Dr. Harold G. Koenig is co-director of the Center for Spirituality, Theology, and Health at Duke University Medical Center, where he also serves on the faculty as Professor of Psychiatry and Behavioral Sciences, and Associate Professor of Medicine. Dr. Koenig is the author of many books, including "The Healing Power of Faith," "Faith and Mental Health," and "Spiritual Caregiving," and he has been nominated twice for the Templeton Prize for Progress in Religion. He spoke with us recently about why he believes being part of a religious community can make people healthier—and happier. A recent study suggests that praying for others does not improve their health. How do you interpret the results?
I think the results are very consistent with good science and good theology. Good science because there's no acceptable scientific mechanism or pathway by which prayer—at least the way it was designed in this study without people knowing whether or not they were prayed for—could have any effect, and it's good theology because God is not predictable, he's not a part of the material universe.
It tells us nothing about the effectiveness of prayer.
Do you think it's impossible to do that?
It's impossible for studies designed like this. God would have to be quantitative and predictable, which is ludicrous in the context of any Christian or Jewish or Islamic tradition and even within the Eastern traditions.
How do you measure God's will for a person? Ninety-six percent of the participants in the Harvard study had someone else praying for them. We don't know how much prayer they had, we don't know how sincere the prayers were. None of that was taken into account, and it would be very hard to measure those things. And none of the benefits to the prayed-for group were measured after 30 days. Maybe God healed them after 30 days—we don't know. You can see that this study is ridiculous.
Putting aside the ability to be able to prove it or not, do you believe that prayer can heal—specifically help someone, for example, recover from cancer?
Absolutely. I believe that on faith and I also believe it because I've seen that happen with people, including personal friends. Of course they knew they were being prayed for, by their families and their churches, and those people have had remarkable recoveries. I believe it because it says it in the scriptures that I believe in. So there's no doubt in my mind that prayers help people—those who are prayed for and those saying the prayer.
One thing we do know is that God is good and because God is good, whatever God allows to happen or does in response to prayer has to be good. Theologically speaking it may be bad for a person to do well after coronary artery bypass surgery. It may be that if a person had some complications, he would realize his limitations, he may reach out to God, he may forgive his neighbor, he may tell his loved one that he loves them. Good things come out of difficult situations.
Would you distinguish between the effectiveness or the power of intercessory prayer (praying for others) and people praying for themselves?
I think for the person who is praying, that praying for someone else is better than praying for him/herself. It may give you comfort to know that God is listening, so I would encourage people to pray; but if you're praying for someone else that's like a prayer one step above, because that means you're concerned about the benefit of that other person, which is something which, according to the scriptures, you're rewarded for.
So if you want to be healthy you should pray for others?
Pray for others, pray for yourself, and don't worry about these crazy studies. Faith is evidence of things not seen. If you could reliably predict the effectiveness of prayer, you wouldn't need faith, because you'd have proof.
Beyond the effects of prayer, do you believe religious practice can lead to other health benefits? What are they?
Bear in mind that these benefits are not intended, they're kind of a consequence of going to church or praying or reading the Bible or being religiously committed. They're kind of a side effect of being religious for more valid, more intrinsic reasons.
The benefits of devout religious practice, particularly involvement in a faith community and religious commitment, are that people cope better. In general, they cope with stress better, they experience greater well-being because they have more hope, they're more optimistic, they experience less depression, less anxiety, and they commit suicide less often. They don't drink alcohol as much, they don't use drugs as much, they don't smoke cigarettes as much, and they have healthier lifestyles. They have stronger immune systems, lower blood pressure, probably better cardiovascular functioning, and probably a healthier hormonal environment physiologically—particularly with respect to cortisol and adrenaline [stress hormones]. And they live longer.
The psychological, the social, and the behavioral mechanisms—which we can study and measure—are probably the reasons why these people are healthier. We don't think that we're trying to study anything supernatural, other than that perhaps God created the body in such a way that because of our faith and devotion, we would live the fullest, happiest, longest life. That is the only part that might be a little supernatural—that there was a design to all this. But of course you can't prove that; it could be we just evolved like this too.
