds. Scholarship on religion and

psychiatric disorders dates to the nineteenth century, most famously in the writings

of Freud. Less known are earlier discussions within the nascent pastoral

care movement, exemplifi ed by Observations on the Infl uence of Religion upon the

Health and Physical Welfare of Mankind (Brigham, 1835), authored by a founder

of the APA. The British Medical Journal (Review, 1905) noted, with an optimistic

tone refl ecting the place of religion in medical discourse of the time, “The

interdependence of religion and health, which may both be regarded as inherent

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birthrights of mankind, is a broad fact which is generally accepted and which is

capable of easy demonstration” (p. 1047).

For many clinicians and scientists of the day, religion was highly relevant – for

better or worse – as an etiologic, therapeutic, or palliative agent in psychotherapy.

Whether thought to be a malign or salutary infl uence on mental and

emotional well-being, the sphere of religiousness, faith, and sacred beliefs and

experiences had been a source of exploration for decades. Whatever one’s beliefs

or preferences about faith or God, it at least was agreed that these things

mattered.

The polarities of early discourse on this subject are represented by Freud and

James. In The Future of an Illusion (Freud, 1927/1961b) and Civilization and Its

Discontents (Freud, 1930/1961a), Freud asserted that “religion and science are

moral enemies and that every attempt at bridging the gap between them is

bound to be futile” (Gay, 1989, p. xxiii). Religious practices, and belief in God,

moreover, were taken by Freud as signs of obsessive neurosis, narcissistic delusion,

and an infantile life outlook, and thus a dangerous threat to individual psyches

and to society. They were believed to be determinative of, or indeed to refl ect,

an unhealthy psychological status.

James was not as pessimistic. In The Varieties of Religious Experience (James,

1902/1958), he identifi ed two types of religious expression, the “religion of the

sick soul” and the “religion of the healthy-minded soul.” The former is a product

of a damaged psyche, expressed as “positive and active anguish, a sort of psychical

neuralgia wholly unknown to healthy life” (p. 126). In extremis, this includes

loathing, irritation, exasperation, self-mistrust, self-despair, suspicion, anxiety,

trepidation, and fear. The latter is grounded in “the tendency which looks on

all things and sees that they are good” (p. 83). Healthy-minded religion is the

faith of the literally healthy minded, whose psyches are implicitly hopeful, optimistic,

positive, kind, and prone to happiness.

Others who followed James also saw benefi t in expressions of religion – e.g.

Jung (1934, 1938) and Fromm (1950) – but the psychiatric profession as a whole

remained dubious. Not unanimously, but largely so, and not without reason.

Unchecked manic expressions of religion have been, throughout history, sources

of delusion, instability, and pathology, readily visible to clinicians who serve,

essentially, as fi rst responders for people whose religious practice has taken

pathological form. Yet, until recently, there was minimal interest in testing the

idea that religion lacked positive instrumentality for mental and emotional

well-being. A presumption of guilt was tacit, with little impetus to validate this

view. After half a century of scholarly disinterest (see Beit Hallahmi, 1989),

things began to change in the 1950s and 1960s (see for example Allport,

1954/1979).

The advent of psychology’s third and fourth schools encouraged critical

examination of issues related to the human spirit. Humanistic and transpersonal

theorists (e.g. Maslow, 1964; Tart, 1975) were infl uenced by yoga, Vedanta, Zen,

the esoteric traditions, and various integral perspectives (see Chaudhuri, 1977;

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Ghose, 1950; Wilber, 2000). 

While not mainstream within psychiatry and psychology,

the subject of spirituality, broadly constructed as related to the quest

for human potential and fl ourishing, became an acceptable, or at least tolerated,

topic of inquiry. A broad take on spirituality was emphasized, focusing on a wider

swath of experiences than the traditional usage of this concept contexted within

normative religion. Rather than defi ned solely as a state of attainment resulting

from a lifetime of religious observance and piety (a theological defi nition of

spirituality), the new wave of psychologists explored spirituality in the context

of the developmental process of attaining transcendent union with something

“beyond” than the individual ego, such as the eternal source of being.

