Winter 2008 Newsletter
On-Line Newsletter Volume 6, Number 2
Published February 12, 2008
Edited by Chaplain John Ehman, Network Convener
Network members are encouraged to submit articles for upcoming issues.
The Newsletter is published three times a year: Fall, Winter, and Spring-Summer.
The Spring 2008 issue is scheduled to be published in May.
Table of Contents
- Author's Perspective on "Beliefs, Mental Health, and Evolutionary Threat Assessment Systems in the Brain," by Kevin Flannelly
- Chaplain Receives Grant for fMRI Research
- Ideal Intervention Paper (IIP) Project Continues to Develop --An Update
- Bias in the Medline Literature Database: Thoughts on a Study of the Portrayal of Islam and Muslims
- Convener's Report of the Annual Network Meeting, October 26, 2007, Dallas, TX
1. Author's Perspective on "Beliefs, Mental Health, and Evolutionary Threat Assessment Systems in the Brain," by Kevin Flannelly, PhD
[Editor's Note: Dr. Kevin Flannelly, Associate Director of Research at The HealthCare Chaplaincy (New York), was asked to offer some background information and reflection on our February 2008 Article-of-the-Month: Flannelly, K. J., Koenig, H. G., Galek, K. and Ellison, C. G., "Beliefs, mental health, and evolutionary threat assessment systems in the brain," Journal of Nervous and Mental Disease 195, no. 12 (December 2007): 996-1003.]
In trying to put the article in perspective I realized I had to provide some background about the development of my own thoughts on the topic. I did basic research in comparative and physiological psychology throughout the 70ís and early 80ís, before becoming involved in survey research. In 1995, Dr. Andrew Weaver introduced me to the field of religion and health. I was sure there had to be a physiological connection between the two that involved the brain in some way. My working hypothesis was that emotions, which I studied extensively in animals, were the key to this relationship, at least with respect to mental health. As we discuss in the article, primitive parts of the brain collectively called the limbic system are known to be involved in emotions and some psychiatric disorders.
The theoretical model we present hypothesizes that even more primitive areas of the brain, called the basal ganglia, also play a role in religion and mental health. There was a time when I did not think that was possible, and I recall telling that to a CPE resident taking a research course that Dr. Kathleen Galek and I taught. We got into a discussion about the brain and psychiatric problems because the resident was doing his student practicum at a mental health clinic. At some point, the conversation naturally turned to religion. I said I thought religion certainly did influence the limbic system, which evolved in mammals, but I did not think it could influence the basal ganglia, which evolved in reptiles. I just could not imagine how so primitive a part of the brain could be affected by religion, even though I knew the basal ganglia were implicated in obsessive-compulsive disorder, which includes obsessive thoughts or beliefs.
Part of my problem was that I, like most researchers in the field, had a tendency to conceptualize religion in behavioral terms -- such as church attendance or prayer -- or subjective measures of religiosity: e.g., How often do you attend religious services? How often do you pray? How important is religion to you? We all too often ignored the fact that religion is, first and foremost, a set of beliefs. Dr. Christopher Ellison brought this point home for me when he gave a talk at The HealthCare Chaplaincy in January, 2004. Soon thereafter, the four of us [article co-authors] began to work together on various studies of religious beliefs and psychiatric symptomology. Our theoretical model is a natural outgrowth of that collaboration.
A common and legitimate criticism of research on religion and health is that there is no known biological mechanism through which religion can directly influence physical or mental health. How can prayer or religious attendance influence biology? How can they influence the brain or physiological processes? Both Dr. Ellison and Dr. Koenig have done extensive research on and written major reviews about the relationship between religion and health and well-being. But neither their work, nor any other work in the field has offered a plausible biological mechanism, or mechanism of action, through which religion influences physical or mental health.
The current paper offers such a mechanism, proposing that religious and other types of beliefs can influence those functions of the limbic system and the basal ganglia that underlie certain psychiatric symptoms. We do not think this is the only way religion can directly influence health, but we think the model represents a vital step towards convincing many in the scientific and medical community that the connection between religion and health is real, and that it can be scientifically tested. Several testable hypotheses about religious beliefs, the brain, and mental health follow directly from the theory, including potential studies about how chaplainsí interventions may affect patientsí psychological well-being.
