As anything other than a reference volume, the book founders on its own assumptions. Early on, "spirituality" is defined as "the personal quest for understanding answers to ultimate questions about life, about meaning, and…the sacred" and thus essentially defined as undefinable from a scientific standpoint. "Religion," by contrast, "is an organized system of beliefs, practices, rituals, and symbols" that fosters "responsibility to others in living together in a community." This builds in a confounding variable—a community of shared values and mutual social support. Research on the secular community, such as David Spiegel’s work on group therapy and breast cancer outcomes, has clearly shown how strong a confounding variable community might be in such discussions.