The Psychology of Religion, Chapter 4: The Main Thesis

With all of that in mind, I still come back to my conclusion: the literal supernatural claims at the core of the world's religions are not true. Many sacred stories have, at most, an idealized or embellished relationship to actual figures or events; many others are best understood as products of the same mythic and literary world as the cultures around them.

We see recurring motifs across civilizations. Some of the parallels are strikingly close: the flood narratives of Mesopotamian texts such as Atrahasis and the Epic of Gilgamesh—a divinely sent deluge, a chosen man, a vessel, the release of birds to find dry land—clearly predate and parallel the later biblical flood story. Others are real but looser: traditions of extraordinary or divinely marked birth, and narratives of divine descent, death, and return that some readers compare with resurrection themes, though here the parallels are more debated and should not be overstated. Even the moral ideas often presented as uniquely Christian have deep pre-Christian pedigrees. The command to love one's neighbour appears already in the Hebrew Bible (Leviticus 19:18); versions of the ethic of reciprocity appear in Confucius's Analects and in the Indian epics; and the psychological logic of non-retaliation emerges in multiple moral traditions long before Christianity. Christianity did not invent moral grammar from nothing; it inherited, recombined, amplified, and ritualized themes that human cultures had been discovering for a very long time.

All religions contain stories that can carry moral lessons and often reflect the history of cultural groups striving to improve justice, security, morality, happiness, and harmony in their civilizations, while reflecting on human foibles. In the respect that matters here—literal truth—modern religions are not so different from older mythologies, such as Greek, Roman, or Egyptian: they have profoundly shaped culture, and they continue to give us thoughtful stories, but we do not treat these older myths as literal descriptions of reality. The fact that religious narratives can be psychologically helpful, ethically suggestive, or esthetically beautiful does not make their supernatural claims true; it makes them powerful cultural creations, which is a different category.

While religion is ancient, many features of large-scale organized religion—public priesthoods, written canons, institutional authority, standardized doctrine, and state alignment—intensified alongside agriculture, cities, and larger political structures. In such settings, religion can function as social "glue": a way to unify large groups, encode shared identity, and establish norms for how people should behave together in communities far larger than anything most hunter-gatherer minds evolved to manage.

Not surprisingly, many sacred texts contain themes of intergroup conflict, invasion, conquest, boundary maintenance, and rules for cooperation—stories shaped by the political pressures, environmental constraints, and moral agendas of their times, repeatedly revised and reinterpreted, and naturally inclined to aggrandize the moral standing of the home tribe. In that way, religions can function like other art forms—literature, theatre, poetry, film—sometimes illuminating human experience, sometimes acting as tools of persuasion, and sometimes sliding into outright propaganda.

People become deeply attached to religious beliefs through powerful psychological forces. Most of all, there is longstanding commitment—often beginning in childhood—bolstered by parents, friends, admired community figures, and the sheer comfort of familiarity. It is as though roots form around a belief system, growing deeper over time, intertwined with identity, memory, and the need for coherence. Weakening those roots can feel like a threat to one's sense of self, one's social safety, and one's personal integrity. For many, it would also be embarrassing—or even humiliating—to admit that something they have honoured for decades might be false or misguided; so the mind protects itself by doubling down on prior commitments.

We see versions of this phenomenon far beyond religion, including in medicine and science. Many people like to imagine that scientists change their views rationally, in proportion to the evidence. But even among highly educated experts, new frameworks are often resisted when they threaten status, identity, professional sunk costs, or a lifetime of being "the one who knows." History is full of examples: the Copernican move toward a Sun-centred system; the germ theory of infectious disease; the slow acceptance of plate tectonics; the bacterial role of Helicobacter pylori in peptic ulcer disease; Boltzmann's atomic theory and statistical mechanics; Cecilia Payne's early demonstration that stars are composed primarily of hydrogen and helium; and the recognition of prion diseases as a genuinely new kind of infectious process.

The pattern is so consistent it is almost a law. When Cecilia Payne showed in her 1925 doctoral thesis that the stars are made mostly of hydrogen, Henry Norris Russell—the most eminent astronomer of the day—pronounced the result "clearly impossible" and pressed her to soften it in her dissertation.  Four years later he reached the same conclusion himself.  He did cite her work, but the credit largely went to him.  She later wrote, with painful honesty: "I was to blame for not having pressed my point. I had given in to Authority when I believed I was right." When Barry Marshall and Robin Warren proposed that bacteria, not stress and acid, caused most peptic ulcers, the medical establishment met them with disbelief and ridicule, until Marshall resorted to swallowing a culture of Helicobacter pylori himself, showing that a healthy stomach could be infected and inflamed.  In each case, the evidence did not simply land on neutral minds; it collided with human psychology—pride, fear, loyalty, identity, and the discomfort of having to revise one's story about reality.

But here is the decisive difference: unlike religion, science contains formal mechanisms for correction. As Karl Popper argued, what distinguishes science is not that its practitioners are more open-minded, but that its claims are published so that others can attack them. Experiments are repeated. Most important of all, science's reward structure is inverted relative to dogma. In a religion, the person who overturns the central doctrine is a heretic, to be silenced or expelled. In science, the person who overturns the reigning consensus may, in the end, win the Nobel Prize. Payne and Marshall were not excommunicated; they were, in the end, honoured. The system resisted them, as systems run by human beings always will—but the system was built to be changed by evidence, and eventually it was. That capacity for self-correction, more than the truth or falsity of any single claim, is what most sharply distinguishes a scientific worldview from a dogmatic one.

But the hardest case against my own argument comes from my own field—and unfortunately it is only one of many. In 1935 the Portuguese neurologist Egas Moniz—already celebrated for inventing cerebral angiography—began destroying the frontal white matter of psychiatric patients, first with injected alcohol, later with a surgical tool that he designed himself. The evidence was thin to the point of embarrassment: twenty patients, no controls, follow-up measured in weeks, and the outcomes assessed by the man who had invented the operation. In those years, there was a pressure to develop new treatments, since the asylums were overflowing and there was nothing else to offer, but this does not excuse the brutality of the technique. By 1946 Walter Freeman had simplified the procedure into a transorbital version—an ice pick through the eye socket, under ten minutes, no operating room and no neurosurgeon. In 1949 Moniz received the Nobel Prize "for his discovery of the therapeutic value of leucotomy in certain psychoses." That same year American surgeons performed more than five thousand lobotomies. It was the peak. 

Then it collapsed. Careful follow-up began to show that the docility following the procedure was not improvement at all, but a flattening of the person's personality; the first antipsychotic medication, chlorpromazine, arrived in the mid-1950s offering something that could at least be stopped, and the profession turned. Freeman performed his last lobotomy in 1967, on a woman who died of a brain hemorrhage. After that he was barred from operating. Some fifty thousand Americans had been lobotomized by then. This dark chapter of medical history was a travesty.  Its association with the Nobel Prize is shocking, and I have no wish to explain it away. But notice how this episode ended: not with a heresy trial or a schism, but with evidence, arriving late and unwelcome, and a profession that finally let itself be corrected.

Religions also change, of course, and sometimes for the better—reinterpreting texts, softening old cruelties, absorbing moral criticism from the wider culture. But this usually happens through reinterpretation, groups splitting apart, or slow cultural pressure, not through a method in which public evidence is allowed to defeat a central claim. A doctrine can be quietly revised and still be called eternal truth—which is a very different thing from a system built to let evidence overturn even its most prestigious ideas.