Concurrently, the putative mental health consequences of formal religious

involvement became a topic for empirical study, especially within community

and geriatric psychiatry and social, developmental, and health psychology. The

pioneering Midtown Manhattan Study, began in the 1950s, was one of the earliest

and is still among the most comprehensive and insightful epidemiologic

explorations of psychiatric morbidity and its sociodemographic determinants.

The study features analysis of variations in the prevalence of certain diagnoses

and subsequent use of mental health services. The initial volume of fi ndings,

Mental Health in the Metropolis (Srole, Langner, Michael, Opler, & Rennie, 1962),

is a classic text of social psychiatry and psychiatric epidemiology. The study is

highlighted by a detailed analysis of the impact of religious affi liation (Srole &

Langner, 1962). Investigators found that “religious origin” – Catholic, Protestant,

or Jewish – is a source of signifi cant variation in symptom formation, psychiatric

impairment, patient history status, and attitude toward mental health

professionals.

While investigations of physical morbidity had been ongoing for decades,

prior to this study psychiatric epidemiologists showed less interest in the impact

of characteristics or functions of religion on population rates of psychopathology.

The Midtown Manhattan Study led to other studies, which have since snowballed.

In the early 1980s, literature reviews began summarizing this work, by

then consisting of about 200 empirical studies of various outcomes (e.g. Gartner,

Larson, & Allen, 1981; Larson, Pattison, Blazer, Omran, & Kaplan, 1986). The

verdict was consistent. According to one authoritative review, “The mental

health infl uence of religious beliefs and practices – particularly when imbedded

within a long-standing, well-integrated faith tradition – is largely a positive one”

(Koenig, 1998b, p. 392).

These early efforts at quantifying the impact of religious identity, belief, and

practice on mental health were not the whole of the religion–mental health

discussion. In 1980, the National Institute of Mental Health (NIMH) published

Religion and Mental Health (Summerlin, 1980), an annotated bibliography of 1836

entries – journal articles, chapters, books, reports, other media. Approximately

1500 of these had appeared just since 1970. Empirical research studies, clearly,

were just one expression of a more widespread intellectual and professional

engagement of this subject.

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Since then, fi ndings have accumulated from large research programs, such as

by Koenig and colleagues at Duke University (see Koenig, 1999). Yet this subject

remains provocative due to issues related to conceptualizing religion and to

theoretical perspectives that underlie a religion–mental health connection.

While study designs and analyses are increasingly sophisticated, the fi eld as a

whole has been less successful in making sense of results. For example, statistically

signifi cant fi ndings implicating religious membership, church attendance,

belief in God, and so on in rates of psychiatric symptoms or well-being do not

tell us about a salutary infl uence of spirituality, no matter how much some wish

it were so. Spirituality remains underinvestigated, not just in studies of mental

health but in all domains of religious research.

To understand how faith impacts on something as personal as psychological

status, thoughtful investigation of spirituality would be more fruitful than continued

enumeration of discrete religious behaviors. Features and correlates of the

trajectory of inner evolvement toward perceived union with the transcendent

– a decent functional defi nition of the spiritual process – seem to tap dimensions

of life experience more germane to the struggle to maintain intrapsychic equilibrium

than counts of participation in congregational events. But this is a

hypothesis, not a conclusion. Researchers, generally speaking, have shown little

enthusiasm for addressing issues not easily amenable to conventional approaches

to religious assessment (see Levin, 2003).

In studies of physical and mental health, the most common religious measures

are single-item questions on affi liation and attendance at worship services. Such

questions (ostensibly) emphasize something observable and quantifi able. For the

most part, investigators have avoided assessment of attitudes, beliefs, states, or

experiences. Very little is thus known about their impact on outcomes of interest,

such as rates of mental health or psychological well-being.

Likewise, most studies focus on dimensions of well-being: life satisfaction,

congruence, happiness, positive affect, depressed mood – constructs for which

validated indices are available. Fewer studies explore religion’s impact on psychiatric

diagnoses, except for attention to its etiologic or preventive role in clinical

depression and anxiety disorders and to some addictive behaviors. Most of these

studies use single-item measures or unidimensional indices.

