Psychological Medicine, 1982, 12, 291-294

Printed in Great Britain

The effect of pilgrimage on anxiety, depression and

religious attitude
P.A.MORRIS1
From Kingsway Hospital, Derby

SYNOPSIS This investigation aimed to ascertain the levels of anxiety, depression and religious
attitude, by means of rating scales, in a group of physically sick men and women planning to go
on a pilgrimage to Lourdes. These levels were reassessed one month and ten months after the
pilgrims had returned. There was a statistically significant decrease in anxiety and depression
which was sustained. The possible reasons for these findings are discussed.

INTRODUCTION
Pilgrimage is a human activity which has been
popular for many centuries, and in various
religions. It probably reached its peak with
Christianity in medieval times, but there has been
a resurgence of interest in recent years with the
advent of modern travel and 'package tours'.
Mecca is the most popular venue for the
followers of Islam, but for Christians Lourdes is
generally regarded as being the most important,
over three million visitors going there each year.
These are mainly Roman Catholics, though
Christians of other denominations also visit the
shrines. Lourdes is the site of the visions of the
Virgin Mary in 1858 by Marie Bernarde
Soubirous who was later canonized in 1933 as St
Bernadette, and its importance as a pilgrimage
centre increased after the consecration of the
basilica in 1876. Many of the pilgrims are sick in
mind or body, and since 1858 there have been 64
cures of physical conditions accepted as miracu-
lous by the Church. There is an active medical
bureau of Lourdes and adequate hospital
facilities in the town. There have been many
accounts of the cures and ameliorations of
physical conditions of patients attending, sup-
ported by well-documented medical and surgical
investigations.
There have not, however, been any investiga-
tions into the emotional changes of pilgrims.
While many sick people go to Lourdes in the
hope of an improvement in their physical state,
1
Address for correspondence: Dr P. A. Morris, Kingsway
Hospital, Derby DE3 3LZ.
291
they realize that the chance of this happening is
very remote. It is generally accepted that the sick
pilgrims return home, feeling better in themselves
for the experience, and seem more able to accept
their condition with equanimity.
The present study was designed to ascertain
whether there was any demonstrable change in
the levels of anxiety and depression and of the
depth of religious belief as a result of a
pilgrimage to Lourdes. It was decided to use
three rating scales which were fairly short and
were not specifically geared to psychiatric
patients. The tests selected were the State-Trait
Anxiety Inventory (STAI) (Spielberger et al.
1970), the Depressive Inventory (Beck et al.
1961) and the Religious Attitude Scale (Poppleton
& Pilkington, 1963).
MATERIAL
On the preliminary list for the 1980 Nottingham
Roman Catholic Diocesan pilgrimage to Lourdes
were 50 people who were classed as sick,
requiring either hospital or hostel accommoda-
tion, on the basis of reports received from their
doctors.
These patients were contacted by letter and
asked to cooperate in the study. Agreement was
received from 28 persons, 12 men and 16 women.
Subsequently, after interview, 1 man and 3
women had to be rejected because of severe
organic dementia, leaving a final total of 11 men
and 13 women. They came from a wide area,
including the counties of Nottingham, Derby,
292 P. A. Morris

Leicester, Lincoln and Humberside. The average Table 1. State Anxiety

age of the men was 63-3 years, of the women 57-5
years, and of the total 60-1 years. Male Female Total

The illnesses from which they suffered were as Mean

follows: 11 neurological conditions (including (1) 31-9 34-6 33 4
(2) 25-4 280 26-8
multiple sclerosis, 4; cerebrovascular accident, 2; (3) 22-8 26-8 24-8
brain tumour, 1; parkinsonism, 1; spastic P<
diplegia, 1; spinal injury, 1; and muscular (1) v. (2) 001 005 001
(1) v. (3) 001 001 001
dystrophy, 1); 4 cardiovascular conditions; and (2) v. (3) 001 NS 005
7 others (including 1 case each of leukaemia,
bronchiectesis, carcinoma of breast, gout, rheu-
matoid arthritis, ulcerative colitis, and endogen- Table 2. Trait Anxiety
ous depression). Two men were frail and elderly
Male Female Total
(aged 86 and 84). Approximately half the
patients (45-8%) had not been on a pilgrimage Mean
before; of the rest, 6 had been on one occasion (i) 35-9 400 38-1
(2) 24-4 27-1 25-8
only and the remainder up to 9 times. Twenty- (3) 22-4 28-2 25-3
two of the patients were practising Roman P<
Catholics, the other 2 being a Methodist married (1) v. (2) 001 001 001
(1) v. (3) 001 001 001
to a Catholic and a retired Anglican minister. (2) v. (3) NS NS NS

