being a social isolate, being depressed,
or being weak. As noted above, we now
know these accounts to be incorrect, and
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that acute loneliness, just like acute
physical pain, serves an important
biological function for our species.
Being aware of how loneliness fits into
our remarkable achievements as a social
species and what loneliness does to our
social cognition and behavior can help
us better understand the actions of others
toward us. Third, to the extent that
desperation for social connections leads
chronically lonely individuals to
misguidedly vest their interest in those
who are unlikely to meet their
relationship needs, they may need to
learn how to be selective and choose
friends and groups with whom
reciprocally rewarding relationships can
be expected. This decision is critical to
success. Research indicates that the
people with whom we are most likely to
form positive, lasting relationships are
those who have similar attitudes, beliefs,
values, interests, and activities to our
own. Therefore, people should not seek
friendships based on physical
appearance, status, popularity, or
convenience, but rather on attitudes,
beliefs, values, and behaviors. Finally,
because chronically lonely people expect
to be disappointed with themselves and
others in their relationships, they may
benefit from training and practice in
taking a more optimistic perspective, in
expecting the best from themselves and
from others. We play a much more
important role in shaping our social
environment than we often realize.
Although no intervention to date
has incorporated all of these elements, at
least one randomized trial has
demonstrated that an intervention based
upon volunteerism (Experience Corps)
can increase social activity in older
adults (19). In this trial, older adults are
paired with grade-school children and
dedicate at least fifteen hours per week
throughout the school year to assist the
teachers in supporting and encouraging
children in reading, writing, and
mathematics. This strategy engages at
least two of the principles that emerged
out of Cacioppo and Patrick’s theoretical
framework (5)—the provision of a
“safe” venue for making social
connections (i.e., the classroom of nonthreatening
children), and the shifting of
older adults’ attention away from their
own concerns and toward the needs of
someone else. In addition, this strategy
capitalizes on Erikson’s notion of
generativity (i.e., helping future
generations) (20). Interventions of this
form deserve further assessment (21).
Conclusion
We began this chapter by noting
that loneliness is not uncommon and,
although unpleasant, may prompt
individuals to attend to and repair their
social connections. Loneliness affects
cognition as well as well-being,
however, and when loneliness persists it
is a risk factor for myriad health
problems. Previous reviewers have
suggested that loneliness can be reduced
through interventions that emphasize
social skills development and groupbased
activities. By quantitatively
analyzing twenty-two well-designed
studies, we found no evidence that these
strategies were any more effective in
reducing loneliness than increasing
social opportunities or social support, or
modifying maladaptive social
cognitions, whether in a group or
individual context. A larger number of
intervention studies may be needed to
determine the relative efficacy of these
intervention strategies. In the interim, it
is clear from this review that global
impressions and intuitions will not
suffice when trying to reduce loneliness.
Future interventions should
Page | 136
acknowledge that loneliness is not
synonymous with social isolation but is a
social pain that functions to motivate the
formation and renewal of meaningful
social relationships. When feelings of
loneliness fail to accomplish their
adaptive purpose, chronic loneliness
may ensue. Chronic loneliness tends to
be self-perpetuating through
confirmatory biases that alter cognitions,
emotions, and behaviors. Given the
importance of social connection to
people’s health and well-being, it is
important that we solve the puzzle of
how to help the chronically lonely
connect with others in meaningful and
satisfying ways.
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Reflections on Invisible Connections
Echoing a prominent theme in
this volume, Christopher Masi highlights
once again the centrality of social
connectedness for human well-being and
the function of loneliness in signaling a
rupture in a sense of social
connectedness. One might reasonably
expect that a social species like Homo
sapiens would have a sufficiently large
behavioral repertoire to be able to
resolve feelings of isolation and restore a
sense of social connectedness. Although
resolution is accomplished readily in
some instances for some people some of
the time, the reality is that at times
people are at a chronic loss for how to
satisfy their need for social connection.
Unfortunately, the invisible bonds of
social connection are not easily repaired.
We see others’ social activity, but we do
not see how they feel about their social
lives and sense of connection. Despite
our inability to recognize loneliness in
others, or, as Nick Epley and Jean
Decety argued earlier in this volume,
because of this handicap in seeing into
the minds of others, we tend to attribute
to others what we ourselves have felt or
would expect to feel in particular
circumstances. Is it any surprise that we
target for intervention those
circumstances where we observe few
opportunities for social interaction,
inadequate social skills, and poor social
support? On the other hand, because
loneliness is in the mind of the sufferer,
it is perhaps surprising that we would
expect changes in objective social
circumstances to be sufficient to
alleviate loneliness in all its sufferers.
Masi provides a quantitative review of
strategies employed to alleviate
loneliness to show that interventions to
date have been only modestly successful
in reducing feelings of loneliness,
attesting to the challenge of effectively
addressing the problem of ruptured
social connections.
Invisibility should not thwart
attempts to alleviate distress, however.
