State of Mind: Can being religious improve your mental health?

What is our purpose on the planet?

Two decades ago, USA TODAY asked its readers what singular question they would ask God or a Supreme Being if they could get a direct, immediate answer. More than the existential fears that come with what happens to us when we die or why bad things happen to good people, the question that grips American adults the most is our purpose in life.

It's perhaps the greatest question we can ask, one whose beauty and terror belies the total and absolute lack of an answer.

This brings me to the topic of this month's discussion, and it's one that probes some of our deepest moral and psychological quandaries: A reader recently posed the question, "What evidence is there regarding whether religious and spiritual practices have positive or negative effects on mental health?"

Before we delve further into this conversation, a disclaimer: Neither I nor the experts quoted in this article purport to definitively answer the reader's question. The goal of this piece is not to diminish anybody's faith or lack thereof, but to explore, as objectively and as curiously as we can, the heart of the matter.

Dr. Fred Coleman, a clinical assistant professor of psychiatry at University of Wisconsin-Madison Department of Psychiatry, offered important framings to consider.

First, religion is distinct from spirituality. Religion is an organized faith group, replete with a set of texts, a place, a set of services, rituals, observances and practices all centered around a community, Coleman said. Spirituality, on the other hand, focuses on an individual's relationship to a higher plane, whether that points to a deity, greater meaning, or living as a grounded being.

Important to this discussion are the three pillars of religion Coleman defines: community, structure and a sense of purpose.

Religion and mental health have been strongly intertwined across millennia. It wasn't until the 1950s that the science community folded in behavioral health, Coleman explained. By the 1980s, medical and theological journals were publishing studies where religion, spirituality and mental health overlapped, and that trend continues.

Coleman has worked with a range of religious groups, from conservative Evangelical Christians to those who follow Islam, Judaism and Native American spiritualities, Catholicism and Buddhism.

Across all groups, this triad of community, structure and purpose-making exists, which can improve the quality of one's mental health (but not always, a point we'll address soon).

"(This triad) places a person in a community, and you're less likely to struggle with — or struggle as severely with — anxiety and depression if you're in a community," Coleman said. "Secondly, there's an overarching sense of meaning or purpose in life. That also helps with general mental health. And finally, there's a structure. … Those three pillars are really aided for people in religious communities."

The question of purpose

Mary Salm, vice president of mission integration and spiritual care at Hospital Sisters Health System Wisconsin, works with patients who especially find themselves grappling with existential crises atop recent diagnoses. The question of purpose and meaning ignites greater degrees of soul-searching and spiritual distress in those given grave or life-altering prognoses.

"There's an overwhelming amount of patients who want to visit with a chaplain, they want that opportunity of the chaplain to be able to remind them of God's care and presence," Salm said. "There are times when they are seeking chaplain support as they sort through some moral or ethical concerns. If we can do those things, that helps them find more peace and be able to connect with meaning and purpose."

Patients who can access some kind of spiritual peace and comfort, whether through praying, eating a culturally specific meal that lines up with their religions, finding mindfulness through meditation or reading sacred texts, often rely less on pain medication, Salm said. They've been granted a kind of control outside of pharmaceutical management, she said, which can also offset mental health struggles.

Conversing with spiritual leaders is one means of potentially finding peace with one's circumstances. Another is by consulting literature, sometimes in the form of sacred texts, sometimes in the form of self-help advice.

Christine Whelan, a professor in the School of Human Ecology at UW-Madison, was interested enough in the question of purpose that she wrote a book about it called "The Big Picture: A Guide to Finding Your Purpose in Life." She cites the USA TODAY poll from 1999 in the book and asks readers to answer the question by honestly investigating their beliefs, core values and, importantly, in what way they want to positively impact the world.

Whelan agrees with Coleman that religion and mental health have a profoundly connected relationship. Looking at this from a contemporary, more commercial vantage, religious books make up the largest subset of self-help books printed at any given time in the United States, Whelan said, for the very reason that a majority of people yearn for "religious-based happiness advice." She's only half-joking when she says the Bible is "the best-selling self-help book of all time."

"If you think about what a self-help book is, it is a guide to trying to lead a better life, to find happiness and peace and wellbeing," Whelan said. "The Bible is a book about how to live a good life in this life, so that you can achieve something greater, which is happiness and wellbeing in the afterlife."

The Bible, she continues, offers a set of rules to achieve this inner peace and there's a great deal of mental health lessons along the way. Looking at one of the more basic commandments, "Love thy neighbor as thyself," for example, we can hear echoes of a modern-day therapist reminding us that we should give ourselves the same dignity that we give to those close to us.

"What most people see on the surface is that you've got to be nice to everybody else — and that's true. But to love your neighbor as yourself means that you also have to love yourself and see yourself as a worthy child of God, and then bring that worthiness of yourself to your interactions with others," Whelan said. "I mean, that's Therapy 101 right there."

In sickness and in health

Looking at this from a public health perspective, some evidence suggests spirituality is beneficial, but that comes with its own heap of caveats.

Corrie Norman is the associate director of the Religious Studies Program at UW-Madison and teaches a course to undergraduates called "Religion in Sickness and Health" where she examines religion and spirituality through the lens of public health.

Studies tell us, broadly, that there are correlations between religion and living longer, Norman said, but in terms of why this is, that's harder to answer. The common thread across studies emphasizes the role of community support and being present with other people.

"Groups that suffer from health disparities often have very powerful resources in their religious communities. And so being able to work with that is really, really important in public health and in clinical medicine," Norman said.

