Taking both secular, spiritual and
religious meaning making seriously
RESEARCH IN FAITH AND HEALTH IN
SECULAR SOCIETY
May 18th 2010
University of Southern Denmark
Peter la Cour
Multidisciplinary Pain Center,
National Hospital, Copenhagen
Niels Christian Hvidt
Health, Man, and Society
University of Southern Denmark
Trends in medical care, where more focus is laid
on patient centered care and on prevention,
lifestyle and chronic conditions - issues all
linked to an overall attitude toward life.
Contemporary medical research focuses on the
need for taking existential, spiritual and
religious issues much more serious, even in
Denmark – the “least religious nation” in the
world (Zuckerman)
How to make research?
Theory and research in this field
have been divided in two major traditions
The existential psychology (theology/philosophy) tradition
This is mainly rooted in European tradition. Although the tradition is very
broad (and has many American thinkers) it is mainly centered on meaning
making strategies that do not include belief in any transcendent reality.
There are both theistic and atheistic versions of the existential psychology,
but usually the tradition is founded on concepts of secular nature
(meaning, worth of life, values, freedom, responsibility, loneliness etc).
These concepts are seen to potentially include the spiritual and religious, but
they are neither elaborative nor concise in these domains.
Often linked to qualitative methods (phenomenology)
“Who needs the concept of ‘spirituality?’” - provocative title of a Letter to
the Editor of Psycho-Onchology, published by professor Pär Salander
(2006) from Lund University, Sweden.
How to make research?
Theory and research in this field
have been divided in two major traditions
Religious/spiritual coping tradition
The (almost exclusive) American theories and research on religious coping
and the development and debates about useful concepts in this research.
For some years a debate about the concepts of “religiosity” versus
“spirituality” has been going on. These concepts and this debate are only
relevant in ery religious societies, where it can be supposed that the vast
majority of medical patients can relate to either spirituality or religiosity.
This is not that case in modern secular countries like in Northern Europe
(especially Scandinavia) where only minorities can be called spiritual or
religious in a traditional meaning of the words.
Often linked to quantitative methods (social science)
“Who needs the concept of spirituality? Human beings seem to” William
Breitbart, published in Palliative and Supportive Care, (2007)
Religion and health research
Examples: Religious problem solving (Pargament).
Three first questions in the main religious coping
questionnaire:
1. When I have a problem, I talk to God about it and together we
decide what it means.
2. Rather than trying to come up with the right solution to a
problem myself, I let God decide how to deal with it.
3. When faced with trouble, I deal with my feelings without
God's help.
We can not ask this way, when people have no thought of God in
the first place…
Reality is multilayered
The split between the academic traditions is artificial and
counterproductive
Coping with medical conditions is about coping with
meaning making.
Real patients think both in secular, spiritual and religious existential
terms. Their understandings maybe melted together, maybe
situated at different places, maybe separated at different times of
their lives.
Reality is multilayered, and investigation, theory and research should
basically reflect this multilayered reality, or at least try not to
exclude other tangled dimensions, when focusing on one.
The need for more consensus in concepts are obvious
Simplistic understanding of coping
Good result
Coping
(while under current stress)
Bad result
This model is not working…
The general problem: When are life
events good?
A man is divorced (after long time quarrels with wife about children)
…and he copes with it
a) Immediately he feels relief, but do not see the children very often
b) Half year later he feels rather lonely
c) One year after he gets a depression and can not work for a year
d) Five years later he marries a new woman and feels very happy for many years,
but has no kids with her
e) Twenty years later he has grand-children from first marriage, but no contact
with them
f) When old, he bitterly regrets that he had nor been present for his children and
grandchildren
g) The day he dies he thinks about the missing contact to children and
grandchildren
Was it good or bad coping with the divorce?
Meaning making and illness
- general theory of coping with personal crisis
The person
before crisis
The person
during crisis
The person
after crisis
1. World view as a personal ressource
2. World views as a current coping strategy
3. World view as outcome / (posttraumatic growth)
Conceptual work is troublesome
It includes at least two un-answareable
questions:
1. What is the meaning of the words: Religion,
spirituality, and existential orientation?