2. Chaplain Receives Grant for fMRI Research
Chaplain Kyle Johnson, US Army (Retired) and Visiting Professor at Jarvis Christian College, Hawkins, TX, has been awarded a grant by the Effie and Wofford Cain Foundation for a study involving Neuropsychology/Neuropsychiatry of Religion and Neuropastoral Care and Counseling, using Functional Magnetic Resonance Imaging (fMRI) of the brain. Chaplain Johnson has contributed Article-of-the-Month pages on Neuroscience and Emotion (September 2006) and Cerebral Blood Flow During Glossolalia (April 2007). He is collaborating with Andrew Newberg, MD, Director of the Center for Spirituality and the Mind at the University of Pennsylvania (--see the Spring 2006 Newsletter, §6). More about this study will be reported in the Newsletter as it develops. Inquiries, comments, and suggestions are invited by Chaplain Johnson and may be addressed to firstname.lastname@example.org.
3. Ideal Intervention Paper (IIP) Project Continues to Develop --An Update
The Ideal Intervention Paper (IIP) project continues to develop under the leadership of John Gleason, DMin, and Henry Heffernan, SJ. A special section of our website will soon be added to provide a central source for project news and materials. Fr. Heffernan is in the process of contacting CPE supervisors in the National Association for Catholic Chaplains (NACC), and he has prepared with Dr. Gleason three new "fact sheets" explaining the IIP Exercise for Clinical Pastoral Education Curricula, the Benefits of the IIP Exercise for CPE Students, and the project's Progress through 2007 [--all are printable PDFs]. Sample IIPs will soon be available. Also, there will be an IIP workshop at the conference of the Eastern and Northeastern Regions in Stony Point, NY (April 28-30, 2008). Seven supervisors are currently using the IIP exercise in New York, Indiana, and Ohio. A memo to students explaining the Ideal Intervention Paper may be downloaded [as a PDF] by clicking HERE. (Note that the project was also discussed at the Network's annual meeting, as reported in §5, below.) For more information, contact Dr. Gleason at email@example.com.
4. Bias in the Medline Literature Database: Thoughts on a Study of the Portrayal of Islam and Muslims
Like most people interested in spirituality & health, the Medline database is my first source for literature searches, and it would be safe to say that it is the principal gateway for clinicians to information on all subjects, including religion/spirituality. I find it generally a good source, but as a result of occasionally encountering articles of dubious quality or objectionable content, I am reminded that Medline is only a database of journals that have been deemed to be reputable --it does not itself act as a filter for the quality of any particular article, and it reflects in its listings all the broad trends of ideas (including misguided ones) that are at play in a literature that is continually changing in tone and perspective as well as in conclusions. I would argue that, by and large, the current literature on spirituality & health--going back to the mid-1990s--is quite useful, given that the field is still only in an early stage of development. Nevertheless, where are there enduring problems of misconception and misrepresentation in this literature? Where should researchers and clinicians remain wary when searching the database? Where might chaplains identify a particular need to raise an insightful voice to counter religious/cultural bias that has accumulated in the indexed articles? A recent study in Social Science and Medicine [65, no. 12 (December 2007): 2425-2439] by Lance Daniel Laird and Linda L. Barnes from the Boston University School of Medicine, and Justine de Marrais from the Boston Medical Center, "Portraying Islam and Muslims in Medline: A Content Analysis," indicates that there may be reason for chaplains to speak up especially regarding Islam and Muslim patients.
