Fall 2020, Issue 3, pp. 4–9
[Online 23 Nov. 2020, Article A019]
[PDF]
Interview with Dr. Neal Krause
Angela Monahan,[1] Andrea Jacobo,[2] and Angela-Maithy Nguyen[3]
Editors’ Note: We are pleased to present the third in PHRS Bulletin’s series of featured interviews with influential contributors who have shaped the field of public health, religion, and spirituality.
We present an interview with Neal Krause, PhD, Professor Emeritus of Health Behavior & Health Education at the University of Michigan, and Marshall H. Becker Collegiate Professor of Public Health. Dr. Krause’s work on stress and the resources that people use to cope with stress – including especially religious resources – have been a huge contribution to the field of religion, spirituality, and public health. Identified by the Institute for Scientific Information as one of the 250 most frequently cited social scientists, Dr. Krause has published 350 refereed journal articles as well as 40 book chapters and, to date, two books; he was also chair of the working group that produced the widely used set of recommended measures, Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research (Fetzer Institute & National Institute of Aging, 1999; 2003). Dr. Krause was interviewed for the PHRS Bulletin by graduate students Andrea Jacobo and Angela Maithy-Nguyen of U.C. Berkeley, working in conjunction with Angela Monahan, an ASPPH/CDC fellow at the Department of Human and Health Services.
Angela Monahan: Fairly early in your career, since 1989, you’ve studied religious involvement. What motivated you to start studying religion and how did that influence your other interests?
Neal Krause: I was a big stress guy up until 1989 – that was my thing. When I did my first community survey, it was on stress and health in older adults. I had nothing on religion, and every time the interviewers came back to my office, they said, “there’s another one that said ‘I rely on religion’”. I remember thinking I didn’t want to go there, you know? Those people that do that are weird. They have a personal agenda to sell and on and on; But what can I say? I’m one of the geeks now and I got into it for that. I avoided it for a long time and then it found me.
What’s the shortest list in the world?… Disciplines that aren’t doing something with religion.
– Neal Krause
I wrote my first paper on religion in 1989 and it was a secondary data analysis (Krause & Van Tran, 1989). I get a call from the National Institutes of Health and they tell me they’re having a meeting on religion and health, and that I was an expert on subject. I said, “Wait, wait, wait. I’ve written one paper; I’m not an expert.” “Oh, but you should come” [they responded], so, I went and there was about three hundred people. They said, “we’re going to break out sessions in the afternoon and one of the breakout sessions is going to be on how to measure religion”; And they told me I was going to chair it. I did that and I didn’t really know what it was all about. Probably two years after, I chaired the group and we put together measures that could be inserted in epidemiologic surveys on religion. That’s what got me into it and then I just got fascinated by it. It’s such an integral part of life. My guess is you get older and you start thinking about those kinds of things.
Angela Nguyen: Speaking of when you chaired the group that put together that influential and highly cited book of measures [Fetzer Institute & National Institute of Aging, 1999, Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research] ― how would you describe your experience working with the group, especially your role as chair? Were you satisfied with what you produced, and did it have the impact you were hoping for?
Neal Krause: I participated in that book project because I really believe in the social basis of religion. I think you can’t talk about religion without talking about people plural. I know it’s not that way in all faiths, but certainly in the United States. It’s all about congregations and relationships that people develop within them. I felt that wasn’t given any major attention. People kind of asked a few questions about it, but there was nothing serious being done. I used that initial point of departure for getting into stuff that I had done just prior to that. It’s funny; I wrote a grant to the National Institute on Aging, saying that I really wanted to study religion, but I don’t know what it is. I wanted to do three years of qualitative work, develop good measures from that, and then get into the research. I remember my project officer said, “it’ll never be funded. They don’t fund small-scale development projects”. I didn’t care because it was what I needed, and guess what? It got funded the first time through, and for three years I did amazing amounts of qualitative research, with focus groups, 113 in-depth interviews, and more. I actually developed a tight set of measures, many of which were social support. I wanted to pull it all together in one place and show that this is an area in the field of religion and health that has been left out. I wanted to see if I could get that out there on the stage a little more clearly, and if you provide people with measures of the things you’re talking about, you can do it. I can just say “don’t just talk about social support, here are questions you can use to measure it”.