At times, the advent or widespread adoption of a new religion has been followed by improvements in a society's stability. But the reasons for this, as I will argue, often have less to do with the truth of any particular doctrine, or the real existence of any divinity with imagined powers, and more to do with nonspecific factors: the social technology of shared rituals, shared identity, shared moral language, mutual aid, and coordinated behaviour—effects that can be psychologically and culturally potent even when the beliefs are false.


References

El-Hai, J. (2005). The lobotomist: A maverick medical genius and his tragic quest to rid the world of mental illness. John Wiley & Sons.

A biography of Walter Freeman, the American neurologist who did more than any other individual to spread the lobotomy in the United States, and who devised the transorbital method that could be performed in minutes without an operating room or a neurosurgeon. El-Hai follows Freeman from evangelical enthusiasm through professional isolation to his final operation in 1967, after which he was barred from operating. It is the fullest account available of how one determined advocate can carry a procedure far beyond the evidence supporting it.

Festinger, L., Riecken, H. W., & Schachter, S. (1956). When prophecy fails: A social and psychological study of a modern group that predicted the destruction of the world. University of Minnesota Press.

The classic field study of a group whose apocalyptic prophecy failed, documenting how disconfirmation paradoxically intensified belief and proselytizing. Belief systems often respond to threatening evidence by "doubling down"—a tendency that operates with special force when identity and social belonging are at stake.

Gross, D., & Schäfer, G. (2011). Egas Moniz (1874–1955) and the "invention" of modern psychosurgery: A historical and ethical reanalysis under special consideration of Portuguese original sources. Neurosurgical Focus, 30(2), E8. https://doi.org/10.3171/2010.10.FOCUS10214

A reassessment of Moniz's original work drawing on Portuguese primary sources rather than the secondary accounts on which most English-language treatments depend. The authors scrutinize the evidentiary basis of the first leucotomies—the small series, the absence of controls, the outcomes assessed by the man who devised the operation, the follow-up measured in weeks—along with the ethical questions surrounding patient selection and consent. It is the most rigorous modern account of what Moniz actually demonstrated, as distinct from what he claimed.

Heidel, A. (1949). The Gilgamesh epic and Old Testament parallels (2nd ed.). University of Chicago Press.

A foundational comparative study of the Mesopotamian flood traditions (the Gilgamesh and Atrahasis epics) alongside the Genesis flood narrative. It documents the close structural parallels—the divinely sent flood, the warned and chosen survivor, the great vessel, the sending out of birds to find land—that establish the biblical account as part of a much older Near Eastern literary tradition.

Kuhn, T. S. (1962). The structure of scientific revolutions. University of Chicago Press.

The landmark account of how science changes through "paradigm shifts" rather than purely cumulative reason, with established communities resisting anomalies until the weight of evidence forces a wholesale reconfiguration. It supports the distinction between resistance to new ideas (common to all human institutions) and the formal capacity for self-correction (distinctive of science).

Merton, R. K. (1973). The sociology of science: Theoretical and empirical investigations (N. W. Storer, Ed.). University of Chicago Press.

The founding collection of the sociology of science, including the 1942 essay setting out the norms that govern the scientific community—among them "organized skepticism," the institutionalized expectation that every claim be exposed to communal scrutiny and attempted refutation. Merton also analyzed the reward system of science, which grants its highest honours for overturning established belief. Science is built to be corrected in a way dogma is not.

Nobel Foundation. (n.d.). The Nobel Prize in Physiology or Medicine 1949. NobelPrize.org. https://www.nobelprize.org/prizes/medicine/1949/summary/

The official record of the 1949 prize, divided equally between Walter Rudolf Hess and Egas Moniz, the latter cited "for his discovery of the therapeutic value of leucotomy in certain psychoses"—the wording quoted in this chapter. The Foundation's own site also hosts a retrospective essay by Bengt Jansson, a psychiatrist and long-serving member of the Medical Nobel Assembly, which concedes the controversy and reviews how the award came to be made. The prize has never been withdrawn.

Norenzayan, A. (2013). Big Gods: How religion transformed cooperation and conflict. Princeton University Press.

Argues that belief in moralizing, omniscient, punitive "Big Gods" co-evolved with large-scale agricultural societies, helping to extend trust and cooperation among strangers far beyond the small groups in which human psychology evolved. Organized religion functioned as social "glue" enabling cooperation at unprecedented scale.

Popper, K. R. (1963). Conjectures and refutations: The growth of scientific knowledge. Routledge & Kegan Paul.

The classic statement that scientific knowledge advances not by accumulating confirmations but by bold conjectures deliberately exposed to attempted refutation, with falsifiability as the mark that separates science from dogma.

Swayze, V. W., II. (1995). Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935–1954): A historical overview. American Journal of Psychiatry, 152(4), 505–515. https://doi.org/10.1176/ajp.152.4.505

A systematic review of the psychosurgery literature from Moniz's first operations to the arrival of the antipsychotics, written by a psychiatrist in his own field's flagship journal. Swayze documents that the early enthusiasm rested on uncontrolled studies reporting benefit in roughly a third of patients, that short-term results looked favourable while long-term controlled studies were mixed at best, and that the practice is intelligible only against an era in which nothing else was available for psychosis. The episode stands as a lasting argument for rigorous, prospective, long-term outcome studies before a treatment is adopted.

Wootton, D. (2006). Bad medicine: Doctors doing harm since Hippocrates. Oxford University Press.

A history of medicine's slow, often resisted progress, including the prolonged rejection of germ theory and effective therapies. Even empirical, life-and-death fields revise their core beliefs reluctantly, against the friction of professional identity and sunk cost.

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The Psychology of Religion, Chapter 3: Benefits of Religion

For most believers, faith is not just an intellectual position. It is an emotional world, built over a lifetime. Religious beliefs are often taught in early childhood, and they can represent a fundamental bond and a shared culture with parents and ancestors, sometimes going back centuries.

Religion as Family Inheritance

Religious stories, passages from religious texts, and familiar rituals can become like a "native language," in the sense of the fluency and familiarity people develop through repeated exposure and practice over many years. Shared religious beliefs can be a bridge to memories of parents—alongside memories of fishing together, playing baseball, going camping, playing music, or cooking together. In that sense, religion is not simply an "idea." It is the atmosphere of the family home—a mood, a shared vocabulary, and a living link to one's past.

Unlike hobbies, however, religion carries a far heavier weight. A parent might be mildly disappointed if a child dislikes baseball; with religion, the stakes are much higher. Parents may insist—with fear, sadness, anger, or a sense of emergency—that their children must remain within the same faith. If the children stray, guilt can be induced in ways that are far deeper than ordinary family disagreements. In extreme cases, the divergence leads to estrangement or disowning. In some families, the price of doubt is guilt, exile, or the fear of breaking a parent's heart. It is hard to overstate how high the emotional cost can be, for questioning or leaving the family’s faith tradition.

One of the deepest reasons why many people are religious is because the people they have loved most have been religious: parents, grandparents, mentors, teachers, community leaders, or admired public figures (for me, someone like Desmond Tutu or Martin Luther King). When these beloved figures explain their moral courage, comfort, or meaning as flowing from God, the religion becomes fused with the goodness of the person.