Laird (who holds a ThD) and his colleagues analyzed Medline-indexed articles containing the keywords Islam and Muslim from 1966 through August 2005, and while there obviously have been some changes in portrayal over the decades (and I would note that there have been over 550 articles on Muslims and Islam indexed on Medline since the study's period ended), they identified seven manifest and three latent themes in the literature. The manifest themes are fairly predictable but worth noting: Muslim religious practices, Islamic law and ethics, history of Islamic medicine, public health, social medicine, and cultural competence [--see the descriptions on pp. 2428-2430]. However, the latent themes are striking, especially:
1) To be Muslim is to be in particular need of biomedical intervention:
The first latent theme represents Muslims as Others "in need of intervention." Those in non-Western contexts are portrayed as less educated rural or urban poor, bound by "tradition" and "conformity" to "undeveloped" pre-modern beliefs and practices. Muslims in Western settings figure as underserved minorities, often refugees or immigrants with low socio-economic status, who face discrimination and should assimilate or acculturate to a majority culture. Research focuses, too, on Muslim groups who have experienced political violence, "underdevelopment," war trauma, and emigration as refugees or economic migrants. As such, they "need" health education, and make "difficult adjustments" to new cultures and "community" identities in the US, Canada, the UK, the Netherlands, and Australia. Two sub-themes nuance this latent theme of deficiency: (a) being a religiously observant Muslim poses health risks, and (b) Muslims are negatively affected by tradition, and should adopt modern ways. [p. 2430]
2) "Islam" is a problem for biomedical healthcare delivery:
...[B]iomedical providers may describe [Muslim patientsí use of traditional medicine] rhetorically as part of a "communication problem," or as a "noncompliance" factor potentially undermining their treatment plan. ...Cultural competence literature regularly addresses "problems" posed by treating Muslims with insulin-dependent diabetes during Ramadan and the immunization of children. "Difference" in approaches to gender and sexuality--including "conservative" attitudes toward discussing extramarital sexual behaviors--are "problems" for healthcare providers, who by implication hold normal attitudes. ...[H]owever, the notion of Islam as subversive anomaly arises most prominently in portrayals of women. [p. 2432]
The authors also identify a third and countervailing latent theme: namely, that being Muslim may promote good health, but they suggest that this is the less-prevalent of the three. Overall, their conclusion is that the portrayal of Islam and Muslims in the Medline-indexed literature is problematic.
The lack of nuanced portraits of Muslim lives in medical literature is the first issue. While growing numbers of Muslim clinicians and researchers work to correct misperceptions about their coreligionists, and to offer guidelines for care, publication and indexing structures may undercut significant change in accurately representing Islam and Muslims. [p. 2435] ...The second issue is that the aggregate portrait available is skewed, through publication and research bias, toward representing the negative impact of Islam on health. Medical literature, by its nature, frames issues within a disease model, such that they can potentially be addressed by medical interventions. To legitimize health researchers attending to them, social problems are medicalized as social deficits or deficiencies. While much fruitful work has resulted from the careful articulation of problems and solutions, a deficiency discourse risks perpetuating unexamined biases. [And] ...The portrayal of groups who live in or who emigrate from non-Western countries as poor, rural, uneducated, and refugees (from their own problems) desiring the freedom and prosperity of the West is a classic trope of colonialist discourse. Our analysis of Medline coverage of Muslims suggests that poor, rural, and refugee populations for the most part "represent" Islam to the reader. When such bias merges with cultural scripts drawn from orientalist/colonialist discourse about "Others" (particularly less powerful Others), it portrays Muslims as endangering their health, creating unhealthy environments for women, clinging to tradition, and as posing anomalous problems for the biomedical system. [p. 2436]
The lessons from this analysis may illuminate ways that other religious/cultural minorities are portrayed in the literature (--a point made in discussing future research [p. 2437]). The authors note, generally, that "[m]edical anthropologists argue that the 'biomedical gaze' pathologizes and Otherizes its objects" [p. 2426], referencing the theoretical work of Michel Foucault. In light of the article, this reader has been challenged to consider afresh how, even though "[c]ritical research requires us to portray our subjects with accuracy and balance, to check for bias, allow for nuance, and avoid broad generalizations about whole religious traditions" [p. 2436], there are enduring tendencies in the literature of the scientific-medical establishment to treat spiritual/religious issues with a lack of sophistication and proper regard. The researchers were guided in their exploration of latent themes by the relatively simple question, "What may this text be conveying to the reader, albeit indirectly, about Islam or Muslims?" [p. 2430]. This may be a very useful formulation for chaplains to use (and for CPE supervisors to encourage students to use) as a standard for reading in the field of spirituality & health about any religious/cultural group or subject. Medline is effectively the canon for clinical knowledge in the US. By highlighting particular prejudices in today's literature, research like that by Laird et al. lays the groundwork for an overall correction to this canon of health care knowledge. --JE
Supplemental Note: The article by Laird, et al. does not cite a 2005 report by Rodriguez Del Pozo, P. and Fins, J. J., "Death, dying and informatics: misrepresenting religion on MedLine," in BMC Medical Ethics [6 (July 1, 2005): E6], which found that Islam, as a subject, was under-represented.
