Chapter 3. Thinking sociologically about religion and health
Hannah Cooke
Introduction
Religions are concerned with life’s meaning and with explanations of pain, suffering and death. Thus, their importance to sociologists of health and illness might seem obvious. Nevertheless, religion has been strikingly neglected by sociologists of illness. Williams (1993b), has suggested that this has been because both medicine and sociology are highly secular and have therefore regarded religion as unimportant.
When sociologists have turned their attention to religion, it has often been only to predict its death. Meanwhile healthcare has become an increasingly secular domain with only a few remains of its religious foundations. For example, the routine of ward prayers at the start of each shift, which this author remembers from her nurse training, is largely a thing of the past. However, as nurses in particular have come to define their interest in the patient as holistic, there has been a new interest in religion and spirituality. This is reflected in a proliferation of books on spiritual issues (McSherry, 2000 and Narayanasamy, 2001). These changes reflect both the changing role of nursing and the changing role of religion in contemporary society.
In this chapter, we will look at classical and contemporary sociological studies of religion and their application to healthcare. We will consider how these can help us to understand the complex relationships between religion, society, illness and healthcare in the contemporary world.
Classical sociological accounts of religion
The key theme which has united much sociological writing about religion is that of secularization. By secularization, we mean the progressive decline of the importance of religion in the world. Many sociologists of health and illness have assumed that secularization is an inevitable feature of modern society but the empirical evidence to support this assertion is complex and contradictory.
It is important to distinguish between secularization and secularism. Secularization refers to the declining significance of religion; what Max Weber described as the ‘disenchantment of the world’ (Gerth & Wright Mills 1970). Secularism refers to a materialist system of thought which rejects religious beliefs as irrational. One of the leading contemporary proponents of secularism is Richard Dawkins (2006). Secular rationalism draws on a philosophical distinction between reason and faith. Faith is seen as superstitious and backward and thus the decline of religion is seen as a positive and progressive development in the modern world. Secular rationalism can be traced back to the eighteenth century ‘Enlightenment’ period following the French revolution, when science and rationality became increasingly influential in society. This was an era of massive social, political and economic change heralding the dawn of the industrial revolution. This ‘Enlightenment’ way of thinking is now often described as modernism.
The influence of secular rationalism on sociological theories of religion is obvious. Many of them proceed from an assumption that religion entails a suspension of reason, which requires explanation. Many secularist sociologists therefore seized on evidence of the decline of religion as a reason for optimism. It was evidence of the increasing ‘enlightenment’ of the world. A pessimistic reading of the evidence for secularization on the other hand, sees it as representing a decline in moral and communal values. Furthermore, in an era of global warming faith in scientific progress has itself been severely curtailed.
Beckford (1989) suggests that it is impossible to disentangle the sociological view of religion from wider social theories and problems. Classical sociologists shaped their theories about religion in response to their attempts to understand the massive social changes brought about by the industrial revolution. They were particularly concerned by the problems of deprivation and disharmony they saw following in its wake. According to Beckford (1989), sociological thinking about religion has failed to keep pace with the changing nature of society and is still rooted in these classical theories. This is particularly true of the theory of secularization which, according to Beckford, has failed to appreciate that the disappearance of nineteenth-century forms of religion does not necessarily imply the disappearance of religion itself. As a starting point therefore, we need to understand how classical nineteenth-century sociologists viewed religion and the way in which their ideas have shaped contemporary debates. We will then consider how our society has changed and the way in which religion has adapted to contemporary social conditions. According to some authors, we now live in a post-industrial or post-modern age.
MARX’s ACCOUNT OF RELIGION
Marx’s view of religion was typical of nineteenth-century secular rationalism in its dismissal of religious beliefs (to read about Marx’s major ideas, see Chapter 5). Marx saw religion as a form of human self alienation. Marx’s ideas drew on the work of the nineteenth-century philosopher Feuerbach (1957), who described the idea of God as an alienation of the highest human powers. According to Feuerbach, humans projected their own power onto a deity and thus became estranged from their true nature. Humanity had only to see behind this disguise to grasp that religion was an illusion. Liberation and progress would then result from the establishment of a humanist belief system. Marx agreed with Feuerbach in seeing religion as a form of alienation.
