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Religion, Spirituality, and Health: The Research and Clinical Implications

It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between and , including a few seminal articles published since First, I provide a brief historical background to set the stage. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

Religion, medicine, and healthcare have been related in one way or another in all population groups since the beginning of recorded history [ 1 ]. Only in recent times have these systems of healing been separated, and this separation has occurred largely in highly developed nations; in many developing countries, there is little or no such separation.

The history of religion, medicine, and healthcare in developed countries of the West, though, is a fascinating one. The first hospitals in the West for the care of the sick in the general population were built by religious organizations and staffed by religious orders.

Throughout the Middle Ages and up through the French Revolution, physicians were often clergy. For hundreds of years, in fact, religious institutions were responsible for licensing physicians to practice medicine. In the American colonies, in particular, many of the clergy were also physicians—often as a second job that helped to supplement their meager income from church work. Care for those with mental health problems in the West also had its roots within monasteries and religious communities [ 2 ].

In , the Priory of St. Mary of Bethlehem was built in London on the Thames River [ 3 ]. In , however, St. Mary's was torn down and replaced by Bethlehem or Bethlem Hospital [ 4 ]. In later years, an admission fee 2 pence was charged to the general public to observe the patients abusing themselves or other patients [ 4 ]. Not long after this, the Quakers brought moral treatment to America, where it became the dominant form of psychiatric care in that country [ 6 ].

Psychiatric hospitals that followed in the footsteps of Friends Asylum were the McLean Hospital established in in Boston, and now associated with Harvard , the Bloomingdale Asylum established in in New York , and the Hartford Retreat established in in Connecticut —all modeled after the York Retreat and implementing moral treatment as the dominant therapy. It was not until modern times that religion and psychiatry began to part paths. This separation was encouraged by the psychiatrist Sigmund Freud.

These writings left a legacy that would influence the practice of psychiatry—especially psychotherapy—for the rest of the century and lead to a true schism between religion and mental health care.

That schism was illustrated in by a systematic review of the religious content of DSM-III-R, which found nearly one-quarter of all cases of mental illness being described using religious illustrations [ 12 ].

The conflict has continued to the present day. This conflict has manifested in the clinical work of many mental health professionals, who have generally ignored the religious resources of patients or viewed them as pathological.

Even more concerning, however, is that the conflict has caused psychiatrists to avoid conducting research on religion and mental health. This explains why so little is known about the relationship between religious involvement and severe mental disorders see Handbook of Religion and Health [ 17 ].

Despite the negative views and opinions held by many mental health professionals, research examining religion, spirituality, and health has been rapidly expanding—and most of it is occurring outside the field of psychiatry. This research is being published in journals from a wide range of disciplines, including those in medicine, nursing, physical and occupational therapy, social work, public health, sociology, psychology, religion, spirituality, pastoral care, chaplain, population studies, and even in economics and law journals.

Most of these disciplines do not readily communicate with each another, and their journal audiences seldom overlap. The result is a massive research literature that is scattered throughout the medical, social, and behavioral sciences. To get a sense of how rapidly the research base is growing see Figure 1. The graphs plot the number of studies published in peer-reviewed journals during every noncumulative 3-year period from to Google Scholar presents a more comprehensive picture since it includes studies published in both Medline and non-Medline journals.

Before summarizing the research findings, it is first necessary to provide definitions of the words religion and spirituality that I am using. For an in depth discussion, including an exploration of contamination and confounding in the measurement of spirituality, I refer the reader to other sources [ 18 — 20 ]. Here are the definitions we provided in the Handbook.

This often involves the mystical or supernatural. Religions usually have specific beliefs about life after death and rules about conduct within a social group. Religion is a multidimensional construct that includes beliefs, behaviors, rituals, and ceremonies that may be held or practiced in private or public settings, but are in some way derived from established traditions that developed over time within a community.

Religion is also an organized system of beliefs, practices, and symbols designed a to facilitate closeness to the transcendent, and b to foster an understanding of one's relationship and responsibility to others in living together in a community.

Spirituality is intimately connected to the supernatural, the mystical, and to organized religion, although also extends beyond organized religion and begins before it. Spirituality includes both a search for the transcendent and the discovery of the transcendent and so involves traveling along the path that leads from nonconsideration to questioning to either staunch nonbelief or belief, and if belief, then ultimately to devotion and finally, surrender.

Thus, our definition of spirituality is very similar to religion and there is clearly overlap. For the research review presented here, given the similarity in my definition of these terms and the fact that spirituality in the research has either been measured using questions assessing religion or by items assessing mental health thereby contaminating the construct and causing tautological results , I will be using religion and spirituality interchangeably i.

The information presented here is based on a systematic review of peer-reviewed original data-based reports published though mid and summarized in two editions of the Handbook of Religion and Health [ 23 , 24 ]. How these systematic reviews were conducted, however, needs brief explanation. This is particularly true for ratings of study methodology that are used to summarize the findings below. The systematic review to identify the studies presented in the Handbooks and summarized in this paper was conducted as follows.

