Nottingham ESRC Doctoral Training Centre

Overseas Institution Visit Report: Katja Milner

K Milner OIV

Nottingham DTC student Katja Milner, reporting back after her ESRC-funded Overseas Institution Visit to Durham, North Carolina in the United States in August 2017:

The aim of my PhD is to explore the role of spirituality in mental health, specifically from the perspectives of those with lived experience of mental health problems. Spirituality is defined very broadly and personally, being expressed through both religious and non-religious forms, but generally to do with what gives people meaning and purpose, how people make sense of life and what can help people to cope with challenges and struggles including illness. Although I believe it is a fascinating topic, it is also a tricky one, because it lends itself very well to the conundrums of subjectivity during research, trying to disentangle interpretation, belief and the deep, often not particularly rational, layers of the human psyche, and the attempt to make into science that which perhaps inherently is not.

In a rather under-stated town in North Carolina sits an incredibly beautiful university called Duke. It is one of the top medical universities in the United States and along with its hospital and clinical research centres is visited by the wealthy and influential on a global scale. The huge campus includes beautiful botanical gardens, old style gothic buildings, an impressive cathedral, and modern shiny futuristic architecture which enshrines the medical and clinical centres. Duke University is home to one of the key academics who has been able to turn spirituality and health research into a science and has placed this still quite niche topic firmly on the health science and medical map. Dr Harold Koenig is Professor of Psychiatry and Behavioural Sciences, associate Professor of Medicine and Director of the Centre for Spirituality Theology and Health at Duke University. He has published extensively in the fields of mental health, geriatrics and religion, with over 500 peer reviewed articles and book chapters. He is the most widely cited name in the field of religion spirituality and health research, having compiled together and systematically reviewed over 3000 studies exploring the effects of religion on health, mental health and wellbeing. The consequence of this research was to highlight the important role that religion and spirituality can play in health and recovery including a wide range of physical illnesses and mental health problems. It contributes towards a dynamic shift in academic and clinical fields from viewing religion and spirituality as harmful or irrelevant to health within the context of the increasing emphasis towards biomedical or secular psychosocial models of understanding, to viewing religion and spirituality as important and potentially contributing positively towards a huge variety of health outcomes.

Despite this shift, spirituality is still a newly emerging field within academia and clinical practice. Although traditionally, spirituality would have been understood as very much connected with religion and theology, its application to clinical healthcare fields is gaining prominence, such as within fields of nursing, occupational therapy, psychology and psychiatry, and the topic is emerging as an exciting new frontier ripe with possibilities and potential for research and exploration. One of the issues about the topic, however, that it is still very niche and under-researched and taught about on educational programmes, especially beyond specifically theological or chaplaincy applications. For this reason I was deeply grateful to be able to visit Dr Koenig at Duke University and his now popular and well known week long spirituality and health research summer school as part of an overseas institutional visit funded by the ESRC. The materials on this summer school formed part of a post-doctoral course which had been taught previously, condensed into a week-long programme attended by people from all over the world since 2004.

When I arrived at the highly air conditioned church building which was to be the venue of the course, I was met by over 40 friendly group attendees from Saudi Arabia, Australia, Hong Kong and all over the United States.  People were mostly all involved in research, some were PhD students like myself, others were chaplains, nurses, social workers, psychologists, doctors and psychiatrists. Used to being alone or at least in the minority in relation to my research interests, it was music to my ears to hear so many people speak about their specific areas of research relating to spirituality, religion and health. These included researching spiritual care development in nursing, the spiritual needs of women coping with the loss of child, the connection between spirituality and healing in equine therapy for children with special needs, and the efficacy of spiritual and religious interventions in clinical psychotherapy.

