Journal of Religion and Health, Vol. 32, No. 3, Fall 1993
Religious Themes in Medical Journals ROBERT LYMAN PO T T E R
ABSTRACT: The dialogue between medicine and religion has been expectedto intensify. To test the degree of interaction empirically, the contents of four clinical medicaljournals for the years 1981 to 1991 were examined for reference to religious themes. Religion was important in 13 of 17,345 articles. Reasons proposed for this relative neglect are hostility, lack of interest, inadequate empirical studies, and the substitution of ethics and humanities as surrogates for religion. Scholars of religion are encouraged to submit relevant material to medicaljournals.
Th er e has been a general expectation t h a t the dialogue between medicine and religion would grow over the past t w e n t y years since the blooming of t he holistic h e a l t h movement, the continuing st rengt h of clinical pastoral education, and the renewed interest in the philosophy of medicine? Assuming t h a t the periodical l i t e r a t u r e both reflects and guides the professional discourse, an analysis of periodical l i t e r a t u r e should provide a m easure of t h a t discourse. 2 Oth e r studies have investigated religious variables in four major examples of the psychiatric literature, and for a t en-year period of The Journal of Family Practice? This study asks the question: Does reference to religious variables in the medical periodical l i t e r a t u r e w a r r a n t the conclusion t h a t th er e is growth in the medicine and religion dialogue?
Method The contents of four widely circulated clinical medical journals were examined by the author. The following journals were reviewed: Journal of the
American Medical Association, New England Journal of Medicine, Annals of Internal Medicine, and The Journal of Family Practice. The index of each of 1,400 issues of these journals for the years 1981 t h r o u g h 1991 was examined for reference to words t h a t fell into t a r g e t categories. Editorials were included, b u t letters to the editor, news reports, book reviews, and other brief communications were excluded. Robert Lyman Potter, M.D., Ph.D., is Associate Clinical Professor of Medicine at the University of Kansas School of Medicine and Adjunct Professor of Religion and Medicine at Central Baptist TheologicalSeminary in Kansas City, Kansas. 217
9 1993 Institutes of Religion and Health
218
Journal of Religion and Health
The target categories included religious, psychosocial, ethical, and humanistic clue words. Overlapping of more than one category in a single title was resolved by examining the article and assigning it by weight of content to only one category. It is possible that some articles not differentially tabulated may have made significant reference to any one of the four categories in the body of the article rather than in the title. Therefore, the number of articles containing reference to religious variables m a y be underestimated.
Results
In each table the total number of articles and the numbers falling into each category are listed for each year examined. The totals for the eleven-year period are calculated. A composite of totals for all four journals reveals that titles of only 13 of 17,345 articles contain reference to religious variables. These tabulations reveal that there is a weak trend to increasing numbers of articles dealing with religion and medicine in The J o u r n a l o f F a m i l y Practice. The trend is weak in that it has decreased rather than increased over the past four years. The numbers of articles having to do with psychosocial issues appear to have remained constant with a period of increase in the early years of the last decade. Numbers of humanistic articles have remained relatively constant, while ethical articles have substantially increased. These two categories are often closely related in content, and together they represent 5.23% of the total body of clinical literature considered in this study.