Out of love and respect, many people continue the same faith—not because they have weighed the evidence with fresh eyes—few of us ever do that with our deepest commitments—but because questioning the belief can feel like questioning the beloved person. It can feel, emotionally, like an insult to one's parents, or a betrayal of one's ancestors, or a rejection of one's own story. Over time, religion can become so interwoven with identity that challenging it feels less like an intellectual inquiry and more like a renunciation of a precious part of oneself.

Religion as Neurobiological Experience

Beyond family attachment, there is the brain itself: the human mind is remarkably capable of mystical experience. Many people have had moments—alone or in groups—of awe, presence, unity, transcendence, or "spiritual certainty." Whatever one concludes philosophically, the raw fact is that such states are part of the normal range of human experience. And they can be intensified or triggered by particular brain states: by psychedelics and other drugs that alter serotonin or dopamine signalling, by sleep deprivation, by stress, and in some neurological conditions. Wilder Penfield's mid-twentieth-century work at the Montreal Neurological Institute showed that direct electrical stimulation of the temporal lobe could conjure vivid "dreamy states" that felt profoundly meaningful to the patient. Penfield thought he was replaying stored memories; later research suggests something more striking still—that the brain was partly reconstructing, and partly fabricating, these experiences on the spot. The feeling of deep significance, in other words, can be manufactured by the tissue itself, and then clothed by the mind in whatever meaning its culture provides. In temporal lobe epilepsy, similarly, some people report intense subjective or spiritual states in association with seizure activity.

The brain constantly seeks to make sense of things. When something unusual happens in perception, emotion, or bodily feeling, the mind strains to explain it. Often a mystical explanation feels logical even when the actual cause is biological. A powerful feeling state can be interpreted as "God," "fate," "destiny," "the universe speaking," or "a presence," depending on one's cultural vocabulary and expectations.

The same instinct often fuels belief in other mystical phenomena, such as ghosts, spirits, or psychic abilities. These beliefs can act as a lens for understanding reality, where coincidences are read as evidence of a hidden world. This can make life feel "magical" in a satisfying way, offering a sense of specialness and wonder akin to the feeling one gets from a fantasy story like Lord of the Rings or Harry Potter.

Religion as Psychological Comfort

Religious beliefs, services, and rituals have helped countless people cope psychologically with death and loss. You can have less fear about death—your own death, or the death of someone you love—if you believe that death is an entry point to another world, and that separation is temporary.

I think it is a psychological skill, for any person, to practice acceptance of the fact that everything ends: every pleasant experience, every day and night, every song, every meal, every breath, every firework, every life, every mountain. They all have a beginning, a middle, and an end, and then they are gone—sometimes literally in a puff of smoke. It is entropy in action: one of the underlying realities of the universe. Some forms of religion can interrupt that acceptance by bypassing finality with an imagined eternity. This calms fear. But it can also be a kind of avoidance—a comforting story that softens grief by blunting the truth.

It is easy to see why the idea of "taking away" religion can feel like taking away a rich cultural inheritance and a shield against despair. Many people imagine that without religion they would be left adrift, empty, or nihilistic. I do not believe that is a necessary outcome, but I do believe it is a real fear—and a psychologically understandable one.

Religion as Culture

Many religious phrases are woven into everyday language; other words and symbols have roots in ancient mythology. For example, our word "panic" comes from the Greek god Pan, and our month "January" is named for the Roman god Janus. Language forms a lens—deeply ingrained in the brain through memory infused with emotion—through which we describe and interpret experience; in a religious household, one naturally develops the habit of interpreting events with religious references in mind, because those are the interpretive tools one has practiced. And historically, in some homes and communities, scripture was not merely a weekly reading—it was a central text around which literacy and moral education were organized.

Religion has also served, in many families and cultures, as a framework for moral development. Lessons about how to be kind, how to deal with guilt or mistakes ("sin"), how to navigate conflict, how to be a decent citizen, how to face suffering and loss—these have often been taught through weekly sermons, study of sacred texts, and the social modelling that occurs in a community of adults trying (at least some of the time) to be better people. Daily habits—such as saying grace—can instill a rhythm of gratitude. Religious services often use architecture, music, and ritual to evoke awe and reverence. A great deal of human beauty has come through religion: Bach, Handel, hymns, icons, mosques, temples, cathedrals, and the mysterious emotional power of a room built for reverence.  Many of my own favourite pieces of music are deeply tied to that history.

For many people, their happiest memories—friendship, loyalty, meaningful service, celebration, "ecstatic" spine-tingling moments of being emotionally moved—are associated with church or religious community. Many believers interpret these peak emotional states as manifestations of God. But these are natural emotional states whose interpretation is culturally shaped: in a cathedral, at a concert, at a political rally, in nature, or even at a sports event. The state is real and valuable; it is the supernatural explanation, not the experience, that the evidence fails to support.

Religion also organizes time.  It gives people ceremonies for birth, coming of age, marriage, and death, and it fills the year with holidays, fasts, and feasts.  A family gathering for Christmas dinner, or lighting candles, does not think of itself as "doing theology"—and this is precisely one of religion's quiet powers: it sets private life inside a shared calendar.  

This communal power is often concentrated through the figure of the minister. Some ministers are wonderful orators: gifted storytellers with compelling voices, humour, and genuine moral seriousness—sometimes with a breadth of knowledge about history and literature that makes their sermons a kind of free education in the humanities. Some of the great orators in modern history, such as Martin Luther King, were ministers. Churches have been one of the few sustained modern venues where people regularly gather to hear impassioned, ethically themed rhetoric delivered with skill and intensity. Mind you, preaching can be used for darker purposes: demagogues can weaponize charisma, spectacle, and group emotion to fuel intolerance.

Religion as Refuge

Religion can also function as refuge. Many people who feel lonely, adrift, or ungrounded are drawn to a religious or spiritual group because it offers instant community: new friendships, mentorship, comforting rituals, structure, sometimes even material support, and a ready-made language for meaning. This differs from many other community organizations because the commitment is thicker: it is not merely "we play badminton together," but "we share a destiny that goes beyond this life." It's a little bit like an orphan finding a home and then gratefully adopting the new family's beliefs.

This is also part of why religious (and ideological) communities can become so resilient: they meet deep social and psychological needs. Research on radicalization and extremist commitment—including the work of Nafees Hamid, Scott Atran, and Harvey Whitehouse—has explored how peer influence, identity, and social exclusion can harden commitment in tightly bound groups. Ordinary religious life and extremism are very different, but they share a human vulnerability: questioning faith or contemplating a departure from the group can feel like abandoning your family or your core values.   

Religion as Charity

Churches help many people through charity work.  In downtown Vancouver, for example, a well-known fundamentalist church has helped provide temporary winter shelter for street-involved adults.  On a much larger scale, the Salvation Army—which operates roughly one in five of all emergency shelter beds in Canada—provides thousands of shelter, detox, and supportive housing beds each night, along with millions of meals and extensive street outreach. Religious organizations in Canada receive billions of dollars per year in donations.

Still, this needs to be interpreted carefully. These figures do not mean that all religious giving goes directly to the poor, and church charity can at times be paternalistic or conditional—tied to doctrinal messaging or a subtle expectation of loyalty. Nor is this benevolence unique to religion: secular charities, food banks, municipal programs, and public agencies also provide shelter, low-cost food, outreach, housing support, and addiction services. So the charitable success of churches is real, and sometimes admirable, but it demonstrates the power of organized community, volunteer labour, and pooled resources more than it demonstrates the truth of any supernatural claim.