Biological causes of disease were no
more visible or evident in the 18 th
century than psychological causes are
today. Yet significant scientific advances
during the 19 th and 20 th centuries
completely revolutionized medical
practice, life expectancy, and quality of
life. Farr Curlin is less interested in the
invisible causes of disease than in the
primordial need for social connection
that John Cacioppo introduced and that
Curlin regards as a preexistent condition
for medicine. If science can be viewed as
a cognitive system that steps us back so
that we can deal more objectively and
effectively with another person’s
distress, then religion can be viewed as a
cognitive system that steps us forward to
connect and care for others. Curlin
argues that the practice of medicine
requires a balance of these forces, and
that the resulting tension between the
two produces better care for the patient
than does the practice of medicine using
either alone.
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Chapter 15 15
15 The lead author is Farr A. Curlin, M.D., a
hospice and palliative care physician, researcher,
and medical ethicist at the University of
Chicago. His empirical research charts the
influence of physicians' moral traditions and
commitments, both religious and secular, on
physicians' clinical practices. As an ethicist he
addresses questions regarding whether and in
what ways physicians' religious commitments
ought to shape their clinical practices in our
plural democracy. Curlin and colleagues have
authored numerous manuscripts published in the
medicine and bioethics literatures, including a
New England Journal of Medicine paper titled,
“Religion, Conscience and Controversial
Clinical Practices.” As founding Director of the
Program on Medicine and Religion at the
University of Chicago, Dr. Curlin is working
with colleagues from the Pritzker School of
Medicine and the University of Chicago Divinity
School to foster inquiry into and public discourse
regarding the intersections of religion and the
practice of medicine.
In the world of contemporary medicine,
science is front and center, and for good reason.
Science provides modern medicine with
extraordinary diagnostic and therapeutic
capacities that can be employed to care for
patients. Yet there is more to medicine than
science can know. Science cannot provide
visions to animate care of the sick, moral
frameworks to guide the application of medical
technology, or practices that nurture and extend
our sociobiological capacity to care for others.
For these medicine turns to religious and secular
moral traditions and practices. This essay
examines how religious concepts are implicit and
operative in practices of medicine and in the
formation of fully human physicians. By
attending to these concepts, we may gain a richer
understanding of the way self-conscious human
practices like medicine both depend on and
Social Brain, Spiritual Medicine?
No one ever asks what science
has to do with medicine any more than
they ask what books have to do with
education or what tools have to do with
carpentry. Before the middle of the 19th
century, there was almost nothing that
physicians, however well intended,
could do to actually restore health to the
ill. Modern science changed that. Over
the past century and a half, dramatic
improvements in health outcomes have
been wrought through the application of
sterile surgery techniques, specialized
hospital care, public health measures to
prevent the spread of infectious diseases,
antibiotics to treat those diseases, and
myriad subsequent technologies. All of
these have been undergirded by the
discoveries of biomedical science.
As a result, the life expectancy in
developed nations has doubled. People
live not only longer but with much less
disability. Diseases that formerly
disfigured and killed, such as smallpox
and polio, have been almost completely
eradicated. Epidemics of malaria, yellow
fever, measles and diphtheria have been
restrained. Injuries from war or other
traumatic events, which in earlier
periods led predictably to death or
profound disability, now can be
ameliorated using sophisticated surgical
reconstruction techniques, advanced
prostheses, and intensive rehabilitation.
Medical science already has
accomplished an extraordinary amount
in alleviating human illness and
forestalling death, and there is good
reason to expect further progress. Yet,
for all that science has made possible,
medicine is animated by other, less
tangible, forces.
extend our unique, human, biopsychosocial
capacities.
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To give a robust account for the
practice of medicine, one must explain
why sick and debilitated strangers are
worthy of attention and care, and how
the medical arts contribute to human
flourishing. For some Americans, such
accounts begin in secular moral
tradition, but for most they begin in
religion; nine out of ten Americans
endorse a religious affiliation 1 . Either
way, medicine looks beyond science to
find a vision that animates care of the
sick, a moral framework that guides the
application of medical technology, and
practices that nurture and extend the
human capacity to care for patients as
persons rather than as mere objects. In
this sense, even though religious
concepts are rarely made explicit in
public and professional discourse about
medicine, they are everywhere implicit
and operative, and necessarily so.
Why care for the sick?
Humans in all cultures are moved
to care for the sick. The question is why?
The concept of the social brain provides
the beginning of an answer. The peculiar
human need and capacity for
constructive, complex and meaningful
relationships seems to involve
neurological structures and functions
that also facilitate attending to the sick.
For example, Epley describes the human
capacity to pay attention to our own
mindedness and the mindedness of
others. We are not only conscious of
ourselves, but we are conscious of others
being conscious of themselves and of us.
This capacity allows us to be mindful of
others’ bodily suffering and mindful of
their consciousness of our relation to
them in that suffering. To mindfulness is
added the capacity to empathize. Decety
describes a neurological structure
through which the sight of pain in
another person triggers a response in our
own brains that mirrors (albeit at a level
attenuated by training and other
contextual factors) the response we
would have if we were suffering the pain
ourselves. These features of the human
brain allow us to pay attention to and to
some extent share in the suffering of
others—capacities that are psychological
building blocks for caring for the sick.