‘The more the worker expends himself in work the more powerful becomes the world of objects which he creates in face of himself and the poorer he himself becomes in his inner life, the less he belongs to himself. It is just the same in religion. The more ofhimself man attributes to God, the less he has left of himself’. (Marx, cited inBottomore & Rubel 1973: 178)
Marx took Feuerbach’s concept of alienation and applied it in a new way. For Marx, the source of alienation was not religion itself but the economic relations of society. Workers were not oppressed by their beliefs but by the new relations of industrial capitalism which exploited them. For Marx, religion was problematic because of the role it played in reconciling working people to that oppression. Religion expressed fundamental values of compassion, freedom and justice but it encouraged the exploited to accept the status quo and aspire to salvation in an afterlife rather than realizing these values on earth.
‘Religious suffering is at the same time an expression of real suffering and a protest against real suffering. Religion is the sigh of the oppressed creature, the sentiment of a heartless world and the soul of soulless conditions. It is the opium of the people. The abolition of religion, as the illusory happiness of men is a demand for their real happiness. The call to abandon their illusions about their condition is a call to abandon a condition which requires illusion’. (Marx, cited inBottomore & Rubel 1973: 41).
Thus Marx looked forward to a society rid of oppression in which justice would be realized on earth and religion would become unnecessary.
We have seen that Marx was concerned with the ways in which industrial society produced alienation – a sense of powerlessness. How do you think that a sense of alienation might affect a person’s health? How did Marx think that religion contributed to a sense of alienation? Do you think that he was right to criticize religion in this way?
DURKHEIM AND RELIGION
If Marx was concerned with the inequality and oppression created by industrial capitalism, then the sociologist Emile Durkheim was concerned above all with the breakdown of communal values and the social order. Marx has given us the concept of alienation – a sense of self estrangement engendered by the oppression of capitalist social relations. By contrast, Durkheim saw contemporary humanity as threatened by the condition of anomie. Anomie refers to a sense of normlessness (from the Greek anomia absence of law) – the individual’s estrangement from societal rules and values. Durkheim believed that anomie led to suicide, crime and social breakdown.
Emile Durkheim was a French sociologist from a Jewish background. He is credited along with Herbert Spencer with being the founder of sociology as an academic discipline and with changing forever the way we would think about and study society. Durkheim was a socialist and his work addressed the problems of social deprivation and disharmony that followed in the wake of the industrial revolution. He believed that religion had played an important part in promoting social cohesion and that professions would play an important part in promoting civic morals in industrial societies.
Durkheim was concerned to establish the social origins of social problems, such as crime and suicide. Durkheim presented a critique of individualistic explanations of social behaviour. He said that social phenomena were ‘social facts’ which could not be explained simply by reference to the motivations or propensities of individual actors (methodological individualism). Social facts had, according to Durkheim, their own logic which was not reducible to explanations at the biological or psychological level. Social facts are external to any particular individual considered as a biological entity and act as an external constraint on individual choices and actions. They are ‘endowed with coercive power, by … which they impose themselves upon him, independent of his individual will’. A social fact can hence be defined as ‘every way of acting, fixed or not, capable of exercising on the individual an external constraint’ (Rules of the Sociological Method 1895).
