The Psychology of Religion, Chapter 16: Sacrifice

Most religions have some form of sacrifice woven into their theology. Sometimes this involves literal offerings—killing and burning animals, or destroying valuable objects. Other times it is "bloodless": giving money, time, obedience, or the renunciation of pleasures through fasting, abstinence, or celibacy. In all these cases the underlying idea is the same: something costly is offered up, in the hope of securing meaning, favour, purity, forgiveness, protection, or belonging.

Some sacrificial motifs move disturbingly close to human sacrifice. In the Abrahamic traditions, the willingness of Abraham—Ibrahim—to sacrifice his son is presented as the peak test of obedience. In Islam it is commemorated each year at Eid al-Adha, the "Festival of Sacrifice," where the animal offering serves as a memorial of that story. And in Christianity the theme is carried into the central story of Jesus—a dramatic reframing of sacrifice into self-sacrifice, offered "for others."

These stories share a hidden architecture: substitution. The ram caught in the thicket dies in Isaac's place; the Levitical scapegoat is loaded with the community's sins and driven into the wilderness to carry them away; and Christianity universalizes the logic completely, casting Jesus as the "Lamb of God" whose single sacrifice is meant to end the need for any further sacrifice at all. Much of the moral force of sacrifice lives here—in the idea that suffering can be transferred, that one life or one death can be made to stand in for another.

Across much of the ancient world, sacrificial traditions were common, and often brutal. Ancient Greek religion had animal sacrifice. Vedic religion in India revolved around yajña, the sacrificial fire ritual. Ancient China had elaborate sacrificial practices directed toward ancestors and higher powers, sometimes involving animals and—as the royal tombs at Anyang attest, on a large scale—human beings. The Aztecs are especially notorious for human sacrifice; the numbers reported by their Spanish conquerors were very likely inflated, but archaeology at the Templo Mayor has confirmed that the practice itself was real and substantial.

Why would an all-powerful deity, especially one associated with the highest moral standards, want a dead animal or a burnt work of art as a gift? One might think a god worth revering would count it a gift if you helped other people or cared for the natural world, rather than destroyed objects or killed living things. But sacrificial systems do not usually work that way.

This objection is not a modern or anti-religious invention; the traditions raised it against themselves long ago. The Hebrew prophets are scathing on exactly this point: "I desire mercy, not sacrifice," says Hosea; Micah asks whether the Lord wants "thousands of rams," or rather that one do justice and love mercy; Amos has God declare that he despises the festival offerings and demands instead that "justice roll down like waters." Socrates presses the same nerve in Plato's Euthyphro, mocking the notion of piety as a kind of commercial exchange with the gods—a trading relationship in which the right offering buys favour. The most humane corrections to religion have often come from inside it, and the critique of sacrifice is a striking early example.

Reciprocity, Magical Thinking, and Social Technology

Sacrifice is, in my view, an extension of ordinary human ideas about reciprocity and gratitude—infused with magical thinking. In a community we do favours, give gifts, and care for one another; these behaviours can be altruistic, but they are also held in place by norms of reciprocity. If one believes that a mystical power controls destiny, fertility, weather, health, wealth, or victory in war, it becomes psychologically "reasonable," within that worldview, to give that power a gift—and to hope for a return.

And once a person enters this mindset, the logic can become self-sealing. If you make a sacrifice and misfortune still comes, you can conclude the offering was not large enough, or not sincere enough, or not given with the right purity of heart—so next time you must give more. If something good happens afterward, it feels like proof that the sacrifice worked, and should be repeated. There is no result that can disconfirm the practice; every outcome feeds it. In this way sacrifice can escalate into something brutal and destructive—and the sacrificed animals, often the most vulnerable and least able to "consent" to the human story being told about them, get no say in the matter.

Another motivation for sacrifice likely came from the grim necessities of ancient life: hunting, or killing domestic animals for food. Most humans bond to animals easily, and it is troubling to watch an animal struggle and suffer. Ritual can function as a kind of moral anaesthetic—a way to consecrate violence, assuage guilt, and turn a hard necessity into a story of gratitude, order, and meaning.

Two scholars loom over any modern account of sacrifice, and it is worth setting these intuitions against theirs. Walter Burkert, in Homo Necans, argued that Greek sacrificial ritual grew out of the guilt and anxiety of the Palaeolithic hunt—that the solemn choreography around the killing is, at bottom, a way of managing the unease of taking life. That is close to the "moral anaesthetic" idea. René Girard, in Violence and the Sacred, proposed something darker: that sacrifice channels the contagious, escalating violence of a community onto a substitute victim—a scapegoat—whose death discharges the tension and restores peace, after which the victim is often made sacred. One need not accept either theory wholesale to notice that both converge with the argument here: sacrifice is a technology for metabolizing the violence and anxiety that group life generates.

Sacrifice can also be political performance. Public ritual consolidates hierarchy—especially priestly hierarchy—displays power, intensifies fear, and signals unity. It makes shared belief visible and costly. It puts loyalty on display: it shows who is serious, who is obedient, who can be trusted, and who has the authority to declare what counts as holy.

This is also where sacrifice connects to group psychology. The anthropologist Richard Sosis has argued that costly rituals—the things you would not do unless you were genuinely committed—work as hard-to-fake signals that strengthen trust and cooperation within a group, partly by screening out free riders. A community bound together by shared sacrifice can feel safer, warmer, and more morally serious to its members. But the same mechanism can harden boundaries and deepen suspicion of outsiders.

And costly sacrifice does not only send a signal to other people; it also works on the person making it. As we saw earlier with initiation, people are deeply reluctant to admit they have suffered for nothing. So the greater the sacrifice, the stronger the pressure to reinterpret the suffering as meaningful, noble, or necessary. That is what makes sacrificial systems self-protective: the cost itself becomes part of the "evidence" that the belief must matter.

Which raises a deeper question. Sacrifice is only the most vivid of a whole set of shared, costly markers—shared dress, shared food, shared song, shared taboo—and all of them seem to produce the same effect: they make strangers feel like family. But why should a shared ritual generate the feeling of kinship at all? To answer that, we have to look at something far older than any religion: the machinery by which living things came to favour their own kind in the first place.

Kin Altruism

Reciprocity has a deeper and older root than social custom. There is a strongly selected tendency to favour and help genetic relatives, sometimes even at real cost to oneself. The logic was formalized in 1964 by W. D. Hamilton: a gene that inclines an individual to help close relatives can spread down the generations, because those relatives are disproportionately likely to carry the very same gene. Hamilton's rule states the condition precisely—an allele prompting costly help toward kin can spread when the benefit to those relatives, weighted by the probability that they share the allele, outweighs the cost to the helper, even when that cost is steep.