People who suffer from certain mental illnesses can also benefit from religious or spiritual practices, Coleman said, but it depends on the category of illness. In people who struggle with depression, anxiety disorders or mood problems, religious involvement can reduce symptoms, and the same can be said for people experiencing cognition and memory issues.

People who experience psychosis, whether severe bipolar illness or schizophrenia, don't experience that same reduction of incidence by religious or spiritual involvement, Coleman said, although it might aid in their recovery.

Then there's the question of those wrestling with PTSD and other trauma disorders.

"One of the things that happens to people with severe PTSD — war, disaster, intrafamilial trauma — is the loss of a sense of future, and loss of a sense of meaning and purpose in life," Coleman said. "The fact of a trauma … isn't necessarily prevented by being actively involved in religious spiritual traditions. But the recovery of regaining a sense of a future, and a sense of meaning and purpose, obviously fits in with what those traditions help to provide."

'We use binaries to simplify life, but they're rarely true.'

Years ago, Whelan's 5-month-old son died unexpectedly and the cause of death was never known. A practicing Catholic, she found herself frustrated when people offered condolences like "It was God's plan" or "God needed another angel."

"My response was always, 'Do you want to offer your angel then?' I mean, come on," Whelan said. "Everyone gave me the damned 'Heaven Is For Real' book. That was so awful. That drove me batshit."

She was able to cut the offending comments some slack, of course. After all, there's no script for how we face something as incomprehensible as the death of a baby. She could even see how comments like this could be helpful for other people.

"Often people lean on religion when they don't know what else to lean on and what else to say. That actually can be quite good, because in times of tragedy, we do need a cultural script," Whelan said. "One of the things that I don't think people talk about enough in our current world is that we used to have a very rule-directed world and that had tons of bad stuff associated with it."

It's easiest to see the "bad stuff" when we confront the general makeup of cults and extreme offshoots of mainstream religions. In her research, she sees connecting patterns: The core ideas may be good, but they go too far, pushing someone psychologically, financially and emotionally beyond their limits.

Whelan likes to remind people that if you believe something is powerful enough to transform you for the better, you must also acknowledge that a belief can potentially harm you, too.

Whether it's with supplements or various wellness treatments or self-help or religion, we often are happy to give people or ideas the power to help us. But we don't acknowledge that power "can go both ways," Whelan said. "Your faith can lift you up. It can also break your heart."

And this veers into where things can go wrong in religious and spiritual circles. Binary thinking, this notion of "good" vs. "bad," provides a shortcut in the brain's decision-making, Coleman said, but, generally speaking, that line of thinking can be harmful.

"If we had to deal with every bit of sensory input — everything around our environment, every person, every relationship — on a carefully graded continuum, it would overwhelm us," Coleman said. "We generally say, 'That's good for me, that's bad for me.' … We use binaries to simplify life. But they're rarely true."

There's a long history of seeing someone's mental illness as a possession in need of excising, and that sends an obvious message that a person's behaviors are bad. Accommodating behavioral and cognitive illnesses with charity and goodwill represent what Coleman sees as an "open-handed" approach to religion and spirituality, as opposed to a "close-fisted" approach, terms he first read in a Denver Post column following 9/11.

A close-fisted religion serves only those established within that line of thinking. It's exclusionary, self-serving and makes no accommodations outside of its values. This does harm, Coleman said. It invites aberrant beliefs and toxic forms of spirituality and religious practices.

"People who live in the close-fisted way, religiously or otherwise, generally are not as healthy because they're not as connected to their neighbors," Coleman said.

'What matters to people'

On a basic level, religion can be defined as "what matters to people," says Norman, the religious studies scholar from UW-Madison. Encompassed in that description are the things we typically associate with religion, but she said that things like food, relationships in and out of the religious community and environmental spaces can all be part of that fervor.

Religion, she said, invites in a number of contradictions, and the same can be said of life itself. That's part of what makes religion so expansive, Norman said — that its contradictions and complexities don't diminish the power.

"To an outsider, religion can really look contradictory at times," Norman said. "For religious folks, that's complexity, the complexity of life: You can have joy and pain at the same time."

Norman shared the story of an immunologist named Esther Sternberg who found herself calling up Psalm 23 while creating a garden in her backyard. It was a prayer that her father, a Holocaust survivor, reflected on often, especially the section "he leadeth me beside still waters, he restoreth my soul."

The moment, mounting a deck in her backyard, was mundane, but the prayer filled her suddenly with a new meaning, one she hadn't considered. She remembered her father, and his appreciation for nature. She realized she was copying her parent's backyard garden, living out their values. It took being in a specific place for these revelations to strike her.

"Religion can work that way. It can work for people who pray the same prayer like the Lord's prayer or something from the Book of Common Prayer or something from the Catholic missal. The same prayer that they have prayed all of their lives all of a sudden gels for them in the situation they're in," Norman said. "How they act on that can create an enormous, impacting mood and then it can create a kind of motivation to think about something a certain way, to act about something a certain way."

Next time, on State of Mind

Next month, we'll turn to a question about how to address the stigmas associated with people experiencing homelessness. One reader wants to learn about proactive ways people in the community can help. It's certainly timely. We'll get into it next month.

In the meantime, acquaint yourself with the prohibitive laws that unaccompanied homeless minors face in the state of Wisconsin and elsewhere.

Want to ask a question? Go ahead.

Be well, Wisconsin.

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Central Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.

This article originally appeared on Green Bay Press-Gazette: Wisconsin scholars weigh in on whether religion can help mental health