Yet to explain medicine strictly
on the basis of empirical science, one
must solve a particularly thorny version
of the more general problem of
explaining altruistic human behavior.
Decety notes, “The emergence of
altruism, of empathizing with and caring
for those who are not kin, is … not
easily explained within the framework of
neo-Darwinian theories of natural
selection.” Indeed one can scarcely
imagine a practice less conducive to the
reproductive fitness of a population than
spending enormous resources caring for
the sick, the deformed, the weak, and the
aged. Natural selection and the physician
would seem to be at cross-purposes: one
works to eliminate the sickly, the other
to save them from elimination. On this
account, medicine appears to be the sort
of dead end into which the evolutionary
process sometimes blindly drifts.
Cacioppo, however, argues that
altruistic behaviors can be explained
within evolutionary theory by paying
attention to inclusive fitness and the
multiple levels of selective pressure:
…for species born to a period of
utter dependency [e.g., humans],
the genes that find their way into
the gene pool are not defined
solely or even mostly by
likelihood that an organism will
reproduce but by the likelihood
that the offspring of the parent
will live long enough to
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reproduce… one consequence is
that selfish genes evolved
through individual-level selection
processes to promote social
preferences and group processes,
including reciprocal social
behaviors, that can extend
beyond kin relationships
The concept of inclusive fitness helps to
explain why humans care for the young
when they are sick, and even why they
care for those who when healthy are able
to contribute to caring for the young. In
addition, it may be that hunter-gatherers
were more likely to survive and
reproduce when they cared for a
wounded or sickened member of the
clan—thereby establishing an
expectation of reciprocity that would
contribute to social cohesion, collective
effort, and defense of other group
members. These provide at least the
rudiments of an evolutionary rationale
for the practice of medicine.
Yet, medicine does not involve
caring merely (or even primarily) for the
young, much less for those who are most
genetically fit. Rather, medicine in large
measure involves caring for those who
either have no capacity to contribute to
the gene pool because they are aged and
otherwise infertile, or whose
contributions to that pool will reduce
population fitness because they are
genetically predisposed to sickness and
disability. Concern about the latter led
Francis Galton and many of his
American and European contemporaries
to embrace social Darwinism and to
champion efforts to keep the diminished
and infirm from reproducing. In the
United States, the eugenics movement
was memorialized in the infamous words
of Supreme Court justice Oliver Wendell
Holmes, who justified the
constitutionality of the forced
sterilization of mentally ‘unfit’ women
in the case of Buck v. Bell by writing,
“Three generations of imbeciles are
enough.” Sterilization rates under
eugenic laws in the United States
increased following this ruling until the
Skinner v. Oklahoma case in 1942, after
which point they declined.
The practice of medicine
expresses more than a straightforward
social instinct for protecting the young.
To borrow from Browning, it may be
that medicine builds on and extends the
dynamic of inclusive fitness much like in
Catholic moral theology caritas (love)
builds on and extends eros (desire).
Browning writes, “[Aquinas] held – and
Christianity has always taught – that
Christian love includes more than kin
altruism and the care of our familial
offspring; it must include the love of
neighbor, stranger, and enemy, even to
the point of self-sacrifice.” The
theological concept of God as creator
and Father of all “made it possible for
Christians to build on yet analogically
generalize their kin altruism to all
children of God, even those beyond the
immediate family, their own children
and their own kin.” Even those beyond
the reasonable hope of reproducing or
helping others to reproduce.
Notably, the self-conscious
commitments that animate medicine do
not include promoting population fitness
or ensuring survival of offspring to the
point of reproduction. Rather, physicians
discipline themselves to practices that
make possible the commitment of
medicine: to preserve and restore the
health of patients, notwithstanding
patients’ other characteristics. Religions
ground this care for the sick in sacred
and transcendent obligations to God and
neighbor, and it is not incidental that the
hospital began when Christian monastic
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communities enfolded the care of the
sick into a communal life of liturgy and
prayer. This is not to say that the
substantively irreligious lack proper
motivation to practice medicine. It is to
say that an animating vision for
medicine as a good and worthy activity
seems to require moral concepts that
science alone does not provide.
How should medical science be
deployed?
Medicine is not only animated by
something like a religious vision; it also
requires a thick moral framework for its
ongoing direction. To know how best to
care for patients, we need to know
something about what human flourishing
entails and how medicine can contribute
to it. Medical science is less helpful here
than one might hope.
Science facilitates the sort of
religious humanism that Browning
encourages, because it helps us better
understand the empirical world and
therefore helps all moral communities
refine their efforts to bring about human
flourishing. Science elucidates a range of
technical possibilities and provides
information about what we can
reasonably expect as the consequence of
choosing one course over another. Yet,
even the successes of medical science
highlight its limits. As medical science
generates technologies that can be put to
ever-wider uses, it exposes
disagreements about which of those uses
are worthwhile. Although medicine
proceeds in scientific ways in the care of
patients, it does so in pursuit of goals
that science cannot set. These goals
come from moral traditions and cultures,
religious or otherwise.
