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Journal of Adult Development PP487-373396 May 31, 2002 21:11 Style file version May 31, 2002
Journal of Adult Development, Vol. 9, No. 2, April 2002 ( C
°2002)
Mental Health, Depression, and Dimensions
of Spirituality and Religion
Shannon Hodges1
The author explores the relationship between spirituality and religion and human growth and
development, specifically examining emotional well-being during adulthood. Dimensions of
spirituality to be explored are meaning in life, a transcendent purpose, intrinsic values, and
spiritual community. The argument is made that spirituality is related to emotional well-being
during adulthood. Implications for further research and relevant information for counselors,
psychologists, and educators are included.
KEY WORDS: meaning; bereavement and comfort; social function; intrinsic faith; extrinsic faith.
From the onset, scholars in the helping fields
have had conflicting feelings about the value of re-
ligion and spirituality on emotional development and
well-being. Freud (1954) believed that spirituality was
merely an illusion to keep humans from distorting re-
ality, and Ellis (1980) described religious beliefs as
irrational. Jung (1958) believed, however, that with-
out an “inner transcendent experience humans lack
the resources to withstand the ‘blandishments of the
world’ (p. 24).” Jung thought that neither intellectual
nor moral insight alone was sufficient, and he found
that for his patients over age 35 the real problem was
discovering a healthy spiritual perspective. To Jung,
this meant coming to understand one’s connection to
a purpose beyond ourselves (Jung, 1933). For this ar-
ticle, spirituality represents transcendent beliefs that
may or may not be incorporated into an organized
religion.
Frankl (1978) emphasized the innate need of hu-
mans to find sentient meaning in their lives in order to
live a healthy, well-adapted life. While an individual’s
meaning may not necessarily be spiritual or religious,
Erikson (1969) recognized that spiritual development
represented a natural process in adult development.
Allport (1960) asked, “Does a person ever really
1To whom correspondence should be addressed at Department
of Counseling, Niagara University, P.O. Box 2042, New York,
New York 14109-2042; e-mail: shodges@niagara.edu.
attain integration until he (she) has signed and sealed
a treaty with the cosmos?” (p. 90). Maslow (1971)
described this integration in terms of the transcen-
dent self-actualizer. For Maslow, transcendent self-
actualization carried a spiritual significance, including
an appreciation of beauty, truth, and unity and recog-
nition of the sacred in life.
Scholars, including theologians and philosophers,
have not only explored the role of spirituality in hu-
man growth and actualization but also have ques-
tioned the impact of the lack of a spiritual outlook on
mental health. Kelley (1994) surveyed 343 graduate
students in counseling programs. Ninety percent of
those surveyed rated religious/spiritual issues as very
important,important,orsomewhat important in coun-
selor education. For Frankl (1978), the major neurosis
of the modern era was what he called the “existen-
tial vacuum,” or meaninglessness. Frankl’s method of
choice for coping with and transcendence of this state
was through what he termed Logotherapy (Frankl,
1967). In essence, Logotherapy was the rediscovery
of personal values and also coming to understand
that a benevolent force (i.e., God) was at work. May
(1975) observed a growing need for psychotherapy as
society lost its connection with symbols, myths, and
values. Seligman (1990) has linked increased feelings
of hopelessness and helplessness to the narcissism
and alienation of modern society. Seligman observed
that spirituality made a difference in depression rates
109 1068-0667/02/0400-0109/0 C
°2002 Plenum Publishing Corporation
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110 Hodges
of the close-knit spiritual community of the Amish
in rural Pennsylvania, as incident rates of depres-
sion among this cloistered community are significantly
lower than Western society.
The purpose of this article is to suggest a link
between the practice of spirituality, participation in
a faith community, and emotional well-being during
adulthood, specifically on the tendency of spirituality
to serve as a coping mechanism to manage depres-
sion. The article is presented in three sections. The
first attempts to clarify terms such as spirituality, reli-
gion, and spiritual well-being. Second, Westgate’s four
dimensions of spiritual well-being, meaning in life, in-
trinsic values, transcendence, and the community of
shared values, are utilized as a means of examining the
impact of the spiritual dimension in human develop-
ment (Westgate, 1996). Finally, the article concludes
with implications for professionals in mental health
and education.