But humans do not walk around calculating degrees of genetic relatedness. Instead we rely on crude, fast cues—ones that, over most of human history, were reasonably well correlated with kinship. People who live near one another, marry one another, and raise children together will, over generations, tend to share not only genes but language, accent, customs, dress, habits, and norms. On average, they will also tend to resemble one another physically more than they resemble people from a distant village or lineage. Conversely, people who look different, speak differently, or keep very different customs were, historically, more often from a different family network—and so, on average, somewhat less closely related.

Similarity of appearance, familiarity of accent, shared habits, shared rituals, shared dress, shared taboos—all of these can become proxies, very imperfect proxies, for "one of us." And religion supplies them in abundance: common dress, common restrictions, common foods, common sacrifices, common songs, common stories, common enemies. In effect, it manufactures the feeling of kinship among people who are not literally kin.

A caution is in order, because the step from "looks different" to "treated as an enemy" is looser than it first appears. In a well-known set of experiments, Robert Kurzban, John Tooby, and Leda Cosmides found that the mind does not seem to track race, or physical similarity, as a fundamental category at all; what it tracks is coalition—who is allied with whom. Subjects' tendency to sort others by race dropped sharply, within minutes, once they were given a more salient cue to who was on which team. If that is right, then physical appearance is encoded only insofar as it has historically predicted alliance, and it can be overwritten when a better predictor comes along. This does not weaken the argument so much as relocate it: religion's real power is that it floods the mind with vivid, durable coalition markers—shared dress, shared rites, shared sacrifice—and so recruits a coalitional psychology far older and deeper than any doctrine.

The mind appears to have evolved to be slightly more generous, trusting, and self-sacrificing toward those who are more likely to be "one of us," and correspondingly less generous, more wary, or more distant toward those who feel like "not us." These tendencies are not destiny, and they are not moral justification—but they do appear to be among the psychological and evolutionary foundations of prejudice. They are precisely the sort of inherited inclination we have to learn to recognize, question, and actively override.

Belonging and Group Boundaries

Religion can widen the circle of felt family. But it can also sharpen the line between those inside the group and those outside it. Once sacrifice, loyalty, and identity are fused, shared customs take on unusual emotional and moral weight, and group boundaries begin to feel enormously important. The stronger those boundaries, the easier it becomes to view outsiders with suspicion, distance, or moral distrust. This does not mean religion always produces hostility, or that it does so uniquely—these are broad features of human social psychology, and the willingness to sacrifice for one's own group has been linked, in some evolutionary models, to hostility toward rival groups, the two evolving together. But religion can give the whole pattern a sacred language, a ritual structure, and a heightened sense of seriousness. In that way, stronger religious boundaries can feed exclusion and, in some cases, open hostility between groups. Religion does not invent this psychology—but it can consecrate it.

References

Aronson, E., & Mills, J. (1959). The effect of severity of initiation on liking for a group. The Journal of Abnormal and Social Psychology, 59(2), 177–181. https://doi.org/10.1037/h0047195

The classic effort-justification experiment: people who underwent a more embarrassing initiation in order to join a group afterward rated the group more highly, not less. The result has been replicated many times and is counterintuitive—the steeper the price of entry, the greater the reported attachment.  The cost of a sacrifice tends to deepen commitment to the belief it serves rather than weaken it.

Burkert, W. (1983). Homo necans: The anthropology of ancient Greek sacrificial ritual and myth (P. Bing, Trans.). University of California Press. (Original work published 1972)

A foundational anthropological account tracing Greek sacrificial ritual to the guilt and anxiety of Palaeolithic hunting, and reading the solemn choreography of the kill as a way of managing the unease of taking life. Burkert treats sacrifice as something humans developed to live with violence rather than to celebrate it. 

Choi, J.-K., & Bowles, S. (2007). The coevolution of parochial altruism and war. Science, 318(5850), 636–640. https://doi.org/10.1126/science.1144237

A formal evolutionary model showing how in-group self-sacrifice ("altruism") and hostility toward out-groups ("parochialism") can evolve together, each making the other adaptive: groups with altruistic warriors outcompete groups without them. The authors argue the two traits are not opposites but partners. The warmth of belonging and the suspicion of outsiders are two faces of a single mechanism.

Girard, R. (1977). Violence and the sacred (P. Gregory, Trans.). Johns Hopkins University Press. (Original work published 1972)

Advances the "scapegoat" theory of sacrifice: that a community discharges its own escalating, imitative violence onto a substitute victim, whose killing restores order and who is then made sacred. For Girard, the mechanism is largely hidden from the participants, which is part of how it works. 

Hamilton, W. D. (1964). The genetical evolution of social behaviour. I. Journal of Theoretical Biology, 7(1), 1–16. https://doi.org/10.1016/0022-5193(64)90038-4

The founding paper of kin-selection theory, introducing the rule now named for Hamilton: a gene for helping relatives can spread when the benefit to kin, discounted by the degree of relatedness, exceeds the cost to the helper. It gave a precise mathematical basis for the evolution of self-sacrificial behaviour toward family. 

Kurzban, R., Tooby, J., & Cosmides, L. (2001). Can race be erased? Coalitional computation and social categorization. Proceedings of the National Academy of Sciences, 98(26), 15387–15392. https://doi.org/10.1073/pnas.251541498

Experimental evidence that the mind encodes race not as a primitive category but as a cue to coalition or alliance, such that race-based sorting drops sharply once a competing cue to team membership is made salient. The finding suggests that what looks like an automatic focus on physical difference is really a search for who is allied with whom.  Appearance matters only as a proxy for "us versus them," and can be overwritten.

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 widely cited review of costly-signalling theories of religion, arguing that hard-to-fake ritual commitments stabilize cooperation by screening out free riders—those who would take the benefits of group membership without paying its costs. The more expensive the ritual, on this account, the more reliably it identifies the genuinely committed. 

The Binding of Isaac appears in Genesis 22:1–19; the parallel Qur'anic narrative is in Surah as-Saffat (37:99–113), where the son is not named. The prophetic critique of sacrifice is found at Hosea 6:6, Micah 6:6–8, Amos 5:21–24, 1 Samuel 15:22, Psalm 51:16–17, and Isaiah 1:11–17.

Socrates' treatment of piety as a form of exchange with the gods appears in Plato's Euthyphro*, especially at 14e–15a.*

← Chapter 15 | Contents | Chapter 17 →

The Psychology of Religion, Chapter 15: Spirituality & Superstition

Humans have cognitive tendencies that make superstitious beliefs easy to generate—and hard to extinguish. By "spirituality" here I do not mean awe, contemplation, or reverence in a broad sense; I mean the more specific belief that hidden forces—fate, synchronicity, spirits, or nonphysical "energy"—are actively guiding events. Beliefs in spirits, ghosts, magic, luck, or fate are widespread across cultures. The specifics vary wildly—local spirits, protective rituals, sacred objects, gnomes, invisible dangers—but the underlying psychology is similar.

