How Faith Heals: A Theoretical Model

This paper summarizes theoretical perspectives from psychology supportive of a healing effect of faith. First, faith is defined as a congruence of belief, trust, and obedience in relation to God or the divine. Second, evidence for a faith-healing association is presented, empirically and in theory. To exemplify religiously sanctioned affirmation of such a connection, selected passages are cited from the Jewish canon attesting to biblical and rabbinic support for a faith factor in longevity, disease risk, mental health and well-being, disease prevention, and healing. Third, reference to theories of hope, learned optimism, positive illusions, and opening up or disclosure, and to theory and research on psychoneuroimmunology and placebos, demonstrates that contemporary psychology can accommodate a healing power of faith. This is summarized in a typology of five hypothesized mechanisms underlying a faith-healing association, termed behavioral/conative, interpersonal, cognitive, affective, and psychophysiological. Finally, implications are discussed for the rapprochement of religion and medicine.

Introduction

In 1910, Sir William Osler, a founding father of Western scientific medicine and at the time the Regius Professor of Medicine at Oxford University, published a now classic paper in the British Medical Journal entitled, “The Faith that Heals.”¹ In his article, Osler extolled the many virtues of faith, especially in relation to a putative salutary role in health, healing, and medicine. To wit: “Nothing in life is more wonderful than faith,” “[F]aith is the cement which binds man to man in every relation in life,” “Faith is indeed one of the miracles of human nature which science is as ready to accept as it is to study its marvelous effects,” and, “[F]aith has always played a strong role as a popular measure of cure.”^{1(pp1470,1471)}

Sixty-five years later, Dr Jerome D. Frank, preeminent Johns Hopkins psychiatrist, revisited these themes in a seminal paper also named, “The Faith that Heals.”² Frank concurred with Osler that faith “is an important topic that is conspicuously absent from the medical school curriculum,”^2(p127) and explained that the concept has significant connotations for healing besides its obvious religious context. For Frank, “The most powerful single stimulator of the patient's expectant faith is, of course, the physician himself.”^2(p130) The role of faith in healing, then, was seen as an important marker of the salience of the human mind and its associated functions and effects for medicine and healthcare, a topic just beginning to emerge into the mainstream of biomedical consciousness at the time of Frank's article, published in The Johns Hopkins Medical Journal in 1975.

Use of these two words, “faith” and “heals,” juxtaposed, in the title of not just one but two historically significant articles in premiere medical journals may be surprising and not a little bit unnerving to those previously unexposed to these now classic papers. These words, together, evoke curiosity, at best, and controversy, at worst, conjuring up lurid images of fraudulent faith healers and other connotations that for biomedicine might best be relegated to the past. Nonetheless, Osler had something important in mind that he articulated clearly: that the impact of faith is very real and cannot be denied, as honest clinical observation will attest. He noted, “Faith in St. Johns Hopkins, as we used to call him, an atmosphere of optimism, and cheerful nurses, worked just the same sort of cures as did Aesculapius at Epidaurus.”^1(p1471)

Frank, too, believed this to be true. “The point,” he concluded, “is that all medical and surgical procedures conducted within the walls of Johns Hopkins, although viewed as purely scientific by the staff, mobilize the faith that heals in the patients.”^2(p129) Osler and Frank did not know it at the time that their articles were published, but their sentiments presaged a coming sea change both in our understandings of the determinants of health and in the practice of medicine.

In the 30-plus years since Frank's revisiting of Osler, scientific investigation of the health impact of faith, in a broad sense, has steadily expanded within public health, medicine, and the medical social and behavioral sciences. What many investigators may not realize is that scientists and clinicians have been exploring this topic, empirically, for over a century. Comprehensive literature reviews of the inclusion of religious variables in health and medical surveys have identified epidemiologic investigations that calculated risks or odds of such measures in relation to population-health indices as long ago as the late 19th century.³ Theoretical exploration of putative faith-health connections, within the nascent literatures of psychiatry and pastoral care, date back even further.⁴

At the beginning of this decade, one comprehensive overview found over 1,200 empirical studies of religion and health that had been published in the peer-reviewed literature.⁵ According to various reviews, between three quarters and in excess of 90% of these studies obtained positive findings, depending upon the health outcome in question. Various competing “mechanisms,” or scientific explanations, have been posited for these results, grounded in biobehavioral and psychosocial functions or sequelae of religious expression that are posited to mediate putative religion-health connections. These include health-related behavior, social support, positive emotions, healthy beliefs, and positive expectations.⁶

This latter possibility has been suggested as a possible explanation for that subset of studies identifying significant health or healing effects of measures capturing some sort of cognitive self-appraisal of the strength of one's commitment to a religion or to God. These include subjective self-assessments of the depth or magnitude of one's global or overall sense of religiousness. Several notable studies have validated these sorts of measures as significantly health related,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 and the possibility of a salutary function of positive expectations seems a good place to begin in making sense of these findings.