Durkheim’s major works include:
▪ Division of Labour in Society 1893
▪ Rules of the Sociological Method 1895
▪ Suicide 1897
▪ Elementary Forms of the Religious Lifestyles 1912
▪ Professional Ethics and Civic Morals (published in 1955)
For Durkheim, some form of religion was necessary to society if anomie was to be contained. Religion was the means, whereby society collectively expressed its central values and identity through ceremonials and rituals. In his major study of religion, The Elementary Forms of Religious Life ([1912] 1976), he tried to outline the different forms that these rituals took and the functions that they performed. Durkheim believed that there was something eternal in religion although the dynamic nature of society meant that religious forms and beliefs would change. Religion promoted social cohesion and acted as a ‘social cement’. Durkheim was preoccupied with the way in which industrialization both threatened and changed the basis of social cohesion. However, religion would survive because:
‘There can be no society which does not feel the need of upholding and reaffirming at regular intervals the collective sentiments and the collective ideas which make up its unity and its personality’. (Durkheim [1912] 1976: 427)
Durkheim predicted that while religious institutions might decline, the functions of religion would persist. Whereas, in pre-industrial society, religious worship was largely collective, in modern society, religion would become individualized. Religion would express the sacredness inherent in each individual as an expression of a moral community. Durkheim’s ideas have found expression in the work of contemporary sociologists who have argued that religious beliefs have persisted but have become increasingly individualistic and privatized. Thus, Luckmann (1967) described this new private form of religion as ‘invisible religion’.
We have seen that Durkheim believed that religion was like an invisible glue that helped to hold society together. Durkheim believed that this was because it helped people to express shared social values. What values do you think that people share within contemporary society? How are these expressed? How important are shared values in healthcare? What part do you think that religion plays in this?
WEBER’s VIEW OF RELIGION
Max Weber was concerned both with the way in which society shaped religious ideas and also with the way in which religious ideas influenced society (Weber’s major ideas are discussed in Chapter 4). Weber’s ideas about the interplay of religion and society are expressed in particular in his best known study on the influence of Protestant ideas on the rise of capitalism (Weber 1974). Thus, Weber was interested in the social psychology of religion and he has a lot to say that is of relevance to healthcare. He paid particular attention to the ways in which religions construct explanations of suffering and death. Such justifications and explanations of suffering are described as theodicies
The poor and suffering still have to make sense of their lot and can find small comfort in the idea that they deserve to suffer. The persistence of injustice and undeserved suffering therefore led to the idea of a saviour or redeemer who will right all wrongs by either ‘the return of good fortune in this world or the security of happiness in the next world’ (Weber 1920, reprinted in Gerth & Wright Mills 1970). Thus, new theodicies periodically emerge which promise to right the wrongs of the world and offer salvation to the poor and suffering. Examples include the Christian Messiah and the Cult of Krishna in Hinduism.
Weber saw the modern world as characterized by increasing rationalization. The spread of rationality pushed the need for explanations of suffering to the margins of our consciousness. Rationality had demystified the world. Science, however, can explain how events such as sickness occur, but it is limited in its explanations of why such events occur. Weber’s discussion of theodicies reminds us that these questions remain central to how people make sense of the world. According to Clark:
‘How and why questions seem therefore to keep alive the distinction between science and religion. When related to some conditions of human misfortune – say sickness – they may be posed as the opposition between two problems ‘how is my condition caused’ and ‘why is this happening to me.’ Where does the individual find answers to these “why” questions?’ (Clark 1982: 7)
How individuals find meaning in suffering is key to understanding a person’s response to illness. Weber’s ideas suggest that these ‘why’ questions are marginalized by secular rationalism. The rise of modern medicine is one instance of the increasing rationalization of the world with its central focus on how illness is caused and its location of the source of illness in the physiology of the individual. However, for Weber in contrast to some of his more recent followers the disenchantment of the world was ‘more of a tendency than an accomplished fact’ (Beckford 1989).
There would always be counter tendencies and areas of social life which resisted the process of rationalization. Weber utilized the concept of charisma to explain the rise of new religious and social movements not based on rational or traditional authority.
Charismatic authority is wielded by an individual or social group who are able to achieve power through ideas, revelations, magical power or simply force of personality. Charismatic authority implies the breakdown of existing systems of authority whether rational or traditional and therefore, entails the creation of new and revolutionary social, political or religious movements. By its very nature, charismatic authority is short-lived and charisma becomes ‘routinized’ as the movement settles down and becomes institutionalized. James and Field (1992) analysed the ‘routinization of charisma’ in the growing bureaucratization of the hospice movement and we return to this in the final chapter.