What particular practices are associated with these health benefits—prayer, meditation, scripture reading, going to church?
The strongest and most consistent by far is attending worship services, which is a proxy for level of involvement in religious community.
Why do you think that is?
It's probably because it combines a number of things: reinforcement of a belief system when you meet together with others and they believe the same thing and then you hear the preacher reinforcing it every week. And I think some of what goes on during the service probably has health benefits: singing, praying, being in a peaceful atmosphere together. That's not been studied, but it's possible that physiological changes occur as a result of just being in that environment.
That, combined with not only the receiving of support—but especially the giving of support to others. Because even if the only reason you do it is because you think you should do it, the giving of support to others has both mental and physiological health benefits. People who volunteer, people who are involved in altruistic activities–study after study shows health benefits to that.
In terms of health benefits, is it useful to distinguish between personal spiritual practice and organized religion?
I think the word "spirituality" is much more inviting and it includes religion. But from a research perspective, it's really religion that's studied and been shown to benefit health— not the less definable, more vague, and individualized spirituality.
In your writing, you say that the crucial support system tends to be missing from individual spiritual practice.
Yes. Not only the social support, but the social guidance, too. You can bounce things off other people you know, crazy ideas you have. Everybody has crazy ideas. If you're alone, they can get blown out of proportion, and pretty soon you're off on some weird tangent. But if you've got people around you, helping to say "OK, that's an interesting idea, but that sounds a little weird, maybe," it's helpful for people.
Is there a reason to believe that the religious practices are somehow more powerful than other forms of stress-reduction and social support?
I think getting a pet is useful; it can help somebody who is lonely and living alone as long as they're not using that pet to replace interacting with others. Exercise too—all of these things are beneficial; the question is, there are situations where you can't do those things. When you're sick you can't exercise, you can't bring your pet to the hospital or to the nursing home with you, and sometimes your friends get tired of calling you when you can't go out and socialize and then they stop calling you.
Religion, on the other hand, is very positive, it's social, and it has expectations regarding behavior, so all of these things together are health-beneficial. You can have a pet and you can smoke, but the pet's not going to say '"don't do that." And some of the things we'd like to get rid of in religion—the dogma, the laws—may be the ingredients that result in better health. You should have only one spouse, you shouldn't cheat on your spouse, you shouldn't get involved in Internet pornography—all that's forbidden. We've learned that if people get involved in doing those things they risk their health. Whether it's a sin in a spiritual sense or not, it's bad for them. So these rules and regulations and laws—love your neighbor and help your neighbor and forgive your neighbor—are good for us, they're good for our mental and our physical health.
Do you think that religious practices like prayer, attending a house of worship, etc. should be prescribed by doctors?
No. These are things that doctors should be aware of, they should take the spiritual history and learn about the patient's religious perspective because those beliefs so oftentimes will influence their medical decisions and all sorts of other things. But a doctor can't prescribe that. That's just—well, first of all, we don't know even if they prescribed it, if it would work. If somebody says, "well, I'm going to go to church and lower my blood pressure," that may not work, it may go up. So, we don't know that, there's no randomized clinical trial that proves that if you become religious you're going to be healthier over time.
What doctors and healthcare professionals can do is acknowledge [religion], because it's important to 90 percent of their patients, they can make sure that the patient has religious resources at the hospital, consider the patient's beliefs when designing the course of treatment so it doesn't conflict with their beliefs.
What about psychological health—are religious people happier?
In general, and all things being equal, the answer is yes. If you have nothing stressing you, if you're wealthy and you're well educated, you've got plenty of friends, you're probably going to be pretty happy—[religious or not]. But if you're studying instead a group of people who are undergoing stress—they're physically ill, they're disabled, maybe they are in bereavement, or they've lost a job—then if you look at religious people compared to those who are less religious, you're going to find the religious people are coping better.
What does religion offer that makes the difference—hope, a positive outlook, meaning, a source of strength?