TABLE 1
J o u r n a l of the American Medical Association Year
Articles
Psychosocial
Ethical
Humanistic
Religious
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 totals
603 607 617 562 539 514 488 534 481 490 541 5,976
5 9 13 13 13 13 8 11 11 11 8 115
12 14 13 9 22 17 14 21 28 20 14 184
22 23 29 27 24 7 15 26 10 22 21 226
0 0 0 0 0 1 0 0 1 0 0 2
~-.-~ ~q~ I-~ ~,.~ C.~ Oi~ I. ~
C~.~ L ~ C.~ L ~
~D
bmlo
Oo
L~
220
Journal of Religion and Health
TABLE 5
Composite of all four journals Year
Articles
Psychosocial
Ethical
Humanistic
Religious
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 totals
1644 1661 1667 1647 1553 1521 1488 1548 1486 1533 1597 17,345
27 37 49 31 44 32 38 41 22 26 23 370
24 27 33 30 44 32 29 47 49 49 50 414
47 58 64 58 50 31 33 42 29 27 55 494
0 0 4 0 0 1 0 3 2 2 1 13
Discussion
It can be concluded that the small number of articles related to religion that were found in this sample of mainstream medical literature does not support the claim that a strong or growing medicine and religion dialogue is occurring. It is possible to cite the weak trend in the last few years in The Journal of Family Practice as a possible warrant for the argument, but it appears to be an anomalous finding. At the same time, ethical and humanistic issues appear to be holding strong with a slight tendency to increase. It could be concluded that these categories have been the surrogates for religion within professional medical discourse. The secularization of ethics has been noted by Callahan, and there are liberal religionists who have status within departments of medical humanities. 4 Despite the lack of strong support for the medicine and religion dialogue from mainstream clinical journals, the impression of important growth in this field m a y be affirmed from trends in other types of periodical literature, books, and movements within clinical settings and health care institutions. ~ The fields allied to the medical profession, such as nursing, behavioral sciences, and medical sociology, have produced abundant data relating medicine and religion. There are institutions that are dedicated to the dialogue, such as Park Ridge Center in Chicago and the Institute of Religion in Houston. There are academically based individuals working in medical humanities, behavioral medicine clinics, or clinical pastoral departments who are giving strong attention to the spiritual dimension of the h u m a n being. There are specific journals devoted to this dialogue, including Second Opinion and
Robert Lyman Potter
221
and its allies in pastoral counseling and chaplaincy also m a k e substantial contribution through journals such as the Journal of Pastoral Care. What is evident is that there is widespread and scholarly support for the medicine and religion dialogue, but it is not located in the center of medical professional discourse as reflected in the periodical literature. ~ The reasons are unclear for the relative absence of religion in the mainstream medical journals. I suggest four principal reasons that in combination might explain the relative neglect of religion in medical discourse. The first reason is hostility toward religion. Many scientists are convinced t h a t religion in general is an invalid superstition incompatible with a modern world view. Those who hold this position often point to instances in which religious viewpoints interfere with the application of scientific medicine, or cases of sickness directly attributable to religious practice. The second reason to ignore the dialogue is lack of interest in religion. There are those who believe t h a t religion is to be separated from medical practice because it is an inappropriate partner for dialogue. It is often the opinion of medical professionals t h a t religion is not important to health matters, or t h a t it has no practical application to healing, and is, therefore, of no interest to them. The third reason is a sense that religion is such a personal, diffuse, and pluralistic subject that it cannot be defined, and is very difficult to study empirically. While there is a definitional problem coupled with complex methods of data gathering, religion is no more disqualified from objective analysis t h a n any other psychosocial factor in h u m a n life. There is strong evidence of highly sophisticated empirical m e a s u r e m e n t of religion and its consequences. There m a y be some journal editors who would be willing to publish articles involving religion and medicine if scholars would submit studies of sufficient empirical quality to pass their peer review system. The fourth reason for neglect is the acceptance of the humanities and ethics, or even the psychosocial, as adequate surrogates for the subject m a t t e r ordinarily contained within religion. It may be a "safe" use of this material without having to justify its appearance in a "scientific" journal. This strategy of disguising religious concerns in terms that are more neutral and acceptable to a secular society has allowed some covert dialogue to continue. The editorial policy of the Journal of the American Medical Association provides a case study to illustrate this problem of the neglect of religion. In 1987 the editors of the Journal stated that the key objective is "to promote the science and art of medicine and the betterment of the public health." One of the ten "critical objectives" was "to inform readers about nonclinical aspects of medicine, including the political, philosophic, ethical, legal, social, economic, and cultural. ''7 It could be inferred that religion was implied in some of these categories, but it is clearly absent as a named, distinct "nonclinical aspect of medicine." This omission is reflected in the fact that only two articles of a religious nature were published in the J A M A from 1981 to
222
Journal of Religion and Health
1991. One article described the pathophysiology of death by crucifixion, and the other was an epidemiological study of longevity in a cohort of members of the Church of Christ, Scientist. As an example of how mainstream medical journals avoid the subject of religion and medicine, the editorial policy of JAMA is, at the very least, a strong case for lack of interest as a reason for such neglect.
