New Directions in the Study of Late Life Religiousness and Spirituality 9781134731107, 9780789020383

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New Directions in the Study Religiousness and Spirituality

of

Late

Life

New Directions in the Study of Late Life Religiousness and Spirituality has been co-published simultaneously as Journal of Religious Gerontology, Volume 14, Numbers (1) 2002 and (2/3) 2003.

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The Journal of Religious Gerontology™ Monographic “Separates” (formerly Journal of Religion & Aging)* Below is a list of “separates,” which in serials librarianship means a special issue simultaneously published as a special journal issue or double-issue and as a “separate” hardbound monograph. (This is a format which we also call a “DocuSerial.”) “Separates” are published because specialized libraries or professionals may wish to purchase a specific thematic issue by itself in a format which can be separately cataloged and shelved, as opposed to purchasing the journal on an on-going basis. Faculty members may also more easily consider a “separate” for classroom adoption. “Separates” are carefully classified separately with the major book jobbers so that the journal tie-in can be noted on new book order slips to avoid duplicate purchasing. You may wish to visit Haworth’s website at… http://www.HaworthPress.com … to search our online catalog for complete tables of contents of these separates and related publications. You may also call 1-800-HAWORTH (outside US/ Canada: 607-722-5857), or Fax 1-800-895-0582 (outside US/Canada: 607-771-0012), or e-mail at: [email protected] New Directions in the Study of Late Life Religiousness and Spirituality, edited by Susan H. McFadden, PhD,

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Mark Brennan, PhD, and Julie Hicks Patrick, PhD (Vol. 2/3 2003). Refreshing. … encouraging.… This book has given us a gift of evolving thoughts and perspectives on religion and spirituality in the later years of life.… Of interest not only to university students, researchers, and scholars, but also to those who provide sendees to the aged.” (James Birren, PhD, Associate Director, UCLA Center on Aging). Aging Spirituality and Pastoral Care: A Multi-National Perspective, edited by Rev. Elizabeth MacKinlay, RN, PhD, Rev. James W. Ellor, PhD, DMin, DCSW, and Rev. Stephen Pickard, PhD (Vol. 12, No. 3/4, 2001). “Comprehensive … The authors are not just thinkers and scholars. They speak from decades of practical expertise with the aged, demented, and dying.” (Bishop Tom Frame, PhD, Lecturer in Public Theology, St. Mark’s National Theological Centre, Canberra, Australia) Religion and Aging: An Anthology of the Poppele Papers, edited by Derrel R. Watkins, PhD, MSW, MRE (Vol. 12, No. 2, 2001). “Within these pages, the new ministry leader is supplied with the core prerequisites for effective older adult ministry and the more experienced leader is provided with an opportunity to reconnect with timeless foundational principles. Insights into the interior of the aging experience, field-tested and proven techniques and ministry principles, theological rationale for adult care giving, Biblical perspectives on aging, and philosophic and spiritual insights into the aging process.” (Dennis R. Myers, LMSW-ACP, Director, Baccalaureate Studies in Social Work, Baylor University, Waco, Texas)

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Aging in Chinese Society: A Holistic Approach to the Experience of Aging in Taiwan and Singapore, edited by Homer Jernigan and Margaret Jernigan (Vol. 8, No. 3, 1992). “A vivid introduction to aging in these societies.… Case studies illustrate the interaction of religion, personality, immigration, modernization, and aging.” (Clinical Gerontologist) Spiritual Maturity in the Later Years, edited by James J. Seeber (Vol. 7, No. 1/2, 1991). “An excellent introduction to the burgeoning field of gerontology and religion.”(Southwestern Journal of Theology) Gerontology in Theological Education: Local Program Development, edited by Barbara Payne and Earl D. C. Brewer* (Vol. 6, No. 3/4, 1989). “Directly relevant to gerontological education in other contexts and to applications in the educational programs and other work of church congregations and community agencies for the aging.” (The Newsletter of the Christian Sociological Society) Gerontology in Theological Education, edited by Barbara Payne and Earl D. C. Brewer* (Vol. 6, No. 1/2, 1989). “An excellent resource for seminaries and anyone interested in the role of the church in the lives of older persons… must for all libraries.” (David Maldonado, DSW, Associate Professor of Church & Society, Southern Methodist University, Perkins School of Theology) Religion, Aging and Health: A Global Perspective, compiled by the World Health Organization, edited by William M. Clements* (Vol. 4, No. 3/4, 1989). “Fills a

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long-standing gap in gerontological literature. This book presents an overview of the interrelationship of religion, aging, and health from the perspective of the world’s major faith traditions that is not available elsewhere…” (Stephen Sapp, PhD, Associate Professor of Religious Studies, University of Miami, Coral Gables, Florida) New Directions in Religion and Aging, edited by David B. Oliver* (Vol. 3, No. 1/2, 1987). “This book is a telescope enabling us to see the future. The data of the present provides a solid foundation for seeing the future.” (Dr. Nathan Kollar, Professor of Religious Studies and Founding Chair, Department of Gerontology, St. John Fisher College; Adjunct Professor of Ministerial Theology, St. Bernard’s Institute) The Role of the Church in Aging, Volume 3: Programs and Services for Seniors, edited by Michael C. Hendrickson* (Vol. 2, No. 4, 1987). Experts explore an array of successful programs for the elderly that have been implemented throughout the United States in order to meet the social, emotional, religious, and health needs of the elderly. The Role of the Church in Aging, Volume 2: Implications for Practice and Service, edited by Michael C. Hendrickson* (Vol. 2, No. 3, 1986). Filled with important insight and state-of-the-art concepts that reflect the cutting edge of thinking among religion and aging professionals. (Rev. James W.Ellor, DMin, AM, CSW, ACSW, Associate Professor, Department Chair, Human Service Department, National College of Education, Lombard, Illinois)

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The Role of the Church in Aging, Volume I: Implications for Policy and Action, edited by Michael C. Hendrickson* (Vol. 2, No. 1/2, 1986). Reviews the current status of the religious sector’s involvement in the field of aging and identifies a series of strategic responses for future policy and action.

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New Directions in the Study Religiousness and Spirituality

of

Late

Life

Susan H. McFadden, PhD Mark Brennan, PhD Julie Hicks Patrick, PhD Editors New Directions in the Study of Late Life Religiousness and Spirituality has been co-published simultaneously as Journal of Religious Gerontology, Volume 14, Numbers (1) 2002 and (2/3) 2003.

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First Published by The Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580 Transferred to Digital Printing 2009 by Routledge 270 Madison Ave, New York NY 10016 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN New Directions in the Study of Late Life Religiousness and Spirituality has been co-published simultaneously as Journal of Religious Gerontology, Volume 14, Numbers, (1) 2002 and (2/3) 2003. © 2003 by The Haworth Press, Inc. All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm and recording, or by any information storage and retrieval system, without permission in writing from the publisher. The development, preparation, and publication of this work has been undertaken with great care. However, the publisher, employees, editors, and agents of The Haworth Press and all imprints of The Haworth Press, Inc., including The Haworth Medical Press® and The Pharmaceutical Products Press®, are not responsible for any errors contained herein or for consequences that may ensue from use of materials or information contained in this work. Opinions expressed by the author(s) are not necessarily those of The Haworth Press, Inc. Cover design by Marylouise E. Doyle 9

Library of Congress Cataloging-in-Publication Data New directions in the study of late life religiousness and spirituality / Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick, editors, p. cm. Includes bibliographical references and index. ISBN 0-7890-2038-6 (alk. paper)–ISBN 0-7890-2039-4 (pbk: alk. paper) 1. Aged–Religious life–Congresses. I. McFadden, Susan H. II. Brennan, Mark. III. Patrick, Julie Hicks. BL625.4.N49 2003 291.4′084′6–dc21

2002155324

Publisher’s Note The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original may be apparent.