At its root is pattern-seeking. The mind craves meaning, and when the world is uncertain or painful it will often manufacture meaning rather than tolerate ambiguity. This is not a sign of low intelligence; it is ordinary cognition under stress. And it does not stop at pattern. We also read agency into the world, and imagine hidden minds behind ambiguous events. The anthropologist Stewart Guthrie argued that this is the seed of religion itself: we are built to see faces in clouds and a watcher in the rustling grass. If you mistakenly assume that the shadow of a tree branch swaying in the wind is a tiger stalking you, you will still be alive in the morning. But if you mistakenly assume that an actual tiger is just a shadow in the wind, you and your family might not survive the night. A mind tuned that way will find agents everywhere, including where there are none.

That tuning is not learned at church, or from bedtime stories; it comes installed. In a famous 1944 experiment, Fritz Heider and Marianne Simmel showed people a short animation of two triangles and a circle moving around a box, and almost nobody could describe it as geometry: viewers saw chasing, bullying, hiding, rescue—a drama, complete with villain. And the tendency is at work long before language arrives. In a celebrated series of experiments at Yale, infants of six and ten months watched a character with googly eyes struggle to climb a hill while a second character either helped it to the top or shoved it back down; offered the two afterward, the babies overwhelmingly reached for the helper. (Some of this research, deliberating babies included, can be watched in the Netflix documentary series Babies—filmed, as it happens, in a laboratory in Vancouver.) Whether that second step, infants taking sides, survives the current replication debate is an open question, as the notes describe. The first step, seeing agents and intentions in anything that moves on its own, is not in doubt. The watcher in the rustling grass does not have to be taught; he is on duty in the crib.

When people feel a loss of control, the appetite for pattern intensifies—and coincidence is more readily treated as signal. Superstition can be emotionally satisfying because it converts randomness into a story.

Once a few people begin to read events through a "hidden forces" framework, it spreads: it gives language to fear and hope, it confers a sense of specialness, and it offers the pleasure of explanatory closure. Coincidences become "signs." Ambiguous perceptions become "messages." A confusing life becomes a legible plot. A person has a strong feeling—dread, relief, attraction, foreboding—and the mind is tempted to treat that feeling as information about the outer world. A difficult decision feels as though it has been answered by "the universe." A run of bad luck starts to feel orchestrated. The step from "this feels meaningful" to "this is meaningful" is, for most of us, a short one.

And sometimes the belief helps, at least in the short term. A ritual, a talisman, or the conviction that one has "good energy" can reduce anxiety, steady the nerves, and make a person readier to act. In that sense superstition works a little like prayer, or placebo, or a pre-game routine: it changes the person's emotional state, and the changed state can genuinely improve performance or endurance. But—exactly as with the faith healing and the diets earlier in this book—that does not validate the explanation. It shows that belief can move mood, attention, and confidence. It does not show that a mystical force is operating in the background.

When Meaning Hardens into Causation

The trouble begins when a poetic interpretation hardens into a literal theory about reality. At that point there is no longer a harmless sense of wonder; there is a false model of causation. There is still no robust, independently replicated evidence that psychic forces, spirits, or nonphysical "energies" of this sort actually guide events—and there is no good reason to treat a strong feeling of destiny as evidence that destiny is real. Once such feelings are treated as evidence, judgment drifts away from probability, base rate, character, and consequence. A person stays in a bad relationship because it feels "meant to be." Someone avoids effective medical treatment because the illness is thought to be spiritual. Someone takes reckless risks because fate is presumed protective. Life planning gets worse when omens and vibes displace sober attention to what is actually happening.

There is a darker social risk as well. Once people begin to believe that invisible moral or spiritual contamination clings to persons, places, or groups, superstition becomes a license for prejudice. History offers grim examples of what happens when communities weaponize these causal illusions. The early modern European witch crazes, which claimed tens of thousands of lives, were driven in large part by the urge to assign occult causality to illness, infant mortality, crop failure, or misfortune. Medieval blood-libel accusations, and the pogroms—organized mob attacks on a minority—that swept Jewish communities during outbreaks of plague, drew on the same fantasy of hidden contamination: when the Black Death arrived with no visible cause, Jews were accused of poisoning the wells, and thousands were killed across Europe. In Strasbourg, on Valentine's Day 1349, much of the Jewish community was burned alive before the plague had even reached the town.

In parts of sub-Saharan Africa, people with albinism are still hunted, mutilated, and killed for body parts believed to hold ritual power. In modern, everyday life the same pathology is more banal but no less real: a neighbour is said to have "dark energy." A house is called cursed. A child is treated as spiritually tainted. A stranger is felt to be threatening in some occult way rather than simply unfamiliar. Once a group shares such assumptions openly, they stop being private quirks and coalesce into a moral atmosphere in which exclusion, suspicion, and even violence come to feel justified. This is how a private comfort slides into public harm.

Even so, the topic calls for sensitivity, and this is where I want to be careful. For the person immersed in these beliefs, the experience is not frivolous. It feels visceral, self-evident, woven into memory from early life, and reinforced for years by trusted friends, family, charismatic figures, chosen anecdotes, online communities, and a steady diet of "paranormal" documentaries that showcase the apparent hits and quietly discard the misses. When a belief has been stabilized by familiarity, repetition, and community, challenging it feels less like an intellectual correction than like an attack on lived experience. The humane response is not to mock the feeling. The feeling is real. What deserves challenge is the conclusion drawn from it.

As a psychiatrist, I often feel stuck in a state where the only possible response to stories of this type has to be gentle, non-judgmental curiosity. I say "stuck" because I have to withhold a powerful urge within myself to reach for some evidence-based argument that would move the person away from such beliefs. In a sense this entire book is like that, on a larger scale. But I know the argument would not help, so I bite my tongue—and perhaps write a blog article afterward rather than start a clinical debate. Empathy and trust are the more powerful forces, and any real possibility of an evidence-based conversation about these topics takes far more time, empathy, and trust than most of us realize.

A Psychiatric View

From a clinical standpoint, people genuinely differ in their proneness to unusual, mystical, or numinous experience—and this variation is not itself pathology. Some people reliably feel awe, presence, synchronicity, and "spiritual certainty"; others rarely do. The psychologists Auke Tellegen and Gilbert Atkinson gave this trait a name—absorption, the disposition to become deeply immersed in imaginative and perceptual experience—and it is linked to hypnotic susceptibility, vivid felt significance, and openness to anomalous experience.

