Taking both secular , spiritual and religious meaning making seriously

1. Takingbothsecular, spiritual and religiousmeaningmakingseriously 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

2. 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)

3. 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 PärSalander (2006) from Lund University, Sweden.

4. 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)

5. Religion and health researchExamples: Religious problem solving (Pargament). Threefirstquestions in the mainreligious 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…

6. Reality is multilayered The split between the academic traditions is artificial and counterproductive Coping withmedicalconditions is about coping withmeaningmaking. 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 conceptsareobvious

7. Simplisticunderstanding of coping Coping (while under current stress) Goodresult Bad result This model is not working…

8. The general problem: Whenarelife 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?

9. Meaning making and illness- general theory of coping with personal crisis • World view as a personal ressource • World viewsas a current coping strategy • World view as outcome / (posttraumaticgrowth)

10. 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……

11. Materials at work • 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 ofprevious 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.

12. Premisis: All threeexistential domains are valid and cannotbereduced to oneanother. • 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)

13. 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)

14. 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

15. Example 3. There is no “non-belief” without a specific notion of, what is not believed in The opposite of any meaning making belief would be “meaning making ignorance” – because there is never “meaning making knowledge” This is the premises for taken the domains serious

16. What are the meaning of theMeaning 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

17. Definitions of secular existential orientations  Dimension: From subjective constructivist viewpoints over reflections over collective conditions to inherent meaning

18. Definitions of spiritualityDimension: From evolved humanistic values over striving for an inner truth to contact with the transcendent

19. Definitions of religion Dimension from collective construction of meaning, over individuals meeting the transcendent to relation between man and God

20. 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.

21. AGAIN: The two questions: • 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 ofprevious systematic suggestions for categorizing dimensions of expressed meaning making

22. Question 2. The dimensionsOrganising the many expressions of “meaning making” into dimensions - many efforts have been made before Most prominent examples: • ”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

23. 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/non-organised 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

24. 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!

25. Our suggestion for conceptual coherence (The Grid) Dimensions Domains

26. Final model: Hall et all.’s dimensions distibuted into the grid

27. Examples

28. Examples of questions on meaning making and illness relating to the structure of the conceptual grid

29. www.tro-helbred.org

30. 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

31. Our suggestion for conceptual coherence (The Grid) Dimensions Domains