GOD HELP ME!
Religious Coping in 15 Norwegian
Cancer Survivors.
Paper presented at the conference on
Research in Faith and Health
in Secular Society,
Odense, Denmark, May 17th 2010
by Tor Torbjørnsen,
nursing home chaplain/PhD. Student,
Oslo, Norway.
Background
In this project, Religious Coping (RC) is studied
in patients with Hodgkin’s disease, a kind of
lymph cancer. In Norway, the study of RC is
relatively new, even though it is well established
in the USA and other countries. RC has so far
not been studied by use of Pargament’s theory.
There are reasons to believe that such studies
can contribute to the understanding of RC in
Norway.
Research on faith and health in Norway.
• There has, in the past, only been
performed a few studies on the relation
between faith/religiosity and
sickness/health in Norway (see Sørensen
2008 for a brief survey in Norwegian).
Mine and my colleagues’ quantitative
survey of Hodgkin’s patients religiosity
(Torbjørnsen et al. 2000) is one of the few
cancer specific.
Conclusion
• The study indicates that cancer disease
activates religiosity, and that religiosity
may help patients cope with their disease
• The conclusion contributed to direct
further qualitative research towards
Religious Coping.
International research
• Kenneth I. Pargament’s RC theory and extensive
research has been leading internationally for the last
twenty years. Pargament defines coping as “a search for
significance in times of stress” (Pargament 1997:90) and
RC like this: “Religious coping (like religion more
generally) is multidimensional. It is designed to assist
people in the search for a variety of significant ends in
stressful times: a sense of meaning and purpose,
emotional comfort, personal control, intimacy with
others, physical health, or spirituality” (Pargament et al.
1998:711).
Pargament’s theory in Scandinavia
• Pargament’s theory has been presented in
•
Swedish (Hermanson 2006), Norwegian
(Torbjørnsen 2001) and Danish (la Cour &
Tønnesvang 2007). Pargament has lectured
twice in Norway (2001 and 2008) and once in
Sweden (2008) and now in Denmark.
As his theory and research is known, it will not
be further presented here.
Epidemiology of religion
• Research on RC can be seen as part of a wider field of
research on the relation between religion, spirituality and
health. This is for instance shown in Handbook of
Religion and Health (Koenig et al. 2001, see Torbjørnsen
2002 for a Norwegian review). It reviews and discusses
more than 1200 studies from the last century. The
review shows a predominantly positive association
between religion and health. The largest part of the
studies, however, comes from Northern America, and
studies of RC from other parts of the world, (also
Scandinavia), is therefore relevant (Pargament & Abu
Raiya 2007:760).
Preliminary analysis
• The preliminary analysis of the qualitative
project showed that the Hodgkin’s survivors’ RC
seemed to follow the same coping processes as
shown in international studies regarding
conservation and transformation, but seemed to
differ regarding coping style and especially
coping activities.
Research question
• The primary research question was therefore
•
mainly deduced from Pargament’s theory, but
also from other studies, e.g. narrative
reconstruction (Donders 2004).
Thus, the primary research question is
formulated like this:
• How is religious coping shaped in 15 Norwegian
Hodgkin’s disease survivors with specific focus
on coping processes, coping dynamics, coping
styles and coping activities?
Definitions
• Coping process is the psychological coping process as it is described
by Lazarus, Pargament and others (Lazarus & Folkman 1984;
Pargament 1997:90 – 127), with stressor(s), primary, secondary and
tertiary appraisals, orienting system, coping activities, outcome and
final evaluations of the process.
• Coping dynamic is conservation and/or transformation of means
and ends in the coping processes (Pargament 1997:106-114).
• Coping style is whether the coping processes are self-directing,
deferring, collaborative or petitionary (Pargament 1997:180 – 183).
• Coping activities are religious activities of different kinds used in the
coping processes, such as prayer, religious support, church going,
use of rituals, religious reframing (Pargament 1997:198-271).
Inductive, deductive or abductive?