In the same way that the
influence of a dominant culture on
medical practice is often invisible or
taken for granted precisely because of its
dominance, so the influence of religious
ideas on medical practice is often
invisible in those areas where
commitments are shared in common
among different religions and other
moral traditions. For example, we
generally take it for granted that
mending injuries, treating infections, and
removing diseased organs are good
things to do. That is because the moral
commitments that undergird these
practices are shared by virtually all
moral communities, religious or
otherwise. Moral commitments that are
shared by all may not seem ‘moral’ at
all. Yet even the idea of sickness implies
a norm of and concern for health that are
not fully derivable from empirical
science.
The influence of religion on
medical practice becomes more visible
where the commitments of particular
traditions diverge from one another or
where they diverge from the values of
the dominant culture. For example,
religious measures have been found
consistently to strongly predict
physicians’ attitudes regarding ethically
controversial practices such as abortion,
physician-assisted suicide, withdrawal of
life-sustaining therapies, contraception,
physician interaction with patients about
spiritual concerns and, as we have found,
physicians’ ideas about the relationship
between religion and health. 2
Yet overtly controversial issues
merely highlight the tips of proverbial
icebergs. Disputes about practices such
as abortion or physician-assisted suicide
concern whether the practices are
intrinsically unethical. Much more
commonly physicians agree about the
range of legitimate clinical strategies,
but they disagree about which is to be
recommended in a given moment. For
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example, physicians may agree that the
experience of depression can be treated
legitimately by antidepressant
medications, referral to a psychiatrist, or
referral to a counselor whose practice is
rooted in a specific religious tradition.
Yet our research suggests that the
religious characteristics of physicians
strongly influence which of these
options they would recommend in a
given case 3 .
Controversies over a particular
medical intervention often represent
deeper unspoken disagreements that,
unfortunately, science cannot settle. For
example, controversies over the use of
stimulants to manage childhood behavior
disorders, or the medicalization of social
anxiety, seem to reflect disagreements
about more basic questions: What brings
human happiness? Which moods and
behaviors should be considered normal
parts of human experience and which
should be considered abnormal? What
sorts of suffering should we try to
alleviate? What leads to disordered
behaviors? What resources (social,
psychological, spiritual or otherwise) are
best suited to addressing disruptions in
individuals’ mental and emotional
states? How does modern medicine fit
into our response to these experiences?
Although physicians may not ask or
answer these questions explicitly, they
implicitly answer them in their responses
and recommendations to patients.
So, for all that is hoped for in
‘scientific’ and ‘evidence-based’
practice, clinicians must in the end act as
practical moral philosophers, making
judgments about how best to pursue the
goals of medicine for a particular patient
in a particular context, all things
considered. Among those things to be
considered are moral valuations about
which religions and other moral
traditions have much to say, but about
which medical science remains silent.
Caring for the patient as person
So far I have suggested that
religions provide a vision that animates
care of the sick and a moral framework
that guides the application of medical
technology. Religions make another
contribution by fostering practices that
nurture the human capacity to care for
patients as persons rather than as mere
objects.
Patients commonly complain that
their physicians treat them as mere
objects or specimens rather than
appreciating and attending to them as
unique persons. This problem has always
plagued the profession. To learn how to
heal, the novice physician must learn of
patients as representing abstract general
types and classes. She must learn about
coronary artery disease and hematuria
before she can begin to interpret Mrs.
Smith’s chest discomfort and Mr.
Jones’s red urine. These abstractions
allow knowledge of when and how
things happen, and that knowledge
guides technological interventions that
may bring healing to the body. These
abstractions also help doctors objectify
their patients’ humanity enough to
violate social norms that operate in every
other social situation, such as asking
patients to expose their nakedness in
vulnerable positions, or cutting patients
apart in hopes of making them whole.
As long as the process does not
go too far, scientific detachment serves
to make our concern effective. Yet the
collective experience of both patients
and physicians suggests that such
detachment usually does go too far and
occurs too easily. As a result physicians
treat patients as mere objects and
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instances of disease; they treat patients
as less than the human persons they are.
Physicians, it would seem, are
subject to a particular form of the more
general psychological challenge of
paying attention to other minds. Like all
humans, physicians easily ignore the
mindfulness of others. This matters,
Epley reminds us, “because mindful
agents become moral agents worthy of
care and compassion.” As such, patients
who are seen as mindful “evoke empathy
and concern for well-being, whereas
agents without mindful experience can
be treated simply as mindless objects.”
There are obstacles to recognizing the
mindfulness of patients. Illness makes a
patient different, or deviant, from human
norms, and we tend to pay less attention
to the minds of those who are different
from ourselves. In addition,
“Considering other minds requires some
attentional effort. It does not come
automatically.” Physicians learn to go
through the technical motions of caring
for the sick until those motions become
‘automatic’—that is the mark of a skilled
and effective clinician. But paying
attention to the mindfulness of patients
requires a sustained investment of time
and energy that physicians are often
unwilling to make.