Faith-based expectations also seem to be implicated in studies of ostensible healing sequelae of prayer or religious ministrations among, or offered to, members of clinical cohorts, such as hospitalized medical or psychiatric patients. Several of the studies conducted by Dr Harold G. Koenig and colleagues at Duke University Medical Center over the past 20 years have been of this variety.¹⁸ Koenig, the preeminent clinical researcher in this field, is blunt in his assessment of the operant factor here, attributing results to a “healing power of faith.”¹⁸

The implication of this research and writing, taken together, seems clear: faith can heal. Expressions of faith—in God or in whomever or whatever—are potentially therapeutic. That, we might say, is the “what” of this issue. This conclusion may challenge certain people's negative presumptions and prejudgments about religion, and indeed, may be hard to accept for some. But the empirical data speak for themselves. Yet, in fairness, positive findings alone are rarely enough to alter entrenched perceptions about the salience of a potentially new therapeutic agent that, until then, had been unproven. Accordingly, until we can propose answers for the “how” or “why” of a faith-healing connection, not just the “what,” this topic will remain marginal and likely controversial, and rightly so.

Before going further, here are a few words on what this paper is not about. This is important to clarify, as the juxtaposition of “faith” and “healing” in the context of the medical literature tends to evoke strong reactions and, moreover, implies different things to different people in different fields.

First, this paper is not about the impact of religious participation, in general, on health status indicators or on rates of morbidity or mortality. This has been done elsewhere, repeatedly, and is no longer a particularly controversial topic. Epidemiologic research by now has shown that measures of religious identification, practice, feelings, and belief are associated at statistically significant levels with health and disease outcomes across the spectrum of chronic and acute diseases, across the life course, and across myriad social and demographic subgroups of the adult population.5, 6, 19 The issue taken up in the present paper pertains to a subdimension of the larger construct of religion, namely the expression of faith.

Second, this paper is not about the effects of faith as an explanation for the primary prevention of morbidity or mortality or the promotion of health. This is a subsidiary topic within the literature on the “epidemiology of religion”²⁰ and is discussed to some extent in many of the existing reviews of that field.²¹ Expressions of faith are believed to exhibit a modest primary-preventive impact, perhaps due to engendering hope, optimism, and positive expectations, factors that have been shown or suggested to influence the occurrence and distribution of physical and psychological well-being. Rather, in this paper faith is examined in clinical rather than epidemiologic context—that is, in relation to the healing of disease, not the prevention of deleterious population-health outcomes. We examine that constellation of cognitions and attitudes borne out of a belief and trust in God and reliance upon God's agency as a putative factor in salutogenesis, or the healing process.

Third, and most emphatically, this paper is not about hypothetical supernatural or paranormal types of “faith healing,” whether from a distance or more proximally, that invoke potentially unprovable or currently superempirical forces or energies or theories. This, too, has been discussed elsewhere, and, by contrast to the first point above, remains a contentious and controversial topic.²² Moreover, it has yet to become a serious biomedical or behavioral science topic, garnering instead the attention mostly of physical scientists, parapsychologists, philosophers, and some physicians. No disparagement is meant at all. This provocative and important subject has been explored with great insight and circumspection by respected scholars such as Dr Larry Dossey, the executive editor of this journal, whose discussions of nonlocal consciousness as a factor in healing are foundational for this issue.²³ To be clear, the topic to be discussed in this paper does indeed concern healing, as opposed to disease prevention or population health, as noted, but healing due solely to ostensibly naturalistic forces founded in psychosocial influences operating within the individual whose health is at issue. We are concerned here with the potential healing effect of one's own faith, not the faith of benevolent others projected to one from afar through praying or via some unknown or mysterious pathway.

To summarize, the focus here is on one's faith (not distant prayer, not church attendance, not the now ubiquitous “spirituality”) as a potential explanation specifically for the healing of one's own disease (not the prevention of morbidity or mortality, not the promotion of health or well-being). Our objective is to show that far from being a topic that scientists and physicians should fear or disparage, there is sound rationale, based on mainstream psychosocial theories, for expecting that faith may exhibit a salutogenic effect in certain circumstances.