SPIRITUALITY, RELIGION, AND
EMOTIONAL WELL-BEING
Although the value of spirituality to mental
health has been documented (Frankl, 1967; Jung,
1933; Payne, Bergin, Bielma, & Jenkins, 1990;
Worthington, 1989), research is only beginning to ex-
amine the nature of spirituality and its impact. Previ-
ous research has largely defined spirituality in terms
of religiosity, chiefly because it may easier to concep-
tionalize organized religion, frequency of attendance,
family history, and satisfaction with certain religious
beliefs into a study. Spirituality, which appears more
difficult to define, has received much less attention.
For purposes of simplicity, spirituality and religiosity
are described as separate, though overlapping con-
cepts. Again, spirituality is the broader concept and
represents transcendent beliefs and values that may
have or may not be related to a religious organization.
Religiosity, on the other hand refers to a set of rituals
and creeds which may be manifest in the context of
a religious institution: Jewish, Catholic, Islamic, and
so forth (Ingersoll, 1994). An individual may express
spirituality in a religious context but a person’s reli-
giosity is not always a result of spirituality (Genia &
Shaw, 1991).
The term spiritual well-being has its origins in
the medical model wellness movement. Almost one
hundred years ago, psychiatrist William James stud-
ied the spiritual domain of health (James, 1902/1982).
Cousins (1979), a physician, has also verified the
healing dimensions of spirituality and its importance
both to healthy development and in coping with a ter-
minal illness. Peck (1978), a psychiatrist, described
well-being as an integration of the various dimen-
sions of human functioning, including social, emo-
tional, physical, and spiritual realms. Researchers in
the mental health professions have discussed spiritu-
ality by describing the phenomena conceptually us-
ing models that illustrate how spirituality relates to
the overall adaptability and well-being of the indi-
vidual (Chandler, Holden, & Kolander, 1992; Witmer
& Sweeney, 1992). To summarize, these theorists be-
lieved the spiritual dimension is an innate component
of the human experience and acts as a lynchpin to link
one’s spirituality to other dimensions of life. Several
notable theorists have postulated the search for mean-
ing and purpose in life as a key component of good
mental health (Frankl, 1967; Jung, 1933; Klinger, 1977;
Maslow, 1971; Seligman, 1990). More recently, Myers
(1992) included reference to intrinsic values as an-
other component. Myers described this as a personal
belief system, whereas Banks (1980) described it as
principles to live by.
Transcendence, another dimension currently
popular in the area of spirituality, finds broad recog-
nition among some major theorists (Chandler et al.,
1992; Frankl, 1967; May, 1975). It also encompasses a
recognition of a dimension “beyond the natural and
rational” (Banks, 1980, p. 196), as well as an accep-
tance of its mystery and ineffably and as an article
of religious faith (Banks, 1980; Bulka, 1998; Ingersoll,
1994). Transcendence can include an awareness or be-
lief in a force or power beyond ourselves, whether
this is a formal belief in God, a higher power or some
cosmic energy. Spiritual well-being also implies that
the individual is one part of a larger community. This
larger community includes the terms self, others, and
God (Ingersoll, 1994). A sense of selflessness, life pur-
pose, a desire to assist others (Banks, 1980), and an
increased unconditional love that promotes working
toward a greater good are also present (Bulka, 1998;
Epstein, 1995).