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Indexing, Abstracting & Website/Internet Coverage

This section provides you with a list of major indexing & abstracting services. That is to say, each service began covering this periodical during the year noted in the right column. Most Websites which are listed below have indicated that they will either post, disseminate, compile, archive, cite or alert their own Website users with research-based content from this work. (This list is as current as the copyright date of this publication.) Abstracting, Coverage

Website/IndexingYear When Coverage Began

• Abstracts in Social Gerontology:1991 Current Literature on Aging • AgeInfo CD-Rom

1994

• AgeLine Database

1994

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• Applied Social Sciences Index &1994 Abstracts (ASSIA) (Online: ASSI via Data-Star) (CD-Rom: ASSIA Plus)

• ATLA Religion Database,1991 published by the American Theological Library Association

• CNPIEC Reference Guide:1995 Chinese National Directory of Foreign Periodicals • Educational Abstracts (EAA)

Administration1995

• Family & Society Studies1996 Worldwide (online and CD/ROM)

• FINDEX

1999

• Guide to Social Science &2000 Religion in Periodical Literature • Human (HRA)

Resources

Abstracts1991

• IBZ International Bibliography of1996 Periodical Literature

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• Index Guide to College Journals1999 (core list compiled by integrating 48 indexes frequently used to support undergraduate programs in small to medium sized libraries) • Index to Jewish Periodicals2001

• New Literature on Old Age

1995

• Orere Source, The (Pastoral1998 Abstracts) • Periodica Islamica

1994

• Psychological (PsycINFO)

Abstracts2001

• Religious & Theological Abstracts1991

• Sage Family Studies Abstracts1995 (SFSA) • Sage Urban Studies Abstracts1995 (SUSA) • Social Services

Abstracts1999

• Social Work Abstracts1991

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• Sociological

Abstracts

(SA)1991

• Theology Digest (also made1992 available on CD-ROM) • Violence and Abuse Abstracts: A1995 Review of Current Literature on Interpersonal Violence (VAA) Special Bibliographic Notes related to special journal issues (separates) and indexing/abstracting: • indexing/abstracting services in this list will also cover material in any “separate” that is co-published simultaneously with Haworth’s special thematic journal issue or DocuSerial. Indexing/abstracting usually covers material at the article/chapter level. • monographic co-editions are intended for either non-subscribers or libraries which intend to purchase a second copy for their circulating collections. • monographic co-editions are reported to all jobbers/wholesalers/approval plans. The source journal is listed as the “series” to assist the prevention of duplicate purchasing in the same manner utilized for books-in-series. • to facilitate user/access services all indexing/ abstracting services are encouraged to utilize the

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co-indexing entry note indicated at the bottom of the first page of each article/chapter/contribution. • this is intended to assist a library user of any reference tool (whether print, electronic, online, or CD-ROM) to locate the monographic version if the library has purchased this version but not a subscription to the source journal. • individual articles/chapters in any Haworth publication are also available through the Haworth Document Delivery Service (HDDS).

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New Directions in the Study Religiousness and Spirituality

of

Late

Life

CONTENTS Charting a Course for 21st Century Studies of Late Life Religiousness and Spirituality Susan H. McFadden, PhD Mark Brennan, PhD Julie Hicks Patrick, PhD PART I: EPISTEMOLOGICAL STIRRINGS IN THE STUDY OF RELIGIOUSNESS AND SPIRITUALITY Examining Spirituality Over Time: Latent Growth Curve and Individual Growth Curve Analyses Mark Brennan, PhD Daniel K. Mroczek, PhD Uncovering Spiritual Resiliency Through Feminist Qualitative Methods Rosemary Blieszner, PhD Janet L. Ramsey, PhD Spiritual Issues in Health and Social Care: Practice Into Policy? Harriet Mowat, PhD Desmond Ryan, PhD A Mighty Fortress Is Our Atheism: Defining the Nature of Religiousness in the Elderly 16

Allen Glicksman, PhD PART II. APPROACHES TO THE DEFINITIONAL DILEMMA Practical Philosophies: Interpretations of Religion and Spirituality by African American and European American Elders Holly B. Nelson-Becker, PhD Dwelling and Seeking in Late Adulthood: The Psychosocial Implications of Two Types of Religious Orientation Paul Wink, PhD Widows’ Spiritual Journeys: Do They Quest? Edward H. Thompson, Jr., PhD Mary E. Noone, BA Amanda B. Guarino, BA The Role of Social Context in Religion Linda M. Chatters, PhD Robert Joseph Taylor, PhD, MSW PART III: THE FRUITS OF THE RELIGIOUS LIFE Why Believe? The Effects of Religious Beliefs on Emotional Well Being Julie Hicks Patrick, PhD Jennifer M. Kinney, PhD

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Coping with the Uncontrollable: The Use of General and Religious Coping by Caregivers to Spouses with Dementia Jennifer M. Kinney, PhD Karen J. Ishler, MA, LSW Kenneth I. Pargament, PhD John C. Cavanaugh, PhD Effects of Religiosity and Spirituality on Depressive Symptoms and Prosocial Behaviors Karri Bonner, BA Lesley P. Koven, MA Julie Hicks Patrick, PhD Religiosity, Afterlife Beliefs, Adjustment in Adulthood

and

Bereavement

Shailagh M. Clarke, BA Bert Hay slip, Jr., PhD Ricks Edmondson, PhD Charles A. Guarnaccia, PhD Afterword: A “Conversation” Definitions, and Applications Susan H. McFadden, PhD Mark Brennan, PhD Julie Hicks Patrick, PhD

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About

Theories,

Index

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About the Editors Susan H. McFadden, PhD, is Professor and Chair of the Department of Psychology at the University of Wisconsin-Oshkosh. She is a Fellow of the American Psychological Association (Division 36-Psychology of Religion) and has been active in both the Gerontological Society of America and the American Society on Aging in bringing together researchers and practitioners interested in religion, spirituality, and aging. She serves on the editorial boards of the Journal of Religious Gerontology, the International Journal for the Psychology of Religion, and the International Journal of Aging and Human Development. She co-edited Aging, Spirituality, and Religion: A Handbook and is currently co-editing the second volume of that book. Dr. McFadden’s other co-edited books include Aging and the Meaning of Time and Handbook of Emotion, Adult Development, and Aging. She co-authored (with Carol Magai) The Role of Emotions in Social and Personality Development: History, Theory, and Research. She has published over 20 articles and chapters in the general area of religion, spirituality, and emotion in late life. In addition, she collaborates on research on teaching in higher education, has a number of publications in that area, and co-edits the “Teaching Tips” column of the American Psychological Society Observer. Mark Brennan, PhD, is Senior Research Associate at the Arlene R. Gordon Research Institute of Lighthouse International in New York City. Since 1997, he has conducted research on the effects of religiousness and spirituality in adapting to vision impairment among

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middle-aged and older adults. His other work in this area includes the “Postcards to God” study, in which adolescent and adult workshop participants created picture and text message postcards as a form of spiritual expression. Dr. Brennan’s work in spirituality and religiousness has been published in the Journal of Adult Development and has been presented at a number of national and international conferences. He is a member of the Gerontological Society of America, the American Psychological Association (Division 20-Adult Development and Aging), and the State Society on Aging of New York. In 1993, Dr. Brennan was awarded a Fellowship at the Hunter-Brookdale Center on Aging in recognition of his contributions to the study of older New Yorkers. He was also named a New York State Scholar for Project 2015 by the State Office of Aging and is a recipient of the Pride Senior Network Recognition Award for research on the older gay, lesbian, transgender, and bisexual population. Dr. Brennan’s work has been published in The Gerontologist, the Journal of Gerontological Social Work, Qualitative Social Work: Research and Practice, Perceptual and Motor Skills, and the Journal of General Psychology. In 2000, he co-authored Social Care of the Elderly: The Effects of Ethnicity, Class, and Culture with Marjorie Cantor. His work has also appeared in The Lighthouse Handbook of Vision Impairment and Vision Rehabilitation and Lifespan Development and Behavior, Volume II. Julie Hicks Patrick, PhD, is Assistant Professor in the Department of Psychology at West Virginia University.

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Dr. Patrick has worked in the field of aging for 10 years, serving as Project Director for three federally funded caregiving studies. Her research interests focus broadly on families in their middle and later years, with a concentration on how individuals translate perceptions and beliefs into observable behavior. She has received funding support for her research and teaching activities from the National Institute on Aging, Psi Chi (the national honorary in psychology), and the American Psychological Association (Division 2). Dr. Patrick’s most recent research focuses on everyday problem solving among older adults, with an examination of the relationship between strategic processing and decision quality. She has published her work in a variety of age-related journals, including Psychology & Aging, Journal of Gerontology, The Gerontologist, Research on Aging, and Clinical Gerontologist. In addition, her work has been published by the American Journal on Mental Retardation and Sex Roles. Dr. Patrick co-edited a new book on grandparent caregivers with Bert Hayslip, Jr., which will be released in 2002. She has also been appointed co-editor of the APA Division 20 newsletter. During the 2000-2001 academic year, Dr. Patrick was recognized as the Judith Gold Stitzel Endowed Teacher in Women’s Studies at WVU.