How could religious practices
help? As Luhrmann notes, most people
find it very difficult to pay attention to
God. To help in this difficult and
lifelong task, many religions have
developed disciplines of prayer and
other practices that call to mind what we
tend to forget—including the ideas that
motivate genuine human concern for
those who suffer. Christians, for
example, practice remembering that all
people are ultimately united as children
of the one creator God, that “the ground
is level at the foot of the cross”
regardless of one’s social status, one’s
biological fitness or one’s reproductive
capacity. Epley notes that we are better
able to pay attention to what another is
thinking or feeling when we are
motivated to do so. Christianity seeks to
stimulate such motivation by
encouraging Christians to meditate on
the fact that Jesus comes to us in those
who are sick and otherwise suffer 4 .
Moreover, it reminds us that we are
never alone. As Katherine Tanner
details in her chapter, God is always
with us. This central theological claim,
when remembered in song, prayer,
liturgy, reading of Scriptures and other
rituals, provides a particular form of
what psychologists call “mindful
surveillance”—our actions become more
“prosocial” (even altruistic) when we are
aware of being observed by others. All
of these practices depend on and extend
the capacities of the social brain. They
are also, from the vantage of
Christianity, ways in which one may
come to receive grace, the unmerited
help of God.
Religious practices have
therefore at least the potential to
encourage and strengthen the human
capacity for attending to the
mindfulness, and therefore the
personhood, of those who are sick and
diminished. As Epley suggests, “Making
minds visible, and hence more like one’s
own, enables people to more readily
follow the most famous of all ethical
dictates—to treat others as you would
have others treat you.”
Conclusion
Science and religion are invisibly
and inextricably intertwined in the
practice of medicine. Science has
provided modern medicine with
extraordinary diagnostic and therapeutic
Page | 145
capacities that can be employed to care
for patients. Science gives knowledge of
the remarkable neurological and
psychological features of the social brain
that make activities like caring for the
sick possible. But science can also
depersonalize the patient viewed through
the eyes of the physician scientist.
Religions (and other moral communities)
motivates an attention to the person who
is the patient, providing a fuller vision
for the worthiness of caring for the sick,
and drawing the physician and patient
closer together. Religion and moral
communities can also provide a
framework to guide the application of
medical science in that endeavor, and
practices that strengthen the human
capacity for treating patients as the
mindful persons they are. It is the
balance of the tensions produced by the
forces of science and religion that may
hold a key to better medical practice and
patient care.
References
1 Curlin FA, Lantos JD, Roach CJ,
Sellergren SA, Chin MH.
Religious characteristics of U.S
physicians: A national survey. J
Gen Intern Med. Jul
2005;20(7):629-634.
2 See Curlin FA, Chin MH, Sellergren
SA, Roach CJ, Lantos JD. The
association of physicians’ religious
characteristics with their attitudes
and self-reported behaviors
regarding religion and spirituality
in the clinical encounter. Med
Care. 2006;44:446-53, and Curlin
FA, Sellergren SA, Lantos JD,
Chin MH. Physicians' observations
and interpretations of the influence
of religion and spirituality on
health. Archives of Internal
Medicine. 2007;167(7):649-54.
3 Curlin FA, Odell S, Lawrence RE,
Chin MH, Lantos JD, Meador KG,
Koenig HG. The relationship
between psychiatry and religion
among US physicians. Psychiatr
Serv 2007;58(9):1193-1198.
4 Holy Bible. Matthew 25:40.
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Invisible Forces
Farr Curlin meditates on the
puzzle of medicine—what is its
evolutionary and social function, what
draws individual practitioners to it, and
what grounds its fundamental values.
The values of scientific inquiry lead to
treating the objects of inquiries in just
that way: as objects. But objectifying
patients and their disease would seem to
work against the human values of
empathy and caring for the weak that
also seems to be part and parcel of what
medicine is as a practice. Curlin argues
that religious values inform and nurture
the human side by insisting that there
must be a connection between physician
and patient, acting as an often
unrecognized invisible force that
humanizes the practice of medicine.
Religion is neither necessary nor
sufficient for an individual to adhere to
such values. The question of what it is
that grounds the fundamental values that
govern our relationships, and how those
values are reflected in invisible social,
psychological, and biological forces, is
central to the work of our network. In a
concluding essay, Ronald Thisted
reflects on the many threads of
investigation and discussion that have
made up our conversation, and how they
are interwoven into a network of inquiry
that sheds light on invisible forces and
the social brain.
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Chapter 16 16
Epilogue
Over the past six years, our
network of scholars has engaged in an
16 The lead author is Ronald Thisted, Ph.D., a
Professor in the Departments of Health Studies,
Statistics, and Anesthesia & Critical Care at the
University of Chicago, where he currently chairs
the Department of Health Studies. Trained in
philosophy and mathematics at Pomona College
and in statistics at Stanford University, his
interests include the nature of argument and
evidence, particularly in the context of health,
disease, and medical treatment. He has
published articles on topics ranging from
treatment for back pain to computational
mathematics, and from social determinants of
health to the size of Shakespeare’s vocabulary.