And so, in this funded research project, I went through every dimension of the major social relationships in the church and had measures for each one, and theoretically, why they’re relevant for health. I wrote a book about it (Krause, 2008). It was fun; I’d never written a book before because, you know, public health doesn’t like books – it’s all about peer reviewed articles. I wrote that book and now I’m writing another. When you write a book, it’s really amazing. You have a lot more room. When you first start writing a book, you’re a deer in the headlights. “I have to fill 300 pages, what am I going to say?”, but it fills up fast enough.
Angela Nguyen: I like your perspective on the process of writing a book versus writing an empirical paper. Depending on what journal you’re submitting to, there’s so much focus on methodology and you don’t really get to delve into the conceptual frameworks of why you’re doing the study. You mentioned you’re writing a book. Are you able to share about that?
Neal Krause: This new book is really different. I told my wife that at this stage in my career, this is my Sergeant Pepper’s. When the Beatles did Sergeant Pepper’s, it was so different. It was unique from start to finish and it blew the whole music industry away. I’m writing all in the first person – I want the readers to feel who I am. I want them to look beyond the words to the man that wrote them. There are three things I want to do. First, I want to tell you how I actually practice my craft, warts and all; About the dead ends, the times I was wrong, the things that I didn’t understand, and how I even reversed my position at some points, only because after much deeper thought I could arrive at a better thinking. The second thing is where I’m going next, which is kind of built around communities of faith. There’s good theological and sociological research that says something unique happens when people get together in a church. The whole becomes larger than the sum of the parts. People stop thinking about ‘I’ and start thinking about ‘we’ – there’s something almost mystical at that level. There are two different sources: one is a man named Dietrich Bonhoeffer – a pastor who was hung by the Nazis because he was involved in the plot to try to assassinate Hitler. He wrote a lot about this and Émile Durkheim writes the same thing. I thought we really have to get down to it and understand this. In this book, I have a chapter that lays out all the different things that a community of faith is likely to involve, and then this mystical thing that I can’t really get my fingers on yet. I call for a very detailed qualitative study to find out, just like I did way back in the 80s. The third thing I’m doing with this book is addressing some very fundamental problems with latent variable modeling. That’s the book; I’ve been offered a contract by one press and I’m waiting on another. The peer reviews have been amazing. They’re just lovely and saying, “nobody but you could have written this book”. In a way, it’s true because this is my swan song that I’ve worked on for all these decades and what I have learned. I like this book better than the first, and I think the reception has been better. I’m giving the book a shot, in between going to school and some of the other stuff.
Angela Nguyen: You’re balancing a lot!
Neal Krause: We’ve also gotten re-funded to go back and do a mortality study for the Landmark Spirituality and Health Survey, a project I began in 2013 that surveyed a national sample of more than 3000 US adults. The literature on mortality and religion is largely focused on church attendance only and we have to pull it apart and find out what’s really going on there. One time ago, I heard a colleague of mine say that these big grants are like getting hit with a golden brick – if anything can go wrong, it will, and stuff you couldn’t imagine going wrong, will go wrong. They don’t teach you this in graduate school. You learn it, God knows how.
Andrea Jacobo: Could you say a bit more about those grants and your experience conducting them? What are some of the lessons that future investigators can learn from you in this process?
Neal Krause: I learned grant writing on the bended knee of my good friend Jersey Liang, who was fabulous at getting money. It’s important to find somebody that knows what they’re doing. I recommend networking and postdoctoral fellowships. Find a good group of mentors that can really help you with stuff like this because that’s how you learn. Students tend to think that they’re done once they have their PhDs. Not quite; you’re actually just getting started.
Andrea Jacobo: How would you compare the challenges faced by the religion and health field in the late 90s to the ones we face today, and what do you think were the major shifts and trends? From your experience, where are we going in the future with spirituality and religion?