In defining the term spiritual well-being, one dis-
covers some agreement in the literature regarding the
integrating and self-actualizing tendency of spiritu-
ality, as well as attempts to delineate between the
various components of spirituality. Ingersoll (1994)
attempted to explain the various elements of spiritual-
ity: “The observable elements can point to, but never
finally explicate, the nonobservable elements. As this
article explores the meaning of spirituality, the term
description is used in lieu of definition to avoid the
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Depression and Dimensions of Spirituality 111
illusion of full explication” (p. 100). In describing the
term spiritual well-being, the professional literature
is clear that such is a broad concept involving multi-
ple characteristics. Despite the difficulty in agreeing
on a narrow definition, Westgate (1996) and Ingersoll
(1994) in separate extensive surveys of the literature
on spirituality and religion determined that spiritual
well-being was a multidimensional construct. Never-
theless, there were at least four distinct dimensions
of spiritual wellness that emerge from the literature:
meaning in life, intrinsic values, transcendence, and
spiritual community. Although these dimensions do
not represent a complete review of the literature, they
do represent important information regarding the re-
lationship between spirituality and mental health. The
next section will examine the four dimensions of spir-
itual well-being and how they are important for emo-
tional well-being. The article will also include supple-
mental commentary and examination.
MEANING IN LIFE
The first dimension of spiritual wellness is mean-
ing in life and life purpose. This particular dimension
is highlighted in the studies of the major existential
writers as an innate capacity (Frankl, 1959; Maslow,
1971). Although the self-actualizing individual is de-
picted as having discovered meaning in life, nonactu-
alized individuals may struggle with hopelessness and
meaninglessness of life (Frankl, 1959). Frankl (1959)
termed such meaninglessness as the existential vac-
uum or depression. Studies on meaninglessness and
depression are among the best documented among
the literature (Beck, 1967; Frankl, 1959; Seligman,
1990). Beck (1967) reported such expressions as “see-
ing no point in living” and a “sense of futility of life”
(pp. 12–13). Seligman (1990) added other character-
istics to depression, including pessimism, gloominess,
emptiness.
Other studies examining the relationship be-
tween church attendance and levels of depression,
meaningfulness of religion, and depression of ado-
lescents, found significantly lower depression rates
among adolescents who found meaning in life through
their religion (Wright, Frost, & Wisecarver, 1993).
Olszewski (1994), in studying the effects of divorce
on children, found those who had a religion where
the emphasis was on “God is empowering me to
deal with my problems” fared much better in ac-
cepting their parents’ divorce and were significantly
less depressed than nonreligious adolescents. Those
adolescents surveyed, who were active in a fundamen-
talist church that espoused “God will take care of my
problems,” however, were even more depressed than
nonreligious adolescents. It may well be, therefore,
that there are “healthy” religions and “unhealthy”
religions, with the former group advocating an
“intrinsic” belief and the latter an “extrinsic” belief.
Beck (1967), Seligman (1990), and Yalom (1995)
have postulated that a sense of life purpose and satis-
faction both relate to the state of hope. Hope was ex-
amined as both a trait (as a personality characteristic)
and state (based on specific situations). It was discov-
ered that a sense of life purpose and satisfaction was
related to both trait and state hope. Because hopeless-
ness is common among clients with depression (Beck,
1967; Seligman, 1990) further study into the relation-
ship between meaning in life, hope, and depression
could be beneficial. Interestingly, Benson and Splika
(1973) demonstrated that a positive outlook toward
oneself corresponded to a similar perception of God.
These studies imply a negative relationship be-
tween discovering meaning in life and depression
since depression is partially defined by hopelessness
(Beck, 1967). The Beck Depression Inventory (BDI;
Beck, 1967) measures levels of depression, and the
most salient question for predicting suicidology is the
item related to hopelessness (Beck, 1967). Thus, tran-
scendent meaning in one’s life may be crucial not only
to life development, but may also be a sustaining fac-
tor in times of crisis (e.g., death of a loved one, divorce,
unemployment).
INTRINSIC VALUES
The second dimension of spiritual wellness is an
intrinsically held value system that forms the basis of
one’s behavior. Maslow (1971) believed that an in-
trinsic value system was the defining characteristic of
human nature. He postulated that intrinsic values are
necessary “to avoid sickness and to achieve fullest
potential” (p. 312). Allport (1960) examined the rela-
tionship between intrinsic and extrinsic orientations
toward religions. He defined extrinsic values as being
self-serving, influenced by peer pressure, and fluctuat-
ing depending on the situation. He believed intrinsic
values provided the foundation on which life mean-
ing and understanding are built. Intrinsic values are
stable over time and situation, regardless of the re-
wards, situations and consequences, and they assist in
defining important issues related to achievement of
life tasks and goals (Maslow, 1971).