While findings are often interpreted as relating to richly nuanced and multidimensional

spirituality–mental health connections, this is not true. Most findings are results of analyses of one-off measures of public and private religious

behavior, mostly in relation to single-item measures or unidimensional indices

of self-reports of general or domain-specifi c well-being. Moreover, these are

mostly prevalence (cross-sectional) studies of religion as a correlate of distress/

well-being in general populations; they do not examine religion as a therapeutic

agent for existing pathology. These are thus not studies of healing but of prevention.

Further, existing studies have been conducted mostly within populations

of US Christians of one denomination or another. To be clear, this is not problematic,

in and of itself; this is a thriving area of study at the forefront of several

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fi elds, including religious gerontology, health psychology, and medical sociology.

But it is important to underscore these points, as this work is often tacitly

believed to imply a presumably global and therapeutic impact of spirituality on

mental health, something it does not address. There is reason to believe that

religion or spirituality may function in this way, but the wealth of fi ndings accruing

on religion and health have little to say about such an effect.

RESEARCH FINDINGS

Empirical investigations of religion and mental health include epidemiologic

studies involving population-based national or community samples, clinical

studies of psychiatric outpatients or inpatients, and social and behavioral research

on psychological distress and well-being. Due to a wealth of published work over

the past two decades, this review is selective rather than comprehensive. Many

good reviews are available, and interested readers are directed to them for greater

detail (e.g. Levin & Chatters, 1998; Koenig et al., 2001).

Early systematic reviews of studies of religion in psychiatry journals identifi ed

a paradox: research on the impact of religion was not uncommon (139 published

analyses just between 1978 and 1989), but conceptual and theoretical engagement

was lacking (see Larson et al., 1986; Larson et al., 1992). In 78 percent of

studies no hypothesis was tested, in 64 percent no adequate statistical analysis

was conducted, and only superfi cial measures were typically used (e.g. broad

categories of affi liation). Findings were largely positive – indicative of a generally

salutary effect of religious identity or practice – but what they implied was

unclear. The subject was still touchy for academics; the unspoken “R word,” as

one paper described it (Larson, Sherrill, & Lyons, 1994).

Over the past 20 years, empirical study has expanded greatly, highlighted by

large funded research programs. The fi rst edition of his Handbook of Religion

and Health (Koenig et al., 2001) summarized hundreds of studies analyzing

effects of dimensions of religion on depression, suicide, anxiety disorders, schizophrenia

and other psychoses, alcohol and drug use, delinquency, features of

personality, and other outcomes. The weight of evidence was positive: over half

of the studies in these categories point to a statistically signifi cant protective

effect. Nevertheless, besides Koenig’s own work and that of several of his colleagues

and collaborators, most studies are one-off analyses from small samples

of convenience.

Medical sociologists, health psychologists, and gerontologists have done a

more sophisticated job at identifying impacts of religious life on mental health

indicators. Studies of dimensions of psychological distress and well-being, many

of them large-scale probability surveys, consistently fi nd a protective effect of

religious participation (see Levin & Chatters, 1998). Within the gerontological

literature, especially, features of institutional religious involvement (e.g. attendance

at worship services) and non-institutional involvement (e.g. private prayer,

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embeddedness in religious support networks) have been associated with positive

mental health outcomes and high scores on scales and indices assessing psychosocial

constructs such as self-esteem, mastery (self-effi cacy), optimism, hope,

and dimensions of well-being. This overall fi nding has been replicated across

age cohorts, in both sexes, and regardless of social class, race or ethnicity,

religious affi liation, and specifi c diagnosis or outcome measure (see Levin,

1997). Much of the literature focuses on symptoms of mood disorders, such as

depression or anxiety, and many studies have found a health-promoting

effect of religion on overall and domain-specifi c life satisfaction, happiness,

and positive affect. Sophisticated systematic reviews and meta-analyses (e.g.

Smith, McCullough, & Poll, 2003) provide depthful critiques of conceptual,

theoretical, and methodological issues and offer guidance for the next generation

of research.