Neal Krause: Well, a couple things. Back in the early 80s, there were untruths in the articles. Jeff Levin used to say the ‘r word’; as soon as somebody sees the r word, religion, you’re stuck. There was a lot of academic prejudice against it – they didn’t think it was a real science. Once people got out there and started doing really decent work, it gradually began to change and religion found itself integrated. If you think about it, what’s the shortest list in the world? The answer to that is disciplines that aren’t doing something with religion. Think about it – medicine, nursing, public health, sociology, psychology, social work, humanities, and anthropology. All of these fields are doing it now and that’s a good thing because what it shows is the versatility of religion.
Where do I think it’s going in the future? We’re getting more biomedical. There’s this ‘let’s get accepted by the real doctors, and the way you do that is with biomarkers. When I did the Landmark Spirituality and Health Survey, we got a whole range of biomarkers and I wrote a number of papers on those. That was a brand-new world for me and a way of getting my feet wet. You can’t argue with that stuff. When you say religion is related to lower levels of bad cholesterol, it’s hard to turn that around and say higher levels of bad cholesterol make you less religious. It does not make any sense, so the direction of causality becomes more clear. You never prove it, but you sure get a lot closer. I think that’s the direction of where the field is going.
Andrea Jacobo: Earlier you mentioned communities of faith. In Memphis, there’s the Memphis Interfaith Coalition and they address the different determinants of health like education, economics, and social economic status. The work that comes out of their community of faith is fantastic and beautiful. How would you say that communities of faith are similar to communities of practice and how can we incorporate what we already know with communities of practice and coalitions, and integrate them with faith?
Neal Krause: A lot of people are actually already doing that. Many congregations have formal programs like for lowering blood pressure or nutrition. I think what we need to do is two things. One is seeing what is unique about doing these things in a church. Part of the answer to that is you can access individuals through the church easier than you can with other ways. The second thing is, we need to see what is unique about what we are doing. Can we go to the Elks club and offer the same services, or is there something special that’s going on in communities of faith? I’m betting that something special is happening, but we have to find it.
You know sometimes, when there’s nothing out there, you freak out and wonder what to do and where to start. I say, start anywhere, but above all else, just listen to your gut and heart. You’re getting into this field because something about it has appealed to you at a pretty deep level. Start with what has brought you here and pursue it. See where it leads you, and it could be dead ends. When you put your CV together, you list all your papers accepted for publications. Why don’t we list the ones that were rejected? Isn’t that a more honest reflection of what it is that you’re doing? I still get papers rejected all the time, but follow your heart.
Angela Nguyen: Could you say a bit more about the process of dealing with rejected papers? I think that’s relevant to everyone. [Editors’ Note: See video of this interview for additional advice from Dr. Krause on topics such as grantwriting, publication, and rejection.]
Harold Koenig once told me he got three papers rejected in the same day. He’s one of the pillars of religion and health, and he’s gotten three papers rejected in the same day. If we’re really honest, we would put our rejected papers on our CVs and they would be a lot thicker. Babe Ruth had more strikeouts than home runs and no one talks about that, but they should. It tells you something about real life.
Another thing that’s helpful; Ken Pargament – he’s a good friend of mine – laughs at me because I actually have 35 different files that deal with 35 different issues reviewers have raised about my papers in the past. It all comes down to experience and I suggest that you save everything you get back. When you when you go through these things, save some of your responses and you’ll use them again, because chances are, you’ll see these things again.
Angela Nguyen: Your perspective has been very valuable, not only for this interview, but for all of us here. How do you think religion and spirituality can be better integrated into academia and into curriculum?
Neal Krause: It really depends on the flexibility in the school where you wind up. Unfortunately, a lot of the time when students first finish their PhD and get their first tenure track job, they’re given a lot of the equivalent to intro classes and don’t have a whole lot of flexibility, at least initially. If you find yourself in a place that gives you that kind of flexibility, then do religion and health; but if you don’t find yourself in that situation, I think you can still use it as examples in class. Try to extract the broadest possible principles from religion and health so that you say, “we’re going to see social relationships that are good for health, but let’s think about such social relationships in a particular context and see if that makes any difference”. The principle is still the same: social relationships matter. We’re just changing the venue a little to sneak it in that way. Then you can even raise questions about if there is anything unique about those social relationships.
