Religion, spirituality, and mental health.

Abstract

190:697–704, 2002In recent decades, the mental health professionshave begun to reckon with the influence of religionin American life and its ramifications for the individ-ual’s personal functioning. Other sectors of soci-ety—social welfare, the media, education, the legalsystem, and medicine—have made similar efforts totake religion into account, each from its own stand-point. Thus, social workers have attempted to mapout feasible social and rehabilitation goals for cli-ents under the mandate of “faith-based” welfare. Inmedicine, studies have shown that religious belief isvery important to many patients, and that manyseriously ill patients wish that health professionals,including doctors, would demonstrate interest intheir religious beliefs (King and Bushwick, 1994;Ehman et al., 1999; Puchalski, 2000). A new currentis rising in medical education whereby students areinstructed in how to conduct a “spiritual history,”covering the patient’s religious beliefs and valueconstructs (Nichols and Music, 1999).In assessing religion in the United States, it is wellnigh obligatory to recall the separation of church andstate. The federal Constitution prohibits the establish-ment of an official church, and it enjoins governmentfrom supporting, regulating, or curtailing religiousactivity. Neither religion nor government can lean onthe other for legitimation. The founding fathers whoframed the Declaration of Independence and the Con-stitution—Franklin, Jefferson, and Madison—were so-phisticated political thinkers of the Enlightenment. Fa-miliar with European autocracy, they sought anAmerican political framework of limited authority, del-egated powers, and, in regard to religion, no powers orauthority whatsoever reserved to government.Without centralized political focus or administra-tion, religion in the United States flourished. Peoplewere free to form their own religious associations;energies were mobilized that, taken in sum, ex-ceeded what could have been achieved under a cen-tral national establishment. Religion was a small-scale private and family matter. In a broaderterritorial sense, it imparted distinctive culture andcolor to localities and regions (Mormons in Utah,Jews in New York City, Baptists throughout theSouth). As an expression of the convictions andbeliefs of the individual, religious commitment alsobecame, in free society, a meaningful component ofpersonality in assessing mental and emotional well-being. In an open, fluid society, one’s religious ori-entation stands as a clearer lens into his or herpsychic reality than in a society “occupied” or dom-inated by a state religion.The separation of church and state, though a basicAmerican political motif, says nothing about theactual religious composition of the nation. Apartfrom the traditions of the Native American peoples,the United States was overwhelmingly ChristianProtestant in the era of its founding. With the mas-sive flows of immigration that followed, it has sincebecome what Eck calls “the world’s most religiouslydiverse nation” (Eck, 2001). The 19th century sawlarge waves of Catholic and Jewish immigration,which have continued to the present. Muslim immi-gration commenced in the early 20th century andlikewise remains significant today.What can be referred to descriptively as religiousdiversity translates at the levels of community, pub-lic policy, and private attitude into pluralism andtolerance. This does not mean, however, that therehave not been considerable prejudice and discrimi-nation against non-Protestants, and later, againstnon-Christians. Nevertheless, there has been nolarge-scale, prolonged religious conflict or vio-lence—no Inquisition and no Thirty Years’ War. Onthe whole, tolerance has arguably characterized thenational history, which is perhaps all the more re-markable given that religious sentiment has beenhistorically stronger in the United States than inmany other industrialized nations.Although religion is a salient component in theAmerican psyche, there is an aura of reserve aboutthe promotion and display of one’s own religious