A useful, imperfect metaphor is that some minds run with higher gain. Turn up the gain on a receiver and faint signals become audible—but so does the static, and past a certain point the receiver begins to pull voices out of pure noise. An absorptive, high-gain mind receives the world vividly and meaningfully, which is a gift; it also runs a greater risk of hearing signal in what is only noise. The brain's salience machinery is part of this story, though it is not reducible to dopamine alone. And this is where the ordinary shades, by degrees, into the clinical. Shitij Kapur's influential account of psychosis describes it as a state of aberrant salience: a dysregulated system stamps neutral events—a passing car, a stranger's glance—with a feeling of intense personal meaning, and the mind, doing what minds do, builds an explanation to fit. The delusion is not a failure of reasoning so much as reasoning applied, faithfully, to a feeling of significance that should never have been there.

Frank psychotic delusions are, in a strange way, often easier to help than large-scale systems of false belief. There is usually a more immediate biological cause, and a few weeks or months of medication will often make the delusions recede—sometimes vanishing entirely, without a trace. But beliefs that have grown over a lifetime, braced by community, probably never vanish, even if they can lose some of their grip when the conditions are right.

There is one more thread worth pulling, because it bears on how we treat people who hold these beliefs. Gordon Pennycook and his colleagues have shown that a more analytic cognitive style—the habit of stopping to check an intuition against probability—predicts weaker paranormal and religious belief, and, crucially, it does so even after controlling for raw intelligence, education, age, sex, and politics. It is not that believers are less able. It is that the disposition to question a compelling feeling varies from person to person—and, unlike intelligence, that disposition can be taught. The problem is not a deficient mind; it is an intuition left unchecked, and checking is a skill.

Spirituality and Religion

Many members of organized religions look down on "superstition" and free-floating "spirituality." Yet in psychological terms—at the level of cognitive ingredients—the difference is often one of degree rather than kind. Organized religion formalizes these same human tendencies: it standardizes the stories, professionalizes the interpreters, and binds belief to group identity and obligation. "Spirituality" tends to keep the intuitions while loosening the institutional grip. But both draw on the same human appetite for meaning, comfort, narrative, and relief from uncertainty. The gain is turned up in both sanctuaries; one has simply built more architecture around it.

I think I have a "high gain" mind—not in the way a gifted poet or artist does (I wish I had that kind of talent), but in a way I enjoy. I am easily moved to awe and wonder. In an emotional moment I cry easily. I feel things strongly, and I love unconventional thoughts, which tend to flow freely. But I also seem to have another part of myself that keeps a hand on the amplifier—perhaps I inherited the two from each of my parents, in a way that balances out. And I think balance is the point, for all of us. We cannot, and should not, try to eradicate parts of ourselves; the task is to learn to hold them in some kind of equilibrium.

References

Babies. (2020). [Documentary series]. Netflix.

The twelve-part series follows fifteen families around the world through the first year of life, alongside the scientists studying each capacity as it arrives. The helper-and-hinderer experiments appear in the episode "Relationships" (Part 2, Episode 4), filmed at the Centre for Infant Cognition at the University of British Columbia, where the lead researcher also discusses the multi-laboratory replication project then underway. The puppet shows, and the babies deciding, can be watched in full.

 

Calin-Jageman, R. J., & Caldwell, T. L. (2014). Replication of the superstition and performance study by Damisch, Stoberock, and Mussweiler (2010). Social Psychology, 45(3), 239–245. https://doi.org/10.1027/1864-9335/a000190

Two high-powered, preregistered attempts to replicate the well-known "lucky ball" golf experiment, in which activating a superstition supposedly improved performance. Neither found any benefit, and a small meta-analysis of the best-designed studies found no effect. Even the appealing claim that superstition helps performance does not survive rigorous testing.

 

Guthrie, S. E. (1993). Faces in the clouds: A new theory of religion. Oxford University Press.

Argues that religion is rooted in a pervasive human tendency to anthropomorphize—to read human-like agency into wind, shadow, and chance. Guthrie treats this not as a defect but as a sensible perceptual strategy: in an uncertain world, over-detecting agents is safer than missing a real one. His account is the intellectual forerunner of the agency-detection theories of religion later formalized by Justin Barrett and others.

 

Hamlin, J. K., Wynn, K., & Bloom, P. (2007). Social evaluation by preverbal infants. Nature, 450(7169), 557–559. https://doi.org/10.1038/nature06288

The original hill studies. Infants of six and ten months watched a climber struggle uphill while a second character either helped it to the top or shoved it back down; at both ages the babies selectively reached for the helper, and the authors proposed that evaluating others by their conduct toward third parties may be a foundation of later moral thought. The finding launched a large literature, and its afterlife is instructive: single-laboratory replications were mixed, and the large coordinated replication cited below did not find the preference. Whether the effect is fragile, or the standardized method removed something essential—live puppets among it—is now the live question.

 

Heider, F., & Simmel, M. (1944). An experimental study of apparent behavior. The American Journal of Psychology, 57(2), 243–259. https://doi.org/10.2307/1416950

The original demonstration that agency attribution is nearly irresistible. Shown a simple animation of two triangles and a circle moving around a box, almost all viewers described the scene in terms of intentions, personalities, and social drama—chasing, fighting, protecting—rather than motion and geometry. The film runs barely a minute, is easy to find online, and has lost none of its force.

 

Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry, 160(1), 13–23. https://doi.org/10.1176/appi.ajp.160.1.13

The landmark aberrant-salience account of psychosis. Kapur proposes that dysregulated dopamine signalling assigns exaggerated significance to neutral events, so that ordinary coincidences come to feel intensely and personally meaningful; delusions are the mind's attempt to explain that misplaced significance.

 

Krummenacher, P., Mohr, C., Haker, H., & Brugger, P. (2010). Dopamine, paranormal belief, and the detection of meaningful stimuli. Journal of Cognitive Neuroscience, 22(8), 1670–1681. https://doi.org/10.1162/jocn.2009.21313

A double-blind study using levodopa to probe how dopamine, paranormal belief, and the detection of meaning interact. The results were nuanced and in places counter-intuitive, and the authors are careful not to claim a simple causal chain. There is no simple "dopamine causes belief" story.

 

Levack, B. P. (2016). The witch-hunt in early modern Europe(4th ed.). Routledge.

The standard scholarly synthesis of the European witch trials of roughly 1450 to 1750. Careful regional accounting yields a consensus estimate near 45,000 executions out of perhaps 100,000 trials—genuinely "tens of thousands," but far below the wildly inflated figures of popular legend.