Religion as Moral Leadership

Many religious leaders are wonderful people: warm, generous, giving, gentle, and wise. They can motivate others to focus on positive values, inspire acts of kindness, encourage a healthy lifestyle, and even exert political influence as peacemakers or as voices standing up to injustice.

On a small or local scale, a church minister, rabbi, priest, or imam may be a gentle and respected pillar of the community, organizing acts of kindness, comforting people in need, mediating conflicts, and providing counselling.

On a larger scale, some religious leaders have offered real moral leadership on the world stage. Desmond Tutu, the Anglican archbishop from South Africa who helped lead his country peacefully out of the apartheid era, was one of the great moral figures of the late twentieth century. Mother Teresa, a Roman Catholic nun, was beloved for her profound acts of charity. Thich Nhat Hanh, a Vietnamese Zen monk, spread a message of compassion and peace. The Dalai Lama, the spiritual leader of Tibetan Buddhism, has become a global symbol of nonviolence, gentleness, and compassion. Dietrich Bonhoeffer, a German Lutheran pastor, drew on his Christian theology to resist the Nazis, ultimately leading to his execution in 1945. Rabbi Abraham Heschel used his standing as a Jewish theologian to combat racism and support the civil rights movement. Abdul Sattar Edhi, a Pakistani Muslim whose charitable work followed a simple religious ethic of mercy and service, was one of the world's great humanitarians. B.R. Ambedkar, the Indian intellectual leader who helped write India's constitution, used a Buddhist framework later in his life to stand peacefully against caste-based discrimination. Pope Leo XIV, elected in 2025, is emphasizing a theology of peace, while other darker forces in the world use religious language and symbolism to support war. In early 2025, Bishop Mariann Edgar Budde, the Episcopal bishop of Washington, used the moral language of Christianity not to flatter power but to restrain it, calling on political leaders to show mercy toward people living in fear—and she did so as a plea for mercy rather than a denunciation, which is part of why it carried. There are thousands more examples—many people of extraordinary courage and kindness have been religious leaders or devout believers.

Religion & Persecution

There is another layer as well: persecution and trauma. Many individuals and communities have been oppressed because of their religion, sometimes brutally—often by other religious groups, including rival branches of the same tradition. This happened to my own ancestors, most recently in my grandmother's generation near the beginning of the Soviet era. There were experiences of fear and brutality that she could never speak about for the rest of her life. Trauma can cement belief—or at least cement loyalty to the people, symbols, and stories associated with survival.

Mind you, people who questioned the religious beliefs of their time have often been persecuted and executed through the ages. The point is simply that fear—whether fear of outside violence, or fear of internal exclusion—can make belief feel like survival.

Religion, Stigma, and Politics

Finally, we should acknowledge the stigma surrounding the word "secular." To many ears, it evokes coldness: a painting devoid of colour, music devoid of emotion. It can evoke memories of totalitarian states that suppressed religion. Some people equate secularism or atheism with nihilism, criminality, or a lack of moral grounding. Many believers sincerely think that without God there would be moral decay. People who are religious benefit from its association with moral stability, regardless of whether the association is valid.

Politics amplifies this. In many contexts, public piety is rewarded, and some leaders clearly perform religiosity to secure loyalty. This is a cross-partisan and cross-cultural phenomenon: politicians of many faiths and parties learn to display the symbols of belief—a visit to a church, a mosque, or a temple, a well-timed scriptural quotation, a Bible held up for the cameras—because the gesture rallies the faithful regardless of how the leader actually lives. So it is politically beneficial to appear religious.

All of this is why critique of religion, to be intellectually honest, must begin with an accounting of religion's benefits: the attachment, the community, the rituals, the moral vocabulary, the beauty, the refuge, the saintly leaders, the buffering against death. These are good things, even when the supernatural claims do not align with the evidence. The political advantages of religiosity are also understandable. Understanding these benefits is not a concession. It is the only way to explain why religion persists, and why leaving it can feel less like changing one's mind than losing a world.  

References

Atran, S. (2010). Talking to the enemy: Faith, brotherhood, and the (un)making of terrorists. HarperCollins.

A field-based study of what binds people to sacred causes, drawing on interviews with militants and on the "devoted actor" framework. It argues that commitment to extremist groups arises less from doctrine than from small-group loyalty, kinship-like bonds, and identity—shedding light on the broader human tendency for belonging and belief to fuse so tightly that abandoning the belief feels like abandoning the self.

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. Harper & Row.

The foundational work on "flow," the state of deep, self-forgetful absorption. It supplies the psychological vocabulary for the absorbed, joyful states people often experience during collective worship, prayer, and music—states that are genuinely beneficial regardless of how they are interpreted.

Hamid, N., Pretus, C., Atran, S., Crockett, M. J., Ginges, J., Sheikh, H., Tobeña, A., Carmona, S., Gómez, A., Davis, R., & Vilarroya, O. (2019). Neuroimaging 'will to fight' for sacred values: An empirical case study with supporters of an Al Qaeda associate. Royal Society Open Science, 6(6), 181585. https://doi.org/10.1098/rsos.181585

An fMRI study of men sympathetic to a radical Islamist cause in Barcelona, examining the brain basis of willingness to fight and die for "sacred" values. When participants contemplated sacrifice for values they held sacred, activity fell in prefrontal and parietal regions associated with cost-benefit calculation—suggesting such commitments are processed as non-negotiable duties rather than weighed as trade-offs. Willingness to fight also shifted once participants saw how their peers rated the same values, underscoring the role of social influence in hardening commitment. When identity and belief fuse, the ordinary machinery of cost and consequence is bypassed.

Inzlicht, M., McGregor, I., Hirsh, J. B., & Nash, K. (2009). Neural markers of religious conviction. Psychological Science, 20(3), 385–392. https://doi.org/10.1111/j.1467-9280.2009.02305.x

An experimental study finding that religious conviction and belief in God were associated with reduced neural responses (in the anterior cingulate cortex) to uncertainty and error. The work supports the idea that religious belief can buffer anxiety and provide a felt sense of certainty and comfort—one of the psychological benefits surveyed here.


Lim, C., & Putnam, R. D. (2010). Religion, social networks, and life satisfaction. American Sociological Review, 75(6), 914–933. https://doi.org/10.1177/0003122410386686

Panel research showing that the life-satisfaction benefits of religion flow primarily through congregational friendships and a shared religious identity rather than through private belief. Directly relevant to the claims that religion functions as community, refuge, and belonging, and that these communal mechanisms—rather than doctrine—account for much of religion's measurable good.


Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, practice. Guilford Press.

A comprehensive scholarly treatment of how people use religion to cope with stress, loss, and mortality. It documents both adaptive and maladaptive forms of religious coping, supporting the account of religion as psychological comfort—particularly in confronting death and grief—while noting that such coping can sometimes function as avoidance.


Penfield, W., & Perot, P. (1963). The brain's record of auditory and visual experience: A final summary and discussion. Brain, 86(4), 595–696. https://doi.org/10.1093/brain/86.4.595

The classic summary of Penfield's findings that electrical stimulation of the temporal lobe can evoke vivid experiential and "dreamy" states. Although Penfield interpreted these as the replay of stored memories, later researchers have argued that many such experiences are partly fabricated or reconstructed—supporting the point that the brain can manufacture feelings of profound significance that are then interpreted in supernatural terms.