To summarize, religious involvement, broadly defi ned, exhibits a salutary and

primary-preventive function in relation to psychological distress and outcomes

related to mental health and well-being. Findings are consistent, and a protective

effect of religiousness seems to be especially salient among older adults. But it is

important not to overinterpret this overall result.

The present author (Levin, 1996) has identifi ed common misinterpretations

of the larger religion–health literature; the same points are applicable to mental

health. For example, results are often taken to mean that religious involvement

promotes healing. It may, but, as noted, studies do not address that topic; they

focus almost exclusively on primary prevention. Nor do fi ndings mean that religious

people do not become ill; of course they do. When examining population

rates of morbidity, however, there is a modest advantage, on average, attributable

to religious practice. Nor do fi ndings tell us much about spirituality. While that

would be a fi ne research topic, studies mostly look at the impact of affi liation

with and participation in established religions. Studies also do not provide evidence

for or against a healing power of prayer. Nor do they suggest that religiousness

or faith (or spirituality) is the most important factor in health. As a public

health scientist, the present author fi nds this latter claim especially unfortunate.

These factors may measurably impact on morbidity, both physical and mental,

but tobacco use and socioeconomic disparities, for example, far outweigh a religious

effect. Finally, and this goes without saying, studies of religion using epidemiologic

or social or behavioral research methods cannot tell us anything

about the possibility of a “supernatural” infl uence on health or the human body

or mind. If folks are looking to scientifi c research (on health, of all things) to

validate the existence or motives of God, then they are looking in the wrong

place.

So what can we conclude for certain? Simply this: there is considerable

evidence that one’s religious life has something signifi cant to say about one’s

mental health. This includes both the “being” and “doing” aspects of religion

– our religious identity and how we believe or feel or act as a consequence.

This does not mean that religious people do not become ill – one of the usual

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misconceptions of this work, noted earlier – just that higher categories of response

to questions about religious participation are associated with lower rates of symptoms

or pathology or with higher scores on well-being measures. No more, no

less. The take-home point is simply that religion merits a place at the table with

those factors known to impact the risk or odds of subsequent psychiatric morbidity

in adult populations. This, we can say, is the “what” of a religion–mental

health relationship. But what about the “how” or “why”?

THEORETICAL PERSPECTIVES

To explain these fi ndings, we must rely on interpretive grids – theoretical perspectives,

in the language of social science. These are respective lenses by which

empirical observations are made sense of in light of existing or proposed scientifi

c mechanisms and clinical observations. Within psychiatry, psychology, and

the mental health fi eld, generally, such lenses are many. We are all familiar with

the famous four forces or schools of modern psychology: behaviorism, psychodynamics,

humanism, and transpersonalism. But these do not exhaust the ways

that the human psyche and patterns of behavior, and their antecedents, are

understood to infl uence health by behavioral and social scientists. For purposes

of this discussion, several broad meta-categories of potential explanations for

religion–mental health associations are examined.

Behavioral Explanations

The religious impulse is expressed through myriad behaviors, emotions, motivations,

beliefs, attitudes, thoughts, values, experiences, and relationships.

Independently of religion, we have long known that our behaviors, emotions,

and social relationships are signifi cant health determinants. Physical and mental

health – self-rated and objectively diagnosed – and rates of psychiatric morbidity

are known to vary by categories of behavioral and psychosocial variables, including

stress, social support, life-style behaviors, and health-related cognitions and

affects.

Researchers have proposed many possible mediators of observed religion–

mental health associations, drawing on various functions and domains of the

psyche. Collectively, these help us understand how the practice of faith or a

spiritual path may impact psychological health. Commitment to a religious belief

system may benefi t mental health by promoting healthy behaviors conducive

to wellness (e.g. avoidance of tobacco, alcohol, drugs, antisocial behavior).

Fellowship with likeminded congregants embeds one in formal or informal social

networks that facilitate receipt of tangible and emotional support. Private or

group prayer or worship may produce salutary emotions – gratitude, humility,

grace, forgiveness, love – with preventive or therapeutic benefi t. Religious beliefs

(about God, human existence, the purpose of life, life after death, free will, the

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nature of evil, human obligations) may be consonant with beliefs that foster

preventive health care practices. Faith, or religious certainty, may engender positive

expectations that instill hope and optimism capable of preventing or ameliorating

distress. In sum, psychological mediation of a religion–mental health

link is plausible and consistent with research on correlates and determinants of

health and healing (Levin, 2009).