The central part of it is [the way religion can ascribe] meaning to the events, so that even seemingly bad events don't necessarily have to be bad overall. Scripture promises that all things work together for good for those who love and serve God. You can decide to look for those good things. This understanding can give them hope, meaning, and a sense of purpose, which will enable them to go through those events.
Viktor Frankel, who was in the concentration camps in Nazi Germany, said the ones who survived those camps were the ones [who felt like their lives had] meaning. It was very clear that if they had something to look forward to, if they had a positive belief system, that they could survive, despite what was going on in their lives.
How should someone who is depressed, for example, decide between going to a psychiatrist and consulting a clergy person?
I think if they have mild symptoms, if they're not losing weight, if they're sleeping fairly well, if they're upset over a stress and they're physically not upset or stressed out, and they have this bad thing happen, the loss of a loved one or the loss of their job, I'd go see the pastor. If the person starts losing weight, has trouble sleeping at night, feels tired all the time, and begins to have any suicidal thoughts, it's certainly time to go see the psychiatrist or a doctor.
We have shown that it's mainly the milder to moderate symptoms of depression that are responsive to religious intervention, and once people get really, really depressed, they can't pray. They're unable to get out of bed to go to church. They can't concentrate. They're afraid to read religious scriptures. When it gets to that point, you are actually unable to access those religious resources, and through medication or other biological means or even different types of psychotherapy, the person might then get well enough so that they can access those religious resources.
What about some of the potentially negative aspects of religion? For example, sometimes people feel that when prayers aren't answered it means their faith is weak, which can add to their stress. Are there dangers people should look out for?
One of the things people have to be aware of is not to emphasize the physical healing too much, because that's what we naturally do. When we're in pain, when we're suffering, we are naturally going to pray for physical healing, that the cancer would be healed, or that our loved one would not have Alzheimer's disease.
Not everybody's prayer for physical healing is going to be answered, but there may be a greater healing going on as a result of the illness. There may be a spiritual healing going on, a healing of relationships, a healing of one's relationship with God, something that wouldn't happen if that person were cured of physical illness. Physical health may be pretty far down in God's list of things that are important. So you may not get it, because it's not for your own good, it's not in your best interest overall.
So if your prayer is not answered, if you don't get over the cancer, you shouldn't feel like you're being punished or you're being abandoned by God.
Or that your prayer isn't being answered some other way. So be alert, if your prayer isn't being answered, then maybe you're not looking for the answer that you really need. Just consider that we really, as humans, have limited information. We don't know the future at all, and most of us have forgotten the past, and we're not alert to everything that's happening in the present! And so we have to have the a little humility and not say "OK, I want this from God in my prayer. I won't take anything else." I mean, that sounds like my children.
Yes. Not only the social support, but the social guidance, too. You can bounce things off other people you know, crazy ideas you have. Everybody has crazy ideas. If you're alone, they can get blown out of proportion, and pretty soon you're off on some weird tangent. But if you've got people around you, helping to say "OK, that's an interesting idea, but that sounds a little weird, maybe," it's helpful for people.
Is there a reason to believe that the religious practices are somehow more powerful than other forms of stress-reduction and social support?
I think getting a pet is useful; it can help somebody who is lonely and living alone as long as they're not using that pet to replace interacting with others. Exercise too—all of these things are beneficial; the question is, there are situations where you can't do those things. When you're sick you can't exercise, you can't bring your pet to the hospital or to the nursing home with you, and sometimes your friends get tired of calling you when you can't go out and socialize and then they stop calling you.
Religion, on the other hand, is very positive, it's social, and it has expectations regarding behavior, so all of these things together are health-beneficial. You can have a pet and you can smoke, but the pet's not going to say '"don't do that." And some of the things we'd like to get rid of in religion—the dogma, the laws—may be the ingredients that result in better health. You should have only one spouse, you shouldn't cheat on your spouse, you shouldn't get involved in Internet pornography—all that's forbidden. We've learned that if people get involved in doing those things they risk their health. Whether it's a sin in a spiritual sense or not, it's bad for them. So these rules and regulations and laws—love your neighbor and help your neighbor and forgive your neighbor—are good for us, they're good for our mental and our physical health.