Conclusion While the impression of growth in the medicine and religion dialogue has its support in a variety of factors dynamically influencing the medical profession, this study reveals only a weak warrant for the claim that any growth has occurred in the clinical medical literature. Those who are interested in moving the dialogue into the mainstream medical discourse by way of the clinical medical literature will have to provide counter-evidence to neutralize the four reasons given for the relative neglect of religion.
References 1. Clinebell, H., Jr., "Introduction." In Montgomery, D., ed., Healing and Wholeness. Richmond, Va., John Knox Press, 1971, p. 13. 2. Katerndahl, D., and Cohen, P., "Research Methodology Series Quantitatively Reviewing the Literature: The Application of Meta-Analysis," Family Practice Research J., 1987, 6, 123-129. 3. Larsen, D., et al., "Systematic Analysis of Research on Religious Variables in Four Major Psychiatric Journals, 1978-1982," Amer. J. Psychiatry, 1986, 143, 329-334; Craigie, F., et al., "A Systematic Analysis of Religious Variables in The Journal of Family Practice, 1976-1986," J. Family Practice, 1988, 27, 509-513. 4. Callahan, D., "Religion and the Secularization of Bioethics," The Hastings Center Report, 1990, July/August, 2-4. 5. Levin, J., and Schiller, P., "Is There a Religious Factor in Health?" J. Religion and Health, 1987, 26, 9-36. 6. Miller-McLemore, B., '~rhinking Theologically About Modern Medicine," J. Religion and Health, 1991, 30, 287-298. 7. Lundberg, G., "Key and Critical Objectives for the The Journal," J. Amer. Medical Association, 1987, 258, 2567.
Religious Themes in Medical Journals ROBERT LYMAN PO T T E R
ABSTRACT: The dialogue between medicine and religion has been expectedto intensify. To test the degree of interaction empirically, the contents of four clinical medicaljournals for the years 1981 to 1991 were examined for reference to religious themes. Religion was important in 13 of 17,345 articles. Reasons proposed for this relative neglect are hostility, lack of interest, inadequate empirical studies, and the substitution of ethics and humanities as surrogates for religion. Scholars of religion are encouraged to submit relevant material to medicaljournals.
Th er e has been a general expectation t h a t the dialogue between medicine and religion would grow over the past t w e n t y years since the blooming of t he holistic h e a l t h movement, the continuing st rengt h of clinical pastoral education, and the renewed interest in the philosophy of medicine? Assuming t h a t the periodical l i t e r a t u r e both reflects and guides the professional discourse, an analysis of periodical l i t e r a t u r e should provide a m easure of t h a t discourse. 2 Oth e r studies have investigated religious variables in four major examples of the psychiatric literature, and for a t en-year period of The Journal of Family Practice? This study asks the question: Does reference to religious variables in the medical periodical l i t e r a t u r e w a r r a n t the conclusion t h a t th er e is growth in the medicine and religion dialogue?
Method The contents of four widely circulated clinical medical journals were examined by the author. The following journals were reviewed: Journal of the
American Medical Association, New England Journal of Medicine, Annals of Internal Medicine, and The Journal of Family Practice. The index of each of 1,400 issues of these journals for the years 1981 t h r o u g h 1991 was examined for reference to words t h a t fell into t a r g e t categories. Editorials were included, b u t letters to the editor, news reports, book reviews, and other brief communications were excluded. Robert Lyman Potter, M.D., Ph.D., is Associate Clinical Professor of Medicine at the University of Kansas School of Medicine and Adjunct Professor of Religion and Medicine at Central Baptist TheologicalSeminary in Kansas City, Kansas. 217
9 1993 Institutes of Religion and Health
218
Journal of Religion and Health
The target categories included religious, psychosocial, ethical, and humanistic clue words. Overlapping of more than one category in a single title was resolved by examining the article and assigning it by weight of content to only one category. It is possible that some articles not differentially tabulated may have made significant reference to any one of the four categories in the body of the article rather than in the title. Therefore, the number of articles containing reference to religious variables m a y be underestimated.
