Soul and Self
Spirituality and the Moral Self
Michael McCarthy, PhD(c), Loyola University Chicago
Over 75% of U.S. medical schools have incorporated “spirituality”, broadly defined, into their curricula, and despite the American Association of Medical College’s (AAMC) encouragement, research indicates that it is infrequently, or at least inconsistently, incorporated into patient care. While a patient’s spirituality maybe “religious,” i.e. a shared set of beliefs and practices that shape the way in which one views the world and the transcendent, it might also be considered, as the AAMC does, a person’s framework for establishing meanings and values. If spirituality/religion is about meanings and values, either personally or communally held, then it is not surprising that 95% of patients for whom spirituality/religion is important want their physicians to ask about it (Puchalski, 2006). Despite this, however, the chief indicator of whether an inquiry is made about religion/spirituality tends to be the physician’s propensity toward religion/spirituality herself (Curlin, et.al. 2006). Yet, its primary importance does not rest with the significance for the health care professional, nor even its propensity towards positive health outcomes, but rather for the way in which spirituality/religion continues to shape the dialogically constructed moral self of the patient.
Philosophers and theologians have argued that the moral self is constructed through a discursive process that both constrains and enables, through one’s engagements with other moral selves, an elusive understanding of the self as sovereign, i.e. autonomous (Haker, 2004). In the context of an illness the lack of sovereignty possessed by the self proves more present, given the dependence of the patient on the care of the health professionals. Thus, the patient’s sense of self continues to be shaped by and to derive meaning from one’s interactions with other selves, and in particular with that of the physician. Insofar as one as spirituality/religion forms a constitutive foundation for one’s expression of meanings and values, ignoring this dynamic results in misrecognition of the patient on the part of the physician. When the health professional misrecognizes a constitutive dynamic of a patient’s self-understanding, in this case spirituality, the way in which the physician relates to the patient is altered. While spirituality/religion may not seem fundamental to the construction of all moral selves, insofar as spirituality takes refers to the broad reference of meaning and values, it proves fundamental for recognizing the patient as a person, which is ultimately what both patients and physicians need.
Practices of the Self in Medicine
Paul Scherz, PhD, Catholic University of America
Contemporary medicine, along with nearly every other sphere of life, engages in a technological rationality, perhaps best analyzed by Martin Heidegger as a way of seeing the world and our body as fundamentally manipulable. In his book The Anticipatory Corpse, Jeffrey Bishop describes how the daily practice of and training in technological medicine shape one to see the body as mere dead matter that can be adjusted through efficient causes. The patient may become the sum of her test results rather than an embodied spirit with a narrative history. Heidegger and Bishop both note that this way of viewing the world threatens to deprive us of an understanding of ourselves as spiritual creatures. From a theological perspective, this way of interacting with the world stands in contrast with Christian conceptions of Creation that respect the inherent teleologies of other creatures and the rights of other people. In this paper, I seek to describe ways by which medical professionals can continue to enjoy the many benefits and tools that contemporary medical technology provides while still seeing their patients in a holistic manner.
At first glance, the tradition of virtue ethics exemplified in Alasdair MacIntyre’s work, which attends to the everyday communal practices through which ethical formation occurs, seems to offer a solution. However, I argue that this approach is bound to fail in the case of medicine, since, as Bishop shows, it is the daily reductionist practices of medicine that shape one to see the world in a technological manner. Moreover, the cosmopolitan community of medicine cannot simply be set aside in favor of the practices and small-scale communities that are conditions of virtue for MacIntyre.