2. How can the endless numbers of expressions
and dimensions of meaning making be
captured in research?
- Well, we have made a try……
Materials at work
1. For the domains of meaning making:
- systematic reviews of definitions of the three
conceptual domains or layers
2. For the dimensions of meaning making:
- analysis of previous systematic suggestions for
categorizing dimensions
We do not propose either clear-cut borders or specific definitions connected
to the model, but merely want to draw a possible frame for theory and
research with the purpose to be more aware of own status and
limitations.
Premisis: All three existential domains are
valid and cannot be reduced to one
another.
• There are great areas of
overlay
• Phenomena placed in
the middle might be
pure experience
• Phenomena placed at
the sides might be pure
contextual (cultural)
(Context, culture)
Secular existential orientation
(Body)
Spirituality
Religion
Example 1. The enchanting feeling of “being
alive when looking up on the stars in a clear
night”
- can be placed in the
middle
- every elaboration in
words or deeds are
drawing to a side
(cultural elaborated as
existential, spiritual,
religious)
(Context, culture)
Secular existential orientation
(Body)
Spirituality
Religion
Example 2. “What happens after personal
death”
- is usually elaborated in
all three domains.
- It is not one question, it
is three
Secular – sorrow, history
Spiritual – consciousness
Religious - justification
(Context, culture)
Secular existential orientation
(Body)
Spirituality
Religion
Example 3. There is no “non-belief” without a
specific notion of, what is not believed in
(Context, culture)
The opposite of any
meaning making belief
would be “meaning
making ignorance”
Secular existential orientation
(Body)
Spirituality
– because there is never “meaning
making knowledge”
This is the premises for taken the domains serious
Religion
What are the meaning of the
Meaning Making conceptual domains?
Systematic reviews of definitions of the three
conceptual domains
1. Selecting and grouping definitions
2. Organize definitions into nodes and themes
3. Ranking definitions, finding endpoints of
definition continua
Definitions of secular existential orientations
Dimension: From subjective constructivist viewpoints over reflections
over collective conditions to inherent meaning
Interest in the abstract sense of identity, meaning, value, and purpose … a trend
Pyszcynski, et al. 2004
toward consideration of existential themes…
There is not one space and time only, but as many spaces and times as there are subjects.
Binswanger 1956 (p196)
A philosophy that confronts the human situation in its totality to ask what the basic conditions of human existence are and how man can
Barrett, 1959
establish his own meaning out of these conditions.
A conflict that flows from the individual’s confrontation with the givens of existence.
Yalom, 1980 (p 8)
Death, freedom, existential isolation, and meaninglessness. These are deep, potential terrifying issues, and consequently, people typically avoid Yalom in: Pyszcynski, T. et
direct confrontation with them.
al, 2004
How do people cope with their understanding of their place in the universe? Often, this amounts to the study of how people shield themselves
Pyszcynski, T. et al 2004
from their knowledge of their mortality, their uncertainty, their isolation, and their deficits of meaning.
QUEST “These persons view religion as an endless process of probing and questioning generated by the tensions, contradictions, and tragedies
Batson, 1976, (p 32)
in their own lives and in society. Not necessarily aligned with any formal religious institution or creed, they are continually raising ultimate
“whys”’ about the existing social structure and about the structure of life itself.
Ultimately, man should not ask what the meaning of his life is, but rather must recognize that it is he who is asked. In a word, each man is Frankl, Viktor, 1963. (p
questioned by life; and he can only answer to life by answering for his own life; to life he can only respond by being responsible.
172)
The meaning of our existence is not invented by ourselves, but rather detected.
Frankl, Viktor 1963, (p157)
Definitions of spirituality
Dimension: From evolved humanistic values over striving for an
inner truth to contact with the transcendent
..gives expression to the being that is in us; it has to do with feelings, with the power that
Roof, 1993
comes from within, with knowing our deepest selves and what is sacred to us.