We utilized a combination of strategies to identify the studies excluding most reviews or qualitative research. Second, we asked prominent researchers in the field to alert us to published research they knew about and to send us research that they themselves had conducted.

Third, if there were studies cited in the reference lists of the studies located, we tracked down those as well. All of these studies are described in the appendices of the two editions of the Handbook.

Bear in mind that many, many more qualitative studies have been published on the topic that were not included in this review. In order to assess the methodological quality of the studies, quality ratings were assigned as follows. Ratings of each of the more than 3, studies were made on a scale from 0 low to 10 high and were performed by a single examiner HGK to ensure rating consistency. Scores were determined according to the following eight criteria: study design clinical trial, prospective cohort, cross-sectional, etc.

Cooper emphasized the definition of variables, validity and reliability of measures, representativeness of the sample sample size, sampling method, and response rates , research methods quality of experimental manipulation and adequacy of control group for clinical trials , how well the execution of the study conformed to the design, appropriateness of statistical tests power, control variables , and the interpretation of results.

To assess the reliability of the ratings, we compared HGK's ratings on 75 studies with the ratings made by an independent outside reviewer Andrew Futterman, Ph.

Since scores of 7 or higher indicated higher quality studies, we also compared the scores between the two raters in terms of lower 0—6 versus higher 7—10 quality. This was done by dichotomizing scores into two categories 0—6 versus 7—10 and comparing the categories between the two examiners. I now summarize the results of the systematic review described above. In the present paper, I have chosen to cite original reports as examples of the most rigorous studies in each area based on ratings in the Handbooks i.

Cited here are both positive and negative studies reporting significant relationships. For some topics, such as well-being and depression, there are too many high-quality studies to cite, so only a few examples of the best studies are provided.

In the first edition of the Handbook [ 27 ], we identified studies published prior to the year and studies published between and for a total of studies. Positive emotions include well-being, happiness, hope, optimism, meaning and purpose, high self-esteem, and a sense of control over life. Related to positive emotions are positive psychological traits such as altruism, being kind or compassionate, forgiving, and grateful.

Of the six highest quality studies, half found a positive relationship [ 79 — 81 ]. Again, as with hope, no studies reported inverse relationships. These studies were often in populations where there was a challenge to having meaning and purpose, such as in people with chronic disabling illness. Of the 10 studies with quality ratings of 7 or higher, all 10 reported significant positive associations [ 86 — 89 ].

Not surprisingly, these findings are parallel to those of depression below in the opposite direction, of course. With regard to character traits, the findings are similar to those with positive emotions. Admittedly, all of the studies measuring character traits above depend on self-report.

Again, however, this has not been found in the majority of studies. Given the importance of depression, its wide prevalence in the population, and the dysfunction that it causes both mental and physical , I describe the research findings in a bit more detail. Although this is a small correlation, it translates into the same effect size that gender has on depressive symptoms with the rate of depression being nearly twice as common in women compared to men. Those who are depressed, without hope, and with low self-esteem are at greater risk for committing suicide.

Anxiety and fear often drive people toward religion as a way to cope with the anxiety. There is an old saying that emphasizes this dual role: religion comforts the afflicted and afflicts the comforted. Sorting out cause and effect here is particularly difficult given the few prospective cohort studies that have examined this relationship over time.

Among these studies were cross-sectional studies, 19 prospective cohort studies, 9 single-group experimental studies, and 32 randomized clinical trials. Of these studies, seven had quality ratings of seven or higher; of those, two found inverse relationships, two found positive relationship, two reported mixed results negative and positive , and one found no association.

Of the two studies with high-quality ratings, one found a positive association and the other reported mixed findings. The first study of US veterans with BP disorder found that a higher frequency of prayer or meditation was associated with mixed states and a lower likelihood of euthymia, although no association was found between any religious variable and depression or mania [ ].

A second study examined a random national sample of 37, Canadians and found that those who attributed greater importance to higher spiritual values were more likely to have BP disorder, whereas higher frequency of religious attendance was associated with a lower risk of disorder [ ].

In a qualitative study of 35 adults with bipolar disorder not included in the review above , one of the six themes that participants emphasized when discussing their quality of life was the spiritual dimension. In another report, a case of mania precipitated by Eastern meditation was discussed; also included in this article was a review of nine other published cases of psychosis occurring in the setting of meditation [ ].

Personality traits most commonly measured today in psychology are the Big Five: extraversion, neuroticism, conscientiousness, agreeableness, and openness to experience. Another personality inventory commonly used in the United Kingdom is the Eysenck Personality Questionnaire, which assesses extraversion, neuroticism, and psychoticism [ ].

They score especially low on psychoticism and especially high on agreeableness and conscientiousness. These personality traits have physical health consequences that we are only beginning to recognize [ — ]. Findings are similar with regard to drug use or abuse. The vast majority of these studies are in young persons attending high school or college, a time when they are just starting to establish substance use habits which for some will interfere with their education, future jobs, family life, and health.

We identified 79 studies that examined relationships with marital instability. An independent meta-analysis reviewing research conducted before the year likewise concluded that greater religiousness decreased the risk of divorce and facilitated marital functioning and parenting [ ]. For older adults in particular, the most common source of social support outside of family members comes from members of religious organizations [ , ].