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112 Hodges
There are a number of studies on the relationship
between intrinsic values, depression, and life satisfac-
tion. Brown and Lowe (1951) used a questionnaire re-
garding religious values that provided guiding princi-
ples for the participants. Results grouped participants
into those with an intrinsic orientation and those with
an extrinsic orientation. Each orientation was then
correlated separately with depression. Their findings
suggested lower levels of depression (and higher life
satisfaction) correlated with an intrinsic orientation,
and higher levels of depression (lower life satisfac-
tion) correlated with an extrinsic orientation. Like-
wise, Watson, Hood, Foster, and Morris (1988) found
that ratings for life satisfaction were slightly higher for
religious than nonreligious participants. In examining
gender implications, Brown and Lowe found lower
levels of depression for both male and female partici-
pants with deeply held religious (intrinsic) values, and
higher levels of depression among male participants
who lacked religious values. The major criticism of
this study was the use of orthodox Christian language
on the survey. Participants who rejected this language
may have held equally spiritual (intrinsic) values that
may have gone unrecognized due to terminology used
in the operationalization.
There is an important footnote to this research.
In one of the studies, lower levels of depression were
found for those with an intrinsic orientation verses
those with an extrinsic orientation (Genia & Shaw,
1991). In a separate study however, no significant
differences in depression levels were found between
individuals with an extrinsic orientation and those
with an intrinsic orientation (Nelson, 1989). When
he examined further however, Nelson found that
while African American subjects were more intrin-
sically oriented than Caucasian American subjects
they displayed higher levels of depression than their
Caucasian American counterparts. This may suggest
some influences regarding societal prejudice, social
complexities impoverished living conditions and per-
ceived limited future opportunity. Nelson also discov-
ered that intrinsic orientation was significantly related
to church attendance, which has implications for the
fourth dimension of spiritual wellness, community,
which will be discussed later in this article.
In another study Rosik (1989) found no differ-
ence in depression levels between those with an in-
trinsic versus an extrinsic orientation. His study, ex-
amining elderly participants who had experienced the
death of a spouse within the past 24 months, found
these results held steady even when controlling for
the amount of time since the spouse’s death. Sanders
(1999) noted that frequent church attendees (once a
week or more) were likely to respond with more op-
timism in the even of sudden death of a spouse. The
most significant results were noted, however, when
frequent attendance at religious services was paired
with close ties with significant family members.
In the final two studies, there were also no
significant differences in depression levels between
those with an intrinsic orientation and those with
an extrinsic orientation (Bergin, 1991; Spendlove,
West, & Stanish, 1984). Spendlove et al. (1984) found
that correlations between depression and orientation
were insignificant when conditions such as education,
income, health, and caring for spouse were controlled.
Bergin (1991) also found no significant relations
between and extrinsic orientation and depression,
though their study did reveal that an intrinsic orien-
tation was positively correlated to a sense of well-
being. Furthermore, as the majority of participants
expressed an intrinsic orientation, further research is
suggested.
TRANSCENDENCE
The third dimension of spiritual well-being is
transcendence. For Allport (1960) and Walsh and
Vaughn (1993), intrinsic or ultimate values ultimately
connotated a spiritual or transcendent meaning.
There are various definitions of transcendence in the
literature. Maslow (1971) described transcendence as
“going beyond commonly understood boundaries”
(p. 273); Alcoholics Anonymous Services (1976) de-
scribes it as “having a relationship with a higher
power” (p. 10); and Banks (1980) views it as “creator
of the universe” (p. 197). Still, there are other theorists
who define transcendence more globally such as a be-
lief in a creative and universal force (Chandler et al.,
1992; Maslow, 1971; McLaren, 1994). Maslow went
on to describe the “transcendent self-actualizer” as
one who recognizes the sacredness of life and who is
“metamotivated” by truth, beauty, and unity (p. 275).