 

Lucca, K., Yuen, F., & the ManyBabies4 Consortium. (2025). Infants' social evaluation of helpers and hinderers: A large-scale, multi-lab, coordinated replication study. Developmental Science, 28(1), e13581. https://doi.org/10.1111/desc.13581

A preregistered replication of the 2007 hill studies across thirty-seven laboratories on five continents, testing over a thousand infants with standardized video stimuli designed to remove a perceptual confound in the original. The primary analysis did not find a reliable preference for helpers. The original authors are participants in the effort, and the interpretation—fragile effect, or method too far from the original live puppet shows—is being worked out in the open, which is how science is supposed to behave.

 

Office of the United Nations High Commissioner for Human Rights. (2021). Independent Expert on the enjoyment of human rights by persons with albinism. United Nations. https://www.ohchr.org/en/special-procedures/ie-albinism

The UN mandate documenting the abduction, mutilation, and killing of people with albinism for body parts used in witchcraft-related ritual—more than six hundred reported attacks across some two dozen sub-Saharan African countries over a decade. The mandate and the accompanying Human Rights Council resolution frame these as ongoing, witchcraft-driven human-rights violations.

 

Pennycook, G., Cheyne, J. A., Seli, P., Koehler, D. J., & Fugelsang, J. A. (2012). Analytic cognitive style predicts religious and paranormal belief. Cognition, 123(3), 335–346. https://doi.org/10.1016/j.cognition.2012.03.003

Across two studies, a more analytic cognitive style predicted weaker religious and paranormal belief even after controlling for cognitive ability, education, sex, age, and political orientation. Belief tracks thinking style—the disposition to check an intuition—more than raw intelligence, and for the hopeful corollary that such a disposition can be cultivated.

 

Tellegen, A., & Atkinson, G. (1974). Openness to absorbing and self-altering experiences ("absorption"), a trait related to hypnotic susceptibility. Journal of Abnormal Psychology, 83(3), 268–277. https://doi.org/10.1037/h0036681

The paper that introduced "absorption," the stable disposition to become deeply immersed in imaginative and perceptual experience. The trait is repeatedly linked to hypnotic susceptibility, vivid felt significance, and proneness to anomalous experience.

← Chapter 14  |  Contents  |  Chapter 16 →

The Psychology of Religion, Chapter 14: Religion as a Business

We usually say that a church can operate "like a business." But the arrow points the other way. Religion solved the hardest problem in commerce—how to make people loyal, for life, often without paying them—thousands of years before there were corporations, and business has been trying to reverse-engineer it ever since. Companies speak of brand "evangelists," of "converts" and "the faithful"; they build "communities," stage "rituals," and dream of the customer who never checks a competitor. That is religion's vocabulary, borrowed by people who wish they could do what religion does and mostly cannot. So the interesting comparison is not that religion resembles a business. It is that religion is the master technology of human commitment, and business is the imitation.

Marketing has quietly learned from faith. There is branding: symbols worn on clothing, around the neck, stuck onto bumpers. There is loyalty to the brand and suspicion of rival brands. There is outreach and proselytization. And beneath it, an organized financial structure with work to be done and an aim of retaining members, expanding the fold, eliciting contributions of money and labour, and keeping morale high. Any marketing department would recognize the org chart. Few could reproduce the devotion.

Consider what business would most like to copy and can't: the initiation. In tribal, high-commitment groups—fraternities are the benign example, gangs the dark one—entry is often made deliberately costly. In a classic 1959 experiment, Elliot Aronson and Judson Mills found that people who endured a more embarrassing initiation to join a group afterward rated it more highly, not less. The mind justifies what it paid to enter; this is effort justification, and Leon Festinger's theory of cognitive dissonance explains why. Religions have always known it in practice. Prospective members are vetted, sit through instruction, and then make solemn, public commitments in a ritual—a wedding to the community. No loyalty program can manufacture that.

Sometimes the model is not mass-market but luxury. Rather than broad proselytization, the "product" is restricted, and only a select few gain entry. In some traditions you must attain advanced standing—often over years—before you may enter the most sacred buildings or take part in the deepest rituals; sometimes only men may occupy certain roles or spaces. The obstacle is the point. It heightens the allure and selects for people willing to give more time, money, and devotion. If everyone had a Rolex or a Gucci bag it would stop being special; exclusivity is much of what makes a thing feel high-end—and much of what makes an inner circle feel sacred.

Then there is the masterstroke, the one no corporation has ever managed to pull off cleanly: the elevation of belief itself—faith—into a virtue. Belief without evidence is not merely tolerated but praised. Imagine what a company would give for that. Customers would form loyalty to the brand without ever looking too closely at the reviews; doubt could be reframed as weakness, betrayal, or impurity; and the most credulous buyers would be the most honoured, their standing rising in proportion to how little they questioned. Businesses attempt versions of this and mostly fail, because a dissatisfied customer can always leave and a competitor is one click away. Religion made not-looking a sacrament.

I have watched a version of this from inside my own profession. At a former workplace, a great deal of effort went into "branding" for mental health, involving a great deal of money; later came the fancy new buildings and offices. But the heart of the work does not require branding, or grand architecture, or a marketing staff, or layers of corporate management. None of it was what a frightened person in a small room actually needs, which is simply to be listened to, and to be able to come back.

The same misplacement of substance appears in religion on a far grander scale, and the numbers can be staggering. Across history and around the world, religious institutions have amassed extraordinary wealth—in land, buildings, art, and investments—on a scale hard to square with the ordinary believer's image of humble stewardship. The Roman Catholic Church holds a patrimony of cathedrals, real estate, and priceless art accumulated over nearly two millennia; the Church of England is among the largest landowners in Britain; and a good many megachurches and television ministries have made their founders very rich. Precise figures are often impossible to obtain, because most religious bodies are under no obligation to disclose them—which is part of the point. The clearest documented case is recent, and it became clear only because the law forced it into the open: in 2023 the Securities and Exchange Commission penalized the investment arm of the Church of Jesus Christ of Latter-day Saints, Ensign Peak Advisors, for using shell companies to obscure an equity portfolio that public filings put at roughly thirty-two to thirty-eight billion dollars; a whistleblower had earlier estimated the fund at close to a hundred billion. It stands as an illustration rather than an outlier—the one instance where the curtain happened to be pulled back. And much of this wealth, across traditions, operates with significant tax advantage. In the United States, churches are automatically tax-exempt and, uniquely among nonprofits, need not file the public disclosures other charities must. In Canada, registered charities, many of them religious, pay no income tax while registered.