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Charting a Course for 21st Century Studies of Late Life Religiousness and Spirituality Susan H. McFadden, PhD Mark Brennan, PhD Julie Hicks Patrick, PhD This collection of papers originated in several symposia offered at the 2001 meeting of the Gerontological Society of America (GSA). Since its inception, GSA has emphasized scientific studies of age, aging and older adults–studies that until very recently have rarely paid attention to religion and spirituality. However, early in the 1990s, an Interest Group formed within GSA to bring researchers and practitioners together who shared a commitment to studying these subjects so often omitted from the gerontological mainstream. This group was delighted when the 2001 conference planners selected its title: “2001–A Gerontological Odyssey: Exploring Science, Society and Spirituality.” Therefore, a number of symposia were organized to take advantage of the window of opportunity opened by the conference theme. The papers in this collection examine questions of “how,” “what,” and “why” in relation to religiousness and spirituality and the lives of older adults. The first section focuses on the epistemological assumptions guiding gerontological research on religion and spirituality. It introduces readers to new ways of thinking about research methodology and data analysis. The second section of this collection addresses issues of definition. Since its founding, a persistent theme at the

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GSA Religion, Spirituality, and Aging Interest Group meetings has been the problem of definition. What are we studying? What social and psychological influences shape our thinking about definition? Do the definitions used by gerontologists match the definitions held by older people? Finally, a group of papers was organized with the goal of moving the study of religion, spirituality, and aging beyond the focus on health and mortality to examine well being more broadly in the context of older adults’ life experiences. The study of religion, spirituality, and aging is in the process of taking an important developmental step forward. Current trends in this field include: (1) a greater understanding of the complexity of these phenomena; (2) increased tolerance of diverse forms of inquiry; (3) more openness to the variety of religious and spiritual experiences and practices among older persons; and (4) consideration of a wider array of life circumstances that may be affected by religiousness and spirituality in the older population. These papers reflect these trends and in many ways represent a transition between the old and the new. Some of the authors in this collection are well known in the field while others are just beginning to publish their work. Before summarizing these papers, we must describe one that appeared in the GSA symposium on epistemology but is not represented here. Gisela Labouvie-Vief of Wayne State University is well known and highly regarded for her many important studies of knowing and feeling in later life. What many people do not know is that she is also an artist and musician who profoundly

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understands that empiricism is but one way of knowing; metaphors and images also offer knowledge-knowledge that is sometimes more universal than that produced by science (Royce, 1973). For her presentation titled “Spirituality and images of wisdom,” she offered a series of slides showing her own sculptures as well as pictures depicting mythic and spiritual imagery from ancient times. Labouvie-Vief suggested that these figures revealed embodied representations of aspects of positive later life development, such as wisdom and imagination. Unfortunately, we could not reproduce the many colorful slides she used to illustrate her talk; she decided that they were integral to the ideas offered in her paper and that words alone could not convey her meanings. Thus, in studying the papers included in Part I of this collection, the reader should keep in mind that a third way of knowing–metaphorism–stands alongside the empiricism and rationalism represented in the papers that do appear here. Epistemological Stirrings in the Study of Religiousness and Spirituality Imagine the astonishment of the audience attending that GSA symposium when they heard a group of presentations that included a detailed exposition on new statistical treatments of longitudinal data, a description of research conducted from a hermeneutic, phenomenological perspective grounded in feminist theory, and Labouvie-Vief’s discussion and illustration of goddess figures! These three very different papers were then skillfully integrated in a discussion by Ruth Ray, a Professor of English Literature. We relate these

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details from the 2001 GSA meeting to support our contention that there are many, equally valid ways of answering the “how” question regarding our approaches to the study of religiousness and spirituality. Granted, most of the papers in this collection take an empirical pathway to knowing, but even within the four papers in Part I, the reader will find diverse perspectives. Mark Brennan and Daniel K. Mroczek begin Part I with a paper that explains structural equation modeling, a statistical method that can help researchers capture the dynamics inherent in the passage of time. Older people enduring life crises as well as everyday stressors may show different forms and levels of spirituality over time. Most research on spirituality and religion measures people’s responses at only one point in time. With longitudinal designs increasingly being used in gerontology, researchers need to be able to account for change across time that occurs within groups as well as within individuals. In order to do this, they need statistical methods like latent growth curve and individual growth curve analyses. Readers who have not taken a statistics course in many years may not be familiar with these newer approaches; they will be rewarded for persistence if they work through Brennan and Mroczek’s contribution slowly and carefully. These authors have presented difficult and complex statistical theory in a clear and understandable fashion, and, moreover, they have connected this to the study of spirituality and aging. The paper by Rosemary Blieszner and Janet L. Ramsey turns away from measurement and the need for statistical

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analyses as they describe how they set out to listen, not to measure, when studying spiritual resiliency in older women. Arguing that methods and goals need to match, they believe that increasing respect for older women depends upon research that does not impose meanings upon participants and that honors their immersion in their own culture and life experiences. Situating their work in symbolic interactionism and feminist theory, Blieszner and Ramsey show that the “how” question of research is intimately tied to theory, and they note the atheoretical nature of so much contemporary research. Their work offers an excellent model of how to conduct rigorous qualitative research and shows the benefits of methodological triangulation. Moreover, they offer a compelling argument for their feminist approach in terms of the ways they designed the research, interpreted their observations, and treated the women who contributed their insights on spiritual resiliency. Harriet Mowat and Desmond Ryan next describe their action research that connected empirical studies of spirituality in Scottish health and social care to a government supported program for encouraging the integration of spiritual issues into practice with older adults. Drawing upon research that has shown the salutogenic outcomes of religion and spirituality, they argue that spirituality should be seen as a public health issue and that researchers can become agents of social change when they articulate the connections between their findings and public policy. Offering many provocative ideas in this paper, Mowat and Ryan not only describe their own work but they also show how just considering issues of spirituality forces us to

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reexamine many of the assumptions we make about research and practice. In particular, they offer a pointed critique of the construct “successful aging” and the problems that arise when limited views of “successful aging” become incorporated into policy. They believe that consideration of spirituality forces a reframing of culturally accepted images of “successful aging.” The final paper in this section is also provocative, beginning with its title. Allen Glicksman challenges us to think about whether science can study religion at all. Citing Max Weber, he urges researchers to return to the classic works on the scientific study of religion that paid attention to the specific nature of belief systems. Even those that are nontheistic can nevertheless function as religions, and by understanding them better, researchers can gain deeper insights into religion itself. He points out that it is also important to pay attention to these nontheistic forms of belief as not all older persons embrace religion as enthusiastically or as uniformly as national surveys sometimes imply. Articulating a theme that reverberates through many of the papers in this collection, Glicksman states that it is essential that researchers pay attention to the specific nature of beliefs associated with different religions. Approaches to the Definitional Dilemma Establishing definitions of religion and spirituality about which all researchers can agree presents us with an enormous– and perhaps unresolvable–challenge. And yet if we cannot come to some agreement about what we are studying, then how can we foster communication among researchers to advance our knowledge of these complex

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phenomena? Perhaps even more important is recognizing that the older persons who participate in our research may have their own definitions of religion and spirituality. Holly B. Nelson-Becker put this question about definitions to two different groups of older people, all of whom reside in public housing. One group was predominantly African American while the other group was composed of European Americans, mostly Jewish in their cultural identity. She found that there are many shaping forces on belief, a point later explicated in detail by Linda M. Chatters and Robert Joseph Taylor. Referring to what she calls “practical philosophy,” Nelson-Becker places older adults’ responses to her questions about religion and spirituality within the framework of their daily lives and emphasizes the functions of their definitions in their responses to life challenges. For aspiring researchers, Nelson-Becker offers an excellent suggestion on conducting interviews when she notes the problems that arose in her study due to the order in which she asked her questions about how older people define religion and spirituality. Nelson-Becker’s elders offered definitions of religion and spirituality that showed some overlap but could also be clearly differentiated. Paul Wink uses metaphors of religious dwelling and spiritual seeking to show that these are two intersecting ways of being religious and that we do not need to split them. These gentle, evocative metaphors also help to avoid the evaluative tone that creeps into some discussions of religion and spirituality wherein religion is enveloped in a pejorative group of images implying authoritarian, rigid, institutionalized belief systems. Wink notes, as do

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several other authors in this collection, that we need to be careful about psychological and social scientific biases against what might be viewed as “traditional religion,” and that both religious dwelling and spiritual seeking have their “shadow” sides. Through his analysis of longitudinal data collected throughout their adult lives from people now in their late 70s, Wink is able to show patterns of religiousness and spirituality across the life course. He offers details about two individuals’ lives to show similarities and differences in the patterning of religiousness and spirituality as people age. Longitudinal research can span decades, as illustrated by Wink, or it can involve much shorter time periods as is evident in the paper by Thompson, Noone, and Guarino. Using the popular metaphor of “journey,” these authors compared older women’s responses to the experience of widowhood at two times. The researchers wanted to know whether the deaths of their husbands motivated these elderly women to question their religious beliefs and to consider whether previously embraced “answers” to existential questions still functioned well in the new reality of widowhood. Their study showed that religious “questing” diminished over time but that the women’s intrinsic religious orientation deepened through prayer and devotional behaviors. Thompson, Noone, and Guarino demonstrated that even if we could agree on one definition of “religion,” psychologically there are different ways of being religious (i.e., viewing religion as an end in itself, a means to an end, or as a focal point for engagement with questions about meaning in life). Interviews with a small group of women from the

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sample revealed how their religious faith sustained them through the many difficult adjustments of widowhood. A paper by Linda M. Chatters and Robert Joseph Taylor completes this section on definitions by urging us to consider how social context influences our definitions, measures, and interpretations of people’s religious beliefs, behaviors, and experiences. Although themes related to the contextual perspective reverberate through many of the other papers in this collection, this paper explicitly addresses contextual factors related to world views and to differences in social location. Moreover, Chatters and Taylor argue for the significance of this contextual perspective in efforts to show the relation of religion to health, stress, and well being in older persons. Religion can have direct and indirect effects and if the researcher fails to account for diversity among religions and among religious persons, then there is little hope of explicating the ways that people’s lives are affected by their religion. These four papers do not focus on abstract, scholarly debates over immutable definitions of religion and spirituality. Rather, they locate the definitional project–challenging and complex as it is–within the transactional space created when researchers (and practitioners) respect older people’s lives and listen to their views on experiences of religion and spirituality. In addition, these papers all bring to the foreground a communal perspective sometimes lost in the social scientific study of religion, spirituality, aging. While social scientists often cite “social support” as one “mechanism” that may explain some of the relation

