January 2005 Article of the Month
Hall, D. E., Koenig, H. G. and Meador, K. G. "Conceptualizing 'religion': how language shapes and constrains knowledge in the study of religion and health." Perspectives in Biology and Medicine 47, no. 3 (Summer 2004): 386-401.
COMMENT AND SUMMARY: The very first Article-of-the-Month, when this web site began (September 2002), addressed the variety of definitions of spirituality in the health care literature. For all of the methodological complexities that face the study of spirituality/religion and health, the greatest difficuty in the field may be the conceptualization of its basic terms: spirituality and religion. Since the early 1990s, spirituality has been the ascendant term, depicted as more individual and inclusive than religion and not bound by religion's so-called "limits" of particular institutions, dogmas, and practices. However, the authors of this month's featured article argue for a new focus on the concept of religion and on epistemological issues concerning how one can know such a thing, for the purpose of research.
Hall, Koenig and Meador have written an important and provocative article "to assist medical scientists in clarifying and advancing the concept of religion" [p. 387] and "to stimulate debate over the conceptual basis for the scientific study of religion" [p. 398]; and this should be of interest to chaplains and chaplain researchers alike. They maintain that religion is best conceived as a "cultural-linguistic system that must be studied from the inside" [p. 398, my italics], yet the "secular worldview" that is said to dominate the medical literature is "a view from the outside looking in, observing religious phenomena and reinterpreting them on secular terms" [p. 391], thereby creating serious distortions. They argue for research that seeks to understand religion with the sensitivity of an insider who is "fluent" [see pp. 391-394] in the particular cultural-linguistic system of a religion. One possible implication of this line of thought is that by holding out a central place in research for "experts" who are "fluent" in religious traditions, there would seem to be a significant role to be played by chaplains (though the authors do not explicitly make this point).
Their argument is epistemological and practical, and they provide a good tour through the philosophical issues at play here, from a critique of foundationalism to an explanation of the cultural-linguistic approach (which denies that a single worldview, even a secular worldview, may claim any intrinsic privilege on purely philosophical grounds [see p. 390]). Their challenge to researchers is "to understand religion on its own terms, as a different way of knowing or a different way of being-in-the-world" [p. 391]. They liken the study of religion to the study of a foreign language: "grammar, syntax, and vocabulary define necessary linguistic content, but fluency is demonstrated only through skillful reading, writing, and speaking" [p. 390]. They note, however:
Most existing measures of religiousness attempt to define and measure the various domains of "spiritual belief" or "numinous experience" that make up the vocabulary and syntax of religion. ...[and by] so doing, these measures have identified some of the important ingredients in religion, but this approach is not sufficient. Fluency in a faith tradition requires both content and skill. [Pp. 391-392]They charge that measures popular in current research do not attend to what is most important or appropriate for the study of religion and health but rather to what is most convenient [see p. 393]. The authors admit that "there will be unique methodological challenges to measuring something like faith fluency, but solving such methodological hurdles may yield insights more meaningful than the current approaches, which divert religious measurement to the content of belief or experience" [p. 394].
There is obviously a great deal here to spur discussion, but one section of the article particularly caught this reader's attention: namely the treatment of the fact that "many people identify themselves as spiritual but not religious" [p. 394]. In light of their focus on religions as cultural-linguistic contexts for meaning, Hall, Koenig and Meador consider such "individualized 'spirituality'" to be like a "private language," and they go on from there to criticize the idea that spirituality might be some a kind of "universal language" [pp. 394-395] for research in the field. What is not clear to this reader is what the authors would actually do in research with the people who claim to be spiritual but not religious. After all, the very reality of the number of such people, and the shifting popular sense of spirituality vis-a-vis religion, is part of the impetus behind the ascendancy of the term spirituality. Can such people really constitute single-member religions with their own cultural-linguistic contexts, or should such people be grouped into some larger cultural-linguistic context? Moreover, what is the researcher to do with the people who are part of a religion because of the circumstance of personal history and who may hold worldviews that vary greatly from the dominant cultural-linguistic context of the religion in which they are fluent and which may serve essentially as a modality of expression for their personal spirituality? How might the religiousness of such a person be measured when assessed by experts in a particular tradition, especially since such a person may operate on the outer fringes of the cultural-linguistic context? How might the dynamic of orthodoxy play into this assessment? Of course, questions like these show how the article may be a catalyst for further discussion.
The overall thrust of the article is a call for researchers to pull back from the quest for generalization and to concentrate on the richness of particular religious traditions. Thus, for instance, rather than attempting to explore the importance to health of prayer in general, researchers should look more closely at how people in certain religious communities pray [see p. 395]. The authors state, "The existing research on religion in general is in many ways like a meta-analysis conducted before collecting the necessary underlying specific data" [p. 396]. The message seems to be that this field of research may have gotten ahead of itself in its development. For chaplains who are dissatisfied by some researchers' crude objectification of religious phenomena or by the apparent superficiality of some scientific measures of religiousness, this article will probably seem cathartic. However, while Hall, Koenig and Meador primarily address physicians, their challenge can also be heard by chaplains as a call to join in the dialogue about the conceptual and epistemological issues in the relatively young study of associations between religion and health.
Chaplains should note that while all three authors are physicians, Daniel E. Hall is also an Episcopal priest, and Keith G. Meador is Professor of the Practice of Pastoral Theology and Medicine at Duke Divinity School. Along with Meador, Harold G. Koenig is co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center [www.spiritualityandhealth.duke.edu].
Suggestions for the Use of the Article for Discussion in CPE:
The epistemological and methodological themes of this month's article may at first make it seem a poor choice for general discussion with CPE students newly acquainted with pastoral care research, but readers of our Fall 2003 Newsletter may recall a proposal to introduce students to research precisely through a discussion of epistemology. In the wake of the lesson plan proposed in the Newsletter, the current article (especially the section on pp. 387-389: Frosting, Cake, and Religion) could work well in the second half of a residency program to reprise and further the discussion of "ways of knowing" relevant to research into religion and health. Students may also be able to relate the idea of fluency in religion's cultural-linguistic context to CPE group issues involving religious diversity and the process of encountering different religious weltanschauungen.
For students more advanced in research, the text should be engaging for its principal challenges regarding methodology, and some students may wish to develop a project to identify assessments/measures suited to particular religious groups. Also, the critique of a utilitarian approach to the subject of religion and health on pp. 396-397 would itself be an engaging discussion starter, especially with the comment that "even the churches have adopted a therapeutic model of faith" [p.396].
Related Items of Interest:
I. The following article is a central reference for Hall, Meador, and Koenig, who praise it as a "landmark article" containing a "nearly prophetic assessment of the conceptual hurdles for this field" [p. 387].
II. With spirituality--not religion--the ascendent term in the health care literature, it is worth noting some of the most recent articles grappling with that concept. Much of the dialogue on this subject during 2004 occurred within nuring. (Readers may also wish to refer back to the basic bibliography about spirituality in the September 2002 Article-of-the-Month.)
If you have suggestions about the form and/or content of the site, e-mail Chaplain John Ehman (Network Convener) at firstname.lastname@example.org