GOD HELP ME!

1. GOD HELP ME! Religious Coping in 15 Norwegian Cancer Survivors.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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).

7. 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.

8. 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).

9. 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.

10. 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?

11. 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).

12. Inductive, deductive or abductive? • The study has had both inductive and deductive processes, and might therefore best be characterized as an abductive project.

13. 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.

14. 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.

15. 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).

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. Results VIIPargament's theory • The analysis showed that Pargament’s theory is suitable also to analyze a Norwegian sample regarding the main aspects of RC.

23. 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.

24. 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.

25. References • Abrahamsen, A.F.: «Clinical studies in Hodgkin’s disease. With 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

26. 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.

27. 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.

28. References IV • Sørensen, T.: ”Livssyn og helse. Forskningsfronten 2008” i Kjølsvik, 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.