Angela Nguyen: On the student side, what are our roles in making that push for integrated curriculum if we’re not going to be teaching after?
Neal Krause: I think the way you do it then is through your research. It gets down to how to write the papers that you write, and part of the answer is talking about the so-what questions in your discussion sections on how and where your research applies and what you’re going to do with it.
Angela Monahan: Out of all your findings on religion and health, what most surprised you?
Neal Krause: That’s a tough question to answer because there is what surprised me, what I liked the best, and what I thought made the most difference to me. The one that I think made the most difference to me was that giving is better for your health than receiving. I’ve shown that now with about five different data sets and with different dependent variables; mortality being one of them. People that give have lower mortality risk than people who receive. It’s really basic stuff but it’s so cool. It’s telling you about who you are, how we’re put together, and what we should be doing with our lives – helping other people is not a bad thing. For me, that’s a big deal because you think about practical applications. What do we know about volunteer work through the church? It’s a good thing and good for health. Well, this is just another context for giving. I think that’s the one that I liked the best and didn’t expect to see it that consistently. One of the things that social and behavioral sciences is always dinged for is that we don’t use an experimental design. One way you get around that is the importance of replication. We get not one but ten studies that show the same thing and that adds a lot of credibility to the work.In the end, empirical science is only going to take you so far. All it does is reflect back to you the quality of your own ideas.
Angela Monahan: Do you have any suggestions for students or young professionals that are beginning their careers in public health and might be interested in religion and health topics?
Neal Krause: I’d say one, don’t be discouraged. Two, you’re going to work harder than you ever thought possible, and the third thing I’ll say something a bit different. I remember my students would say, “if I just finish my preliminaries, everything’s going to be alright. If I just finish my dissertation, everything is going to be alright. If I just get a tenure track job, everything is going to be alright. If I just get tenured, everything is going to be alright. If I just make full professor, everything’s going to be alright”. It’s never going to end. So, if that’s the case, strive to be happy where you are, which I know is hard to do, especially in the middle of the tenure thing. That’s an amazing experience and you just have to keep your eyes on the broader things.
Angela Monahan: Thank you so much. That was all our questions. This was such a great discussion with you.
Neal Krause: It was fun talking to you guys. I love talking to students; they’re great! It’s nice to meet you all. Religion and health is a small town, so who knows? If we ever actually have professional meetings anymore, I hope to bump into you guys some time there.
This interview with Dr. Neal Krause took place over Zoom on October 8, 2020. The transcript has been edited for clarity and brevity. In addition to the published transcript, a video of the interview has been provided. The video also includes a variety of additional suggestions from Dr. Krause for early career professionals for navigating the NIH grantwriting process, publishing articles, and dealing with rejection.
Link to video: https://publichealthrs.org/v001/
References
Fetzer Institute / National Institute on Aging Working Group (1999). Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research: A Report of the Fetzer Institute / National Institute on Aging Working Group (1st ed.). Kalamazoo, MI, USA: Fetzer Institute.
Krause, N., & Van Tran, T. (1989). Stress and religious involvement among older blacks. Journal of Gerontology, 44(1), S4-S13. https://doi.org/https://doi.org/10.1093/geronj/44.1.S4
Krause, N. (2008). Aging in the Church: How Social Relationships Affect Health. West Conshohocken, PA: Templeton Foundation Press.
[1]^ Angela Monahan, MPH, is an ASPPH/CDC fellow at the Department of Human and Health Services, and a recent graduate from the Infectious Diseases and Vaccinology master’s program and the Public Health, Religion, and Spirituality Traineeship at the University of California Berkeley (angela_monahan@berkeley.edu, angela.grace.monahan@gmail.com).
[2]^ Andrea Jacobo, MPH is a current trainee in Public Health, Religion, and Spirituality and a 2nd-year student in the Doctor of Public Health program at the University of California Berkeley (am.jacobo@berkeley.edu).
[3]^ Angela- Maithy Nguyen, MPH, is a current trainee in Public Health, Religion, and Spirituality and a 3rd-year student in the Doctor of Public Health program at the University of California Berkeley (angela_nguyen@berkeley.edu).