Chandler et al. (1992) portrayed transcendence in a
similar manner as the shifting of one’s “locus of cen-
tricity” beyond the narcissistic self to incorporate hu-
manicentricity, geocentricity, or cosmicentricity. Such
individuals consider themselves to be an integral part
of a greater collective, guided by some divine plan, and
experiences a sense of awe and wonder when contem-
plating the universe (Westgate, 1996).
Transcendence also refers to a movement away
from an excessive focus on the self (narcissism) and
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Depression and Dimensions of Spirituality 113
focusing on connecting with a Higher Power (e.g.,
God, Yahweh, the Goddess, etc.). Transcendence em-
phasizes the self as important only in an altruistic man-
ner, whereby such individuals attend to themselves to
provide for others. This concept is similar to Peck’s
definition of love as “the will to extend oneself for the
purpose of nurturing one’s own or another’s spiritual
growth” (Peck, 1978, p. 71).
Scholars have studied the incident rates of de-
pression over the past nine decades of this century,
and noted the steady and consistent rise among clients
with more narcissistic personalities (Beck, 1967;
Seligman, 1990). Seligman (1997) has recently ex-
pressed the opinion that the significant rise in de-
pression rates stems from a sense of people feeling
disconnected from significant human relationships.
His research among the Amish of rural Pennsylvania,
indicated depression one fifth to one tenth that of
mainstream society. Seligman postulated that a mate-
rialistic society impresses upon the individual a sense
of unhealthy individualism that separates and isolates
people from one another, thus making it difficult to
form lasting communal attachments. Thus, the lack of
a common sense of purpose, family ties, spiritual be-
lief, or life purposefulness, has potentially created a
greater sense of isolation and vulnerability, possibly
reinforcing a distant, disengaged, depressed society
(Seligman, 1997). Such results have profound impli-
cations for numerous segments of society including
public schools and the inner city.
Research by Richards, Owen, and Stein (1993)
and Carson, Soeken, and Grimm (1988) has suggested
a relationship between transcendence and depression
for Christian populations. In both studies, transcen-
dence was defined as belief in God. Richards et al.
found improvement in depression levels following
cognitive therapy with a religious–spiritual compo-
nent. Carson et al., discovered significant correlations
between belief in God and factors such as trait hope
and state hope.
The drawbacks in the respective studies of
Richards et al. (1993) and Carson et al. (1988) were
that each study investigated only one factor asso-
ciated with depression, and not depression itself.
These studies furthermore were conducted on exclu-
sively Christian populations, using Christian terminol-
ogy. Although these studies certainly are relevant in
terms of assessing the relationship between religious
faith, coping with depression, and life adjustment,
a broader study incorporating a variety of religious
and spiritual approaches is needed. This point is high-
lighted through the work of Noble (1987), who studied
transcendent experiences among a variety of popula-
tions. She discovered higher levels of emotional well-
being among those who claimed to have had tran-
scendent experiences than those who have not. Her
findings indicated higher levels of self-actualization,
optimism, life purpose, and guiding values among
participants who claimed to have had transcendent
experiences.
Herzbrun (1999) in a study of observant verses
nonobservant Jews, found the more defining issue re-
garding emotional adjustment was “purpose in life”
not religious belief. This “meaning” may involve an as-
sociation with a religious community or some defined
spiritual dimension (A.A.’s higher power), or may be
a separate construct. Still, it is worth mentioning that
much research suggests that religious faith is pos-
itively associated with emotional well-being. Those
with the highest level of religious involvement report
the greatest degree of happiness (Myers, 1992).
COMMUNITY OF SHARED VALUES
AND COMMUNITY SUPPORT
The fourth dimension of spiritual health is a spiri-
tual community of shared values and support (Maton,
1989). A natural function of the spiritual lifestyle is
sharing those values with a religious community, such
as a church, synagogue, or mosque (Banks, 1980).
Through singing, praying, chanting, or meditating
with others, one experiences a sense of unity which
has an empowering effect (Maton, 1989).