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between religious commitments and well being, these papers talk about community. That is, however one defines religion and spirituality, when observing older persons’ lived experience of these phenomena, one must respect their felt connections to communities of persons who together search for “significance in ways related to the sacred” (Pargament, 1997, p. 32). The Fruits of the Religious Life Several decades of research at the end of the 20th century indicated lower rates of depression among religious persons, at least when religion was measured according to public participation in organized activities. The picture became less clear when private religious behaviors were studied, for then researchers often found increased levels of depression accompanying increased levels of nonorganizational religiosity. Because this research was largely correlational in nature, no one drew conclusions about cause, but many suggestions were put forward about possible “mechanisms” that created these connections. In other words, we want to know why religiousness and spirituality are important to many aging persons. Why do religious belief and a spiritual sense of meaningful connectedness become more salient as some people grow older? And, if being religious or holding spiritual values provides a buffer against the deleterious effects of life crises, then why does this occur? Today, we find new questions being raised about the “fruits” of religious life, and the papers in this section represent some important growing edges in research on religion and spirituality. An emerging cohort of

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researchers is challenging previous research that treated religion generically. They understand the significance of studying specific religious beliefs, and they recognize that even within denominations, beliefs can vary in important ways. In addition, they not only attend to negative emotional experiences, often catalogued in terms of depressive symptoms, but they are also seeking insight into positive emotion and possible connections to religiousness and spirituality. Picking up on themes articulated by Chatters and Taylor, Julie Hicks Patrick and Jennifer M. Kinney urge researchers to address more fully the effects of the content and function of religious beliefs on well being as well as on various behaviors associated with religiosity like participation in organizational religious activities. Their research noted that older and younger adults showed considerable similarity in their beliefs about the comfort religion could offer. Nevertheless, for these different age groups, these particular beliefs were associated with different behaviors and experiences, with the older persons more likely to participate in organizational religious activities and the younger persons showing higher levels of depressive symptoms. In the second paper in this section, Jennifer M. Kinney, Karen J. Ishler, Kenneth I. Pargament, and John C. Cavanaugh investigated the ways people caring for a spouse with dementia relied upon religious coping. Unique to their approach was their comparison of general and religious forms of coping. For many years, the stress and coping model of Richard Lazarus and

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Susan Folkman has provided a useful conceptual approach for understanding the ways people manage stressful situations often by attempting to solve problems directly or by regulating their emotional reactions. More recently, Kenneth Pargament’s model of religious coping has delineated three ways people relate to God in coping–they engage in self-directing, collaborative, or deferring forms of coping. This study asked whether these forms of general and religious coping would produce different outcomes for caregivers, particularly in terms of their levels of depressive symptoms. Karri Bonner, Lesley P. Koven, and Julie Hicks Patrick also studied depressive symptoms, but they also added an intriguing new measure to study in light of public and private religious behaviors: prosocial behavior. Public and private religious behaviors (often described as organizational and nonorganizational religiosity) have been studied for many years as separate phenomena. As another indication of how a new generation of researchers is addressing these questions, Bonner et al. argue that perhaps these cannot be so easily split apart and that “subjective spirituality” can be seen as related to both. Thus, they join others in calling for measures of these phenomena that reveal their complexity. The final paper in this section returns to the issue of specific religious beliefs. In this case, Shalaigh M. Clarke, Bert Hayslip, Jr., Rick Edmondson, and Charles A. Guarnaccia examined how people adjusted to bereavement as a function of their beliefs about an afterlife and their evaluation of how religious they felt themselves to be. Once again, longitudinal data

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are needed, for these researchers suggest that as people come to terms with loss, their beliefs about an afterlife may undergo change. This paper also raises questions about whether people’s religiousness affects their response to the death of loved ones in different ways according to how the death occurred. The authors also state that we need to do a much better job of understanding less religious older adults, and that perhaps the common measures used in research on religion and spirituality are not adequately addressing the belief systems of non-religious persons. Applications to Practice We believe that the papers in this collection contain useful information and stimulating ideas for people who work with older adults in various settings and who want to be better informed about the latest thinking about late life religiosity and spirituality. Although none of the papers specifically contains “how to” information, they do address a number of significant issues that are applicable in practice. For example, papers in Part I point out the need to consider older people’s spiritual lives across time, the importance of understanding one’s own theoretical stance as one listens to and interprets what elders say about their spiritual lives, the possibilities for effecting changes in public policy through an intentional approach to spiritual care, and finally, the fact that some older persons may embrace a form of belief that functions like a religion to them but may not fit with commonly held views of what religion is. Papers in Part II remind us of the complexity of the constructs “religiosity” and “spirituality,” especially

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when trying to understand them within the lived experience of today’s older persons. Finally, social workers, clergy, health care professionals and others often encounter themes raised in Part III as they work with older people experiencing bereavement and the challenges of caregiving. Our hope is that the examples of research we have included here will inspire researchers and practitioners to work together so that all may more fully appreciate the intricacies of late life religiousness and spirituality. References Pargament, K.I. (1997). The psychology of religion and coping: Theory, research, practice. New York: Guilford. Royce, J. R. (1973). The present situation in theoretical psychology. In B. B. Wolman (Ed.), Handbook of general psychology (pp. 8-21). Englewood Cliffs, NJ: Prentice Hall. Susan H. McFadden is affiliated with the Department of Psychology, University of Wisconsin-Oshkosh. Mark Brennan is affiliated with the Arlene R. Gordon Research Institute, Lighthouse International. Julie Hicks Patrick is affiliated with the Department of Psychology, West Virginia University. Address correspondence to: Susan H. McFadden, Department of Psychology, University of Wisconsin-Oshkosh, 800 Algoma Boulevard, Oshkosh, WI54901 (E-mail: [email protected]). [Haworth co-indexing entry note]: “Charting a Course for 21 st Century Studies of Late Life Religiousness and

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Spirituality.” McFadden, Susan H., Mark Brennan, and Julie Hicks Patrick. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 1, 2002, pp. 1-10; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 1-10. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Examining Spirituality Over Time: Latent Growth Curve and Individual Growth Curve Analyses Mark Brennan, PhD Daniel K. Mroczek, PhD Summary. Research on spirituality and religiousness has gained growing attention in recent years; however, most studies have used cross-sectional designs. As research on this topic evolves, there has been increasing recognition of the need to examine these constructs and their effects through the use of longitudinal designs. Beyond repeated-measures ANOVA and OLS regression models, what tools are available to examine these constructs over time? The purpose of this paper is to provide an overview of two cutting-edge statistical techniques that will facilitate longitudinal investigations of spirituality and religiousness: latent growth curve analysis using structural equation modeling (SEM) and individual growth curve models. The SEM growth curve approach examines change at the group level, with change over time expressed as a single latent growth factor. In contrast, individual growth curve models consider longitudinal change at the level of the person. While similar results may be obtained using either method, researchers may opt for one over the other due to the strengths and weaknesses associated with these methods. Examples of applications of both approaches to longitudinal studies of spirituality and religiousness are

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presented and discussed, along with design considerations when employing these techniques. [Article copies available for a fee Haworth Document Delivery 1-800-HAWORTH. E-mail

© 2002 Haworth Press, Inc. All rights reserved.]

and data modeling from The Service: address: Website: by The

Keywords. Structural equation modeling latent growth curve analysis individual growth curve analysis longitudinal research spirituality religiousness Research on spirituality and religiousness has reached a crossroads. This burgeoning area of research has recently seemed to cross a threshold of public and professional awareness. Despite this, there is a lingering mistrust between the domains of science and religion, ranging from questions concerning the validity of spirituality as a topic of scientific inquiry to a reluctance to address issues of spirituality and religion in education, research, and practice (Levin, 1994; Pargament, 1997). However, as noted by Levin, much of the research in this area has been characterized by weak study designs, methodologies, and statistical analysis techniques that “… allow findings to be easily dismissed” (1994, p. 15). In order to insure the scientific credibility of research in spirituality and religion, there is a critical need for longitudinal research in this area utilizing sophisticated measurement and data analysis strategies (Chatters & Taylor, 1994;

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Ellison & Levin, 1998; Levin, 1994; McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000; Piedmont, 2001). Our well-documented knowledge of religion, spirituality and their usually positive effects on a wide range of physical and psychological outcomes is based primarily on the examination of concurrent associations, that is, measurements or observations made at a single point in time. To advance the study of spirituality and religion, longitudinal investigation, or examining these constructs and outcomes of interest over time, would permit the field to move beyond our current knowledge base and at the same time pose more sophisticated questions. For example, how do religiousness and spirituality change over time and what is the impact of significant, life-challenging events on these personal resources? Do spirituality and religiousness exert a constant positive influence on the outcomes under study, or is this effect variable, and if so, what is responsible for such variability? Longitudinal studies utilizing repeated-measures have typically relied on two well-known data analytic techniques: repeated-measures analysis of variance (ANOVA) and multiple regression analysis utilizing an auto-regressive model (e.g., spirituality at Time 1 predicting spirituality at Time 2, etc.). However, there are limitations to these approaches. For example, ANOVA tests the differences between group means over time, but is not equipped for examining change at the level of the individual which may be obscured in a group-level analysis. Auto-regressive models are also a form of group-level analysis and may often encounter problems with multicollinearity of predictors.