The summer school kicked off with a talk from a highly prestigious and successful academic who had helped to inspire Dr Koenig’s work, Dr Dan Blazer, Professor Emeritus of Psychiatry and Behavioural Sciences at Duke University Medical Centre, who talked about the personal experience and challenges of doing research. Dr Koenig spoke extensively about his own research into religion, spirituality and health and gave advice about exploring this field. He also focussed on another area of expertise, the use and development of religious measurement scales. Although his research is quantitative, there was also a fascinating talk by qualitative researcher Dr Jill Hamilton, Associate Professor at Emory School of Nursing in Atlanta, who spoke about her experiences of accessing an under-researched and misunderstood group of people in the local community, African-American elders, and challenged existing research outcomes suggesting these communities had lower levels of social support than those of other ethnicities. When she conducted her initial research with these groups, they consistently responded to questions about coping with stresses by explaining their primary sources of support, contrary to the list of pre-supposed questionnaire options already provided, was ‘God’. After this unexpected result, Dr Hamilton visited these communities in a second study, exploring the spiritual and religious songs people sang to help them cope with difficulties in life. She played some of these songs to us and it felt like being given a privileged snap shot into a very different and rarely accessed world. Their songs resonated with an ancient yet timeless beauty perhaps lost to newer generations, like a healing balm sung by their ancestors through the generations to ease life’s struggles.

Other topics covered on the course included very practical aspects of research such as writing for publication, presentation skills, managing research projects and obtaining grant funding. The course was intensive but we had plenty of time as well to integrate and network with other students, creating an e-mail group to stay in touch and share ideas, articles and potentially collaborate in the future. Many of the group were interested in the developments in this field in the UK and the differences here such as the greater emphasis on broader less specifically religious conceptualisations of spirituality compared with the strong emphasis on religion in Dr Koenig’s work which had taken place largely within the US ‘Bible belt’. Therefore, whether Dr Koenig’s research, focussing almost exclusively on religious and often Christian expressions of spirituality, would be generalizable to UK, European and other more secular societies, remains to be seen. However there are indications in some studies that this may not the case, so a great deal of work is required in other parts of the world where people’s expressions of spirituality might be more diverse, less specifically religious and probably influenced by other cultural factors.

Apart from all the interesting people and content of the course, one of the things which struck me most about the visit was learning about the US culture. I found everyone very friendly, helpful, gregarious and open. Dr Koenig’s wife for example, as well as providing a very supportive nurturing presence, gave a very open account of what it is like to be a spouse of a researcher and warned of the importance of maintaining balance and considering family and loved ones within the intensive life of being a researcher. I found this level of openness and transparency very refreshing and was also aware of and fascinated by the strong culture of positivity, aspiration, ‘living the dream’ and ‘going for it’ that American culture really endorses, perhaps sometimes to the critique of other cultures.

After arriving back in the UK, jet lagged and acclimatising to the much cooler less humid weather, a friend asked me ‘What was your key learning’? It is difficult to pin down as I have learned a lot on so many levels. Detailed information about the field of spirituality and health research, conducting this research effectively, how to progress in this quite niche and often under-researched or taught field, and tips and guidance for the journey from one of the most prolific and influential religion and health researchers in the world. I learned about people’s spirituality and health research from all over the world and made great connections, friendships and hopefully future collaborations in a time when thinking and working internationally is a key ‘name of the game’. But perhaps even more, I learned about really extending beyond my own ‘comfort zone’, my smaller world of conceptual knowns and familiars, into a new culture where even the very concept we were studying together meant something quite different to me than it did to my teacher. I realised that by immersing myself even for just a short time in a different culture I could become more aware of some of my pre-conceived ideas and cultural norms, and to gain insight into other points of view, ways of looking at life, at human nature and at what gives people meaning. I was greatly inspired by the effect that being in a different culture had on me, the sense of perspective it gave me and the opportunity to reflect more deeply on my research topic, something I found easier to do when I could step out of the familiar territory of my life and catch a glimpse of how things are seen and done elsewhere.

Katja Milner


Posted on Tuesday 26th September 2017

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