The spiritual or religious community may also
provide an important means of support in what some
researchers see as an era of diminishing sense of con-
nectedness as implied by Seligman (1990). It is
believed that humans have an innate desire for
community with others and, as social beings are
relationship-oriented towards others, with nature, and
with a Higher Power (Koch, 1998). Depressed or
grieving individuals often report the loss of emotional
attachments, which can lead to withdrawal from social
contacts (Beck, 1967). Spiritual communities provide
a means of support for transitioning through bereave-
ment stages and for healthy, postgrief development.
Much research has been gathered on the rela-
tionship between depression and spirituality. In the
majority of studies, researchers have focused on or-
ganized religious groups such as churches probably
because they are the easiest to study. Wright et al.
(1993) examined the correlation between depression
and both meaningful religious beliefs and frequency
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114 Hodges
of church and synagogue attendance. In their study,
regular attendance at religious ceremonies was sig-
nificantly correlated with lower levels of depression
among adolescents. Spendlove et al. (1984) found that
participants with infrequent church attendance were
twice as likely to suffer from depression.
In these studies, a link between religious atten-
dance and low levels of depression was established,
suggesting that involvement in a spiritual community
contributes to stable mental health. Westgate (1996)
has suggested that future researchers expand their
studies to go beyond church attendance and explore
the impact of less formal spiritual gatherings such
as prayer chains, 12-step programs and meditation
groups. The work of Cutrona and Russell (1987) pro-
vides an avenue worthy of exploration. Their research
is based on six aspects of social support: attachment,
social integration, tangible assistance, guidance, posi-
tive self-worth, and providing support to others.
Overall, extensive studies have generally found
the presence of religious beliefs and attitudes to be
the best predictors of life satisfaction and well-being
(Jones, 1993). There are exceptions to this assertion
that religion or spirituality equals healthy develop-
ment. For example, some research has indicated that
more fundamentalist religious outlooks may lead to
a greater sense of isolation and depression (Hood,
1992; Olszewski, 1994). It must be understood then,
that a religious or spiritual community can facilitate
either a sense of life-purpose and community or one
of alienation and despair.
CONCLUSION
The image of emotionally healthy individuals
that emerges from the literature is a person with an
active spiritual life, who finds meaning and purpose
in life and who operates from an intrinsic value sys-
tem that guides their life’s work and decisions. This
person’s transcendent perspective allows for an ap-
preciation of the mystery and sacredness of life. The
spiritually active person also is part of a larger com-
munity, which involves worshipping, praying, meditat-
ing, singing, and establishing a close and supportive
community. The spiritual community not only pro-
vides a sense of identity and shared values but also
offers support systems and an avenue for support. This
has implications for developing healthy relationships,
coping with depression and coping with other life
transitions. In contrast, the depressed individual typ-
ically describes symptoms that include meaningless,
emptiness, and hopelessness, a sense of alienation
from values, a narcissistic focus, and a lack of personal
connections (Seligman, 1997; Westgate, 1996).
Healthy emotional development is dependent on
a variety of factors, involving physical, emotional,
spiritual, social, and medical (Yalom, 1995), and en-
vironmental spiritual dimensions (Westgate, 1996).
The evidence is growing that healthy human growth
and transition must include an examination of the
various factors of the human experience: social, ed-
ucational, family, vocational, and religious/spiritual.
Certainly, an area that deserves attention is the spiri-
tual dimension, with its emphasis on community and
hope. A number of years ago Victor Frankl spoke
about the value of both meaning and a spiritual belief
system:
The fundamental thesis ...posited by logotherapy is
that the striving to find meaning in one’s life is the pri-
mary motivation force in man (1959, p. 23). Humans
are primarily spiritual beings, whose humanness is
rooted in the spiritual dimension (1967, p. 154).
The challenge for counselors, educators and
clergy is to continue researching the relationship be-
tween spirituality and well-being. To be able to work
competently in the area of spirituality may require un-
dergraduate and graduate programs to provide train-
ing and supervision in this area. Although the focus
of the counselor or educator is not the same as the
theologian, rabbi, or minister, the former are pre-
sented with the opportunity of assisting depressed
clients to integrate their spirituality in a manner that
is supportive, reaffirming, and part of a balanced
lifestyle.
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