To address these problems, I draw on the Stoic tradition of virtue ethics that Michel Foucault recovered in his work on Stoic care of the self. This tradition emphasizes that one must consciously shape one’s own initially disordered perceptions that arise from the pressures of daily life in order to adjust one’s way of viewing the world. One shapes one’s subjectivity through an array of spiritual techniques, such as meditation on texts, visualization of philosophical teachings, and the examination of conscience. These spiritual practices encourage the individual to detect when he is seeing the world in problematic ways and thus to correct his representations. These practices have significant overlap with Christian devotional practices, which are also meant to adjust one’s representations and habits in a long process of continuing conversion away from problematic unreflective practices. Such an ethical system is ideal for counteracting the negative effects of formation in a technological rationality in a pluralist society. This continuing work on the self can allow the medical professional to see the patient as a spiritual being despite the daily pressures and institutional imperatives of technological medicine.
A New Model of the Relationship between Religion, Self-Regulation, and Mental Well-Being
Connor Wood, PhD(c), Boston University
This paper articulates a model of the interaction between religion and mental health that centralizes the role of relational obligations in strengthening self-regulation ability. Rather than emphasizing solely belief or spiritual attitudes, my investigation primarily focuses on ritual – the socially communicative acts that researchers such as Rappaport (1999) have argued underpin religion as a social phenomenon. However, while my theoretical mode is broadly Durkheimian, my ultimate focus is strongly on the individual and how being of faith impacts the individual’s well-being. I contend that individual believers build self-regulative ability through participation in the rigorous ritual regimes that are the sine qua non of belonging in good standing to a community of faith.
As previously suggested by McCullough & Willoughby (2009), I argue that participation in obligatory religious practice strengthens believers’ self-regulative resources by demanding that they complete ritual actions which are often mildly difficult, aversive, costly, tedious, or otherwise moderately challenging. Members of functioning religious communities are thus tautologically obliged to develop and maintain the ability to inhibit prepotent and reactive responses, and thus to self-regulate. I advance this line of inquiry further by informing it with club-goods and costly investment theories from the social and evolutionary sciences; I model the difficulty or costliness of religious ritual as a “hard-to-fake signal” that communicates the community member’s level of commitment to the collective (see Irons 2001, Sosis 2004).
In order to be credible signals of commitment, rituals must be at least moderately challenging or offer delayed rewards. A community cannot function as a robust, long-term entity if its criterion for belonging is the willingness to eat ice cream and take long naps; these activities, being intrinsically hedonically rewarding, offer no ability to separate the truly committed from the hangers-on, the wheat from the chaff. Game theory suggests that long-term commitment to collective goals is instead best secured through the erection of investment barriers that impose a genuine cost on belonging. Accordingly, religious acts rarely offer immediate hedonic rewards. From fasting at Ramadan to showing up each week for church on Sunday morning – even in the winter, when the sheets are toasty and the driveway frigid – the signs and markers of religious commitment generally demand some real effort, and willingness to defy immediate hedonic drives.
The result is that participation in a religious collective is coterminous with negotiation of a signaling regime which, by its very nature, strengthens and maintains self-control resources (see Baumeister, Vohs, & Tice 2007). I review significant theoretical and empirical evidence that bolsters the credibility of this model, including the fact that, across studies, mental health is statistically better predicted by religious attendance (a ritual) than mere confession of belief (an internal mental state). I suggest that a respectable portion of the well-established correlation between religiosity and subjective well-being may be explained by the feedback processes operating between religious collectives, the relatively strenuous ritual demands they levy, and the individuals who meet these demands in order to demonstrate their commitment to their faith and to their communities.
Neural Evidence for the Role of Religion in Self-Control: Is It Really a Matter of Strength?
Jonathan Morgan, PhD(s), Boston University
Researchers often explain religion’s positive impact on health as resulting from the way religiosity may bolster self-control. There is good reason for this explanation given the evidence that religiosity corresponds to lower delinquincy, sexual promiscuity, and alcohol and drug use. Any of these behaviors could raise health risks and indeed religion would seem to help people avoid these risks.
Often within this research, self-control is described as an executive system having the strength to resist impulses. Within this strength-based metaphor, religious practices and beliefs become ways to exercise and support the self-control muscle. But does this metaphor potentially misconstrue the manner in which religion facilitates healthy behaviors?
