Harold G. Koenig, M.D., on the integration of theologians into health research

Center for Spirituality, Theology, and Health:
Past, Present, and Future

When I came to Duke University Medical Center in 1986 as a geriatric medicine fellow, I was viewed as a bit odd because of my research interests in religion, spirituality and health. In the previous year that I had spent as a family physician in Springfield, Illinois, however, I had cared for many older patients and frequently heard them discuss how important religious faith was in helping them cope with their illnesses. This prompted me to conduct a small research study examining life satisfaction, death anxiety, and religious involvement that found that persons who prayed more and used religion to cope had higher life satisfaction and less death anxiety. This was truly exciting, since it confirmed my clinical impressions. From then on, I knew that research on spirituality and health is what I wanted to do. However, it took about 10 years at Duke to learn how to conduct research, complete some studies, and get some papers published before I could convince my mentors that this was an area worth pursuing as an academic career.

In 1995, I started the Program on Religion, Health and Aging within Duke’s Center for Aging and Human Development. Dr. Harvey Cohen, Dr. Linda George, Dr. Dan Blazer, and Dr. Keith Meador, were mentors and colleagues who supported me and enabled this to happen. Bear in mind that this was a time when religion was not something that physicians studied and certainly didn’t make a career of. The study of spirituality and health was known as the “anti-tenure” factor in those days. Three years later, though, with the help of Dr. David B. Larson, my colleagues and I were able to secure a 5-year grant from the John Templeton Foundation to start the Center for the Study of Religion, Spirituality and Health in 1998. Our focus at that time was to conduct research, publish papers, write grants, and run a post-doctoral educational program. The Center during the next seven years would be very productive, conducting at least a dozen research studies and publishing close to 100 research papers, along with dozens of books on religion, spirituality and health.

In 2005, though, it became evident that the Center needed to do more than just conduct research and run a post-doctoral research program (although research would continue to be the Center’s strength and core). By this time, the field was beginning to grow rapidly due to the accumulation of a critical mass of research and increasing interest within mainstream medicine and nursing of addressing these issues in clinical care. There were enough interested academic researchers and scholars now in the field so that it was ready to move to an entirely new level. Furthermore, this was happening not only in the United States, but also in the United Kingdom, Europe, Canada, and Australia, where small groups of researchers and clinicians were beginning to show interest in developing programs in this area.

Up until then, clergy had not played much of a part in our Center, its research, or its educational programs, since this was largely a medical center initiative. While there was some collaboration with pastoral care when that department had a director of research in the early 1990’s, after that person left the collaboration could not be sustained. In 2005, it became evident that if the religious community were ever to seriously buy into what scientists were doing, they needed to be more involved in this research. Faith communities – because they represent the people and the patients – have the real power to make a difference in society and health care. Furthermore, the absence of theological input into the research and the clinical applications meant that a vital component was missing from this research that scientists without theological training simply could not provide.

At that time, many clergy and theologians were not fully embracing the research that was coming out, and were looking a bit askance at doctors and nurses who were trying to address the spiritual needs of patients. What were these health care professionals doing addressing issues that they had no training or expertise in? What were scientists doing trying to prove (or disprove) the value of religious faith and practice? Up until then, theologians had not typically been involved in the research, in the development of religion/spirituality measures, or in the interpretation of the results. Instead, it was those who had training in research -- psychologists, sociologists, physicians, nurses and public health researchers – who were carrying the field forward.

Therefore, in the later part of 2005, I invited Dr. Keith Meador – both a psychiatrist and a theologian with academic appointments in both Duke medical center and Duke divinity school – to join me as co-director of the Center. To emphasize the role that theology would play, we changed the Center’s name to the Center for Spirituality, Theology, and Health (CSTH). The difference from the earlier Center for the Study of Religion, Spirituality, and Health would be that we would now include a focus on theology by involving theologians into the design and interpretation of the Center’s research and in its educational programs. There were other changes in the Center that Keith and I dreamed about, including a number of groundbreaking initiatives that would require major grant funding to get off the ground. We were successful in obtaining initial support for these initiatives from the John Templeton Foundation.

Beginning in January 2007, these initiatives included a program to award grants to conduct research on spirituality, theology and health (STH), the development of a world-wide STH membership society, the formation of a community of senior scholars, an annual national/international conference at Duke University, and further development of the Center’s educational programs.

The request for research proposals (RFP) is the first in what we hope will be a series of grant programs that the Center will run for the John Templeton Foundation. The current RFP seeks to award grants to elucidate how involvement in the religious community (attendance, worship, altruistic and caring activities) influences individual and community health. The goals are to document effects on health (where health is broadly defined), clarify the biological, social, psychological mechanisms involved, and interpret what the findings mean for the individual, congregational, and community health. We will be awarding seven $200,000 grants to outstanding research proposals that target these goals.

The STH membership society is open to all, including researchers, clinicians, and others with interest in this area – academic or non-academic -- and will be worldwide in scope. Members of STH networks in Europe, Great Britain, Canada, Australia, and Brazil are being recruited to join the society, which charges a modest yearly membership fee ($75) for a number of benefits. These benefits include a monthly STH e-newsletter on grants, new research findings, and events in the spirituality and health field; reduced tuition for the annual Duke conference; access to the membership directory (which will have the names and contact information for society members); access to the proceedings from yearly Duke conference; and access to senior investigators for mentorship and advice. All major health disciplines have a membership society to help persons make connections and learn about what others with similar interests are doing, and we believe that having such a society in spirituality and health will significantly advance the field, by promoting dialogue, research, and scholarship. The deadline for letters of intent is July 15.

Our community of scholars (COS) consists of 12 leading STH researchers and scholars coming primarily from the United States (although including non-US scholars) and primarily from Duke and surrounding universities. Each month we invite one national STH scholars from outside of Duke to provide a lecture and engage with Duke scholars on the key issues facing the field of spirituality and health. The purpose of the COS is to serve as a leadership core to create a research network, develop collaborative research projects, write consensus reports on controversial issues in STH, mentor young investigators, and raise financial support for research and networking.

The Center also conducts a number of educational programs. First, as noted above, there will be an annual national-international conference at Duke focused on research, scholarship, and networking in spirituality and health (1st conference to be held in April 2008). This will serve as the annual meeting for the STH membership society, and will not only involve presentations by renowned STH researchers and scholars, but also provide young investigators with an opportunity to present their research and receive feedback from peers and senior colleagues. Besides the annual conference, the Center continues to hold research and clinical workshops during the summer. Five-day intensive research workshops are open to persons from all educational levels interested in conducting research in the area of STH, and are designed for both senior and junior researchers. The clinical workshop is for clinicians from a wide range of health specialties who want to integrate spirituality into patient care in a compassionate and sensitive manner.

The work of the Center described above is particularly relevant to pastoral counselors and chaplains, who are the primary spiritual care providers in health settings. The research and clinical programs are ideal for chaplains and will prepare them to both conduct research and help educate other health professionals about their role and the role that faith plays in health and illness. The Center is a liaison organization of the Association of Professional Chaplains. For those who want to know more about our Center and its initiatives, go to our web site at http://www.dukespiritualityandhealth.org.

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