• The study has had both inductive and
deductive processes, and might therefore
best be characterized as an abductive
project.
Material
• The material of the study is 15 interviews
with long time Hodgkin’s disease survivors
recruited from The Norwegian Radium
Hospital in Oslo. Hodgkin’s disease has
been a model disease for oncological
treatment in Norway (Abrahamsen 1999,
1999a, 2000). The Hospital has a Tumor
Registry which has made it possible to do
both medical and other clinical research.
The Interviews
• Most of the informants were interviewed when they met
•
at the hospital for controls. They were not in a state of
acute crisis (shock or reaction phase), but in phases of
adjustment, new orienting and narrative reconstruction,
so they could talk more easily about what had
happened. A list of questions was made, and a semi
structured technique was used.
The interviews were with one exception audio taped and
written out in 456 pages of text, with an average of 30
pages, varying from 20 to 52 pages.
Method
• In the analysis, a qualitative method was used.
This method gives an adequate approach to the
phenomena of Religious Coping. Qualitative
method is also recognized as a suitable method
in health related research (Malterud 2003).
Pargament’s theory is suitable for research in a
qualitative design, and his research program was
started with a qualitative study (Pargament
1990).
Results I Coping
• The religiousness functioned as coping towards the
cancer with fourteen of the fifteen informants, and the
psychological coping processes as they have been
described in the literature was distinct in all the
interviews. This was obvious in spite of differences
among the informants regarding God images and views
of life / orienting systems e.g. related to defining person
and character of the divine and with relation to church
affiliating among the informants. It was also obvious that
the RC was health related.
Results II Conservation
• RC was a dynamic process of conservation
for most (nine) of the informants.
Religious support (both spiritual and
interpersonal) was the most important
element to help the informants to come
through the disease and in the time after.
Being sick did not change their
significance or the way they held on to it.
Results III Transformation
• RC was a dynamic, transforming process
for a distinct minority (six). They changed
what was significant to them and/or the
ways they could reach it. One informant
completely changed belief and orienting
system/view of life.
Results IV Collaborative RC
• RC was of collaborative kind for all the
informants. RC was a partnership between
themselves, the oncological
treatment/staff, and God/the divine.
Traditional oncology, alternative treatment
and traditional RC as e.g. prayer, were
supplementing approaches.
Results V Surviving
• For many of the informants, it was difficult
to be a survivor. Both the sickness period
and returning to everyday life was a
challenge for RC.
Results VI RC Activities
• The analysis detected few different RC activities
than those in Pargament’s predominantly
American samples. One of them is to get
support from God mediated by nature. Some RC
activities e.g. use of rituals, had a different
dynamic. My analysis showed that negative RC
(Pargament 1997:298-300) has to be
differentiated (as Pargament already have done
in later studies, Pargament & Abu Raiya
2007:748 - 751) in regards to outcome to be
used meaningfully in my study.
Results VII Pargament's theory
• The analysis showed that Pargament’s
theory is suitable also to analyze a
Norwegian sample regarding the main
aspects of RC.
Discussion
• Religion can function as coping also in
Norway, and can be health related
• RC can function collaboratively in a secular
public health service
• RC in a Norwegian sample is quite similar
to RC internationally
• RC contributes to give an multidimentional
understanding of secularization.
Publications
• One article, presenting a survey of Hodkin’s disease survivors, is published
•
•
•
•
in the Norwegian medical journal (Torbjørnsen et al. 2000)
One article presenting Pargament’s theory is published in the Norwegian
Pastoral Care Journal (Torbjørnsen 2001)
Knowledge generated from the project is a part of a chapter in a geriatric
textbook in Norwegian (Torbjørnsen 2008)
The project is also briefly mentioned both in Pargament’s lecture at the
IAPR conference in Soesterberg, The Netherlands 2001, and in review on
RC in Archiv für Religionspsychologie (Pargament 2003)
Presentations have been held at different Norwegian conferences on the
psychology of religion and internationally at the IAPR conferences in
Soesterberg 2001, in Vienna August 2009, and at the 8th World Congress
of the International Council on Pastoral Care and Counselling in Krzyzowa,
Polen, August 2007.