Results
In each table the total number of articles and the numbers falling into each category are listed for each year examined. The totals for the eleven-year period are calculated. A composite of totals for all four journals reveals that titles of only 13 of 17,345 articles contain reference to religious variables. These tabulations reveal that there is a weak trend to increasing numbers of articles dealing with religion and medicine in The J o u r n a l o f F a m i l y Practice. The trend is weak in that it has decreased rather than increased over the past four years. The numbers of articles having to do with psychosocial issues appear to have remained constant with a period of increase in the early years of the last decade. Numbers of humanistic articles have remained relatively constant, while ethical articles have substantially increased. These two categories are often closely related in content, and together they represent 5.23% of the total body of clinical literature considered in this study.
TABLE 1
J o u r n a l of the American Medical Association Year
Articles
Psychosocial
Ethical
Humanistic
Religious
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 totals
603 607 617 562 539 514 488 534 481 490 541 5,976
5 9 13 13 13 13 8 11 11 11 8 115
12 14 13 9 22 17 14 21 28 20 14 184
22 23 29 27 24 7 15 26 10 22 21 226
0 0 0 0 0 1 0 0 1 0 0 2
~-.-~ ~q~ I-~ ~,.~ C.~ Oi~ I. ~
C~.~ L ~ C.~ L ~
~D
bmlo
Oo
L~
220
Journal of Religion and Health
TABLE 5
Composite of all four journals Year
Articles
Psychosocial
Ethical
Humanistic
Religious
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 totals
1644 1661 1667 1647 1553 1521 1488 1548 1486 1533 1597 17,345
27 37 49 31 44 32 38 41 22 26 23 370
24 27 33 30 44 32 29 47 49 49 50 414
47 58 64 58 50 31 33 42 29 27 55 494
0 0 4 0 0 1 0 3 2 2 1 13
Discussion
It can be concluded that the small number of articles related to religion that were found in this sample of mainstream medical literature does not support the claim that a strong or growing medicine and religion dialogue is occurring. It is possible to cite the weak trend in the last few years in The Journal of Family Practice as a possible warrant for the argument, but it appears to be an anomalous finding. At the same time, ethical and humanistic issues appear to be holding strong with a slight tendency to increase. It could be concluded that these categories have been the surrogates for religion within professional medical discourse. The secularization of ethics has been noted by Callahan, and there are liberal religionists who have status within departments of medical humanities. 4 Despite the lack of strong support for the medicine and religion dialogue from mainstream clinical journals, the impression of important growth in this field m a y be affirmed from trends in other types of periodical literature, books, and movements within clinical settings and health care institutions. ~ The fields allied to the medical profession, such as nursing, behavioral sciences, and medical sociology, have produced abundant data relating medicine and religion. There are institutions that are dedicated to the dialogue, such as Park Ridge Center in Chicago and the Institute of Religion in Houston. There are academically based individuals working in medical humanities, behavioral medicine clinics, or clinical pastoral departments who are giving strong attention to the spiritual dimension of the h u m a n being. There are specific journals devoted to this dialogue, including Second Opinion and
Robert Lyman Potter
221
and its allies in pastoral counseling and chaplaincy also m a k e substantial contribution through journals such as the Journal of Pastoral Care. What is evident is that there is widespread and scholarly support for the medicine and religion dialogue, but it is not located in the center of medical professional discourse as reflected in the periodical literature. ~ The reasons are unclear for the relative absence of religion in the mainstream medical journals. I suggest four principal reasons that in combination might explain the relative neglect of religion in medical discourse. The first reason is hostility toward religion. Many scientists are convinced t h a t religion in general is an invalid superstition incompatible with a modern world view. Those who hold this position often point to instances in which religious viewpoints interfere with the application of scientific medicine, or