Weber’s concept of charisma implied that religions would not decline inexorably. New religions would arise with charismatic leaders and existing religions would experience periods of charismatic revival. The significance of the concept of charisma has been variously interpreted. For some charismatic religions are mere punctuation points in the irreversible ‘disenchantment of the world’, whereas, for others, they show the continuing social significance of religion and the potential of religious movements to overthrow the existing social order.
Religion: declining or changing?
We can still see the influence of these classical theorists when we look at studies of contemporary religion. However, in the twenty-first century we are arguably facing a different set of social conditions. How different is a matter of debate with some authors seeing the present simply as a continuation of the past; for these authors we continue to live in a largely industrialized modern age in which society will continue to become progressively more secular. For other writers however, we have moved into a new era where we are now disenchanted with science and rationality and new interests in religion and spirituality may develop. These latter authors describe the present as a post-modern or post industrial era (Heelas 1993a). These different schools of thought look at changes in religion in different ways. Three types of evidence have been put forward when examining the changing fortunes of religion in contemporary society:
1 Patterns of religious membership and affiliation
2 Patterns of religious belief
3 The influence of religion on major social institutions.
DECLINING RELIGIOUS AFFILIATION?
When considering changes in religious institutions and their membership we are going to look first of all at the situation in the UK. Later, we will consider whether the UK is typical or exceptional in its attitudes to religion.
Changing patterns of religious affiliation have to be considered in relation to the different types of religious organizations which exist in contemporary UK society. Sociologists have developed a number of typologies of religious organizations. Four main types are generally recognized:
1 Churches
2 Sects
3 Denominations
4 Cults.
Churches are large-scale, formal organizations with professional clergy, which are often highly bureaucratic. They may be closely allied to the state as in the case of the Church of England or the Catholic Church in Eire. The Church of England has suffered a dramatic decline in attendance with only 1.8 million attending regularly in 1992 (Davie 1994a), yet it is still the Church to which the majority (25.5 million of the population) claim allegiance. More recently, Brierley (2005) has suggested that only 6.8% of the population attended church regularly in 2005, yet surveys have shown that the majority of the population continue to claim to be nominally Christian. Most only attend church for significant events such as baptisms, weddings, funerals and Christmas.
In spite of a general decline in active church membership, there remain significant local and regional differences. Congregations still thrive in some areas, particularly rural areas and provinces, such as Northern Ireland. Furthermore, many ethnic minority communities show no signs of adopting the rather lukewarm attitude to religion characteristic of the majority of the UK population. Bruce (1996) argues that religion has an important role in expressing ethnic and cultural identity and that in many of these situations, it is used as a ‘cultural defence’. An alternative argument is that these groups retain the more enthusiastic attitudes to religion typical of their country of origin and that it is the UK population which is unusual in its indifference to religion.
The rather dramatic evidence of a decline in active church membership has fuelled arguments in favour of the secularization thesis. The evidence is visible to all as, throughout our towns and cities redundant churches and chapels are converted into shops, warehouses, flats and bingo halls. However, non-Christian places of worship have fared better with many new mosques being built. The rather more buoyant fortunes of other Christian groups have also sometimes gone unnoticed yet few towns of a significant size have not seen the erection of a Kingdom Hall by their local Jehovah’s Witnesses and new evangelical churches are also increasing in number.
Sects represent an increasingly important feature of the contemporary religious scene. Sectarian groups such as the Jehovah’s Witnesses have usually arisen in radical protest against existing religions often through a charismatic leader. They are highly organized groups which see themselves as true believers and draw strong boundaries between ‘them’ and ‘us’. Many are millenarian groups who believe that the end of the world is imminent and only they will be saved. Some modern sects have been remarkably successful in exploiting mass communications and marketing techniques to spread their message (Schmalz 1994). Some of the larger sects, such as the Mormons and Jehovah’s Witnesses owe much of their success to their use of the techniques of successful business corporations, which is ironic given their ostensible rejection of secular rationalism. Recently, many have added the internet to their armoury of recruitment techniques.
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