Professor Michael King
Royal Free and University College, London Medical Schools
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Michael graduated in Medicine in New Zealand. In 1978 he joined
a UK training scheme in General Practice and went on to study
psychiatry at the Maudsley and then to undertake research in the GP
Research Unit of the Institute of Psychiatry. He is now Professor
of PriMary Care in Psychiatry with interests in psychiatric
epidemiology and the randomised controlled trials of complex
interventions. Throughout the 90's, he has been interested in
research into spirituality and the effects of spiritual belief on
recovery from acute physical illness. He has also looked at how
spirituality and faith can influence the course of
bereavements.
Michael began by asking the almost impossible question, 'what
are spiritual beliefs?' He used as an example the design of an
instrument which he has published from the Royal Free Hospital
before asking, 'what does all this really mean? He welcomed
feedback about his instrument and he raised the following
points:
Definitions
We struggle to define spirituality. Spirituality implies
something at the core of almost every religion and philosophy, 'a
search for reality'. (Michael concentrated on what was held in
common rather than what was discriminating between different
approaches.) It involves:
- a sense of something that transcends man's usual modes of
perception and experience (but not his reason),
- a sense of imperfection or falling short of a moral or ethical
standard
- a sense of unity with others and the world
- a search for meaning
Michael then raised the difficulty of addressing the difference
between superstition and spirituality, that 'hopefully spirituality
is something that goes far beyond what superstition might involve'.
He also suggested that philosophy and religion meet full circle.
Western philosophy, Eastern religions, and Abrahamic faiths are all
searching for meaning in life, seeing existence as part of a wider
whole. Transcendence can be considered the converse of materialism.
He quoted sound bites including one from a TV discussion when Karen
Armstrong had said, 'religion is at its best about the loss of ego,
not about imagining its survival in celestial conditions!'
Measurement of spiritual belief
Michael continued with the question as to whether one could
measure spiritual belief. He suggested that one could measure the
strength of belief without knowing about its content. He paralleled
this with measuring the depth of depression without really knowing
its nature. This attitudinal research looks at what people tell us
about their depression or spiritual beliefs. We can also measure
the salience of a spiritual belief to life and the impact on
behaviour (e.g., affiliation practice) without going into the
nature of that belief. He pointed out that many quantitative scales
have been developed over the years but most of these are in USA and
are from a Judaeo-Christian perspective. He referred to a book by
Hill and Wood (1999) 'Measures of Religiosity' which takes a
critical look at such work.
He used the scale developed by his team - The Royal Free
Interview for Religious and Spiritual Beliefs, 1995, as an example
of how they went about tackling the measurement of spiritual
belief. He got interested in this area after stumbling into a
rehearsal of a talk on religious measures in patients with burns.
Men who were seriously burned were asked if they thought that God
had caused it. Michael was interested in whether the outcome was
any different. A serendipitous meeting followed this with Peter
Speck, a Chaplain at the Royal Free Hospital who happened also to
be a Senior Lecturer in Epidemiology.
Their preliminary study was on 300 medical in-patients. The
instrument was originally criticised for not including material on
religious experience as distinct from beliefs. Spiritual experience
tends to be influenced by peak experiences, experiences quite
outside everyday life. These experiences are related to life change
(King et al. 2001). The Royal Free Interview for Spiritual and
Religious Beliefs: development and validation of a self-report
version. Psychological Medicine 31:1015-1023). The interview covers
areas such as spiritual/religious beliefs, the nature of any
religious beliefs and their practice and importance in day-to-day
life. Questions about communication with a spiritual power and the
meaning and impact for illness were included. Michael was careful
to avoid the word God, as a universal term for this power. A visual
analogue scale was devised with a 'thermometer' scale for each item
measuring strength of belief. The scale is now available in a
self-report format.
There were three groups in their initial studies: hospital staff
/ patients presenting to their GP and lastly a group of nuns,
clergy, imams etc. Hospital staff were less religious than
attendees at GP surgeries. Reliability on test-retest and internal
validity was high in the intensity of belief. The philosophical
questions were also reliable but more chaotic in affiliations and
have now been dropped. Further validation is needed in ethnic
minorities and other religious groups. In the revision there is
also more emphasis on religious experiences. Further validity tests
were satisfactory, including comparison with one US scale, called
the Religious Motivation Scale. The results showed 70-75% had
spiritual beliefs but only 30% were practising.
What is the application of this type of research? Most published
research in the States says, "Religion is good for you". This is
worrying and may reflect bias in the reporting of results in
relation to the funding for this type of research. Michael has
published research that has largely countered this and received a
lot of adverse comment, including anger. There is also fear that
being interested in spirituality as worthy of serious academic
study risks loss of tenure in the States (David Larson's
anti-tenure factor).
Findings so far include the fact that spiritual belief is not
related to any particular personality characteristic such as
neuroticism or robustness. Strong spiritual belief is related to
better outcome in bereavement. Michael is now interested in looking
at the peacefulness of death experiences in relation to spiritual
belief.
Conclusion
In conclusion Michael acknowledged that spiritual belief is
difficult to define but it can be measured reliably. We are
measuring the strength of it rather than what it actually is. The
test-retest reliability is high. Is it a trait or state? The test
was repeated two weeks later, but could hold for a period of years.
Is it a proxy for some other form of coping? Michael finished by
criticising this area of research for being too dominated by a
mechanical world concept, which standardised everything. Perhaps
the essence of life lies within paradox and we need to develop
different research methods that are compatible with this.
References
Hill & Wood, (1999) Measures of Religiosity. Pub. Religious
Education Press, Birmingham Alabama. ISBN 0-89135-106-X
King et al. (1995) The Royal Free Interview for Religious and
Spiritual Beliefs. Psychological Medicine 25: 1125-1134.
King, M. Speck, P. Thomas, A. (2001) The Royal Free Interview
for Spiritual and Religious Beliefs: development and validation of
a self-report version. Psychological Medicine 31:1015-1023