cases of sickness directly attributable to religious practice. The second reason to ignore the dialogue is lack of interest in religion. There are those who believe t h a t religion is to be separated from medical practice because it is an inappropriate partner for dialogue. It is often the opinion of medical professionals t h a t religion is not important to health matters, or t h a t it has no practical application to healing, and is, therefore, of no interest to them. The third reason is a sense that religion is such a personal, diffuse, and pluralistic subject that it cannot be defined, and is very difficult to study empirically. While there is a definitional problem coupled with complex methods of data gathering, religion is no more disqualified from objective analysis t h a n any other psychosocial factor in h u m a n life. There is strong evidence of highly sophisticated empirical m e a s u r e m e n t of religion and its consequences. There m a y be some journal editors who would be willing to publish articles involving religion and medicine if scholars would submit studies of sufficient empirical quality to pass their peer review system. The fourth reason for neglect is the acceptance of the humanities and ethics, or even the psychosocial, as adequate surrogates for the subject m a t t e r ordinarily contained within religion. It may be a "safe" use of this material without having to justify its appearance in a "scientific" journal. This strategy of disguising religious concerns in terms that are more neutral and acceptable to a secular society has allowed some covert dialogue to continue. The editorial policy of the Journal of the American Medical Association provides a case study to illustrate this problem of the neglect of religion. In 1987 the editors of the Journal stated that the key objective is "to promote the science and art of medicine and the betterment of the public health." One of the ten "critical objectives" was "to inform readers about nonclinical aspects of medicine, including the political, philosophic, ethical, legal, social, economic, and cultural. ''7 It could be inferred that religion was implied in some of these categories, but it is clearly absent as a named, distinct "nonclinical aspect of medicine." This omission is reflected in the fact that only two articles of a religious nature were published in the J A M A from 1981 to
222
Journal of Religion and Health
1991. One article described the pathophysiology of death by crucifixion, and the other was an epidemiological study of longevity in a cohort of members of the Church of Christ, Scientist. As an example of how mainstream medical journals avoid the subject of religion and medicine, the editorial policy of JAMA is, at the very least, a strong case for lack of interest as a reason for such neglect.
Conclusion While the impression of growth in the medicine and religion dialogue has its support in a variety of factors dynamically influencing the medical profession, this study reveals only a weak warrant for the claim that any growth has occurred in the clinical medical literature. Those who are interested in moving the dialogue into the mainstream medical discourse by way of the clinical medical literature will have to provide counter-evidence to neutralize the four reasons given for the relative neglect of religion.
References 1. Clinebell, H., Jr., "Introduction." In Montgomery, D., ed., Healing and Wholeness. Richmond, Va., John Knox Press, 1971, p. 13. 2. Katerndahl, D., and Cohen, P., "Research Methodology Series Quantitatively Reviewing the Literature: The Application of Meta-Analysis," Family Practice Research J., 1987, 6, 123-129. 3. Larsen, D., et al., "Systematic Analysis of Research on Religious Variables in Four Major Psychiatric Journals, 1978-1982," Amer. J. Psychiatry, 1986, 143, 329-334; Craigie, F., et al., "A Systematic Analysis of Religious Variables in The Journal of Family Practice, 1976-1986," J. Family Practice, 1988, 27, 509-513. 4. Callahan, D., "Religion and the Secularization of Bioethics," The Hastings Center Report, 1990, July/August, 2-4. 5. Levin, J., and Schiller, P., "Is There a Religious Factor in Health?" J. Religion and Health, 1987, 26, 9-36. 6. Miller-McLemore, B., '~rhinking Theologically About Modern Medicine," J. Religion and Health, 1991, 30, 287-298. 7. Lundberg, G., "Key and Critical Objectives for the The Journal," J. Amer. Medical Association, 1987, 258, 2567.