Whitehouse, H. (2018). Dying for the group: Towards a general theory of extreme self-sacrifice. Behavioral and Brain Sciences, 41, e192. https://doi.org/10.1017/S0140525X18000249

A theoretical synthesis of "identity fusion"—the visceral sense of oneness with a group that can motivate extreme sacrifice. It provides the precise technical concept behind the observation that when identity and belief become fused, questioning the belief can feel like self-annihilation, helping explain the resilience of tightly bound religious and ideological communities.

 ← Chapter 2 | Contents | Chapter 4 →

The Psychology of Religion, Chapter 2: Mennonite Roots

I was raised a Mennonite. My ancestors belonged to this Protestant denomination—part faith, part ethnic culture—that began in the Netherlands in the 1500s and carried its Low German language (Plautdietsch) and its pacifism across four centuries and two continents to reach me. While similar to other Protestant denominations, Mennonites stood out for their pacifism, and for avoiding participation in war except as medics or to assist refugees.

When I was young, I always admired this stance. Later I saw its harder edge: during World War II, Mennonite conscientious objectors were exempted from combat, most doing hard alternative service instead, while other citizens had to fight and die in a war against genocide. Refusing to fight was a principled stand—but in that particular war, it also meant that others carried the lethal risk. My admiration for Mennonite pacifism survives, but not without reservations.

There was cultural unity among the Mennonites, migrating together for hundreds of years, maintaining their language of origin and other shared traditions. Such cultural unity is admirable, but it carries a genetic cost. Because the whole population descended from a relatively small number of founders, certain rare disease-causing genes that happened to be carried by early members became unusually common in later generations. The result is that some recessive genetic disorders occur more often among these Mennonite groups than in the general population. In other small, insular groups, marriages occur between people more closely related than they appear. Many such marriages are genetically comparable to marriages between third cousins, or even closer relatives than that if the two families are tightly interwoven. In general, there are many advantages to being part of a tightly-knit group, including a religion—but there are also costs, many of which might not be apparent unless you step back for a broader view.  

Many Mennonites migrated east from the Netherlands to maintain cultural and religious freedom, settling as farmers in Ukraine for over 100 years. Eventually, most relocated again—under the trauma and duress of war and persecution—to various regions in North America, such as southern Manitoba. Some Mennonite subgroups adopted practices comparable to the Amish, while most others became quite mainstream Protestant denominations, often leaning toward conservatism or fundamentalism, though some became more liberal or progressive. The branch my family was most recently part of was comparable to other mainstream modern Protestant denominations. As with many families, the culture of my family over many centuries has been shaped by its religious involvement. Faith traditions carried within a family become woven into its history, culture, and values. Much of this history is something to feel proud of.

During my childhood, we attended church frequently. For the most part, these were positive experiences. One virtue of weekly church attendance is the opportunity for moral reflection. Sermons contained messages about dealing with difficult issues or about being a better person. Some sermons appealed more to the intellectual side of the audience, with references to academic theologians or philosophers; others would appeal to the more emotional or sentimental side. Many contained moments of gentle humour or playfulness, and many deliberately reached out to children. Sermons were based on Bible passages, many of which were good foundations for moral reflection and also had a poetic quality. Members of the congregation would participate in the services, often volunteering to read the Bible passage aloud. I was frequently moved by stories about Jesus—a gentle, loving, humble, heroic figure who changed lives not through superhuman strength or military prowess, but through wisdom, love, and self-sacrifice.

The congregation was always reminded to care for members who had experienced recent loss or illness, or to celebrate those who had experienced a recent joy, such as a marriage or birth. In some church services, perhaps during prayer or music, some people would become deeply absorbed, in a joyful, flow-like state. This kind of regular experience can be profoundly healthy: it offers structured moral reflection with an attitude of gratitude, service, and reverence, held within a loving and supportive community. It encourages people to be aware of, and involved in, the joys and travails of other people's lives.

However, this format favoured people who could tolerate long stretches of stillness and conformity. For children with ADHD traits, learning differences, restlessness, or physical discomfort, many services would have felt stifling. I remember children who were often scolded simply for being unable to sit still. I suspect this is one reason why some modern evangelical churches—which put on a more exciting and emotionally dynamic show, with charismatic preachers, rock bands, and other performers—have proven so appealing, especially to the younger generation. The form, as much as the content, is what draws people in.

I also attended a religious high school, with significant exposure to daily religious practice and education. Once again, this was quite positive, since the teachers were for the most part kind, thoughtful people. The motivation of most of this education was to help students grow in kindness, morality, and ethical leadership while being conscious of important local and global issues. However, I also noted that the frequency of bullying, conduct problems, and social ostracism among students was not much different from what one would find in a public secular high school. Alongside educational content in religion, there were meaningful, enjoyable, and comforting practices almost every day, such as choral singing, "chapel time," and opportunities for community volunteering. I only noticed major gaps in parts of the science and social studies curriculum years later.

At times my family went to a fundamentalist Christian camp in Minnesota for a summer holiday. I have fond memories of our camper trailer, being out in nature, camp songs, and friendly people. One family there had a wonderful little dog that I loved. I was excited about the use of tambourines by the musicians. People were engrossed by charismatic preachers and energetic sermons every day; many were in an almost trancelike state of excitement or passion fuelled by group energy, music, and prayer. Some people were baptized in the lake; for many, this was emotionally moving and transformative ("Born Again"), accompanied by tears of joy.

In my young adult life, I also appreciated the philosophical contributions of many religious thinkers. C.S. Lewis was a favourite (following a pleasant introduction during my early childhood, reading his children's books aloud with my mother), as were Kierkegaard and Bonhoeffer. In my final undergraduate year, I took a course covering historical theology and its manifestations through art and literature, looking at Western religious themes through the ages. The course fit me: it brought philosophy, art, literature, and history together, and taught me to see religion as part of the whole history of Western thought, not just a set of doctrines to accept or reject.

Prayer and other symbolic actions can have a peaceful, meditative quality which is psychologically beneficial. It can be comforting to know that someone is praying for your well-being, and it can feel meaningful to pray for someone else's well-being. Prayer's comfort, though, seems to lie in the act and the attention rather than in any external answer. The largest and most rigorous trial of intercessory prayer—Benson's 2006 STEP study of more than eighteen hundred cardiac bypass patients, funded, fittingly, by a foundation devoted to reconciling science and religion—found no benefit; patients who were told with certainty that strangers were praying for them actually fared slightly worse.

I have always liked being inside many churches—their architecture, their acoustics, and their association with calm, comfort, safety, and transcendence. Church buildings in much of the world have historically been architectural gems in the middle of communities, sometimes the most visible or distinctive physical feature of the neighbourhood.

I did not arrive at my current views through any bitterness or wound. My childhood faith was, on the whole, a gift. That is exactly why the subject deserves care. A thing can be false in its literal claims and still be bound up with music, family, moral aspiration, and memory—and when we criticize religion, we are often touching those things too.