Biological Explanations

Some theories of psychological mediation of a religion–mental health association

posit “hard-wired” connections among brain, behavior, affect, and immunity.

These connections are not unique here; research on psychoneuroimmunology

dates back 40 years (see Ader, 2007). But consideration of neurocognitive and

neuroendocrine pathways, for example, accounting for positive fi ndings in this

fi eld is a hopeful development for investigators seeking naturalistic explanations

for religious effects. In light of evidence of religious motivations (e.g. intrinsic

religiosity) associated with psychophysiological markers such as absorption

(e.g. Levin, Wickramasekera, & Hirshberg, 1998), and of “spiritual” centers

in the brain (e.g. Beauregard & O’Leary, 2007; Newberg, D’Aquili, & Rause,

2001), neurophysiological mediation of religious effects on mental health is biologically

plausible. A conference on psychoneuroimmunology and religion

(Koenig & Cohen, 2002) suggested that collaboration among neuroscientists,

psychiatrists, and psychiatric epidemiologists should become a cutting edge for

this fi eld.

The complexity of interrelationships between religion and etiologic agents of

or risk factors for psychopathology is exemplifi ed in a model proposed for antecedents

of major depression (Koenig, Blazer, & Hocking, 1995). A maze of

hypothesized and validated pathways connects myriad factors (e.g. health behaviors,

alcohol and drug use, medications, physical illness, chronic pain, disability,

genes, personality, brain disease, comorbid psychiatric illness, stressful events,

aging changes, cognitive appraisal, coping behavior, social support, economic

resources, history of depression) with each other and with diagnosis of an affective

disorder. For most of these factors, research has identifi ed religious correlates

or determinants. This model underscores the complexity of an etiologic role for

characteristics or functions of religiousness – intimately connected with other

accepted etiologic or risk factors for this diagnosis.

Psychodynamic Explanations

In an early review, a dozen explanations for religion–health associations

were proposed (Levin & Vanderpool, 1989). Among these were the psychodynamics

of belief systems and the psychodynamics of religious rites. By the

fi rst of these, the authors referred to the tendency of religious beliefs to “give

rise to psychodynamics engendering greater peacefulness, self-confi dence,

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and a sense of purpose, or, alternatively, guilt, depression, and self-doubt”

(p. 73). These outcomes may be symbiotic with certain personality styles (e.g.

Type A) or with theological perspectives such as Calvinism (determinism)

or Arminianism (free will). The second referred to “public and private rituals

[that] serve to ease dread and anxiety, reduce personal and group tension and

aggressiveness, allay fears, and moderate loneliness, depression, anomie, and/or

feelings of entrapment and inferiority” (p. 74). These rites enable people to

“dramatize or act out their beliefs in settings conducive to or charged with

emotion – provide avenues of escape, purifi cation, catharsis, and empowerment.

These positive affects may serve as sorts of psychic beta-blockers or emotional

placebos” (p. 74).

For sure, “psychodynamic” covers a lot of ground. Different schools and philosophies

posit different theories of religion and faith and disagree as to the

polarity of their impact on psychological health. Freud’s (1927/1961b) antipathy

to the “peculiar value of religious ideas” (p. 18) is well known, but his take no

longer predominates in the fi eld. Jung’s (1938) perspective on the reciprocal

infl uence of religious dogma and the symbolism of the unconscious is also infl uential,

but his references to mystical, gnostic, and occult sources are less pertinent

to normative religion. In Psychoanalysis and Religion, Fromm (1950, p. 9)

appealed for a middle ground:

If I undertake to discuss the problem of religion and psychoanalysis afresh ... it is because

I want to show that to set up alternatives of either irreconcilable opposition or identity

of interest is fallacious; a thorough and dispassionate discussion can demonstrate that

the relation between religion and psychoanalysis is too complex to be forced into either

one of these simple and convenient attitudes.