5. Convener's Report of the Annual Network Meeting, October 26, 2007, Dallas, TX
The Network convened its annual meeting at 9:00 AM on October 26, 2007, at the Adolphus Hotel in Dallas TX, as part of the national conference of the ACPE. (A flyer about the Network was included in the conference material for all attendees.) After approving the financial report, members focused on four agenda items: our website, the Ideal Intervention Paper (IIP) Project, initiatives to promote the Network and research in the ACPE, and various individual projects.
John Ehman reported that the website typically receives roughly 50-100 hits per day, but that it is not unusual for it to receive 130-150 hits per day, especially early each month, when the Articles-of-the-Month pages are posted. He also noted the special contributions to the content of the website this past year by Jack Gleason, Jackson Kytle, Margot Hover, Diane Dodd-McCue, Lex Tartaglia, Kyle Johnson, Steve Dutton, and James Pfeiffer. There was general discussion of the need for more content regarding educational research. Shannon Borchert (Wesley Medical Center, Wichita KS) noted work that he was doing in that area that he hoped to bring to the website soon. Walter Balk (Bronson Methodist Hospital, Kalamazoo, MI) spoke of the need for research about the ACPE educational process itself, and Susan Nance (Memorial Hermann Hospital / Memorial Hermann Children's Hospital, Houston TX) pointed out the potential for research using data from CPE alumni/ae questionnaires. Also, Jackson Kytle (Vice President for Academic Affairs, The HealthCare Chaplaincy, New York, NY) mentioned his interest in educational theory. It was acknowledged that the late ACPE President, Joan Hemenway, who had strongly supported the Research Network, encouraged an emphasis on educational research.
The group discussed the ongoing Ideal Intervention Paper (IIP) Project being led by Jack Gleason and Henry Heffernan. [See §3, above.] A handout describing the IIP for students was distributed. Discussion centered more on the educational value of the IIP exercise for students--it being an innovative expansion of the verbatim exercise so central to CPE--than on research, though the potential of the latter was clear. Several members expressed interest in the project and in exploring participation with Jack Gleason (firstname.lastname@example.org).
The meeting turned to a discussion of initiatives to promote the Network and research within the ACPE. Suggestions included: flyers (as we've done for the past four years at the national conferences), workshops (as we have held in the past, with good attendance and positive feedback), poster sessions (as done by the ACPE at the 2005 Honolulu conference), and greater advertisement of Network honors/awards. It was also proposed that the Network make special contact with newly certified Supervisors, to raise their awareness of the resources of our website and to ask for their support.
Concerning current projects and interests of various members, Gordon Hilsman (St. Joseph Medical Center, Tacoma, WA) spoke of his new survey of spiritual skills, using an extensive self-assessment questionnaire. Peter Holland (Avera Health, Sioux Falls SD) noted a pilot investigation of what criteria supervisors use to accept students into CPE programs and what attracts students to CPE (or causes them to pull away from CPE). Mary Martha Thiel (Hebrew Rehabilitation Center, Boston, MA) talked about introducing students to research, and Jackson Kytle commented on the current research training program at The HealthCare Chaplaincy that could be a great opportunity for supervisors themselves. Regarding patient care issues, Susan Nance (Memorial Hermann Hospital / Memorial Hermann Children's Hospital, Houston TX) talked about the importance of performance improvement projects, and about her interest in research that could foster pathways for particular types of patients/diagnoses. Ralph Ciampa (Hospital of the University of Pennsylvania, Philadelphia PA) reported on a study of how illness affects cancer patients spiritually. The group recalled Gordon Hilsman's research, presented at the Hawaii conference, on Spiritual Patient Needs, Chaplain Functions, and Outcomes for Study [--for more, see the Winter 2006 Newsletter, §1].
One other point of business at the meeting was the unanimous approval of a motion to affirm and authorize individual contributors' ownership of any content that they publish on the Research Network website.
A final, personal word about the meeting and the Network: As Convener, I am continually impressed by the enthusiasm and commitment of supervisors to find time and seek resources for research when they can hardly find time and resources to meet the general demands of running CPE programs and Pastoral Care departments. It is my hope that the ACPE, as a national organization, will consider more ways to support supervisors in their research efforts, including support for grant-writing, the development of grant awards, and the promotion of sabbaticals for continuing education in research methodology and the accomplishment of individual studies. --JE