This paper has two parts. First we present our empirical research on the neural underpinnings of religious cognition and impulsivity. Using a delayed discounting task, we found that religious primes reliably lower discounting rates, an index of impulsivity. The religious priming effect was even strong enough to alleviate the negative side effects D2/D3 dopamine agonists can have on impulsivity. These findings provide new causal evidence for the existing research linking religiosity to self-control.
But, this religious priming effect was not solely an example of religion's ability to activate the executive system to override impulsivity. Instead, through analysis of resting state MRI functional connectivity we found that priming effects were closely associated with activation of neural networks extending from the striatal-limbic system to clusters in the occipital lobe and the precuneus. These circuits are involved with creating mental workspaces in which people manipulate representations to solve problems. Furthermore, the precuneus is integrally connected to self-representation. In other words, our evidence suggests that religious primes lowered impulsivity, in part, by shaping imagined possibilities and self-representation.
The second part of this paper moves into theoretical terrain. Given this evidence we return to the question above– is the metaphor of strength sufficient? Religious primes appear to bias an individual's imaginative weighing of future options, and this bias follows the hopes and values embedded in the individual's ideal self-representation. These religious primes reduced impulsivity, not by strengthening an individual's resolve, but by activating an ideal sense of self that then shifted imaginative possibilities in such a way that holding out for a delayed, but larger reward, became more valuable.
This model of religion's influence on self-control is tentative. But, it provisionally suggests a different way to construe the relationship between religion and self-control. Rather than emphasizing executive strength overcoming impulses, this re-framing emphasizes values and imagination. It suggests that religion's impact on self-control, and thus its capacity to promote health, may come from shaping our sense of who we are, the possibilities we imagine, and the ideals held within these visions. From this perspective, self-control is less a matter of overpowering impulses and more a matter of creating new impulses that do not need to be overcome. If we view the relationship between religion and self-control solely through the metaphor of strength we risk obscuring the role of imagination and self in the spiritual dimensions of healing.
Michael McCarthy, PhD(c), Loyola University Chicago
Over 75% of U.S. medical schools have incorporated “spirituality”, broadly defined, into their curricula, and despite the American Association of Medical College’s (AAMC) encouragement, research indicates that it is infrequently, or at least inconsistently, incorporated into patient care. While a patient’s spirituality maybe “religious,” i.e. a shared set of beliefs and practices that shape the way in which one views the world and the transcendent, it might also be considered, as the AAMC does, a person’s framework for establishing meanings and values. If spirituality/religion is about meanings and values, either personally or communally held, then it is not surprising that 95% of patients for whom spirituality/religion is important want their physicians to ask about it (Puchalski, 2006). Despite this, however, the chief indicator of whether an inquiry is made about religion/spirituality tends to be the physician’s propensity toward religion/spirituality herself (Curlin, et.al. 2006). Yet, its primary importance does not rest with the significance for the health care professional, nor even its propensity towards positive health outcomes, but rather for the way in which spirituality/religion continues to shape the dialogically constructed moral self of the patient.
Philosophers and theologians have argued that the moral self is constructed through a discursive process that both constrains and enables, through one’s engagements with other moral selves, an elusive understanding of the self as sovereign, i.e. autonomous (Haker, 2004). In the context of an illness the lack of sovereignty possessed by the self proves more present, given the dependence of the patient on the care of the health professionals. Thus, the patient’s sense of self continues to be shaped by and to derive meaning from one’s interactions with other selves, and in particular with that of the physician. Insofar as one as spirituality/religion forms a constitutive foundation for one’s expression of meanings and values, ignoring this dynamic results in misrecognition of the patient on the part of the physician. When the health professional misrecognizes a constitutive dynamic of a patient’s self-understanding, in this case spirituality, the way in which the physician relates to the patient is altered. While spirituality/religion may not seem fundamental to the construction of all moral selves, insofar as spirituality takes refers to the broad reference of meaning and values, it proves fundamental for recognizing the patient as a person, which is ultimately what both patients and physicians need.