Do you think that religious practices like prayer, attending a house of worship, etc. should be prescribed by doctors?
No. These are things that doctors should be aware of, they should take the spiritual history and learn about the patient's religious perspective because those beliefs so oftentimes will influence their medical decisions and all sorts of other things. But a doctor can't prescribe that. That's just—well, first of all, we don't know even if they prescribed it, if it would work. If somebody says, "well, I'm going to go to church and lower my blood pressure," that may not work, it may go up. So, we don't know that, there's no randomized clinical trial that proves that if you become religious you're going to be healthier over time.
What doctors and healthcare professionals can do is acknowledge [religion], because it's important to 90 percent of their patients, they can make sure that the patient has religious resources at the hospital, consider the patient's beliefs when designing the course of treatment so it doesn't conflict with their beliefs.
What about psychological health—are religious people happier?
In general, and all things being equal, the answer is yes. If you have nothing stressing you, if you're wealthy and you're well educated, you've got plenty of friends, you're probably going to be pretty happy—[religious or not]. But if you're studying instead a group of people who are undergoing stress—they're physically ill, they're disabled, maybe they are in bereavement, or they've lost a job—then if you look at religious people compared to those who are less religious, you're going to find the religious people are coping better.
What does religion offer that makes the difference—hope, a positive outlook, meaning, a source of strength?
The central part of it is [the way religion can ascribe] meaning to the events, so that even seemingly bad events don't necessarily have to be bad overall. Scripture promises that all things work together for good for those who love and serve God. You can decide to look for those good things. This understanding can give them hope, meaning, and a sense of purpose, which will enable them to go through those events.
Viktor Frankel, who was in the concentration camps in Nazi Germany, said the ones who survived those camps were the ones [who felt like their lives had] meaning. It was very clear that if they had something to look forward to, if they had a positive belief system, that they could survive, despite what was going on in their lives.
How should someone who is depressed, for example, decide between going to a psychiatrist and consulting a clergy person?
I think if they have mild symptoms, if they're not losing weight, if they're sleeping fairly well, if they're upset over a stress and they're physically not upset or stressed out, and they have this bad thing happen, the loss of a loved one or the loss of their job, I'd go see the pastor. If the person starts losing weight, has trouble sleeping at night, feels tired all the time, and begins to have any suicidal thoughts, it's certainly time to go see the psychiatrist or a doctor.
We have shown that it's mainly the milder to moderate symptoms of depression that are responsive to religious intervention, and once people get really, really depressed, they can't pray. They're unable to get out of bed to go to church. They can't concentrate. They're afraid to read religious scriptures. When it gets to that point, you are actually unable to access those religious resources, and through medication or other biological means or even different types of psychotherapy, the person might then get well enough so that they can access those religious resources.
What about some of the potentially negative aspects of religion? For example, sometimes people feel that when prayers aren't answered it means their faith is weak, which can add to their stress. Are there dangers people should look out for?
One of the things people have to be aware of is not to emphasize the physical healing too much, because that's what we naturally do. When we're in pain, when we're suffering, we are naturally going to pray for physical healing, that the cancer would be healed, or that our loved one would not have Alzheimer's disease.
Not everybody's prayer for physical healing is going to be answered, but there may be a greater healing going on as a result of the illness. There may be a spiritual healing going on, a healing of relationships, a healing of one's relationship with God, something that wouldn't happen if that person were cured of physical illness. Physical health may be pretty far down in God's list of things that are important. So you may not get it, because it's not for your own good, it's not in your best interest overall.
So if your prayer is not answered, if you don't get over the cancer, you shouldn't feel like you're being punished or you're being abandoned by God.
Or that your prayer isn't being answered some other way. So be alert, if your prayer isn't being answered, then maybe you're not looking for the answer that you really need. Just consider that we really, as humans, have limited information. We don't know the future at all, and most of us have forgotten the past, and we're not alert to everything that's happening in the present! And so we have to have the a little humility and not say "OK, I want this from God in my prayer. I won't take anything else." I mean, that sounds like my children.