The search for existential meaning.
Doyle 1992 ( p. 302)
Conspicuously in today’s spirituality is the frequent absence of an explicit transcendent object outside of the self
Wulff, 1997 ( p 5)
The way one lives out one's faith in daily life, the way a person relates to the ultimate conditions of existence.
Hart, 1994 (p. 23)
Process of inner change and development, metaphorical described as: Awakening, de-hypnosis, enlightenment, freedom, metamorphosis, and Walsh, 1999
wholeness
Spirituality – the domain of life beyond the body and mind
Levin, 2001
Striving to experience the spiritual source of one’s own existence
Fontana, 2003
Belief in a superhuman reality. Distinction between sacred and mundane. Belief in afterlife. Moral code. Promotion of inner harmony
Fontana, 2003
A way of being and experiencing that comes about through awareness of a transcendent dimension and that is characterized by certain Elkins et al, 1988 (p. 10):
identifiable values in regard to self, life, and whatever one considers to be the Ultimate.
A transcendent dimension within human experience ... discovered in moments in which the individual questions the meaning of personal Shafranske and Gorsuch, 1984 (p.
existence and attempts to place the self within a broader ontological context.
231):
That vast realm of human potential dealing with ultimate purposes, with higher entities, with God, with love, with compassion, with purpose.
Tart 1975 (p. 4)
The presence of a relationship with a Higher Power that affects the way in which one operates in the world.
Armstrong ,1995 (p. 3)
That which is involved in contacting the divine within the Self or self.
Fahlberg and Fahlberg ,1991 (p.
274)
A subjective experience of the sacred.
The human response to God's gracious call to a relationship with himself.
Vaughan, 1991 (p. 105)
Benner, 1989 (p. 20)
Definitions of religion
Dimension from collective construction of meaning, over individuals
meeting the transcendent to relation between man and God
A system of believes in divine or superhuman power, and practices of worship or other
Argyle, 1975 (p. 1)
rituals directed towards such power.
Beliefs and behaviours about: Spiritual reality, God, morality, purpose and the communication of these
Loewenthal, 2000
Religion is the serious and social attitude of individuals or communities toward the power or powers which they conceive as having ultimate control over their interests and destinies
Pratt, 1930
Religion – referring to beliefs, practices and experiences pertaining to organized religions or belief systems
Levin, 2001
Religion is a unified system of beliefs and practices relative to sacred things that is to say, things set apart and forbidden – beliefs and practices which unite into one single moral community called a Church, Durkheim, 1912
all those who adhere to them.
A covenant faith community with teachings and narratives that enhance the search for the sacred.
Dollahite, 1998 (p. 5)
Commitments to beliefs and practices characteristic of particular traditions.
Peteet, 1994 (p. 2):
Systems of belief in and response to the divine, including the sacred books, taltic rituals, and ethical practices of the adherents.
O'Collins and Farrugia, 1991
203):
Human recognition of superhuman controlling power, and especially of a personal god or gods entitled to obedience and worship.
Oxford English Dictionary
...what people normally understand by religious behavior and religious belief… always implicit, never explicit
Grensted, 1952
The representations, behavior and experiences that in man refers to any form of extrasensory and metaphysical reality.
Holm, 1993
…whatever we as individuals do to come to grips personally with the questions that confront us because we are aware that we and others like us are alive and that we will die. Such questions we shall call Batson 1993 (p 8)
existential questions.
…the feelings, acts, and experiences of individual men in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine.
James, 1902 (p 36)
..a careful consideration and observation of certain dynamic factors that are regarded as ”powers”: Spirits, demons, gods, laws, ideas, ideals or what name man has given such factors in the world, which he Jung, 1938
has found powerful, dangerous or helpful enough to be contemplated thoroughly, or vast, beautiful or meaningful enough to be attentively worshiped or loved.