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Multicollinearity occurs when two independent factors are highly correlated with each other and both are included in a regression equation to predict an outcome. In other words, these highly correlated variables (i.e., r > .70) become somewhat redundant in predicting the outcome measure and produce hard to interpret or misleading results. To illustrate, if baseline (i.e., Time 1) and six-month follow-up (i.e., Time 2) spirituality measures were used to predict spirituality at Time 3, the effects of the Time 2 measurement may be hard to detect if it is highly correlated with the Time 1 measure. Hence, both ANOVA and auto-regressive analysis techniques are limited in their ability to study the dynamics of change over time. The purpose of this paper is to provide a general overview of two cutting-edge statistical techniques that will facilitate longitudinal investigations of spirituality and religiousness; structural equation modeling latent growth curve analysis (SEM-LGC) and individual growth curve (IGC) models. The following sections provide an overview of both techniques along with examples of how these statistical tools might be applied to gerontological research on spirituality and religion. It should be noted that detailed descriptions of how to perform these analytic techniques are beyond the scope of this paper, and the reader should consult the references provided herein for such information. Structural Equation Modeling with Latent Growth Curves Overview of Structural Equation Modeling (SEM)

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SEM, also known as covariance structure modeling, lends itself to analysis of complex longitudinal data. There are a variety of statistical packages which will perform SEM, such as LISREL (Jöreskog & Sörbom, 1996), AMOS (Arbuckle & Wothke, 1999), or EQS (Kline, 1998). Other statistical modeling techniques (e.g., conventional path analysis) present the disadvantage of including random effects, making them more easily influenced by individual growth patterns, or relaxing requirements for multivariate normality (Bentler & Newcomb, 1992; Jöreskog & Sörbom, 1996; Müthen, 1991). In SEM analysis a distinction is made between measured and latent variables. Measured variables are comprised of the items or scales obtained through data collection and are directly observed. Latent, or unobserved, variables are the hypothetical constructs that the measured variables are purported to represent. According to measurement theory, any measure is a combination of both its true score (i.e., its representation of the latent construct) and residual variance (i.e., measurement error). SEM includes two modeling steps: a measurement model showing the relationship between measured and latent variables, and a structural model describing the relationship of latent independent and mediating variables to latent dependent variables. SEM measured variables are depicted as rectangles while latent variables are depicted as ovals. Arrows in the SEM model diagram indicate the direction of causality. As can be seen in Figure 1, measures of spirituality and depression (Time 1 through Time 4) comprise the eight measured variables in the model. Latent variables in the model are change in

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spirituality and depression. The error terms associated with the eight measured variables are also depicted as ovals since they are estimated in the modeling procedure and are not directly observed. Thus, measured variables are considered to be a function of the underlying latent variable construct and associated measurement error, as in conventional factor analysis. A further advantage of SEM is that measured variables can be assessed for reliability in estimation of the latent construct while simultaneously examining the casual relationships among the latent variables in question. That is, the measurement model in SEM performs a factor analysis of measured variables of the associated latent construct. Figure 1. Hypothetical Example of SEM Latent Growth Curve Model of Spirituality and Depression

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SEM generally requires a minimum of two measured variables to each latent variable for estimation (Bollen, 1989, p. 17). More than two measured variables may improve the estimation of the latent variable in question, analogous to the relation of the number of test items to

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the accuracy of a total test score. However, the number of measured variables to include in SEM, as well as which variables to include for estimating each latent construct, depend on a number of criteria. These include that measured variables be conceptually related to the latent variable, as well as the empirical relation (i.e., covariation) between measures hypothesized to be similar and dissimilar (Bollen, 1989). Moreover, single indicator latent variables may be used if necessary, and there are a number of techniques available for handling these special cases (Bollen, 1989; Kelloway, 1998). While many elements comprising SEM will be familiar to those with an elementary background in statistics, namely, correlations/covariances, factor loadings, regression coefficients, and t-tests, SEM differs fundamentally from these well-known statistical tools. When one tests a SEM model of measured and latent variables and their relationships, such a model implies a certain covariance structure in the data. SEM is an iterative procedure that compares the covariance structure implied by the model against the observed covariance structure of the data by continually varying estimates of the various parameters in the model. A variety of estimation algorithms are available, including Maximum-Likelihood (ML), Generalized Least Squares (GLS), and Unweighted Least Squares (ULS). However, ML is the preferred and the most widely used since it provides the least biased estimates when assumptions of multivariate normality are met. If the model is adequately specified, SEM estimates converge and the model is evaluated in terms of “goodness of fit” with the

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observed covariance structure. There are numerous indicators of model fit, but perhaps the most widely known is the Chi-square test of exact fit (Hu & Bentler, 1998; Jöreskog & Sörbom 1996; Kelloway, 1998; Marsh, Balia, & Hau, 1996). The objective in SEM is to obtain a nonsignificant Chi-square, indicating that the covariance structure implied by the model does not differ significantly from the observed covariance structure in the data. Other approximate fit indices, such as the Goodness of Fit Index (GFI) and Confirmatory Fit Index (CFI), range from 0 to 1 with higher values (i.e., > .95) indicative of better fit (Hu & Bentler, 1999). However, there is currently considerable disagreement about the usefulness of these approximate fit measures in relation to the Chi-square test of exact fit. Longitudinal studies consist of multiple measurements over time, and SEM can employ these multiple sources of data to produce more robust estimations of underlying latent variable constructs. In SEM, outcome measures are expressed as a linear function of independent and mediating variables, and of residual components (error terms) representing unmeasured variables. A rival hypothesis in any longitudinal study is that the relationship between two variables included in analytic models is not causal, but instead due to the effects of some unmeasured third variable. SEM allows the examination of these unmeasured variables (i.e., residual variance) and correlated measurement error. For example, in a SEM analysis of change in spirituality predicting change in level of depression over time, a high amount of residual unexplained variance might be observed. This would suggest that the investigator

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should examine and possibly include other factors in the model that might be responsible for change in depression, such as change in health status, significant life events, etc. An additional problem in longitudinal analyses concerns repeated measures that are highly correlated (e.g., multiple measures of spirituality over an 18 month period). Standard regression models assume uncorrelated measurement error. SEM allows the extent of error correlation to be assessed, which may result in improved fit if these parameters are added to the model. SEM Latent Growth Curve Analysis SEM latent growth curve analysis (SEM-LGC) is a special case of the SEM model used for examining repeated-measure designs (Jöreskog & Sörbom, 1996; McArdle & Epstein, 1987; Meredith & Tisak, 1990). In the most basic form of SEM-LGC estimation, observed variables over multiple times of measurement (e.g., spirituality, religiousness) are used to estimate growth or change in the latent variable over time. Change in this latent growth variable is indicated through analysis of means, variances, and covariances of the observed variables over the times of measurement, and a mean vector is obtained which indicates the direction, magnitude and significance of the change in the latent growth variable. In this technique, the factor loading of the initial measurement of the observed variable is fixed to one, and serves as the basis for detecting change in the subsequent observations (see Figure 1). This latent growth function may be linear or nonlinear (e.g., quadratic). Another variant of this SEM-LGC model can also examine intraindividual change, similar to

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individual growth curve modeling discussed below, by including two latent growth variables representing both the slope (i.e., rate of change) and intercept (i.e., initial level of the variable) (e.g., see Chou, Bentler, & Pentz, 2000; Hox, 2000). However, only the SEM-LGC model that examines the overall rate of change will be discussed below to better illustrate some of the properties of this somewhat complex procedure. In Figure 1, the SEM-LGC model illustrates a hypothetical longitudinal study examining latent growth variables of change in levels of spirituality as related to change in levels of depression over four times of measurement. Note that in the case of both latent growth variables, the factor loadings of Time 1 observed measures are fixed to one, serving two functions. As mentioned previously, fixing the initial measurement parameter to one provides a baseline for change in the subsequent times of measurement and a starting point for determining the mean vector of the change variable. The path of one of the measured variables must also be fixed to one for each latent variable in order to provide a scale of measurement for the latent variable. In this model, the relationship of change in spirituality to change in depression is represented by a single-headed arrow, which indicates a structural regression coefficient of spirituality affecting depression. This relationship could also be hypothesized as a covariance (or correlation) between the two latent growth variables, or even as reciprocal regression parameters indicating that the two variables are inter-dependent. Limitations of SEM Analysis