Practices of the Self in Medicine
Paul Scherz, PhD, Catholic University of America
Contemporary medicine, along with nearly every other sphere of life, engages in a technological rationality, perhaps best analyzed by Martin Heidegger as a way of seeing the world and our body as fundamentally manipulable. In his book The Anticipatory Corpse, Jeffrey Bishop describes how the daily practice of and training in technological medicine shape one to see the body as mere dead matter that can be adjusted through efficient causes. The patient may become the sum of her test results rather than an embodied spirit with a narrative history. Heidegger and Bishop both note that this way of viewing the world threatens to deprive us of an understanding of ourselves as spiritual creatures. From a theological perspective, this way of interacting with the world stands in contrast with Christian conceptions of Creation that respect the inherent teleologies of other creatures and the rights of other people. In this paper, I seek to describe ways by which medical professionals can continue to enjoy the many benefits and tools that contemporary medical technology provides while still seeing their patients in a holistic manner.
At first glance, the tradition of virtue ethics exemplified in Alasdair MacIntyre’s work, which attends to the everyday communal practices through which ethical formation occurs, seems to offer a solution. However, I argue that this approach is bound to fail in the case of medicine, since, as Bishop shows, it is the daily reductionist practices of medicine that shape one to see the world in a technological manner. Moreover, the cosmopolitan community of medicine cannot simply be set aside in favor of the practices and small-scale communities that are conditions of virtue for MacIntyre.
To address these problems, I draw on the Stoic tradition of virtue ethics that Michel Foucault recovered in his work on Stoic care of the self. This tradition emphasizes that one must consciously shape one’s own initially disordered perceptions that arise from the pressures of daily life in order to adjust one’s way of viewing the world. One shapes one’s subjectivity through an array of spiritual techniques, such as meditation on texts, visualization of philosophical teachings, and the examination of conscience. These spiritual practices encourage the individual to detect when he is seeing the world in problematic ways and thus to correct his representations. These practices have significant overlap with Christian devotional practices, which are also meant to adjust one’s representations and habits in a long process of continuing conversion away from problematic unreflective practices. Such an ethical system is ideal for counteracting the negative effects of formation in a technological rationality in a pluralist society. This continuing work on the self can allow the medical professional to see the patient as a spiritual being despite the daily pressures and institutional imperatives of technological medicine.
A New Model of the Relationship between Religion, Self-Regulation, and Mental Well-Being
Connor Wood, PhD(c), Boston University
This paper articulates a model of the interaction between religion and mental health that centralizes the role of relational obligations in strengthening self-regulation ability. Rather than emphasizing solely belief or spiritual attitudes, my investigation primarily focuses on ritual – the socially communicative acts that researchers such as Rappaport (1999) have argued underpin religion as a social phenomenon. However, while my theoretical mode is broadly Durkheimian, my ultimate focus is strongly on the individual and how being of faith impacts the individual’s well-being. I contend that individual believers build self-regulative ability through participation in the rigorous ritual regimes that are the sine qua non of belonging in good standing to a community of faith.
As previously suggested by McCullough & Willoughby (2009), I argue that participation in obligatory religious practice strengthens believers’ self-regulative resources by demanding that they complete ritual actions which are often mildly difficult, aversive, costly, tedious, or otherwise moderately challenging. Members of functioning religious communities are thus tautologically obliged to develop and maintain the ability to inhibit prepotent and reactive responses, and thus to self-regulate. I advance this line of inquiry further by informing it with club-goods and costly investment theories from the social and evolutionary sciences; I model the difficulty or costliness of religious ritual as a “hard-to-fake signal” that communicates the community member’s level of commitment to the collective (see Irons 2001, Sosis 2004).
