De-Conflating Religiosity/Spirituality

To the Editor: Recently, the American Journal of Pharmaceutical Education published a research brief entitled, “Spirituality and Religiosity of Pharmacy Students” by Purnell and colleagues.¹ The authors describe their recent survey assessing the presence and impact of religiosity/spirituality on various facets of student life and students’ opinions. In three separate instances, the authors advocate for greater support to be provided by pharmacy schools for student religiosity/spirituality. The abstract states “pharmacy schools should find ways to acknowledge and support religiosity/spirituality for pharmacy students…” In the introduction, the authors note that “pharmacy schools may need to provide courses, such as spirituality in health…” and in the discussion section, the authors state that “…pharmacy schools should find ways to support students’ religious and spiritual needs in the community and on campus, through student organizations, in recognizing religious observances, and in resources.” We view these admonitions as a mixture of both welcome and unwelcome recommendations. That pharmacy schools should provide additional support for spirituality as a part of student wellness, and for training in spirituality assessment for patients is a sound, progressive step forward. Support for religiosity is not.

The problem arises because the authors consistently conflate religiosity and spirituality, even though they recognize that “religion and spirituality are separate constructs…”¹ However, the distinction between the constructs is lost as the authors state “they may be referred together.” Purnell and colleagues are not the first to treat spirituality and religion as closely congruent if not inseparable concepts. One of their references provides a comprehensive review of religiosity/spirituality, written by a prestigious author who similarly conflates the two terms. Other well-cited authors claim that religion and spirituality are related but are not independent constructs. When viewed through the lens of religion, this conflation may seem valid, but that perspective is restrictive. For the purpose of recommending actions for pharmacy schools to take, we contend that spirituality and religion are distinct constructs and should be treated as such. We acknowledge that religiosity and spirituality overlap, but we also hold that the positive, wellness-promoting outcomes of spirituality can be achieved independently of religiosity, and, in some cases, may be antagonized by it.

Language meanings change over time, generally in a progressive and constructive fashion. We are currently in a period in which the concept of spirituality is emerging, separated from religion as a prosocial, health-promoting construct. Much of the public recognizes spirituality and religiosity as independent entities. In a recent survey, 40% of Americans surveyed identified themselves as either “religious but not spiritual” or “spiritual but not religious,” 22% and18%, respectively.² Spirituality has become a topic of rigorous scientific study. The Greater Good Science Center at the University of California in Berkley continues to compile a respectable body of well-grounded research on the personal health and prosocial benefits of elements within spirituality such as awe and gratitude.³

Many elements within spirituality, among them transcendence, awe, noetic experience, and connectedness are subjective phenomena that may or may not arise from religiosity. Religiosity is associated with a fixed dogma which is often directed toward the induction of spiritual experience. Spirituality is more likely to be relevant to the desired outcomes of pharmacy educational programs. As a case in point, the distinction is pointedly made by Saslow and colleagues who evaluated subjects’ inclinations toward spirituality or religiosity with respect to their expression of compassion, a presumed desirable outcome of pharmacy education and practice.⁴ Saslow’s findings show that subjects’ spirituality scores are strongly associated with an inclination toward compassion; however, religiosity scores are void of any such association.

Furthermore, it is important to recognize that religiosity is neither a monolithic or uniformly valuable construct, particularly in terms of its prosocial values. This fact is obvious and can be seen abundantly across the internet or mass media where religiosity serves as a vehicle for violence, oppression, exclusion or hatred from groups ranging from religiously motivated terrorists to the Westboro Baptist Church in Kansas. The odious side of religiosity is conspicuous and easy to find. It is stating the obvious to say that religiosity is frequently a vehicle for dehumanization through various forms of tribalism, stigmatization, judgmentalism, claims of moral superiority and a need to control the behavior of “others.”

If schools of pharmacy are to support religiosity (apart from those located at faith-based institutions) inevitable decisions will have to be made regarding which specific religions should be supported. It might be easy to exclude support for extremist groups like those alluded to above, but in reality, there are many nuances between and within the tens of thousands of religious denominations that would need to be considered, and not all of the nuances are readily apparent.

A well-cited study by Lee Kirkpatrick at the College of William and Mary illustrates this point.⁵ Kirkpatrick’s work examined the various Christian religious orientations (not denominations) of his subjects and assessed their inclination for discrimination against several groups, including gays, blacks and women.⁵ Across five religious orientations, intrinsic, extrinsic, questing, Christian orthodoxy and fundamentalism, significant differences emerged. The researchers’ results note fundamentalism’s predominantly discriminatory attitudes toward blacks, and state that “fundamentalism was significantly and positively related to discriminatory attitudes toward all other targets.” Though other studies have not consistently confirmed Kirkpatrick’s specific findings, the resilient point is that religiosity, even when confined to any given denomination has many facets that present widely varying positions of social desirability. Some of its manifestations are patently undesirable.

If Kirkpatrick’s findings accurately identify cohorts of discrimination, should schools refuse to support fundamentalist religious groups? Would such decisions be more confounded by arguments that fundamentalism does not have a universally accepted definition? Would further difficulties arise from the fact that anti-social fundamentalism may be a characteristic of individuals found in varying densities within multiple denominations? Other difficulties arise, as well. Should Christian Science and its formal opposition to “drug medicine” be supported? Should Rastafarians be supported in their use of marijuana as a sacrament? Of course, this is only the tip of the iceberg for making constructive decisions on which religious groups to support.

There are other troubling aspects to religiosity. Most notable for our Academy is its tendency toward a non-evidence-based world view and occasional rejections of scientific facts.⁶ Pharmacy is, after all, a science-based field. Religion and science have been at odds since Galileo, and the resistance of religion to scientific fact continues today. Many sources attest to this, some at length (see Coyne’s “Faith vs Fact”⁷). Among recent and relevant, peer-reviewed papers is a work by Rutjens and colleagues who found that religiosity is affirmatively associated with vaccine skepticism and strongly and negatively associated with faith in science and support for science.⁵

We acknowledge that numerous other studies show broad benefits to religious participation. Examples include Chetty and colleagues who showed that participation in religious activities facilitates upward mobility across economic strata,⁹ and Kendler and colleagues who published evidence that religion may provide some protective effect against certain psychiatric disorders.¹⁰ Other examples are abundant, and there is no doubt of the large contributions made by religious organizations to many worthy, charitable causes in addition to the personal benefits many individuals derive from their involvement with their religion.

However, the suggestion that pharmacy schools support religiosity is a problematic issue, fraught with far too many concerns to be practicable or worthwhile. That said, we do endorse Purnell and colleagues in their call for greater support of spirituality, student, faculty and staff wellness, and additional training in spiritual assessment. It is much easier to see the relationship between the values instilled by spirituality and desired programmatic outcomes than it is to see the same for religiosity. The challenge is to identify and promote the beneficial aspects of spirituality that serve all people through universally shared values and experiences, irrespective of any religion. Even training students that such universality exists seems like a worthy endeavor.

Sincerely,

• Received April 2, 2019.
• Accepted August 12, 2019.

• © 2019 American Association of Colleges of Pharmacy