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There are several shortcomings to SEM, including the inherent correction for attenuation built into the model. That is, when latent variables are measured with different reliability (i.e., varying levels of measurement error), structural equation estimates can be affected through disattenuated effects of variables with lower reliability, resulting in changes in partial relationships with other variables (Cohen, Cohen, Teresi, Velez, & Marchi, 1990). While the effects of measurement error on the stability of regression coefficients is generally well-recognized, the artificial inflation of reliability in the case of poorly measured variables in SEM can lead to erroneous estimates (e.g., regression parameters). Thus, total reliance upon the measurement component of the model is not recommended, and can be addressed by performing preliminary reliability and/or factor analysis. Another issue concerns the judicious use of the modification indices generated in the SEM analysis output. Modification indices suggest ways to improve model fit by alternately freeing or fixing different parameters in the model. For example, in the hypothetical example in Figure 1, no correlations are shown between the error variances of the eight observed variables. However, modification indices could suggest that freeing these parameters would result in a better fitting model. In the instance of error variance within a single latent variable domain, one could make the case that these errors are correlated. However, it would be harder to justify freeing error covariance parameters between the depression and spirituality measures. Thus, model modifications to improve the fit should be limited to those that are

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substantively warranted, either conceptually or empirically. Otherwise model modifications tend to be data-driven and capitalize on chance and random sample variations (Lee & Brennan, 1988). Individual Growth Curve Modeling Individual growth curve (IGC) modeling is often grouped with similar methods under the general headings of multi-level modeling, random effects models, random coefficient models, or hierarchical linear modeling (HLM) (Bryk & Raudenbush, 1992; Kreft, 1995; Mason, Wong, & Entwistle, 1984; Rogosa, Brandt, & Zimowski, 1982; Rogosa, 1988, 1995; Rogosa & Willett, 1985; Singer, 1998; Ware, 1985; Willett, Singer, & Martin, 1998). Although they are identified by various names, IGC models allow the calculation of person-level growth trajectories. The two best known statistical packages for conducting IGC analysis are HLM (Raudenbush, Byrk, Cheong, & Congdon, 2000) and SAS “Proc Mixed” (SAS Institute, 1997). The advantage of the IGC technique is that a regression model is fit for each person; namely, individuals receive their own estimates (Rogosa & Saner, 1995). Specifically, every individual receives an intercept and a slope that defines his or her personal regression line. The intercept is an indicator of the initial level of the variable under consideration (e.g., spirituality) for a given person at the beginning of the longitudinal study period. This could also be the midpoint or endpoint, if time is centered as such (Kreft, de Leeuw, & Aiken, 1995). Thus, the slope represents the person’s rate of change. A slope of zero or near-zero indicates no change. To

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estimate such models, a minimum of three time points are required (Rogosa, 1995). The intercept and slope parameters in the IGC model are estimated using either ordinary least squares (OLS) or maximum likelihood (ML) methods. Rogosa and Saner (1995) contend that OLS with some restrictions can yield accurate estimates of the standard errors, circumventing the need for ML estimators (see also de Leeuw & Kreft, 1995a, 1995b). However, Bryk and Raudenbush (1992) recommend ML estimation, arguing that OLS is not ideal for growth curve models because this method assumes uncorrelated errors in the estimation of within-person effects, which introduce bias in standard errors leading to inaccurate significance tests. A key advantage of ML estimators is that they produce accurate standard errors yielding accurate significance tests. However, estimation of a measurement model and the degree of measurement error (i.e., reliability) is not possible using IGC, and represents one of the major disadvantages of this technique compared to SEM-LGC. Maximum likelihood (ML) allows the simultaneous estimation of both fixed and random effects. Fixed effects refer to the parameters that describe the overall growth curve; they define the average trajectory across participants at the group level. ML can estimate the overall intercept and slope for the entire sample in the same model that estimates the numerous individual-level intercepts and slopes. Random effects, in contrast, refer to the variances of the parameter estimates (i.e., slopes, intercepts, and curvature) for individuals, as well as the

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covariances among them. The variance estimate for the slopes represents the extent of the individual differences in the slopes of the trajectories; it quantifies the variability in the distribution of the slopes. Additionally, ML estimation allows the consideration of a multi-level mixed model, where individual intercepts and slopes can be estimated for each person, and then between-person or class variables can be included to account for variation in these person-specific parameters. This allows individual trajectories to have different weights based on their within-person standard errors, yet another advantage of multi-level mixed model (Willett, Ayoub, & Robinson, 1991). IGC models also easily accommodate the fact that different people often have different patterns and lengths of follow-up in longitudinal studies due to missing observations, and represent one of the major advantages of this statistical approach. Hypothetical Example of Individual Growth Model Figure 2 shows a hypothetical pattern of results from IGC modeling on levels of spirituality over four times of measurement, which would use the following equation: Figure 2. Hypothetical Results of Individual Growth Curve Model on Change in Level of Spirituality Over Time

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Spirituality (ti) = ai + bi (ti) + ei (ti) For an individual i at time t, the dependent variable is the level of spirituality. The intercept, a, is the predicted amount of developmental change where t = 0. The slope, b, is the predicted amount of change per time unit. The top graph in Figure 2 represents the fixed-effects model, which examines average or group-level

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trajectories of change, while the lower graph represents the random-effects model in which trajectories of change are calculated for each individual. Although the fixed-effects model does indicate a pattern of increasing spirituality over time, by averaging this effect it obscures some interesting individual differences in this process. For example, Person 1 starts out at the highest Time 1 level of spirituality, which remains stable at Time 2, but then increases from Time 2 to Time 3 and is stable thereafter. This pattern of growth implies curvature; thus, a quadratic or cubic term would need to be incorporated into the modeling equation described above. In contrast, Person 2 starts out at a low level of spirituality, but then shows a relatively linear increase in this attribute over the subsequent times of measurement. Finally, Person 3 starts out at a low level which remains relatively stable over the course of the study, with some minor fluctuation at Time 3. The preceding example illustrates how important patterns of change and stability in attributes such as spirituality at the individual level are obscured when dealing with average, fixed-effects, as is the case with repeated-measures ANOVA, multiple regression analysis, and the SEM latent growth curve approach without intercepts presented earlier. Choosing the Appropriate Data Analysis Plan As noted earlier, both SEM-LGC and IGC can achieve similar, and in some cases, identical results in performing statistical tests of longitudinal data. As discussed by Schnabel, Little, and Baumert (2000), the choice of which technique to use is a function of the strengths and weaknesses of these two strategies and the

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nature of the data to be analyzed. In terms of strengths, SEM-LGC is well equipped to analyze error or residual factors associated with the model, and permits the inclusion of a greater number of covariates that may have complex inter-relationships in comparison to IGC models. However, while nested-data structures can be accommodated in the SEM framework, these types of data are more easily handled under IGC techniques. IGC models also offer greater flexibility when the time interval between measures is variable in comparison to SEM-LGC (Schnabel et al., 2000). Beyond these general considerations, some specific issues are addressed below. Missing Data Missing data are a recurrent problem in longitudinal studies, ranging from item-to scale-level missing data to missing waves of data for different individuals. Traditionally, SEM analysis has employed listwise deletion of missing data in the constructing the covariance matrix for analysis (i.e., only complete cases are used). However, recent software advances have allowed the imputation of missing data in SEM programs when such data are missing completely at random (MCAR) (Schnabel et al., 2000). Further, there are a variety of statistical programs for the imputation of MCAR missing data using the Expectation-Maximization (EM) algorithm (Little & Rubin, 1987), a derivative of ML estimation that can be applied to both LGC or IGC analysis. One such program is called Estimate (Marcantonio, 1995), which will first determine if the

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data are MCAR and then allows imputation with the EM algorithm. Other missing data replacement strategies, such as sample-mean substitution, are not recommended as they may affect the properties of data distribution, which will have a negative impact on analysis (see below-Assumption of Multivariate Normality). For data that is not MCAR, it is important that the reasons for “missingness” be determined, for example, because of response bias, cultural inappropriateness, participant fatigue, etc., which may provide valuable insights as to potential biases in study findings. However, imputation of missing data under non-MCAR circumstances is not recommended and the researcher should employ the listwise sample for analysis. IGC techniques have been more flexible in the inclusion of cases with missing data at a particular wave; however, these cases do not contribute much to the longitudinal analysis (e.g., Neuendorfer, McClendon, Smyth, Stuckey, Strauss, & Patterson, 2001). It is important to note that this estimation procedure takes into consideration the amount of data available from each person, so that missing data on some occasions are taken into account by giving more weight to persons with complete data than to those with missing data (Dempster, Laird, & Rubin, 1977). Assumption of Multivariate Normality Maximum-likelihood (ML) estimation algorithms are preferred for both SEM and IGC analysis, although other estimators may be employed (e.g., OLS, ULS, etc.). However, one of the assumptions of the ML method is that the data are multivariate normal. Multivariate