The sharpest warnings about all of this come from inside religion itself. The most famous is the line attributed to Jesus, and preserved in all three Synoptic Gospels: "it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God." It is worth sitting with the irony. The institution that built the near-hundred-billion-dollar fund venerates a founder who owned nothing, praised the poor, and told the rich they would struggle to enter heaven at all. That gap—between the carpenter of the Gospels and the portfolio in the filings—is not an argument against faith. It is a warning from inside the tradition, aimed by its own founder at exactly what was later built in his name. The camel and the needle were meant for precisely this.

References

Aronson, E., & Mills, J. (1959). The effect of severity of initiation on liking for a group. The Journal of Abnormal and Social Psychology, 59(2), 177–181. https://doi.org/10.1037/h0047195

The classic effort-justification experiment: young women who underwent a more embarrassing initiation in order to join a discussion group afterward rated the group more favourably than those admitted easily. The result is counterintuitive—the higher the price of entry, the greater the reported liking—and it has been replicated many times since. 

Canada Revenue Agency. (n.d.). Charities and giving. Government of Canada. https://www.canada.ca/en/revenue-agency/services/charities-giving.html

The federal agency's guidance on the tax treatment of registered charities, a category that includes a large share of Canadian religious organizations. Registered charities pay no income tax while registered and may issue tax-receipted donations, though they must file an annual T3010 information return. 

Festinger, L. (1957). A theory of cognitive dissonance. Stanford University Press.

The founding statement of cognitive dissonance theory: the mind experiences discomfort when its beliefs and actions conflict, and works to reduce that discomfort, often by adjusting the belief. Applied to group membership, it is the mechanism beneath effort justification—having sacrificed to join, a person values the group more highly to make the sacrifice feel worthwhile. 

Internal Revenue Service. (n.d.). Tax guide for churches and religious organizations (Publication 1828). U.S. Department of the Treasury. https://www.irs.gov/pub/irs-pdf/p1828.pdf

The federal tax guide for religious organizations in the United States. It explains that churches are automatically recognized as tax-exempt under §501(c)(3) without having to apply, and that they are uniquely exempt, among nonprofits, from filing the annual Form 990 that would otherwise make their finances public. 

U.S. Securities and Exchange Commission. (2023, February 21). SEC charges the Church of Jesus Christ of Latter-day Saints and its investment management company for disclosure failures and misstated filings (Press Release No. 2023-35). https://www.sec.gov/newsroom/press-releases/2023-35

The regulatory action behind this chapter's documented example of religious wealth. The SEC found that Ensign Peak Advisors, the investment arm of the Church of Jesus Christ of Latter-day Saints, had used shell companies to obscure an equity portfolio reported in public filings at roughly thirty-two to thirty-eight billion dollars; a 2019 whistleblower complaint and subsequent reporting placed the total fund near a hundred billion. 

The saying "it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God" appears in all three Synoptic Gospels: Matthew 19:24, Mark 10:25, and Luke 18:25.

← Chapter 13 | Contents | Chapter 15 →

The Psychology of Religion, Chapter 13: to be a scholar, you had to study theology

For long stretches of European history, many able people who wanted to study the biggest questions ended up studying religion. That was not always because religion had the best answers. Often it was because religious institutions controlled much of the schooling, the books, and the road to public influence. If you wanted literacy, training, status, or a respected voice in your community, religion was often the main gate you had to pass through.

Before the printing press, and before secular universities became common, the Church controlled many of the material conditions of scholarship: the copying of books, access to manuscripts, and much of the economic support that let a person read, write, and think rather than spend life in manual labour. In practice, to be a scholar was to be funded, housed, trained, or at least tolerated by a religious institution. That inevitably shaped what could be said, what could be explored, and how far a person could go.

This created a built-in bias. It was not just that highly capable people happened to like theology; it was that theology sat near the centre of educated life. If you wanted mentors, libraries, credentials, or a place to teach and write, you often had to work inside a religious setting, or at least learn to speak its language. In that kind of system, religion could borrow prestige from the educated people who passed through it.

When people saw a brilliant, educated, generous person who was also a priest, minister, or theologian, the inference was almost irresistible: if someone this thoughtful believes it, the religion itself must be true. But that does not follow. A person can be wise, morally serious, and deeply useful to society while still believing things that are false. Learning and talent do not make a doctrine true.

I am reminded of the profession I trained in myself. Psychiatrists of previous generations were educated in an environment where psychoanalysis was king. If you wanted to be a psychiatrist, you had to learn psychoanalytic theory, and perhaps even undergo psychoanalysis yourself; if you did not, you risked being seen as an outsider and suffering a professional disadvantage. The pendulum has since swung the other way, and biological psychiatry is the new king. Express guarded opinions about psychopharmacology, or emphasize longer-term psychotherapy rather than medication management, and you may suffer a similar disadvantage today. The bias runs deeper still: many thoughtful people would not want to enter psychiatry in the first place if they understood the profession to be dominated by writing prescriptions rather than offering therapy. So the field quietly fills with applicants and new members who fit the current orthodoxy—and then that orthodoxy looks, from the outside, like the consensus of the best minds, when in fact it is partly the product of who was drawn in and who was filtered out.

That filter has run through all of intellectual history, and it bends the record itself. In earlier centuries, if you were a serious thinker and openly challenged the religious system, you were not just risking an argument. You could lose your position, your audience, your safety, or even your life. So the historical record is not a fair contest in which every idea had the same chance to survive. People who stayed within accepted limits were more likely to keep teaching, keep publishing, and keep being remembered.

There is a famous illustration of the mistake this leads to. During the Second World War, the Allies studied the bombers that came back from raids, mapping the bullet holes to decide where to add armour. The holes clustered on the wings and tail, so that is where reinforcement seemed to belong. The mathematician Abraham Wald saw what everyone else had missed: they were only looking at the planes that returned. The holes showed where a bomber could be hit and still fly home. The places with no holes—the engines, the cockpit—were exactly where the missing planes had been struck, and those planes were not in the sample, because they were at the bottom of the sea. The armour belonged where the survivors showed no damage at all.

Intellectual history has the same problem, and it is the same filter that shaped my own profession, only vastly larger. We see the scholars who came back from the raid—who stayed inside the lines, kept their posts, and were remembered. We do not see the ones shot down: silenced, exiled, burned, or quietly never permitted to begin. When we notice how many learned people through history were religious, we are counting bullet holes on the planes that landed. The believers are the survivors. The doubters are the missing data.