METHOD Table 3. Trait Anxiety: Spearman's coefficients

Those sick pilgrims who agreed to take part in of rank correlation and test-retest reliability
the study were visited by the author in the month coefficients (in parentheses)
preceding the pilgrimage, in the month following Male Female
their return and again 10 months later. On the
first visit, the opportunity was taken to record (1) v. (2) 0-75 (0-86) 0-34 (0-76)
(1) v. (3) 0-49 (0-76) 0-27 (0-77)
factual details, including age, sex, illness, (2) v. (3) 0-83 (0-76) 0-51 (0-77)
denomination, previous pilgrimages and any
medication. The 3 questionaires were completed
on the first 2 visits, but the Religious Attitude
Scale was omitted on the final occasion. These Lourdes, and that this was sustained over the
were then scored, and the results were calculated year. The only pairs showing a significant
by means of the Wilcoxon signed rank test. difference between the second and third scores on
the Trait Anxiety Inventory were the male and
RESULTS total groups, and this was due to continued
lessening of the anxiety over the year in the men.
1. Anxiety The State Anxiety Inventory, measuring as it
The State-Trait Anxiety Inventory consists of does a transient condition, does not have a
two separate scales, measuring State Anxiety - test-retest reliability coefficient. The Trait
i.e. how subjects feel at a particular moment Anxiety Inventory reliability has, however, been
in time - and Trait Anxiety - i.e. how they have determined, and Table 3 compares these test-
generally felt over the preceding month. Table retest reliability coefficients with Spearman's
1 compares the mean scores on the State Anxiety coefficients of rank correlation on the pilgrims'
Inventory on the first, second and third scores. This shows a lessening of anxiety, even
assessments, with the degrees of significance of allowing for test-retest reliability.
the differences. Table 2 shows comparable An investigation by Spielberger et al. (1970)
figures for the Trait Anxiety Inventory. using the STAI on general medical and surgical
It will be seen from the tables that there was patients was conducted in the USA. It involved
a significant lessening of both types of anxiety in only males in several Veterans Administration
both men and women following the visit to Hospitals; they had a mean age of 55 years. The
 Effect of pilgrimage 293