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normality is an extension of the “normal” distribution to the vector of all variables in a multivariate model. When this assumption is violated under ML estimation, standard errors and model parameters may be poorly estimated. The practical implication of this for researchers is a preference for normally distributed ratioor interval-level variables as indicators in such models. Thus, the use of nominal and ordinal variables, which tend not to have a normal distribution (i.e., are skewed or kurtotic), can lead to problems using the ML algorithm. The issue of selecting measures that will meet the assumption of multivariate normality is one that must be addressed when constructing the study design. For studies of spirituality and religion, this is further incentive to employ better, multidimensional measures of these constructs. Thus, single tem indicators, such as frequency of service attendance, should be avoided in LGC and IGC analysis. Sample and Methodological Issues Adequate sample size is fundamental to insure sufficient statistical power to avoid making Type II errors (i.e., rejecting one’s hypothesis when it should, in fact, be supported). In terms of IGC analysis, sample size may be determined through statistical power analysis for multiple regression which generally fits the fixed effects model of this procedure. In the case of SEM, things are a bit murkier. While power analysis for SEM models has received increasing attention recently (e.g., see McCallum, Browne, & Sugawara, 1996), sample size can affect the Chi-square test of model fit (Tanaka, 1987). With very large samples, it becomes increasingly

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difficult to obtain nonsignificant tests of model fit because trivial differences in the observed and estimated covariance matrices may result in large, statistically significant Chi-square values. Monte Carlo studies have indicated that sample sizes of approximately 200 should be used for SEM procedures to obtain robust goodness-of-fit tests (Lavee, 1988; Tanaka, 1987). A further methodological consideration concerns the number of data points, or times of measurement, in SEM-LGC and IGC models. While in theory it is possible to estimate random effects (i.e., person-level) trajectories with as few as two times of measurement, three data points are generally needed to examine linear growth functions in these procedures (Rogosa, 1995) and four or more data points are needed to model more complex growth functions (i.e., quadratic, cubic). It is recommend that researchers try to incorporate a minimum of four data points for these analyses in order to permit examination of nonlinear growth functions if warranted. For fixed-effects models, it is best to use all available data including those cases with fewer than three times of measurement available. Interaction Effects Often researchers are interested in testing variable interactions between independent factors for their effects on the outcome of interest. When such interactions are constructed from nominal level variables (i.e., gender × race), SEM analysis can easily be used by constructing discreet groups from the various combinations of these “main effect” variables and using a multiple-group analysis strategy in which the estimated

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covariance structure is assessed for equivalence across groups (e.g., see Byrne, Shavelson, & Müthen, 1989; Jöreskog & Sörbom, 1996; McArdle & Hamagami, 1996). However, when such interaction terms cannot be composed into discrete groups (i.e., interval- or ratio-level data), SEM is less adept at testing interaction effects. While interaction terms composed of interval- or ratio-level data can be tested in the SEM framework, this requires a fairly competent level of programming skill because the constraints placed on the various parameters of the model are quite complicated (see Jaccard & Wan, 1996; Jonsson, 1996; Jöreskog & Yang, 1996). Because IGC models are generally analogous to multiple regression models which can easily accommodate interaction terms constructed of continuous data (Cohen & Cohen, 1983), this approach is likely the better option for examining this type of variable interaction when possible. Some Final Considerations Because data are collected over time, it becomes possible to attempt to specify both reciprocal effects, and more importantly, the direction of hypothesized causal influence, because both antecedent and subsequent effects are specified by time of measurement in either SEM-LGC or IGC procedures. However, it is important to recognize that correlational data per se cannot establish causality, nor can causal inferences be made at baseline measurement and within concurrent times of measurement. However, Menard (1991) notes, “In addition to addressing issues of causal order and the existence of reciprocal effects, longitudinal data and

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analysis in conjunction with causal modeling may be used to examine the distinction between long- and short-term effects on behavior” (p. 20). These techniques do incorporate three essential criteria for inferring causality: (1) cause precedes effects in time (temporal precedence); (2) independent and dependent measures are predicted to be empirically related (covariation); and (3) use of covariates/controls that adjust for “3rd variable” explanations (nonspuriousness) (Bollen, 1989; Kelloway, 1998; Lazarfeld, 1959; Menard, 1991). Thus, given a longitudinal research design and SEM-LGC and IGC analytic approach, findings do permit the examination of the plausibility of hypothesized causal influences (Bollen, 1989, p. 39), but do not permit one to “establish” causality, which can only be accomplished within a true experimental design. Conclusion The foregoing presentation is an admittedly brief overview of two somewhat complex statistical tools that may be employed in examining longitudinal data structures in the study of aging, spirituality, and religion. These methods of analysis are neither a panacea for all of the problems facing researchers in this area, nor the most appropriate method of analysis for all longitudinal studies. Furthermore, as discussed in the last section, researchers who wish to employ either SEM-LGC or IGC methods are well advised to follow a number of sample, methodological and measurement guidelines in order to help insure that their efforts will be successful. However, it is hoped that researchers will conduct a greater number of longitudinal studies in order to

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advance the level of hypothesis testing in studies of spirituality and religion, and employ more rigorous measurement and data analytic strategies so that our work in this area, as Levin (1994, p. 15) ruefully notes, will not be “so easily dismissed.” References Arbuckle, J.L., & Wothke, W. (1999). Amos 4.0 user’s guide. Chicago: Small Waters Corp. Bentler, P.M., & Newcomb, M.D. (1992). Linear structural equation modeling with nonnormal continuous variables. In J. Dwyer, M. Feinleib, P. Lippert, & H. Hoffmeister (Eds.), Statistical models for longitudinal studies of health (pp. 132-160). New York: Oxford University Press. Bollen, K. B. (1989). Structural equations with latent variables. New York: John Wiley & Sons. Bryk, A.S., & Raudenbush, S.W. (1992). Hierarchical linear models in social and behavioral research: Applications and data analysis methods. Newbury Park, CA: Sage. Byrne, B. M., Shavelson, R. J., & Müthen, B. (1989). Testing for the equivalence of factorial covariance and mean structures: The issue of partial measurement invariance. Psychological Bulletin, 105, 456-466. Chatters, L. M., & Taylor, R. J. (1994). Religious involvement among older African-Americans. In J. S. Levin (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 196-230). Thousand Oaks, CA: Sage. 62

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Kelloway, E. K. (1998). Using LISREL for structural equation modeling: A researcher’s guide. Thousand Oaks, CA: Sage. Kline, R. B. (1998). Software programs for structural equation modeling: AMOS, EQS, and LISREL. Journal of Psychoeducational Assessment, 16, 302-323. Kreft, I. G.G. (1995). Hierarchical linear models: Problems and prospects. Journal of Educational and Behavioral Statistics, 20, 109-113. Kreft, I.G.G., de Leeuw, J., & Aiken, L.S. (1995). The effect of different forms of centering in hierarchical linear models. Multivariate Behavioral Research, 30, 1-22. Lavee, Y. (1988). Linear structural relationships (LISREL) in family research. Journal of Marriage and the Family, 50, 937-948. Lazarfeld, P. (1959). Problems in methodology. In R.K. Merton (Ed.), Sociology Today. New York: Basic Books. Lee, S., & Brennan, M. (May, 1988). Multiple equivalent models in covariance structure modeling. Paper presented at the annual meeting of the Midwest Decision Science Institute, Louisville, KY. Levin, J. S. (1994). Investigating the epidemiological effects of religious experience: Findings, explanations, and barriers. In J. S. Levin (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 3-17). Thousand Oaks, CA: Sage.

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Little, R.J.A., & Rubin, D.B. (1987). Statistical analysis with missing data. New York: Wiley. Marcantonio, R. J. (1995). Estimate: Statistical software designed to estimate the impact of missing data. Chicago: SciTech International Inc. Marsh, H.W., Balia, J.R., & Hau, K. (1996). An evaluation of incremental fit indices: A clarification of mathematical and empirical properties. In G.A. Marcoulides & R.E. Schumacker (Eds.), Advanced structural equation modeling: Issues and techniques (pp. 315-354). Mahwah, NJ: Lawrence Erlbaum Associates. Mason, W.M., Wong, G.Y., & Entwistle, B. (1984). Contextual analysis through multilevel linear analysis. In S. Leinhardt (Ed.), Sociological Methodology 1983-1984 (pp. 72-103). San Francisco: Jossey-Bass. McArdle, J.J., & Epstein, D. (1987). Latent growth curves within developmental structural equation models. Child Development, 58, 110-133. McArdle, J.J., & Hamagami, F. (1996). Multilevel models from a multiple group structural equation perspective. In G. Marcoulides & R. Schumacker (Eds.), Advanced structural equation modeling: Issue and techniques (pp. 89-124). Mahwah, NJ: Lawrence Erlbaum Associates. McCallum, R.C., Browne, M.W., & Sugawara, H.M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1, 130-149.