References

Benson, H., Dusek, J. A., Sherwood, J. B., Lam, P., Bethea, C. F., Carpenter, W., Levitsky, S., Hill, P. C., Clem, D. W., Jr., Jain, M. K., Drumel, D., Kopecky, S. L., Mueller, P. S., Marek, D., Rollins, S., & Hibberd, P. L. (2006). Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal, 151(4), 934–942. https://doi.org/10.1016/j.ahj.2005.05.028

The largest and most methodologically rigorous randomized trial of intercessory prayer conducted to date. A total of 1,802 coronary artery bypass patients at six US hospitals were assigned to three groups: prayed for (but uncertain), not prayed for (and uncertain), and prayed for (and told so with certainty). Among the uncertain groups, complication rates were essentially identical (52% versus 51%), indicating no benefit of prayer. Patients who were certain they were being prayed for had a higher complication rate (59%). The study was funded by the John Templeton Foundation, an organization devoted to research bridging science and religion. It is frequently cited as decisive evidence against the medical efficacy of distant intercessory prayer.

Orton, N. C., Innes, A. M., Chudley, A. E., & Bech-Hansen, N. T. (2008). Unique disease heritage of the Dutch-German Mennonite population. American Journal of Medical Genetics Part A, 146A, 1072–1087. https://pubmed.ncbi.nlm.nih.gov/18348259

A review devoted specifically to the Dutch-German (Russian) Mennonite line — the branch that migrated from the Netherlands through Prussia and Russia to the Americas. It catalogues the founder disorders characteristic of this population, which differ substantially from those of the Old Order "Plain" Mennonites of Pennsylvania, and traces them to the small size of the founding group.

Sosis, R., & Alcorta, C. (2003). Signaling, solidarity, and the sacred: The evolution of religious behavior. Evolutionary Anthropology, 12(6), 264–274. https://doi.org/10.1002/evan.10120

A review of the evolutionary "costly signaling" theory of religion, relevant here to the practices of baptism, public conversion, and demanding camp rituals described in this chapter. Costly or hard-to-fake displays of commitment—emotional public baptism, sustained collective worship—function to build trust and cohesion within a religious community, which helps explain why such moments feel so powerful to participants.

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. Harper & Row.

The foundational work on "flow," the deeply absorbed, self-forgetful state of optimal engagement. It provides the psychological vocabulary for the "joyful, flow-like state" observed during collective prayer and music in worship; such absorbed states are genuinely beneficial regardless of their theological framing.

Newberg, A., & d'Aquili, E. (2001). Why God won't go away: Brain science and the biology of belief. Ballantine Books.

An accessible account of the neuroscience of religious and meditative experience, including neuroimaging of prayer and meditation. Relevant to the chapter's observation that prayer and ritual can produce meditative, peaceful states with measurable psychological and physiological correlates—independent of any supernatural cause.

 ← Chapter 1 | Contents | Chapter 3 →

The Psychology of Religion, Chapter 1: Introduction

Religion has been woven through my life from the beginning—Mennonite ancestors, a gentle church-going childhood, and a religious high school. Yet as I learned more about science, nature, and humanity, I moved away from the religious ideas I internalized in childhood. While spiritual traditions can be psychologically rich and culturally beautiful, I came—reluctantly at first—to the conclusion that their literal supernatural claims are not true. And despite their capacity for building community and moral leadership, religions have also caused profound harm to both individuals and society. The chapters that follow move from my personal history, to the psychology of belief, to what science teaches us about our origins, to the social harms of dogma, and to how we might preserve what is best in religion.

Growing up, I was drawn to many attractive features of religious life: the warmth of a "church family," an altruistic focus on service, and ideals—love, justice, forgiveness—personified in a gentle, loving deity. Choral music, camp songs, and the ready-made social world of youth groups offered instant belonging.

And religion is not the only home for such longings: for many whose faith lies outside organized religion, magical or mystical beliefs—fate, spirits, psychic phenomena, "the universe"—can create a feeling of specialness and awe. They suggest that hidden powers might be guiding us through an often confusing and unjust world.

In this book, I aim to balance deep respect for the ways faith offers community, moral reflection, and "nonspecific" therapeutic factors—ritual, belonging, comfort, empathic attention—with a critique of dogma. Religion becomes harmful when sacred narratives are treated as facts or as rigid moral law. I have no wish to mock the faithful—many of whom I love. I want to think these matters through honestly, with the same compassion I would hope to receive in return.

Religious belief thrives on the same psychological mechanisms that make us vulnerable to misinformation or propaganda: above all, the primal pull of group allegiance. Our beliefs grow roots that interweave with our social identities. The belief system becomes a costly emblem of tribal loyalty, pushing us to selectively seek confirmatory evidence and to discount or avoid evidence to the contrary. This loyalty offers many benefits—friendship, structure, material support, and safety—but at the price of intellectual narrowness. None of this is uniquely religious; it is an ordinary human tendency that religion can intensify and sanctify.

In fundamentalist communities of every tradition, the same structures that create warmth and solidarity can harden into exclusion. The conviction that one's group possesses divinely mandated truth creates pressure to treat other traditions as inferior—a recipe for arrogance that makes it harder to learn, with humility, from other cultures.

Drawing on evolutionary biology, neuroscience, history, and my clinical experience as a psychiatrist, I explore why people so readily defend spiritual beliefs and how such beliefs can both heal and wound. Understanding the natural world—from evolution to astrophysics to the brain—does not have to leave us nihilistic; I think an appreciation of science deepens our humanity. We can preserve the best ethical and communal aspects of religion without accepting its myths as literal truth.

Faith is deeply shaped by identity, and this process develops over a lifetime; accepting evidence that challenges this identity can feel like betraying one's community. So it can be tempting to stick to the status quo within one's faith system. Yet questioning dogma can lead to a better life, for individuals and groups alike. Ironically, some of the greatest wisdom in sacred texts invites us to reflect humbly upon our blind spots, and to transform ourselves for the greater good.

When I think of the two most inspiring mentors during my professional training, I see that they were equally helpful to their patients. Their style had some similarities: for example, they were both warm, kind, dedicated, and thoughtful. But the two of them had very different belief systems, and I am sure each would have insisted that the other was mistaken. What heals, in the end, is mostly the scaffolding people have in common, not the doctrine that divides them. I will try to convince you that religion works the same way: its benefits flow not from the truth of its supernatural claims, but from the gentle scaffolding—belonging, ritual, comfort, attention—that does its work whenever people gather to care for each other.  

References

Allport, G. W., & Ross, J. M. (1967). Personal religious orientation and prejudice. Journal of Personality and Social Psychology, 5(4), 432–443. https://doi.org/10.1037/h0021212

The classic study introducing the distinction between intrinsic religiosity (faith held as an end in itself) and extrinsic religiosity (faith used as a means to belonging, comfort, or status). Extrinsically religious churchgoers showed more racial prejudice than intrinsically religious ones. The paper remains foundational for understanding how the same religious institutions can house both tolerance and bigotry.

Hall, D. L., Matz, D. C., & Wood, W. (2010). Why don't we practice what we preach? A meta-analytic review of religious racism. Personality and Social Psychology Review, 14(1), 126–139. https://doi.org/10.1177/1088868309352179

A meta-analysis of American studies conducted since the Civil Rights Act, examining the relationship between religiosity and racial prejudice. Strong religious in-group identity was associated with derogation of racial out-groups, and religious racism was tied to underlying values of social conformity and respect for tradition. By contrast, religiosity motivated by humanitarian values was associated with racial tolerance. The findings suggest that in-group, conformity-based varieties of religious involvement—rather than faith as such—drive the association with prejudice.