mean score on the A-Trait scale was 41-3 and on visits to shrines, there is no record in the Medical
the A-State scale was 42-7. These are slightly Bureau of Lourdes of any investigation into the
higher than the results obtained in this study, but emotional state. The majority of people visiting
this is possibly due to the increased tension shrines are not themselves sick, and go for the
engendered by hospitalization in the American spiritual uplift derived from the pilgrimage. This
study. survey was an attempt to quantify the benefits,
on an emotional level, of such pilgrimages for
2. Depression people who were sick in body. The group of
Table 4 compares the mean scores on the pilgrims who were originally asked to take part
Depression Inventory on the first, second and in the survey contained many elderly and
third assessments, with the degrees of significance severely ill people, some of whom felt they were
too ill, too old or too frightened to take part in
Table 4. Depression any repeated psychological assessment. Indeed,
some of the people on the original list died or
Male Female Total were hospitalized before the pilgrimage took
Mean place. Because of the fact that only 56% of the
(1) 6-7 7-6 7-2 sick pilgrims agreed to cooperate in the study,
(2) 0-9 1-2 10 and also because of the virtual impossibility of
(3) 0-4 11 0-8
P< setting up an adequate control group, the results
( l ) v . (2) 001 001 001 become less statistically significant, even though
(l)v. (3) 001 001 001
(2)v. (3) NS NS NS
they are suggestive.
Anxiety may sometimes be a useful state if it
leads to activities designed to reduce the cause.
of the difference. No test-retest reliability At other times, as is the case for these sick
coefficients have been produced by Beck, though pilgrims, anxiety is useless and non-productive
the results at any one time have corresponded and then interferes with the quality of life of the
with the clinical state. Again, we see a reduction sufferer. The assessment of levels of anxiety and
in the degrees of depression of significant level, depression in non-psychiatric patients requires a
and maintained over the year. The levels of special type of rating scale, here represented by
depression obtained on the Inventory were not Spielberger's STAI and Beck's Depression
such as to indicate a clinical degree of depression Inventory. The description of the differences
in the pilgrim. In a survey by Schwab et al. between Trait and State Anxiety are clearly set
(1967), concerned with diagnosing depression in out in various publications by Spielberger, and
medical in-patients, they regarded a score of 10 the STAI has been used extensively for screening
as the cut-off point on the Depression Inventory. normal and patient populations and for giving
an indication of transient anxiety, as well as for
3. Religious attitude more longstanding personality problems. Trait
There was no significant difference between the Anxiety has the characteristics of a class of
mean scores on the first and second assessment constructs, which Campbell (1963) refers to as
on the Religious Attitude Scale. In retrospect, it 'acquired behavioural dispositions'. While these
would seem that the particular scale chosen was are relatively stable, they may be modified by
insufficiently sensitive for the purpose. Further, further life experiences, especially of a long term
since this was a group of religious pilgrims, it or emotional nature. Gorsuch (1969) described
was only to be expected that the initial scores increased anxiety trait levels in subjects who had
should be high, thus leaving little scope for had increased anxiety state levels for a period
improvement. of time. The Beck Depressive Inventory was
developed as an instrument to measure the
behavioural manifestations of depression, and
DISCUSSION has been widely used since 1961. Both these
It is surprising that, though there have been scales are short and easy to understand. It was
difficult to find a suitable religious attitude scale,
many hundreds of papers written about the
and the one used was developed by Poppleton for
physical condition of patients before and after
294 P. A. Morris
use with student populations who were not
unduly religious. Unfortunately, in the present
survey we were dealing with a very religious
group who scored a mean which was 96-5% of
the maximum score on the initial assessment.
While there was an increase in the mean score
on the reassessment, there was insufficient
leeway for a statistically significant result to be
obtained.
Only two patients in the whole series showed
increased anxiety and depression following the
pilgrimage. One was a man of 33 suffering from
a damaged spine due to an industrial accident
who was thought to have had a coronary
thrombosis on his return home. The other was
a lady of 53 suffering from multiple sclerosis who
had been on 9 previous pilgrimages and who felt
guilty on her return that she had failed to
improve and thus had in some way Met down'
her family and the Church. All other patients
showed a reduction in the levels of Trait Anxiety,
State Anxiety and Depression.
Possible explanations for these findings call for
comment. It is generally accepted that a holiday
can improve the emotional state, partly due to
the change of environment and partly due to the
company of other people. Only 10 of these people
were living alone, all had supportive friends and
families, and there was no-one who could be
regarded as socially isolated. For the majority
the pilgrimage was additional to a holiday, and
they had a reasonable social life during the
remainder of the year. For many of the elderly
there was the stress of travelling to Lourdes,
involving as it did coaches and air travel, and the
prospect of institutional accommodation in the
town itself, either in a hospital or a hostel. While
some of the initial improvement may have been
related to cognitive dissonance, this could hardly
have accounted for the sustained benefit which
resulted from the visit to the shrine.
What else may have accounted for the
findings? The patients on the whole did not feel
physically improved. They did, however, with
one exception, feel that the visit had been
beneficial, in that it had strengthened their
religious faith, and had made them more relaxed,
more content and more able to accept their
physical disabilities. The one exception was the
lady with multiple sclerosis, in which condition
mood changes are frequently related to the
organic condition.
This general emotional improvement would
seem, then, to be a direct result of the holiday,
the companionship and the change of environ-
ment, but most of all to the spiritual atmosphere
of the shrine, which engendered hope in the
pilgrims for the future, both in this life and the
life hereafter. As a result of the visit, the quality
of life of most of the pilgrims was improved,
suggesting that pilgrimage might be worth
consideration in many other chronically sick
people with a religious outlook, who have
difficulties in adjusting to their conditions.
I would like to thank Professor C. D. Spielberger,
University of Southern Florida, Professor A. T. Beck,
University of Pennsylvania; and Dr P. K. Poppleton,
University of Sheffield, for held and permission to use
their rating scales; Professor H. J. Eysenck, University
of London, Dr J. F. Napier, the pilgrimage Medical
Officer, and Dr T. Mangiapan, Director of the
Medical Bureau of Lourdes, for their advice and
support; and Dr P. J. Standen, University of Notting-
ham, for her help with the statistics.
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(1961). An inventory for measuring depression. Archives of General
Psychiatry 4, 561-571.
Campbell, D. T. (1963). Psychology. A Study of a Science, Vol. 6.
McGraw Hill: New York.
Gorsuch, R. L. (1969). Changes in trait anxiety as a function of recent
states of anxiety. Unpublished manuscript. George Peabody
College for Teachers, Johns Hopkins University: Baltimore.
Poppleton, P. K. & Pilkington, G. W. (1963). The measurement of
religious attitudes in a university population. British Journal of the
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