He is a Fellow of the American Statistical
Association, and a Fellow of the American
Academy for the Advancement of Science.
The question of how we come to
know—or to claim that we know—things, is left
unexamined all too often. The similarities and
differences in modes of argument across
disciplines, and the variations in what counts for
evidence supporting or refuting a position within
and across disciplines can be illuminating.
Statistics, and statistical argument, provide a rich
framework for thinking about such issues as
measurement, learning, uncertainty, variation,
and experiment. Statistical principles provide a
framework for disciplined investigation, for
communication about the extent of and
limitations to the information at hand, and for
combining information from different sources.
Although there is enormous variability between
individuals, there are also commonalities to their
experience that transcend their differences. As a
species and as individuals, we rely on these
common threads, even when they are invisible to
us.
on-going conversation that we have
come to recognize as being centered on
unseen forces that shape, and are shaped
by, the social nature of human beings.
The essays that make up this volume
give a hint as to what our conversation
has been like, but the linear structure that
a book imposes cannot fully evoke the
give and take of vigorous debate, the
excitement of viewing an old problem
from a new perspective, or the
satisfaction that comes from sharing the
search for knowledge – even when we
did not agree on the interpretation of
what we discovered in our search.
We deliberately chose to describe
our membership as a network rather than
a committee, or seminar, or task force, or
club, or salon. A network is defined as
much by the connections between people
as it is by the individual people
themselves. Networks can be described
pictorially as nodes (points that represent
individuals), some of which are
connected by edges (lines that represent
links between two individuals). In our
network, we have focused on the value
of the edges, and have held the
conviction that much is to be gained by
exploring previously untested
connections. We started with a set of
nodes having only a handful of edges,
and we ended with many more edges
than nodes.
As a result, our network – and
each individual in the network – has
been enriched as we have learned more
about, and more from, perspectives that
initially were unfamiliar to each of us,
the end result being that our whole is
decidedly greater than the sum of our
parts. This illustrates a recurrent theme
in the book, that of emergent
phenomena—characteristics that can be
ascribed to entities at a higher level of
organization that, without conscious
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design or intent, seem to arise from
behaviors and interactions at a lower
level of organization. How this can
come about is a puzzle, but it is a puzzle
that is amenable to thoughtful
investigation, both scientific and
philosophical. What forces are at play,
we might ask, that makes such a
collection cohesive? Just what
chemistry can transform a collection of
individuals into something both more
than and different from what in
aggregate they bring to the table? We
seek to understand more fully the bonds
of marriage, family, friendship, or
membership—invisible forces that bind
and simultaneously transform the
underlying nature of their constituents
no less than chemical bonds transform
atoms of hydrogen and oxygen into
water.
Our origin was rooted in distaste
for the unproductive and unenlightening
shouting matches between proponents of
views of science that denigrate religious
belief and views of religion that are antiscientific.
We started from the
assumption that scholars from the
sciences and from religion and
philosophy could have fruitful
conversations about what is known, what
counts for knowledge, what can be
observed, and what can be tested
through experiment and observation.
And we all believe in the value of the
scientific method as a means for
expanding our knowledge. Internal
tension is needed for the structural
integrity of buildings and bridges, and
that is no less true of social structures
such as our network. Through
appropriate construction, deep tensions
between theology and science (or even
between scientific disciplines or
theological perspectives) that have the
potential to drive us apart can instead be
shaped to release creative energy and
shared purpose.
Berntson notes that “beliefs and
emotions have consequences, both
behavioral and physiological.” The
network starts from the premise that one
can learn about such apparently invisible
phenomena as beliefs by studying and
reasoning about their consequences.
In his essay, Browning advocates
starting with a critical hermeneutic
phenomenology, a “careful description”
of our instruments, our observations, and
the stories we use them to tell. Clearly
articulating our assumptions and starting
points has been of immense value. After
doing so for the benefit of colleagues
outside our disciplines, those colleagues
in turn have helped us become aware of
unarticulated assumptions implicit in our
approaches or in our experiments.
These observations have led in turn to
better science and more convincing
evidence. Our colleagues in the network
have helped each of us to see more
facets of the same elephant that
individually we are too blind to
appreciate fully.
Revising our thinking and our
research to take those observations into
account has increased the rigor of our
thought and broadened the scope of our
conclusions. The presence of a rich
variety of disciplinary perspectives has
helped us to weave the nets of Sir Arthur
Eddington’s parable more tightly,
enabling us to see for the first time some
of the “smaller fish” that earlier would
have escaped our notice.
Shedding light on invisible forces (a
koan)
Invisible forces of culture,
connection, and curiosity bind us
together and define us as a species that is
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at once both individual and social.