Kunda, Z. (1990). The case for motivated reasoning. Psychological Bulletin, 108(3), 480–498. https://doi.org/10.1037/0033-2909.108.3.480

The foundational review of motivated reasoning: people tend to arrive at the conclusions they want to reach, constrained mainly by their ability to construct seemingly reasonable justifications for them. This mechanism helps explain how belief systems of all kinds—religious, political, or otherwise—are maintained in the face of contrary evidence.

Lim, C., & Putnam, R. D. (2010). Religion, social networks, and life satisfaction. American Sociological Review, 75(6), 914–933. https://doi.org/10.1177/0003122410386686

Using panel data, this study found that religious people report higher life satisfaction primarily because they attend services and build friendships within their congregations; the benefit of congregational friendship depended on the presence of a strong religious identity. Private or subjective aspects of religiosity, such as belief itself, showed little independent effect once attendance and congregational friendship were taken into account. Notably, frequent attenders with no friends in their congregation reported lower life satisfaction than others. The well-being benefits of religion appear to flow mainly through community and belonging rather than through doctrine.

Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology, 2(2), 175–220. https://doi.org/10.1037/1089-2680.2.2.175

An encyclopedic review of confirmation bias—the tendency to seek, interpret, and remember information in ways that support pre-existing beliefs—documented across science, medicine, law, and everyday judgment. The review establishes confirmation bias as a human universal rather than a flaw of any particular group or worldview.

Norenzayan, A. (2013). Big Gods: How religion transformed cooperation and conflict. Princeton University Press.

A book-length argument that belief in "Big Gods"—moralizing, omniscient, punitive deities—helped human societies scale cooperation beyond small face-to-face groups, by making people feel watched and accountable even among strangers. One of the strongest scholarly cases that religion played a constructive role in building large, complex societies.

Sosis, R., & Alcorta, C. (2003). Signaling, solidarity, and the sacred: The evolution of religious behavior. Evolutionary Anthropology, 12(6), 264–274. https://doi.org/10.1002/evan.10120

A review of the evolutionary "costly signaling" theory of religion: demanding rituals, taboos, and sacrifices function as hard-to-fake signals of commitment and loyalty to a group and its moral code. Because costly displays are difficult to counterfeit, they promote trust and cooperation among believers—helping to explain why religions so often require sacrifice from their members, and why those requirements strengthen rather than weaken group bonds.

Sosis, R., & Bressler, E. R. (2003). Cooperation and commune longevity: A test of the costly signaling theory of religion. Cross-Cultural Research, 37(2), 211–239. https://doi.org/10.1177/1069397103037002003

An empirical test of costly signaling theory using historical data on eighty-three nineteenth-century American communes. Communes that imposed costlier requirements on their members survived longer, and costliness interacted with religiosity in promoting cooperation. Sacrifice appears to be functional: it binds groups together and improves their durability.

Van Bavel, J. J., & Pereira, A. (2018). The partisan brain: An identity-based model of political belief. Trends in Cognitive Sciences, 22(3), 213–224. https://doi.org/10.1016/j.tics.2018.01.004

A review proposing an identity-based model of belief, showing how identification with a group can bias information processing—altering reasoning, memory, implicit evaluation, and even perception—such that people may place group loyalty above accuracy, and even above truth. Although focused on political partisanship, the model describes general mechanisms of identity-protective cognition that apply equally well to religious belief.

Contents | Chapter 2 →

Reflections on Pandemic Management

During the pandemic I wrote a lot, in terms of analysis and encouragement of public health measures.  Some of my contributions were on this Blog, others were on Twitter.  To this day, I think that the measures taken to manage the pandemic were for the most part necessary and successful, for example restricted activity, masking, and vaccine policy.  

The COVID vaccines in particular have been one of the great achievements in the history of medicine.  

But here are some ideas about ways I think it could have been done better: in sharing this I know I run the risk of dabbling into territory that many would consider outside my lane of expertise.  That was a constant frustration for public health experts during the pandemic.  

However, I was conscious all the way through the pandemic that we did not adequately use the most powerful tool available in science and medicine to evaluate the effectiveness and optimize the efficiency of an intervention: the Randomized Controlled Trial.   

And also in dealing with people who were extremely resistant to adopting mandated restrictions or vaccines, there could have been a way to manage this situation that would have helped rapidly gather much better data about COVID itself, protect the population, while also appeasing people who did not want to get vaccinated or follow restrictions.  

Randomized Controlled Studies (or "Randomized Controlled Trials -- RCTs") 

There were many RCTs during the pandemic, but in my opinion there could have been much more done here, in almost every stage, and there could have been massive public investment to get this done, which subsequently could have saved billions of dollars of economic loss, in addition to saving lives.  

For example, it was very clear from basic science knowledge that masking was valuable to reduce viral contagion.  When some people raised the idea of doing more RCTs on masking, it was met with some resistance, as though we were wasting everyone's time in a dangerous way.  Some used a comparison with doing an RCT of using parachutes when jumping out of an airplane -- obviously this would be recklessly inappropriate, and the entire placebo group would die!  Masks, like parachutes, are obviously effective, and mask proponents made a reasonable case that randomizing people such that a placebo group would not get masks would be needlessly dangerous.  But an RCT does not require that there be a "placebo" wing!  It only requires that the study be randomized to compare one treatment with another.  To follow the parachute analogy, it could be to randomize people jumping out of an airplane to receive one of two different types of parachutes, each of which an accepted standard; or for them to use two different timings for releasing parachutes, if each of these was also within an accepted standard.   

In the case of masks, there could have been RCTs of using different types of masks (e.g. procedure vs. N95), different timings of masking (indoor only vs continuous outside the home), or different replacement times for masks (e.g. re-using N95 masks for days vs replacing them every use), or different N95 use details (e.g. receiving formal instruction on technique vs. not).  And early in the pandemic there was an N95 shortage.  One of the ways to deal with this could have been to randomly distribute the timing of the N95 supply, so that some entire communities would receive an adequate supply first.  Then the entire community would use N95s while adjacent communities would temporarily make do with other types of masks.  Then the disease prevalence rates and hospital admission rates could have been compared between adjacent communities.  This type of design could have been tremendously valuable, since mask use has not only an individual benefit for infection control, but has a collective impact, akin mathematically to the effect of vaccines -- if everyone in the population has a modestly reduced probability of infection, then it could translate to a massive reduction in community prevalence.  If such a study had shown reduced infection and hospitalization rates in the better masked areas, it could have propelled a much more urgent and timely effort to manufacture better masks for everyone, and in the medium term the whole community could have had better access to N95s, saving thousands of lives.   But since such studies were lacking, there was enough doubt about mask effectiveness or effect size to delay the massive investment needed to increase mask production.  

When RCTs are done, it does not settle questions once and for all: in good science, we are always repeating, tweaking, and refining.  New RCTs would have to be done after the first ones, with different details being looked at, or simply for replication.  

One type of mask use behaviour which should have been better guided by evidence, is the use of masks outdoors.  I still see many people outside with their masks, or people wearing them in their cars on the way to work.  It was pretty clear from the ventilation evidence that outdoor mask use was very likely unnecessary, unless one were in very close proximity to crowds, or doing a lot of talking up close.  Perhaps masks would still be needed in playgrounds etc. but certainly not for walks at the beach alone or with just a few people close to you.  

