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January 2005 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Presbyterian, Philadelphia PA.


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 [].


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].

Levin, J. S. and Vanderpool, H. Y. "Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion." Social Science and Medicine 24, no. 7 (1987): 589-600. [The authors point up epistemological, methodological, and analytical problems with 27 studies associating religious attendance with health effects, but they present a theoretical argument for expecting such an association. They moreover give a "primer on religion for epidemiologists and other sociomedical scientists interested in exploring the health-related effects of religious factors" (abstract).]

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.)

Bartel, M. "What is spiritual? What is spiritual suffering?" Journal of Pastoral Care and Counseling 58, no. 3 (Fall 2004): 187-201. [In the process of presenting his own categorization of spiritual needs according to the themes of love, faith, hope, virtue, and beauty; the author, a chaplain, includes an interesting table (pp. 190-193) listing various sets of spiritual needs according to sixteen other authors, plus some illustrations of needs from Hebrew and Christian scripture.]

Bregman, L. "Defining spirituality: multiple uses and murky meanings of an incredibly popular term." Journal of Pastoral Care and Counseling 58, no. 3 (Fall 2004): 157-167. [This editorial by a Professor of Religion at Temple University (Philadelphia PA) sketches the history of the term spirituality to its current ascendant position in the literature and describes how its "vague and shifting" (p. 166) meanings work to satisfy multiple needs.]

Chiu, L., Emblen, J. D., Van Hofwegen, L., Sawatzky, R. and Meyerhoff, H. "An integrative review of the concept of spirituality in the health sciences." Western Journal of Nursing Research 26, no. 4 (June 1004): 405-428. [This scholarly analysis of 73 research articles on spirituality published between January 1990 and September 2000, including 46 reports of quantitative studies, describes core operational definitions of spirituality and outlines elements of a conceptual framework for further research. The article is written with nursing research especially in mind.]

Cook, C. C "Addiction and spirituality." Addiction 99, no. 5 (May 2005): 539-551. [This descriptive study of 265 books and papers on spirituality & addiction details conceptual components of spirituality as it is represented in the literature. There are several very informative tables (pp. 544-546), and the authors propose a specific definition (pp. 548-549) for future research.]

MacLaren, J. "A kaleidoscope of understandings: spiritual nursing in a multi-faith society." Journal of Advanced Nursing 45, no. 5 (March 2004): 457-462; with discussion on pp. 462-464. [In this essay from the United Kingdom, the author explores how spirituality may play into nursing practice in a pluralistic society. She gives good attention to the multiplicity of definitions of the concept found in nursing, including secular and New Age definitions, and argues from a postmodernist perspective against any attempt to narrow the concept.]

McSherry, W. and Cash, K. "The language of spirituality: an emerging taxonomy." International Journal of Nursing Studies 41, no. 2 (February 2004): 151-161. [The authors' review of the nursing literature from 1985-2002 leads them to conclude that a very broad conceptualization of spirituality is taking hold in nursing, and they express concern that this trend may result in a definition of the term that is so broad as to lose any practical value.]

Smith, J. and McSherry, W. "Spirituality and child development: a concept analysis." Journal of Advanced Nursing 45, no. 3 (February 2004): 307-315. [In the process of addressing the subject of spirituality in children, the authors contend with the "theoretical muddle" (p. 310) of conceptualizations of spirituality in nursing.]


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