References
• Abrahamsen, A.F.: «Clinical studies in Hodgkin’s disease. With
•
•
•
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special reference to treatment results and medical and psychosocial
sequele». Doktoravhandling Universitetet i Oslo. Norwegian Cancer
Society, Oslo 1999
«Hodgkins sykdom» Tidsskr Nor Lægeforen nr. 25, 1999a; 119:
3782-3
”Hva er egentlig Hodgkins sykdom?” Tidsskr Nor Lægeforen nr. 23,
2000; 120: 2788-2790.
Donders, J.P.H.: Narratieve reconstructie bij mensen met kanker,
Proefschrift aan de Universiteit Leiden, Tilburg 2004.
Hermanson, J.: ”Religion och coping – om religionens roll i
hanterandet av kriser”, kap. 9 s.357-384 i Geels, A. & Wikström, O.:
- Den religiösa människan. En introduktion till religionspsykologin.
Ny omarbetad utgåva Natur och kultur, Stockholm 2006
References II
• Koenig HG, McCullough ME, Larson DB:
Handbook of Religion and Health. Oxford
• University press 2001.
• la Cour, P. & Tønnesvang, J. (eds.)
•
•
Religionspsykologi, temanummer av Psyke &
Logos 2007
Lazarus RS & Folkman S.: Stress, appraisal and
coping. New York: Springer, 1984.
Malterud K. Kvalitative metoder i medisinsk
forskning. Tano Aschehoug 2003.
References III
• Pargament, K.I.: The Psychology of Religion and Coping - Theory,
•
Research, Practice, The Guilford Press, New York 1997.
- “God help me: Advances in the psychology of religion and
coping.” Archiv fur Religionpsychologie, 24, 2003, p. 48-63.
• Pargament, K. I., Turner Royster, B. J., Albert, M., Crowe, P., Cullman
E. P., Holley, R., Schafer, D., Sytniak, M., Wood, M.: A Qualitative
Approach to the Study of Religion and Coping: Four Tentative
Conclusions. Paper to American Psychological Association, Boston,
Massachusetts 1990.
• Pargament, K.I.& Abu Raiya, H.: “A decade of research on the
psychology of religion and coping: Things we assumed and lessons
we learned”. Psyke & Logos 2007, 28, 742-766.
• Pargament, K, I., Smith, B. W., Koenig, H. G., & Perez, L.: “Patterns
of Positive and Negative Religious Coping with Major Life Stressors”,
Journal for the Scientific Study of Religion, 1998 a, 37(4):710-724.
References IV
• Sørensen, T.: ”Livssyn og helse. Forskningsfronten 2008” i Kjølsvik,
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•
•
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I. og Holmen, J.: Helse – frelse. Samfunnsmedisin og livssyn – et
møte. S. 76-94. Høyskoleforlaget, Kristiansand 2008.
Torbjørnsen, T.: ”Religiøs mestring. Kenneth I. Pargament og The
Psychology of Religion and Coping”, Tidsskrift for sjelesorg,
nr.4/2001 s.251-266.
Torbjørnsen, T.: ”Handbook of Religion and Health”, Tidsskrift for
sjelesorg, nr.4/2002 s.285-287.
Torbjørnsen, T., Stifoss-Hanssen, H., Abrahamsen, A.F. og Hannisdal,
E.: «Kreft og religiøsitet - en etterundersøkelse av pasienter med
Hodgkins sykdom» Tidsskr Nor Lægeforen nr. 3, 2000; 120: 346-8.
Torbjørnsen, T.: "Åndelig omsorg", Kap. 35 i Kirkvold, M., Brodtkorb,
K. og Ranhoff, A.H. (red.) Geriatrisk sykepleie, God omsorg til den
gamle pasienten, Gyldendal akademisk, Oslo 2008.
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GOD HELP ME! - Research in Faith and Health