In order to be credible signals of commitment, rituals must be at least moderately challenging or offer delayed rewards. A community cannot function as a robust, long-term entity if its criterion for belonging is the willingness to eat ice cream and take long naps; these activities, being intrinsically hedonically rewarding, offer no ability to separate the truly committed from the hangers-on, the wheat from the chaff. Game theory suggests that long-term commitment to collective goals is instead best secured through the erection of investment barriers that impose a genuine cost on belonging. Accordingly, religious acts rarely offer immediate hedonic rewards. From fasting at Ramadan to showing up each week for church on Sunday morning – even in the winter, when the sheets are toasty and the driveway frigid – the signs and markers of religious commitment generally demand some real effort, and willingness to defy immediate hedonic drives.
The result is that participation in a religious collective is coterminous with negotiation of a signaling regime which, by its very nature, strengthens and maintains self-control resources (see Baumeister, Vohs, & Tice 2007). I review significant theoretical and empirical evidence that bolsters the credibility of this model, including the fact that, across studies, mental health is statistically better predicted by religious attendance (a ritual) than mere confession of belief (an internal mental state). I suggest that a respectable portion of the well-established correlation between religiosity and subjective well-being may be explained by the feedback processes operating between religious collectives, the relatively strenuous ritual demands they levy, and the individuals who meet these demands in order to demonstrate their commitment to their faith and to their communities.
Neural Evidence for the Role of Religion in Self-Control: Is It Really a Matter of Strength?
Jonathan Morgan, PhD(s), Boston University
Researchers often explain religion’s positive impact on health as resulting from the way religiosity may bolster self-control. There is good reason for this explanation given the evidence that religiosity corresponds to lower delinquincy, sexual promiscuity, and alcohol and drug use. Any of these behaviors could raise health risks and indeed religion would seem to help people avoid these risks.
Often within this research, self-control is described as an executive system having the strength to resist impulses. Within this strength-based metaphor, religious practices and beliefs become ways to exercise and support the self-control muscle. But does this metaphor potentially misconstrue the manner in which religion facilitates healthy behaviors?
This paper has two parts. First we present our empirical research on the neural underpinnings of religious cognition and impulsivity. Using a delayed discounting task, we found that religious primes reliably lower discounting rates, an index of impulsivity. The religious priming effect was even strong enough to alleviate the negative side effects D2/D3 dopamine agonists can have on impulsivity. These findings provide new causal evidence for the existing research linking religiosity to self-control.
But, this religious priming effect was not solely an example of religion's ability to activate the executive system to override impulsivity. Instead, through analysis of resting state MRI functional connectivity we found that priming effects were closely associated with activation of neural networks extending from the striatal-limbic system to clusters in the occipital lobe and the precuneus. These circuits are involved with creating mental workspaces in which people manipulate representations to solve problems. Furthermore, the precuneus is integrally connected to self-representation. In other words, our evidence suggests that religious primes lowered impulsivity, in part, by shaping imagined possibilities and self-representation.
The second part of this paper moves into theoretical terrain. Given this evidence we return to the question above– is the metaphor of strength sufficient? Religious primes appear to bias an individual's imaginative weighing of future options, and this bias follows the hopes and values embedded in the individual's ideal self-representation. These religious primes reduced impulsivity, not by strengthening an individual's resolve, but by activating an ideal sense of self that then shifted imaginative possibilities in such a way that holding out for a delayed, but larger reward, became more valuable.
This model of religion's influence on self-control is tentative. But, it provisionally suggests a different way to construe the relationship between religion and self-control. Rather than emphasizing executive strength overcoming impulses, this re-framing emphasizes values and imagination. It suggests that religion's impact on self-control, and thus its capacity to promote health, may come from shaping our sense of who we are, the possibilities we imagine, and the ideals held within these visions. From this perspective, self-control is less a matter of overpowering impulses and more a matter of creating new impulses that do not need to be overcome. If we view the relationship between religion and self-control solely through the metaphor of strength we risk obscuring the role of imagination and self in the spiritual dimensions of healing.