Similarly, RCTs could have been done on ventilation control in buildings.  The basic science on ventilation was one of the most important and underappreciated areas of science during the pandemic.  There was a wonderful group of engineers who had done great work in this area.  Ventilation improvement was also a totally non-controversial intervention:  regardless of one's views about masks or vaccines or restrictions etc., I think everybody would welcome the idea of having better fresh air inside our homes and workplaces.  Ventilation improvements involved air filtration (such as with HEPA or MERV-13 HVAC filters) but also increased fresh air replacement rates.   But the engineers again used the parachute analogy when there were challenges to do RCTs, arguing that their work was established basic science, which didn't need to be tested in an RCT.  But once again, if RCTs had been done, of whole communities which made ventilation improvements, vs communities which did not, we could have much more quickly found a "signal" of improved infection control, and then made much more rapid investments in ventilation improvement technology for everyone.  

In all of these studies, the data to gather should always have been not only rates of infection, but also most importantly rates of severe disease.  Some interventions such as masks arguably could cause a reduction in infection rate, but perhaps in cases of people getting infected despite mask use, they would have inhaled a smaller inoculum, and possibly could subsequently have developed milder disease, since the immune system would have had a little bit more time to respond to the virus before getting overwhelmed.  The question of whether inoculum size impacts disease severity is yet another one which I don't think is well-enough answered by the research.  

The Covid Hotel 

The "COVID hotel" idea was something I proposed early on as a thought experiment at the very least, and there was at least one other scientist in the US who shared this idea as well... but it was received very coldly by experts--when I gently suggested it I got the sense that they thought it was scandalously inappropriate or unethical.  But this idea could have saved thousands of lives, and could have helped gather optimized, crystal-clear data about COVID in terms of the mechanism of transmission, the effectiveness of masks, the impact of ventilation, etc.  This information could have been obtained within a few months, and then could have helped focus optimal interventions with much better clarity and urgency, and to mobilize public investments in such things as masks etc. much sooner.   

Here's the idea: if people refused to be vaccinated, or insisted on having unrestricted freedoms, instead of punishing them using the justice system, they could instead opt to check into a "covid hotel" in which they would choose, with informed consent about risks, to be deliberately infected with COVID under controlled conditions, with optimal medical support available.  Then they would stay in the hotel for a few weeks under quarantine until they were no longer infectious.  Upon checking out, they would have a much lower risk of spreading COVID--the risk would be comparable to a person who had been vaccinated.  In this environment, there could be meticulously controlled experiments to determine if COVID could be transmitted through an airborne route (perhaps all the time, perhaps only in some cases of "superspreaders" etc.), or through a surface contamination route (after all this time, it is not crystal clear that surface contamination was ever a major route of spread).  And there could have been masking studies in this environment to determine if masks (including styles of mask usage and mask type such as N95 vs procedure masks, as well as the proportion of people wearing masks,  etc.) reduced the likelihood of contagion, or reduced the ensuing severity of disease (since the masks even if they didn't prevent infection might at least reduce the inoculum size).  Similarly there could have been meticulous ventilation control studies, to see if improved ventilation reduced contagion.  

In this environment, participants could even be offered to choose modalities of treatment of their choice, delivered by their practitioner of choice. They could try the "alternative treatments" in vogue if they wished, or opt for standard medical care.  This way, there could have been much more rapid evidence to establish the impact of these alternative treatments (all of these alternative remedies have been utterly disproven, but this could have happened much more quickly and persuasively in the "COVID hotel" environment).  

Some of the benefits of this idea would have been much, much better quality data about mask effectiveness, mode of contagion, effectiveness of ventilation improvement, etc.  And there would have been much less spreading of COVID to vulnerable people by people who refused to adhere to public health guidelines.  And there would have been much less upset from people who wanted more freedoms.  In fact these people, instead of being vilified, could have felt like true heroes, even from a scientific point of view.  The cost of this, of course, would have been that people who chose the "COVID hotel" route would have been much more likely to die, or to have severe long-term consequences of COVID.  But this would have been their choice, and if they didn't check into the COVID hotel, they would have subjected themselves to the same risk in the community, with less medical support and therefore an even higher likelihood of medical harm, and all the while they would have spread COVID to many more people, without contributing anything useful to the world's knowledge about the disease.   There are many other examples in life of people who are willing do risky activities, following informed consent: for example, joining the military, the fire department, or doing risky sports such as hang gliding.  

Animal Studies

There were animal studies during COVID.  It's a sensitive topic, since it is important to respect the rights of animals.  But COVID affected the animal world as well, and the research about contagion would have led to benefit for not only human populations but animals as well.  One very particular type of animal study that was never done well enough was to use an animal model to demonstrate spreading modality.  For example, the ventilation outflow from hospital rooms with human COVID patients could have been pumped into an animal enclosure of susceptible animals.  If these animals developed COVID it would have been tremendously strong evidence for airborne transmission in humans.  If, in a follow-up experiment, the same ventilation pipe passed through a HEPA filter first, and then into the animal enclosure, and if these animals did not contract COVID, it would have been incredibly powerful evidence that a simple filtration technique could prevent contagion.   If animals were simply allowed to visit hospital rooms where COVID patients had spent a few days, but who had left, and where the air in these rooms had been replaced using ventilation, then it could have helped determine if surface contamination unequivocally could cause COVID spreading.  It is quite possible that surface spreading was never a major problem, while airborne spreading was a huge problem, hence efforts would have been directed towards ventilation rather than as much surface cleaning.  But we would have needed the research to prove this.  

Vaccine / Restriction Timing

Restrictions were deployed in the pandemic quite wisely, particularly with a view to prevent the nightmare of ICU and hospitalization overflow.  For some individuals, going beyond mandates, they voluntarily maintained restrictions for months or years following vaccination.  One interesting study issue could have been to randomize people to maintain strict restrictions after vaccination for a long period of time, vs. ending restrictions for those people starting about 4 weeks after each vaccination.  This would have caused the unrestricted individuals to have greater exposure to ambient circulating COVID strains, but this would have occurred in the context of good immunity.  As the vaccine strains kept changing, the vaccinated people would continue having new exposures with new strains, and especially as 3-6 months passed after their vaccines, they most likely would have had some mostly mild cases of COVID along the way.  But I wonder if this process would have in the long term led to improved, robust immunity to multiple strains, with the same or lower long-term health risk, while also improving community freedoms, compared to the situation of maintaining continuous long-term restricted behaviour.  In a sense, this idea would suggest that the vaccine and annual boosters would be the primary preventative defense, but then exposures to the ambient COVID strains in the community would subsequently act as "boosters" for previously vaccinated people, and in the long term (measured over 3-5 years or more) lead to equivalent or better health outcomes, with fewer restrictions needed.  Conversely, the studies might instead show that maintaining more restrictions over the longer term would have led to better long-term outcomes.  We can't know for sure, since the studies were never done.

Unfortunately, in the aftermath of the pandemic, there has been increased polarization in the world about public health measures of all types.  We are seeing decreased rates of vaccination against other diseases, and we are seeing a return of various diseases which had previously been nearly eradicated, such as measles.  Just as with Covid, most people who get these diseases will recover ok, but there will be needless cases of severe disease and death, including among young children.  I hope that the field of public health can work hard on the sociopolitical aspects of their profession as well as the epidemiological parts.  But I also wish that some of the best scientific tools, such as RCTs, could be done much more quickly and on a much larger scale than what we saw during the worst years of COVID.