Because both individuality and sociality
are fundamental to the human species,
we are fundamentally interdependent,
connected by invisible, yet powerful,
threads. In exploring these threads, we
have also been led to questions about
how social forces can have effects on
individuals, how the meaning that
individuals (and groups) apply to
particular phenomena or relationships
affect both behavior and biology, and
how our biology makes social
connection possible. We have used the
phrase “invisible forces” to describe the
mechanisms that account for these
effects that we essentially take for
granted, and to suggest by analogy that
they can be investigated rigorously just
as other phenomena, such as gravity or
autonomic regulation, that also are not
immediately present to our visual or
other senses can be studied.
Human minds are unparalleled at
discerning patterns in what they see
against a background of noise and
variation, and they are equally adept at
attributing meaning to them. As the
essays in this volume demonstrate
repeatedly, we readily ascribe patterns
we encounter (or seek to encounter) to
invisible forces of nature, of God, of
kinship, of genes, of culture, of love, of
social connection. A common premise
underlying the work of the network is
that what we know (or what we think we
know), and how we come to know it, are
social endeavors embedded in a shared
view of both the world and how one
talks meaningfully about the world. And
mindful of our human facility to see
patterns (even where none exist!), we are
acutely aware that constant rigorous
testing of assumptions, methods, and
arguments is necessary to make sure that
we are not fooling ourselves into seeing
only what we hope to see.
Humans have a deep need to
create meaning in their interactions with
the world and with each other. We also
have a deep need for making
connections beyond ourselves. The
biological structure we call our brain has
evolved to reward social connection, just
as it rewards the satisfaction of hunger
or thirst. The human biology that directs
and reflects these human needs is what
we have termed the “social brain.”
It is worthwhile to reflect on the
range of invisible forces that we have
considered here. These forces operate at
several different levels, from the
molecular, to individual bodily
functions, to social groups, to societies,
to species. They include such disparate
ideas as evolutionary selective pressure
favoring social connectedness,
anthropomorphism, loneliness, social
connection, emergent phenomena,
connection to a higher being,
transcendence, empathy, language as
carrier for meaning, belief, collective
will, group synchrony, autonomic
regulation, and neural resonance. These
forces interact with one another, too:
loneliness, for instance, acting as an
internal signal of the inadequacy of
one’s bonds of social connection, with
consequent effects on health, mediated
through autonomic regulation, or the role
of belief in mediating scientific
objectivity and empathy.
It is tempting to view individuals,
both souls and bodies, as arising from
lower-level forces within, such as the
operation of specialized neurons and
regulatory biological processes. And it
is tempting to view social structures and
the forces that tend to maintain them as
arising, perhaps emergently, from the
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individuals that make up societies. On
this view, the social level of organization
arises out of the interaction of lowerlevel
entities. But invisible forces
operate in both directions; one’s degree
of social integration or isolation (at the
higher level) can have profound
influence on one’s mental and physical
health (at the lower level). Just how
these forces operate—in both
directions—is one of the main themes of
this book.
A recurring theme is the human
need for connection. As we have
explored this fundamental need, it has
become clear that it can be satisfied in
part by connections not necessarily to
other human persons, but to other minds.
Since the minds of others are in part of
our own construction, connections to a
higher being, or to our pets, or even to a
transcendent order underlying the world,
can fulfill part of what we strive to
attain. Indeed, such non-human
attachments can share the character of
human connection: we can feel valued
by our pet (just as we can feel validated
in a social relationship), we can have an
intimate dyadic relationship with God
(just as we can be intimate with a close
friend), and we can feel a sense of
belonging to the universe (just as we can
feel that we belong to social group).
This explains how different, even
contradictory, notions of a relationship
to God, for instance, can lead different
people each to find meaning in such a
relationship: finding God on the
downtown bus versus encountering God
in the purposeful unfolding of the natural
order.
The ideas of symmetry,
complementarity, coordination, and coregulation
also run through several of
our essays. Regulation of biological
systems is often maintained through
paired systems of biological checks and
balances; when one system is activated,
the other tends to restore equilibrium.
For instance, one set of muscles flexes
the arm, and an opposing set extends it.
We have seen that the sympathetic and
parasympathetic components of the
autonomic nervous system—the system
that makes us breathe and that makes our
heart pump—operate in this way, and
that chronic stimulation of some
systems, like overstretched elastic bands,
lose their ability to spring back. The
notions of observing a behavior and
performing that behavior not only are
conceptually similar, they may be rooted
in a common set of neurological
structures which may, in turn, help us to
understand how we can perceive another
human being as being like us, but not us.
Anthropomorphism is the belief that
other minds mirror our own; this colors
the way we perceive the world and the
other actors in it, a mechanism that
allows us to simulate getting under the
skin of the other person.
Happiness and loneliness are
perceptions about our place in the world
that profoundly affect our physical
bodies and our social relationships.
Religious beliefs, too, can have profound
effects on health and physical wellbeing,
working through the same
biological mechanisms that in health
maintain equilibrium.
