July 2005 Article of the Month
Hufford, D. J. "An analysis of the field of spirituality, religion and health." See www.metanexus.net/tarp/pdf/TARP-Hufford.pdf [PDF, 72 pages], accessed June 2005.
[EDITOR'S NOTE: While our Articles-of-the-Month page usually highlights selections from the (print) journal literature, this month's article is published on the Internet as a scholarly paper as part of the Templeton Advanced Research Program, though I am confident that some version of it will soon appear as a conventional journal article. --JE]
COMMENT AND SUMMARY: This is one of a handful of "Field Analysis" papers commissioned by the Templeton Advanced Research Program (and posted on the Metanexus Institute's web site) in order to identify successes and limitations, key problems and methodological shortcomings, to be overcome in research on religion and health. David J. Hufford, PhD, Penn State University Professor & Chair, Humanities; and Professor, Departments of Neural & Behavioral Sciences and Family & Community Medicine was tapped to provide the current analysis, and his work is an extraordinarily fresh overview of the state of the science, with many constructive suggestions worthy of discussion.
Hufford offers a concise outline of his paper on the first page, and an extensive bibliography on pages 33-72, so the basic text constitutes only 32 pages (pp. 2-33). I will not attempt to summarize, as a whole, such a clearly organized paper, but I shall raise a few points that chaplain researchers and CPE students should find most thought provoking.
After a brief introduction to the history of the relationship between spirituality/religion and health care/research, Hufford observes that the field of spirituality, religion, and health (S/RH) has not developed a "rich and critical interdisciplinary discourse"--indeed "it has not sought out intellectual relationships with researchers in obviously relevant fields" [p. 4] and has gone relatively unnoticed by researchers in those related fields. "Perhaps most surprisingly, the S/RH field has not emphasized collaboration in research and practice with the one discipline that has always labored to understand and deliver S/R 'interventions' in health settings, chaplains" [pp. 5-6]. He goes on to note the dearth of scholarly infrastructure in the field, in spite of the "scholarship of the humanities and social science fields" that comprise the "intellectual surround" [p. 7] of the field of medicine; and in discussing the lack of research on who should provide attention to S/R concerns in health care settings, he points out how very few studies have focused on chaplains [see pp. 24-25]. Chaplains may sense in these observations the disconnect that many in our vocation feel when reading S/RH literature or attending conferences: the valuable connections that would seem natural between chaplains and S/RH--e.g., our clinical position and elements of our humanities education--often seem unrealized and unappreciated. This is an area for growth in the field.
A key feature of the paper is Hufford's consideration of the problems of language in the study of S/RH, especially in the use the term spirituality. (This topic has long run through discussions of the Research Network and was the focus of the very first Article-of-the-Month page in September 2002.) He calls for good lexical studies in this area, and he makes a remarkable proposal:
Spirituality refers to the domain of spirit(s): God or gods, souls, angels, djinni, demons. In short, this is what was once called the "supernatural" (and still is by many English speakers). When spirituality refers to something else, it is by metaphorical extension to other intangible and invisible things, such as ideas, as in "team spirit" or the "spirit of democracy".... [p. 10]In no other writing has this reader found such a clear challenge to the vagaries of the use of spirituality in the health care literature which seem to strike many chaplains as problematic for reasons of professional practice, if not for research. Pages 7-12 amount to a mini essay on language in the field that could help everyone become clearer about their own use of spirituality, whether or not one agrees with Hufford's definition. Are chaplains comfortable with the idea of spirituality referring to spirit(s)? The proposal certainly sharpens any discussion of language.
However, while Hufford construes spirituality so practically, he does not construe it narrowly, and chaplains may also be challenged by the assertion that many Complementary & Alternative Medicine (CAM) interventions may fall within the realm of the spiritual even though they may fall outside of mainstream theological orthodoxy. He gives the example of Therapeutic Touch, and he observes that while CAM researchers have focused on such interventions--perhaps to the neglect of traditional religious healing practices--S/RH researchers have tended to do the opposite: looking at religious healing practices and avoiding Therapeutic Touch, Qigong, Reiki, etc. If chaplains are willing to accept a definition of spirituality that centers on spirit(s), are they also willing to accept the place of a wide range of CAM interventions in S/RH research? Hufford says of the tension between researchers in the S/RH and CAM fields that the conflict "smuggles personal theological commitments into the scientific discourse..." [p. 17], and chaplain researchers may benefit from this caution in their own work. He raises particularly (see especially pp. 19-21) how the S/RH field is skewed toward Protestant Christianity (and this should resonate with many chaplains who have been involved in the dialogue on religious diversity within the ACPE).
The latter pages of the paper deal largely with strengths and positive trends in the field of SR/H, such as evidence of improving study designs, increased attention to diverse populations, the incorporation of biological measures in research and better instrument development in general, and more research connecting S/R to mental health. One final point that may stand out to chaplains is Hufford's assertion that openness to intercessory prayer research is a positive indicator of the field's maturation. This is admittedly a controversial assertion but one that he explains:
...[B]eliefs in the efficacy of prayer apart from conventional psychological pathways are beliefs that make an empirical claim. The metaphysical dimensions of such claims (e.g., Divine intervention) may be beyond scientific inquiry, but the claim that when these prayers are uttered certain things become more likely is an empirical claim that must be investigable. And given the very widespread public belief in intercessory prayer as capable of operating by spiritual as well as other means, it seems reasonable and an indication of open-mindedness in the scientific community that some researchers will give the subject a try and that some editors and peer reviewers will look thoughtfully at the results. [p. 29](The subject of intercessory prayer research was the topic of the November 2003 Article-of-the-Month.) The paper does not contain a formal conclusion but rather simply ends after a discussion of instruments. Most readers should not find this to be a problem, since the overall narrative is well developed and leads logically into the extensive bibliography.
Suggestions for the Use of the Article for Discussion in CPE:
Topics for discussion have been suggested in the paragraphs above, but since the paper offers so much to discuss, CPE students might best be assigned only sections instead of the whole work. Pages 2-12 (on the background of the field, interdisciplinary dynamics, and language) would be well suited for newer students, pages 12-17 would make for a engaging discussion of CAM in particular, and pages 17-33 could be the center of discussion for more advanced students able to take up issues of research methodology.
Related Items of Interest:
Koenig, H. G., McCullough, M. E. and Larson, D. B., eds. Handbook of Religion and Health. New York: Oxford University Press, 2001. [This is a principal reference in Hufford's paper. It is a massive resource (712 pp.) offering a comprehensive treatment of 20th century research into the relation between spirituality/religion and health, and it certainly deserves a place in every pastoral care library.]
Among David Hufford's writings, the following may be of special interest to chaplains:
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