Transpersonal Explanations

The advent of psychology’s third and fourth schools introduced many concepts

into the lingua franca of psychotherapists. Foremost are the transcendent experience

and the idea of the transpersonal. The latter refers to states “beyond”

the personal and egoic, oriented toward development of human potential,

including attributes and functions of higher consciousness (see Vaughan, 1984).

Transpersonal therapy emphasizes “self-determination, self-actualization, selfrealization,

and self-transcendence” (Vaughan, 1984, p. 25). Therapists acknowledge

higher states of consciousness, neither normal waking nor dreaming states,

whose experience may be a rich source of growth. These may be infused with

spiritual symbolism and serve as gateways to “divine” experiences, such as transcendence.

Accounts of mystics point to subtypes: a “green” type of transcendent

experience “characterized as transitory and involving a profound experience of

pleasure, oftentimes described as ecstatic” and a “mature” type “characterized as

long lasting. . . . a more enduring serenity and equanimity” (Levin & Steele, 2005,

pp. 89–90). An example of the former might be Maslow’s peak experiences; the

latter, the yogic attainment of sama¯dhi.

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The signifi cance here is found in psychophysiological correlates of transcendence

and markers of other transpersonal experiences. Health- and mood-related

sequelae of spiritually motivated pursuits engendering such experiences – e.g.

meditation, prayer – point to a potentially therapeutic instrumentality. While

better mental health may not be an objective of the quest for transcendence,

the large research literature on psychophysiology, consciousness, and spirituality

(see Murphy & Donovan, 1999) suggests a valuable interpretive framework with

interesting tie-ins to the behavioral, biological, and psychodynamic explanation

broached earlier.

CONCLUSION

To summarize, empirical evidence supports a generally protective effect of religious

involvement for mental illness and psychological distress. Like all epidemiologic

fi ndings, there are exceptions: e.g. individuals whose religious ideations

and practices contribute to, or refl ect, pathology. But, on average, this fi nding is

statistically signifi cant, replicated, and modest in magnitude. It is not solely a

function of the assessments used for religion or mental health or of characteristics

of the populations studied. Existing theoretical perspectives provide a reasonable

basis for making sense of this association, which is coherent with

behavioral, biological, psychodynamic, and transpersonal understandings of

determinants of mental and emotional well-being. While much remains to be

learned, scholarship has come a long way in the past 30 years.

One marker of the growing acceptance of this fi eld is the annual Oskar Pfi ster

Award, given by the APA since 1983 in recognition of outstanding career contributions

to religion and psychiatry through research, publications, and clinical

practice. Named for a pioneering psychoanalyst and protégé of Freud, Pfi ster

Award laureates include some of the most infl uential and highly regarded fi gures

in psychiatry, including Jerome Frank, Viktor Frankl, Robert Jay Lifton, Oliver

Sacks, Robert Coles, Don Browning, and Paul Ricoeur.

For researchers, the mainstreaming of this subject presents an opportunity

for substantive, programmatic contributions – in contrast to the one-off

approach of so many papers to date. A fi eld that is suffi ciently established for

the APA to sanction a major career award no longer needs atheoretical “exploratory”

research. The envelope can begin to be pushed. Perhaps someday we will

look back and wonder how we ever presumed that well-being is unrelated to the

workings of the spirit. Just as the relation of mind and body was rejected by

biomedicine until the weight of evidence made such a connection tacit, so, too,

may the role of spirit become acknowledged fact. If so, not just our research

stands to benefi t. Our clients and patients will benefi t from more directed attention

to dimensions of the self that may be sources of both distress and adjustment

but that which, until recently, have been overlooked in our professional

discourse.

Religion and mental health

Int. J. Appl. Psychoanal. Studies 7: 102–115 (2010)

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113

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Jeff Levin, PhD, MPH

University Professor of Epidemiology and Population Health,

Director of the Program on Religion and Population Health

Institute for Studies of Religion, Baylor University,

One Bear Place #97236, Waco, TX 76798, USA

jeff_levin@baylor.edu