Two famous cases show the boundary being enforced. Galileo used a telescope to study the sky and argued publicly that Earth moved around the Sun. Today that sounds ordinary; in his time it crossed powerful religious limits. He was put on trial in 1633 and spent the rest of his life under house arrest. Whatever one thinks about the details of the case, one lesson is clear: a scholar's standing and safety could depend on not going too far beyond approved belief.
Giordano Bruno, a Dominican friar and philosopher, shows a different version of the same pattern, though his case is often misremembered. Bruno did hold radical cosmological views—an infinite universe, countless inhabited worlds—but he was burned in Rome in 1600 chiefly for theological heresy: he had denied the Trinity, the divinity of Christ, and other core doctrines. The popular image of Bruno as the first martyr for science is therefore misleading; his astronomy was a secondary matter beside his religious unorthodoxy. But that correction, far from weakening the point, sharpens it. What killed Bruno was not a scientific theory but the crossing of religious boundaries—and it is precisely the power to set and enforce those boundaries, on pain of death, that shaped which ideas could be voiced and which thinkers survived to be remembered.

This pressure was never limited to astronomy. Reformers, translators, and other dissidents were punished severely in different times and places. Even when the issue was not a new scientific discovery, the deeper conflict was often the same: who gets to define truth, and what happens to you if you say otherwise in public?

Nor was Europe unique. In the Middle East and the wider Islamic world, serious learning often grew around mosques, religious schools, and scholars of law and scripture. In China, higher learning and public advancement depended on mastery of the Confucian classics and success in the imperial examination system. In India too, advanced learning grew around religious traditions, temple settings, monasteries, and learned priestly circles. The details differed from place to place, but the larger point holds: when one tradition controls the road to education and status, its ideas start to look far more intellectually established than they really are.

To be fair, religious institutions also preserved and passed on learning. They copied books, trained students, and kept scholarship alive through centuries when little else did; several of the world's great universities began in religious settings and still carry that identity. The story is not simple—but that is exactly why the bias is easy to miss. When the same institution both protects learning and sets the limits of belief, educated people will be overrepresented inside that system, and their presence will look like an endorsement.

You can still see a milder version today. Many excellent colleges and universities are sponsored by religious organizations and maintain very high academic standards, sometimes while also requiring students to take courses in religion, attend chapel, or absorb a moral outlook shaped by a faith tradition. The academic strength is real; so is the packaging. Strong education and religious commitment arrive bound together, and the binding makes the religion look more intellectually confirmed than it is.

There is a second modern echo, and it is closer to home. In many religious schools, seminaries, tightly bound communities, and other closed systems—including, in their own secular way, some professions and institutions—career paths and social acceptance can still depend on affirming the right beliefs. The penalties are softer now: not execution, but loss of job, status, community, and belonging. The pattern is the same. A belief system becomes part of the ticket into a valued world, and once it does, it will again look as though the best minds endorse it—when in truth some of the critics have left, gone quiet, or been pushed out.

So when we survey the long history of learning and notice how much of it was religious, we should remember what we are looking at. It is a photograph of the planes that came back. The missing ones—the heretics who were burned, the doubters who stayed silent, the students who never enrolled, and, in my own profession, the healers who would have practiced differently had the gate been shaped otherwise—left no holes for us to count. The correlation between deep learning and religious belief is real. It is just not the evidence for religion it appears to be.

References

de Ridder-Symoens, H. (Ed.). (1992). A history of the university in Europe: Vol. 1. Universities in the Middle Ages. Cambridge University Press.

The authoritative scholarly history of the medieval university, tracing how the institution that became the home of Western higher learning grew out of church and cathedral schools. It documents the Church's central role in the material conditions of scholarship—funding, libraries, licensing, and the right to teach. For centuries, the road to serious education ran through religious institutions.

Elman, B. A. (2000). A cultural history of civil examinations in late imperial China. University of California Press.

A definitive study of the civil examination system that, from 1315 to 1905, controlled access to office and status in imperial China by testing mastery of the Confucian classics. Elman shows how a single canonical tradition became the gateway to advancement, shaping what educated people studied and believed. 

Grant, E. (1996). The foundations of modern science in the Middle Ages: Their religious, institutional, and intellectual contexts. Cambridge University Press.

An argument that the religious and institutional conditions of the medieval West—above all the university, established around 1200—actively enabled rather than merely tolerated the later rise of science. Grant's account complicates any simple "conflict" story by showing the Church as a preserver and organizer of learning. The same institutions that set the limits of belief also kept scholarship alive.

Makdisi, G. (1981). The rise of colleges: Institutions of learning in Islam and the West. Edinburgh University Press.

A comparative history of the madrasa and the other institutions of medieval Islamic learning, centred on law and scripture, and their parallels with the later Western college. Makdisi traces how advanced learning in the Islamic world grew around religious foundations. 

Mangel, M., & Samaniego, F. J. (1984). Abraham Wald's work on aircraft survivability. Journal of the American Statistical Association, 79(386), 259–267. https://doi.org/10.1080/01621459.1984.10478038

The scholarly exposition that recovered Abraham Wald's wartime memoranda on estimating aircraft vulnerability from data on planes that returned. It explains his method for inferring where the missing, downed aircraft had most likely been hit—the reasoning now known as an early and classic treatment of survivorship bias. It is the source for this chapter's central analogy about counting only the survivors.

Numbers, R. L. (Ed.). (2009). Galileo goes to jail and other myths about science and religion. Harvard University Press.

The standard scholarly correction to the "conflict thesis," with specialists dismantling widespread myths one by one—including the claims that Galileo was imprisoned and tortured, that Bruno was the first martyr for science, and that the medieval Church suppressed scientific inquiry. 

Rowland, I. D. (2008). Giordano Bruno: Philosopher/heretic. Farrar, Straus and Giroux.

The standard modern biography of Giordano Bruno, establishing that his condemnation and execution in 1600 turned chiefly on theological heresy—his denial of the Trinity and of Christ's divinity, among other doctrines—rather than on his cosmology. 

Wald, A. (1943). A method of estimating plane vulnerability based on damage of survivors (CRC 432). Statistical Research Group, Columbia University; reprinted 1980, Center for Naval Analyses.

Wald's original wartime memoranda, developed at the Statistical Research Group at Columbia University, presenting a statistical method for estimating which parts of an aircraft were most vulnerable using data only from planes that survived their missions. 

← Chapter 12 | Contents | Chapter 14 →

The Psychology of Religion, Chapter 12: Benefits of Unfounded Belief

"It worked for me."

Those four words may be the hardest thing in medicine to answer, because the person saying them is not lying—they really did improve. And sometimes the thing they improved on is an unfounded, or even fictional, belief system, which means the improvement now feels like proof. This is the self-deception Trivers describes, packaged differently—it's the psychoanalysis problem again: the theory was wrong, and the patients improved anyway.  