Social capital, an indirect measure of community health, is usually assessed by level of community participation, volunteerism, trust, reciprocity between people in the community, and membership in community-based, civic, political, or social justice organizations.

First, religion provides resources for coping with stress that may increase the frequency of positive emotions and reduce the likelihood that stress will result in emotional disorders such as depression, anxiety disorder, suicide, and substance abuse.

The Future of America’s Contest with China

At the dawn of the Third Millennium b. The significance of this document c. At the service of the full truth about man d. In the sign of solidarity, respect and love. God's gratuitous presence b. The principle of creation and God's gratuitous action.

Many authors have contended that the North American Indians were descendants of the "ten lost tribes of Israel." Prominent among them was James Adair.

Militarized Cultural Encounters in the Long Nineteenth Century

On October 1st, more than a hundred thousand performers and soldiers mustered downtown, forming waves of color that stretched from voguish skyscrapers in the east to the squat pavilions of the Forbidden City. Xi is sixty-six years old, with a full, reddish face, neatly combed hair, and an expression of patient immovability. Since taking office, in , he has redoubled political repression and suspended term limits on the Presidency, so he will run the country for as long as he chooses. For this occasion, instead of his usual Western attire, he wore a black Mao suit.

1. Historical Background and Introduction

 Джабба хотел сказать, что это, возможно, не шифр-убийца. - Конечно же, это убийца! - закричал Бринкерхофф.  - Что еще это может. Иначе Танкадо не отдал бы ключ. Какой идиот станет делать на кольце надпись из произвольных букв. Фонтейн свирепым взглядом заставил его замолчать.

Сквозь строй - надежная система, но ведь АНБ - ненасытный пожиратель информации, высасывающий ее из разнообразнейших источников по всему миру. Поглощение огромных объемов информации сродни беспорядочным половым связям: какие меры предосторожности ни принимай, рано или поздно подхватишь какую-нибудь гадость. Чатрукьян просмотрел список и изумился еще. Все файлы прошли проверку, в них не было обнаружено ничего необычного, а это означало, что ТРАНСТЕКСТ безукоризненно чист. На что же уходит такая уйма времени. - спросил он, обращаясь в пустоту и чувствуя, как покрывается. Наверное, придется потревожить этой новостью Стратмора.

В связи с одной из таких работ он и познакомился со Сьюзан. В то прохладное осеннее утро у него был перерыв в занятиях, и после ежедневной утренней пробежки он вернулся в свою трехкомнатную университетскую квартиру.

Испания отнюдь не криптографический центр мира. Никто даже не заподозрит, что эти буквы что-то означают. К тому же если пароль стандартный, из шестидесяти четырех знаков, то даже при свете дня никто их не прочтет, а если и прочтет, то не запомнит. - И Танкадо отдал это кольцо совершенно незнакомому человеку за мгновение до смерти? - с недоумением спросила Сьюзан.  - Почему.

 Может, отключить его самим? - предложила Сьюзан. Стратмор кивнул. Ему не нужно было напоминать, что произойдет, если три миллиона процессоров перегреются и воспламенятся. Коммандеру нужно было подняться к себе в кабинет и отключить ТРАНСТЕКСТ, пока никто за пределами шифровалки не заметил этой угрожающей ситуации и не отправил людей им на помощь.

Religion, Spirituality, and Health: The Research and Clinical Implications

 - Мы ищем совсем не .

 Набросок или отшлифованный до блеска экземпляр, - проворчал Джабба, - но он дал нам под зад коленом. - Не верю, - возразила Сьюзан.  - Танкадо был известен стремлением к совершенству. Вы сами это знаете.

Они сцепились. Перила были невысокими. Как это странно, подумал Стратмор, что насчет вируса Чатрукьян был прав с самого начала. Его падение пронзило Стратмора холодным ужасом - отчаянный крик и потом тишина.

Religion, Spirituality, and Health: The Research and Clinical Implications

Вам следовало бы привлечь кого-то .

Мидж развела руками. - О чем. - Квадрат Цезаря, - просияла Сьюзан.  - Читается сверху .

Из нее делают струны для ракеток. - Как мило, - вздохнула. - Итак, твой диагноз? - потребовал .

Он преобразовывал послания таким образом, чтобы текст выглядел бессмыслицей. Что, разумеется, было не. Каждое послание состояло из числа букв, равного полному квадрату, - шестнадцати, двадцати пяти, ста - в зависимости оттого, какой объем информации нужно было передать.

Хейл был уже слишком близко. Она метнулась к буфету в тот момент, когда дверь со звуковым сигналом открылась, и, остановившись у холодильника, рванула на себя дверцу. Стеклянный графин на верхней полке угрожающе подпрыгнул и звонко опустился на место. - Проголодалась? - спросил Хейл, подходя к. Голос его звучал спокойно и чуточку игриво.

Jewish Diaspora in the Ancient World, Africa, and Asia

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It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between and , including a few seminal articles published since