The physician was bewildered. Scientific data indicate that exactly the opposite should have happened. The research on spirituality and health is still in its infancy, but dozens of experiments have linked religious participation with various measures of well-being. Researchers at the Duke University Medical Center, for instance, studied 4,000 men and woman over 65 and found that those who prayed, read scriptures and attended services regularly were 40% less likely to have a stroke or heart attack than subjects who were not religious. Another Duke study found that non-religious seniors were twice as likely as their churchgoing counterparts to have elevated levels of interleukin-6, a protein that impairs the function of the immune system. Other data specifically link spiritual involvement with lower blood pressure and reduced rates of anxiety and depression. And several well-regarded studies have found that those who attend services regularly live longer than the no-shows.

So, what was going on with Janice? What her doctor subsequently learned was that going through the motions of religious activity is not enough, especially if you are burdened by unresolved anxiety, doubt or fear associated with religion. In a study of 595 hospital patients, psychologist Kenneth Pargament and his colleagues found that those with "negative religious coping" had a higher mortality rate than those with "positive religious coping." After controlling for variables such as age, sex, medical diagnosis and severity of symptoms, the researchers found that those with high rates of "religious struggle" (for example, believing that their illness was a form of divine punishment) were 19% to 28% more likely to die in the two years following their discharge.

The description of religious struggle fit Janice to a T. Her crisis had been triggered by a double-barreled trauma: first, her son was struck by a drunk driver and her prayers for his recovery went unanswered; then her minister was fired for having adulterous affairs. The incidents cast doubt on some of Janice's most cherished beliefs, leading her to bitterly reject all things religious. Her prayers were in the spirit of someone who was taking no chances. "They say there are no atheists in a foxhole," said Janice. "Well, I was fighting for my life too. But I was also fighting my own inner demons."

Because she had never resolved her fury at God for "taking away" her son, or her disillusionment with the flawed human beings who represent God on earth, her prayers were riddled with ambivalent feelings. She wanted to fall to her knees in humble supplication, but she also wanted to lash out at the Almighty in rage. At times she felt she couldn't trust God-that is, if God existed in the first place. At other times she would feel so guilty about her anger that she was sure she didn't deserve divine assistance. She even wondered if her cancer was a form of punishment. Because of that inner turmoil, her religious practices, rather than provide comfort, increased her stress level. Eventually, she worked through her conflicted feelings and redefined her relationship to the divine in a way that made sense to her. Only then could she gain the sense of peace and safety that a flourishing spiritual life can bestow.