For example, some people latch onto an extremely rigorous diet with a spurious rationale, and yet end up stabilizing a prior eating problem, bingeing pattern, or weight problem. Often what makes the diet "work" is not the theory but the frame: the diet becomes a ritual, a commitment device, sometimes even a moral identity. Strong belief in the diet's narrative can increase adherence, especially when it is reinforced by "spiritual" practices, authoritative texts, a charismatic leader, and enthusiastic support from fellow adherents. The resulting improvement may have little to do with the supposed mechanism ("toxins," "energy," "impurity," and the like) and much to do with ordinary behavioural ingredients: reduced ultra-processed food, fewer calories, more routine, more attention to quantities and timing, and stronger social accountability. The distinguishing features of the theory may be fictional, while the behaviour change is real.

This should look familiar. It is Jerome Frank's four elements again, which I set out earlier—the confiding relationship, the healing setting, the theory that explains the suffering, the ritual both parties believe in—with faith consolidating them and a community standing around the whole affair. Some strict diets supply every one of them, in a kitchen. Whether the toxins are real is beside the point; the toxins were never doing the work.

In psychotherapy, patients' early positive expectations are associated with better outcomes, and placebo research shows that ritual and a warm practitioner relationship can produce real symptom change. In some settings, even open-label placebos—interventions people are told are inert—can still help. Benefit does not necessarily require the theory to be true. In some cases it does not even require deception.

It is tempting to treat these forays into unfounded belief as harmless whenever they produce visible gains. But there is a dark side, and much of it is similar to religion's dark side. Some dietary regimens are medically dangerous; some aggravate eating disorders; and some cultivate a loyalty to the framework that discourages critical thinking. Social media can intensify the problem, especially when health-focused communities reward purity, rigidity, and bodily control.

When a person's identity becomes fused with a belief system, they may reject better treatments even when those treatments are clearly indicated—especially if a setback is interpreted as evidence of insufficient "faith," insufficient purity, or insufficient devotion. This is the same closed loop I described with faith healing, where the person who is not cured is left to conclude that they did not believe hard enough. The harms here are not merely theoretical. In patients with curable cancers, complementary medicine use has been associated with greater refusal of conventional treatment and worse survival, with the excess mortality appearing to be mediated by delay or refusal of effective care.

These frameworks also often come packaged with community. People who join one cluster of unusual health beliefs can sometimes be pulled, by social gravity, into neighbouring clusters: new spiritual doctrines, anti-vaccine attitudes, conspiratorial styles of explanation, and monetized ecosystems of coaching, supplements, retreats, and memberships. The pattern is not inevitable, but it is real enough to take seriously.

We mostly hear from the success stories. The people for whom the diet failed, or harmed them, or simply became an expensive obsession, rarely become public evangelists. The community's narrative therefore skews toward "miracles," while the quiet attrition and collateral damage remain largely invisible.

Finally, just as in religions, the next step is often proselytizing. People who believe they have found salvation—whether dietary, medical, or spiritual—tend to recruit. They may pressure friends and family to "convert," and disparage outsiders as ignorant, impure, or closed-minded. In the context of fad diets and alternative medicine, that can do real harm to public health.

So the point is not that unfounded belief never helps. It often does—but it helps through the same common human machinery that makes religion work: structure, community, ritual, meaning, and the confident expectation of a cure. And it smuggles in risks that are easy to deny and hard to reverse once the belief has become an emblem of belonging. The deepest problem is the one we started with: the benefit is real, and it gets misread as proof that the belief was true all along. It never was—and it never had to be.

References

Constantino, M. J., Vîslă, A., Coyne, A. E., & Boswell, J. F. (2018). A meta-analysis of the association between patients' early treatment outcome expectation and their posttreatment outcomes. Psychotherapy, 55(4), 473–485. https://doi.org/10.1037/pst0000169

A meta-analysis pooling many clinical samples, finding that patients who begin therapy with more optimistic expectations about their treatment tend to achieve modestly better outcomes. The association is consistent, though not large. It is one of the more direct pieces of evidence that expectancy is an active ingredient rather than a bystander.

Johnson, S. B., Park, H. S., Gross, C. P., & Yu, J. B. (2018). Complementary medicine, refusal of conventional cancer therapy, and survival among patients with curable cancers. JAMA Oncology, 4(10), 1375–1381. https://doi.org/10.1001/jamaoncol.2018.2487

A cohort study of patients with four curable cancers—breast, prostate, lung, and colorectal—finding that those who used complementary medicine were more likely to refuse at least one component of proven conventional treatment, and had roughly double the risk of death. The excess mortality was statistically mediated by that refusal. The authors are careful to note that the data show what the refusal cost, not why patients refused.

Kaptchuk, T. J., Kelley, J. M., Conboy, L. A., Davis, R. B., Kerr, C. E., Jacobson, E. E., Kirsch, I., Schyner, R. N., Nam, B. H., Nguyen, L. T., Park, M., Rivers, A. L., McManus, C., Kokkotou, E., Drossman, D. A., Goldman, P., & Lembo, A. J. (2008). Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome. BMJ, 336(7651), 999–1003. https://doi.org/10.1136/bmj.39524.439618.25

A randomized controlled trial in irritable bowel syndrome that experimentally separates the placebo response into three layers: assessment and observation, a therapeutic ritual, and a warm, attentive patient–practitioner relationship. Each layer added incremental symptom relief, with the relationship contributing the most. Ritual and relationship do real work independent of any specific mechanism.

Kaptchuk, T. J., Friedlander, E., Kelley, J. M., Sanchez, M. N., Kokkotou, E., Singer, J. P., Kowalczykowski, M., Miller, F. G., Kirsch, I., & Lembo, A. J. (2010). Placebos without deception: A randomized controlled trial in irritable bowel syndrome. PLoS ONE, 5(12), e15591. https://doi.org/10.1371/journal.pone.0015591

A randomized controlled trial testing "open-label" placebos—pills the patients were explicitly told were inert and contained no active medication. Even so, the placebo group improved more than those given no treatment at all. The result suggests that the benefit of ritual and expectation need not require deception, which complicates any simple account of what a placebo is.

Trivers, R. (2011). The folly of fools: The logic of deceit and self-deception in human life. Basic Books.

An evolutionary theory of deception and self-deception, arguing that the most effective deception often begins with deceiving oneself, because sincere belief makes the performance more convincing. A chapter applies the logic directly to religion. It explains why a genuinely felt benefit hardens so readily into the conviction that the underlying theory must be true.

Ward, C., & Voas, D. (2011). The emergence of conspirituality. Journal of Contemporary Religion, 26(1), 103–121. https://doi.org/10.1080/13537903.2011.539846

The paper that coined the term "conspirituality" for the convergence of alternative spirituality and wellness culture with conspiracy belief. The authors trace how these once-separate worlds increasingly overlap, particularly online. Joining one cluster of unusual health beliefs can pull a person toward neighbouring ones.

← Chapter 11 | Contents | Chapter 13 →