Unseen, yet powerful, forces
regulate social behavior. Empathy, for
instance, contributes to the regulation of
social interactions. Synchronous
behavior points to a phenomenon that
makes the individual feel subsumed by
the group, feeling part of a larger,
organic whole. These behaviors can be
as disparate as “the wave” at a sports
stadium or congregational prayer at a
church service. Shared feelings of
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transcendence and belonging can
simultaneously lead to greater fitness of
the individual and increased cohesion
and sustainability of the social
organization—another indication of
positive selection associated with the
social brain.
The notion of resonance with
another appears repeatedly through the
book. Our connections to others derive
in part from being able to see what they
see, to hear what they hear, to know
what they know, to feel what they feel.
Or we have to be able to believe not only
that this is possible, but that it happens.
The social brain, in which the same
regions are activated by our own
experience of pain and by our perception
of others in pain, makes both aspects
possible. There is a close connection
between being able to “feel for” another
(empathy) and to “see into” another
mind (anthropomorphism).
Language has the potential to
affect people and groups in part because
it is tied to meaning. Language is the
medium through which we convey,
preserve, and transmit meaning from one
individual to another, and from one
social generation to another. Language
is powerful because it can activate
belief, which in turn can activate
physical responses. Words can bind;
words can terrify; and words can cause
physical pain and death. The power of
words comes from the meanings they
entail about our connections to one
another.
Paradox
Our investigation of invisible
forces involving the social brain has led
us repeatedly to factors that
fundamentally conflict. An important
invisible force is the respect we pay to
the boundary between self and other.
Our relationship to it comes into play in
conceptualizing loneliness,
anthropomorphism, spirituality, group
behavior, empathy, and inclusive fitness.
When we speak of loneliness, this
boundary seems to be an impenetrable
barrier. When we speak of empathy or
anthropomorphism, however, the selfother
boundary is defined by the
similarity and congruence of individuals
to one another, providing a transparent
window through which we perceive and
interact with others (who must be like
us). And when we speak of group
synchrony, the boundary vanishes
completely: self and other are one.
Successful engagement with
others requires work. It is the work of
attending to something, and it is work
that often is needed to resolve competing
forces. Thinking about other minds is a
demanding task and requires attentional
effort. It is this effort that allows us to
manipulate the transparency of the selfother
boundary by what we put in
through learning, attending, seeking, and
projecting. In effect, we can tune the
degree of resonance we have with
members of different groups. Similarly,
consistent attentional effort is also
required for the physician to attend to
the mindfulness of patients, for the
Vineyard church member to experience
God as present in one’s life, and for
another to find connection to an
omnipresent yet invisible God who
works through the very workings of the
world.
What it means to feel a
connection to a higher being is a theme
that several essays explore. As is
evident in these essays, the Network has
considered very different, even
divergent, pictures of what such
connection might entail. These apparent
inconsistencies that can be found in
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these portrayals are rooted in the
different aspects of human connections,
and each is grounded in a social context.
Social connection can be intimate,
relational, or collective. For the member
of the Vineyard Church, connection with
God is an intimate two-way relationship,
while in Jonathan Edwards’s sermon in
the Great Awakening, the connection is
relational and involves the coherence (or
lack of it) of the individual with God’s
approval. And the Christian theological
view of connection as a higher order can
be conceived in terms of one’s belonging
within a whole that God’s constancy
makes larger than oneself.
While religion certainly speaks to
individual connection to others and to
the divine, religious practices can also
serve an evolutionary and social function
by strengthening the human capacity for
attending to the personhood of those
who are sick and diminished. The
objectivity of medical science all too
often leads to an objectification of the
patient or, more frequently, the patient’s
disease. The social brain’s capacity to
see others as minds rather than objects
makes it possible to assign meaning to
patients and the ways in which they lack
wholeness.
Crescat scientia; vita excolatur
The possibility that religion and
science can enrich one other, even as one
sets aside truth claims about such
matters as the existence of a deity, is by
no means obvious. But we have come to
see that science can describe what
religion does in rigorous ways that
benefit religion, and religion can serve a
meaning-making function that science
itself disclaims. Gilpin notes that rifts
between science and religion “have
centered on whether one can make
scientific sense of the notion of divine
mind, purpose, or intention.” Our
network sidestepped this question from
the beginning, focusing instead on
related matters such as the consequences
of believing in such a mind, and of
seeing into that mind, for the one doing
the divining.
Those are questions amenable to
empirical investigation, and it is at that
juncture that we can see benefit from our
discussions. As Berntson says, “beliefs
color the way we perceive the world,
they direct and shape our actions, and
define our personalities.” Studying and
debating about how they do so has been
gratifying and immensely enjoyable.
We have engaged in no theological
debate, but have focused on questions
about human beings, their beliefs, their
behaviors, and how those things affect
and are affected by multiple levels of
human connection.
How we conceptualize our
relationships to persons and things
outside our selves has implications for
our health and well-being. Specifically,
we have seen that viewing our
relationships in terms of meaningful
connections with other minds can have
positive implications for individual – as
well as social – health and function. The
more that we can learn about those
implications, the more our increase in
knowledge has the potential to enrich
human life.