Religion is the state of being grasped by an ultimate concern, a concern which qualifies all other concerns as preliminary and which itself contains the answer to the question of a meaning of our life.
Tillich, 196 (p.4)
A set of symbolic forms and acts that relate man to the ultimate conditions of his existence.
Bellah 1970 (p. 21)
The relationship between man and the superhuman power he believes in and feels himself to be dependent on…the theme of religion is redemption from the powers that prevent man from communing with Schoeps, 1959
the divine.
The inner experience of the individual when he senses a Beyond, especially as evidenced by the effect of this experience on his behaviour when he actively attempts to harmonize his life with the Beyond.
Religion is the connection between man and God
Clark, 1958 (p. 22)
Levin, 2001
(p.
The common continua:
- all three domains of definitions have the same
movement from constructivist (all human
centred) definitions to definitions centred on
the other, whether this is nature, the
transcendent, or a personal God being the
defining substance.
AGAIN: The two questions:
1. For the domains of meaning making:
- systematic reviews of definitions of the three
conceptual domains or layers
Perspective: We can talk meaningful of existential
orientation, spirituality and religiosity, when we
(always) do a notion of how this is meant (in
relation to other understandings).
2. For the dimensions of meaning making:
- analysis of previous systematic suggestions for
categorizing dimensions of expressed meaning
making
Question 2. The dimensions
Organising the many expressions of “meaning
making” into dimensions
- many efforts have been
made before
Most prominent
examples:
1. ”Measures of Religiousity ”
(Hill & Hood, 1997): 17
dimensions
2. Fetzer/NIA group (1999)
(religion broad): 12 dimensions
•
Affiliation
•
Beliefs and values
•
Public practices
•
Private practices
•
Spiritual experience
•
Religious intensity
•
Meaning
•
History
•
Support
•
Coping
•
Commitment
•
Forgiveness
3. Hall, Meador & Koenig (2008)
(religion even broader): 23 dimensions listed
•
•
•
•
•
•
•
•
•
•
•
Religious values
Religious beliefs/creedal
assent/concepts of God
Religious knowledge
Non-belief (denial of religion)
Certainty – orthodoxy –
fundamentalism
Quest – doubts - seeking
Religious views on afterlife
Divine intervention
Organised
activity/participation/attendance
Organisation involvement/membership/activity
Study/discussion/prayer in groups
•
•
•
•
•
•
•
•
•
•
•
•
Ritual participation
Private
reading/prayer/devotionalism/nonorganised religiosity
Religious television/radio/internet
Religious experience
Salience/selfrated religiosity
Intrinsic/extrinsic orientation
Financial support
Religious wellbeing
Coping possibilities/support
History
Development/maturity
Attitudes/consequence of attitudes
Existential orientation dimensions
Jacobsen (1998): 11
dimensions (values)
•
•
•
•
•
•
•
•
•
•
•
Work
Economy
Family
good experiences
Society
Religion
Health
Inner harmony
Intellectual improvement
Helping others
Dignity
McCracken and Yang 2008
(ACT existential values):
6 dimensions
•
•
•
•
•
•
Family
Intimate relations
Friends
Work
Health
Growth and learning
Religious + existential dimensions: All to many!
Our suggestion for conceptual coherence
(The Grid)
Dimensions
Domains
Meaning making
Secular
existential
orientation
Spirituality
Religiosity
Knowing:
Cognitions
Doing:
Practice
Being:
Importance
Final model: Hall et all.’s dimensions
distibuted into the grid
Meaning making
Knowing:
Cognitions
Doing:
Practice
Being:
Importance
Secular
existential
orientation
Existential values
Existential beliefs/concepts
Existential knowledge
Organisation/membership
Certainty/orthodoxy/fundamentalism
Quest – doubts – seeking
Existential views on after-life
Intervention by higher principles
Organised activity/participation/attendance
Organisation involvement/-membership/activity
Study/discussion/activity in groups
“Ritual” participation
Private reading
Existential television/radio/internet
Salience/selfrated commitment
Spirituality
Spiritual values
Spiritual beliefs/concepts
Spiritual knowledge
Organisation/membership
Certainty – orthodoxy – fundamentalism
Quest – doubts - seeking
Spiritual views on afterlife
Spiritual intervention
Organised activity/participation/attendance
Organisation involvement/-membership/activity
Study/discussion/meditation/prayer in groups
Ritual participation
Private reading/prayer/meditation/mysticism
Spiritual television/radio/internet
Religious values
Religious beliefs/creedal assent/concepts of
God
Religious knowledge
Non-belief (denial of religion)
Certainty – orthodoxy – fundamentalism
Quest – doubts - seeking
Religious views on afterlife
Divine intervention
Organised activity/participation/attendance
Organisation involvement/-membership/activity
Study/discussion/prayer in groups
Ritual participation
Private reading/prayer/devotionalism/nonorganised religiosity
Religious television/radio/internet
Religiosity
Existential experience
Intrinsic/extrinsic orientation
Financial support
Existential wellbeing
Coping possibilities/support
History
Development/maturity
Attitudes/consequence of attitudes
Salience/selfrated spirituality
Spiritual experience
Intrinsic/extrinsic orientation
Financial support
Spiritual wellbeing
Coping possibilities/support
History
Development/maturity
Attitudes/consequence of attitudes
Salience/selfrated religiosity
Religious experience
Intrinsic/extrinsic orientation
Financial support
Religious wellbeing
Coping possibilities/support
History
Development/maturity
Attitudes/consequence of attitudes
Examples
Meaning making
Knowing:
Cognitions
Doing:
Practice
Being:
Importance
Secular
existential
orientation
Hard core
enviromentalist
Work hours at
GreenPeace and
time spent in
nature
Essential to
identity, able to
provide meaning
during illness
Spirituality
”Think positive”person
Time in
meditation
Obtaining personal
strength during
daily life
Religiosity
Muslim
Ramadan, daily
prayers
Belonging to the
muslim
brotherhood/com
munity
Examples of questions on meaning making and illness
relating to the structure of the conceptual grid
Meaning making Knowing:
Doing:
Being:
Cognitions
Practice
Importance
To what extent do you find life
During your illness, to what extent
To what extent are you trying to
Secular
meaningful even in the
are you able to do the activities that live our life according to your
existential
condition of pain? How and why you value most in life? Are there
ideals – even during this period of
orientation
- or why not?
obstacles to spend time with the
pain? Does these ideals still
Spirituality
Religiosity
provide meaning for you?
If you consider you have a
spiritual side, how important does
such such spirituality seem to be
during this period of crisis? Do
you obtain any personal comfort
or strength from these
dimensions of life?
Has suffering from illness
While being ill, have you felt a
If you have any religious elements
influenced the way you think
greater need to attend church, to
in your worldview, to what extent
about religious issues? If any, on pray or to read religious scriptures? can this strengthen or weaken
which issues have you grown
Have you actually changed your time your ability to go through this
less certain and on which issues spent in such activities?
period of illness? If any, what
have you grown more certain?
elements of religion are
particularly important for you in
this situation?
During your illness, to what
extent are your thoughts of life
governed by energies or forces
greater than you? How do you
understand or reject such
principles?
activities you really value?
After being ill, do you have a greater
need to confirm your being-in-theuniverse, for example by meditation,
listening to music or being alone in
nature? Do you spend time in such
activities?
www.tro-helbred.org
Perspectives
- This is an attempt to contextualize research
and theory
- We do not propose either clear-cut borders or
specific definitions connected to the model,
but merely want to draw a possible frame for
theory and research with the purpose to be
more aware of own status and limitations.
• www.tro-helbred.org
Our suggestion for conceptual coherence
(The Grid)
Dimensions
Domains
Meaning making
Secular
existential
orientation
Spirituality
Religiosity
Knowing:
Cognitions
Doing:
Practice
Being:
Importance