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McCullough, M.E., Hoyt, W.T., Larson, D.B., Koenig, H.G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19, 211-222. Menard, S. (1991). Longitudinal research. New York: Sage. Meredith, W., & Tisak, J. (1990). Latent curve analysis. Psychometrika, 55, 107-122. Müthen, B.O. (1991). Analysis of longitudinal data using latent variable models with varying parameters. In L. Collins and J. Horn (Eds.), Best methods for the analysis of change: Recent advances, unanswered questions, future directions (pp. 1-17). Washington, D.C.: American Psychological Association. Neuendorfer, M.M., McClendon, M.J., Smyth, K.A., Stuckey, J.C., Strauss, M.E., & Patterson, M.B. (2001). A longitudinal study of the relationship between levels of depression among persons with Alzheimer’s Disease and levels of depression among their family caregivers. Journal of Gerontology: Psychological Sciences, 56B, P301-P313. Pargament, K. I. (1997). The psychology of religion and coping. New York: Guilford Press. Piedmont, R.L. (2001). Spiritual transcendence and the scientific study of spirituality. Journal of Rehabilitation, 67, 1-22. Raudenbush, S.W., Byrk, A.S., Cheong, Y.F., & Congdon, R.T. Jr. (2000). HLM 5: Hierarchical linear

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and nonlinear modeling. Lincolnwood, IL: Scientific Software International. Rogosa, D.R. (1988). Myths about longitudinal research. In K.W. Schaie, R.T. Campbell, W.M. Meredith, & S. C. Rawlings (Eds.), Methodological issues in aging research (pp. 171-209). New York: Springer. Rogosa, D.R. (1995). Myths and methods: “Myths about longitudinal research” plus supplemental questions. In J.M. Gottman (Ed.), The analysis of change (pp. 3-66). Hillsdale, NJ: Erlbaum. Rogosa, D.R., Brandt, D., & Zimowski, M. (1982). A growth curve approach to the measurement of change. Psychological Bulletin, 92, 726-748. Rogosa, D.R., & Saner, H. (1995). Longitudinal data analysis examples with random coefficient models. Journal of Educational and Behavioral Statistics, 20, 149-169. Rogosa, D.R., & Willet, J.B. (1985). Understanding correlates of change by modeling individual difference in growth. Psychometrika, 50, 203-228. SAS Institute (1997). SAS/STAT Manual. Cary, NC: SAS Institute Inc. Schnabel, K. U., Little, T. D., & Baumert, J. (2000). Modeling longitudinal and multilevel data. In T.D. Little, K.U. Schnabel, & J.Baumert (Eds.), Modeling longitudinal and multilevel data: Practical issues, applied approaches, and specific examples (pp. 9-14). Mahwah, NJ: Lawrence Erlbaum Associates.

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Singer, J.D. (1998). Using SAS Proc Mixed to fit multilevel models, hierarchical models, and individual growth models. Journal of Educational and Behavioral Statistics, 23, 323-355. Tanaka, J.S. (1987). How big is big enough: Sample size and the goodness-of-fit in structural equation models with latent variables. Child Development, 58, 134-146. Ware, J.H. (1985). Linear models for the analysis of longitudinal studies. American Statistician, 39, 95-101. Willet, J.B., Ayoub, C.C., & Robinson, D. (1991). Using growth modeling to examine systematic differences in growth: An example of change in the functioning of families at risk of maladaptive parenting, child abuse, or neglect. Journal of Consulting and Clinical Psychology, 59, 38-47. Willet, J.B., Singer, J.D., & Martin, N.C. (1998). The design and analysis of longitudinal studies of development and psychopathology in context: Statistical models and methodological recommendations. Development and Psychopathology, 10, 395-426. Mark Brennan is Research Associate, Arlene R. Gordon Research Institute, Lighthouse International, New York. Daniel K. Mroczek is affiliated with the Department of Psychology, Fordham University. Address correspondence to: Mark Brennan, PhD, Research Associate, Arlene R. Gordon Research Institute, Lighthouse International, 111 East 59th Street, New York, NY 10022-1202 (E-mail: [email protected]).

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Portions of this paper were presented at the symposium, “Epistemological Stirrings in the Study of Spirituality and Aging” (S. H. McFadden, University of Wisconsin Oshkosh, Chair) at the 54th Annual Meeting of the Gerontological Society of America, Chicago, IL, November, 2001. [Haworth co-indexing entry note]: “Examining Spirituality Over Time: Latent Growth Curve and Individual Growth Curve Analyses.” Brennan, Mark, and Daniel K. Mroczek. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 1, 2002, pp. 11-29; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 11-29. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Part I: Epistemological Stirrings in the Study of Religiousness and Spirituality

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Uncovering Spiritual Resiliency Through Feminist Qualitative Methods Rosemary Blieszner, PhD Janet L. Ramsey, PhD Summary. A study conducted in Germany and America explored how spirituality might facilitate resiliency in old women. Believing in the importance of matching research methods with research goals, we used a feminist, qualitative, denominationally specific approach. We proposed that, through such a design, it would be possible to (a) allow the unique experiences of old women to be expressed; (b) identify themes and categories of spirituality contributing to the ability of elders to be resilient; and (c) present living models of spiritually successful aging. Because we wished to increase respect for old, strong women, we chose to listen deeply to narratives of their experiences and focus on the complex, culturally diverse meanings embedded in the interview transcripts. We were not interested for this exploratory project in measuring religiosity through quantitative means. Instead, we used triangulation of methods to achieve confirmability of the results, including multiple readings of verbatim transcripts in speakers’ languages, recording of personal reactions to the interviews, coding of the journals, reviewing of the coding scheme by experts, and following up with visits with the respondents. The qualitative design provided a creative vehicle for articulating fresh constructs not previously identified in religion and aging research. [Article copies available for

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a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Website: © 2002 by The Haworth Press, Inc. All rights reserved.] Keywords. Spiritual resiliency feminist theory symbolic interactionism cross cultural research older women qualitative methods The purpose of this paper is to demonstrate how a careful integration of theoretical roots with innovative methods can yield new insights about the relationship between spirituality and resiliency in the lives of older women. Our goals were to (a) present a new approach for qualitative, feminist, cross-cultural research in religion and aging, based on a combination of traditional theory and innovative methodology; (b) identify themes and categories of older women’s spirituality for future qualitative and quantitative research; and (c) demonstrate the importance of being specific about gender and faith tradition, including denominations among Christians, in conducting research in religion and aging. We grounded the research in symbolic interactionism and feminist theory, considered spirituality as a source of strength, focused on women who appear to be aging successfully, compared two cultural perspectives while holding religious denomination constant, and inquired about meaning systems in the context of religious participation. Three research questions guided this work. First, what is the significance of spirituality in women’s lives? To

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answer this question, we intentionally sought the views of older women who were active in religious functions and deemed deeply spiritual by their pastors. Thus, comments about faith and spirituality were pervasive in the interviews. We readily noted the importance of personal versus communal aspects of spirituality and we heard the relational dimensions of spirituality being described. Second, do women believe that faith in God has enabled them to gain new perspectives on life, especially during times of transition? That is, do they reframe the story of their lives through the symbols and meaning systems of their faith? We aimed to explore in a less rigid, more post-modern sense than in the past, the familiar question of how religion may function to assist older persons during times of loss and crisis and contribute to their well being and life satisfaction. Posing this question in terms of reframing rather than functionality resulted from feminist theory and methodology, because these approaches strive to describe women’s lived experiences without reducing complexities to dichotomous characterizations (Baber & Allen, 1992). It also resulted from the use of symbolic interactionism, a theory that views persons as creators of their own worlds of meaning (Berger, 1967), and from recent writing on religion as a giver of new meanings to the aging experience (Kimble, 1993). Third, how are continuity and change related to women’s sense of themselves as women of faith? This project extended previous work by asking whether and how women’s religious faith is related to a sense of

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self-continuity and community membership in the context of a rapidly changing world. Given that persons establish an identity over time through interacting with primary groups of people with whom they feel comfortable (Worthington, 1989), we wondered whether older women derive a sense of self more from their membership in the religious community, as suggested by Durkheim (cited by Hammond, 1988, p. 1), or from private aspects of their spirituality, as suggested by some feminists (e.g., Yates, 1983). Moreover, we were interested in the extent to which spirituality was one of the cultural forces providing for continuity of the self-concept in the midst of historic changes and events that shape human lives (Kaufman, 1986; Simmons, 1993). Despite increased numbers of publications on religion and aging, some problems with the research literature remain. We designed the study to address various limitations, including the tendency to present descriptive atheoretical reports, a focus on old age as a social problem, blindness to the role of spirituality in life course studies, and imprecise and superficial assessments of religious participation. Although religion is frequently viewed as a positive predictor of subjective well being (Krause & Van Tran, 1989), findings based on general survey methods have been contradictory and inconclusive (Levin, 1989; Witter, Stock, Okun, & Harring, 1985). Empirical studies based on qualitative methods, which might provide explication of some of the contradictions, have been uncommon. Investigations have been biased toward viewing spirituality in

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secularized and individualized terms, such that spiritual well being is conceptualized as centered on the human spirit, not the divine spirit (Simmons, 1991). Although distinctions have been investigated among and between world religions, insufficient attention has been given to denominational variations among Christians. This has resulted in tendencies to use very general religious terms, to assume that these terms have the same meaning across denominations, and to identify religion by designations of functions rather than substance (Wuthnow, 1988). Moreover, gender is a critically neglected area in religion and aging research. Older women’s lack of power and status in church, temple, and synagogue has been ignored, and their unique contributions to spirituality unexplored. Older women’s absence as participants in research endeavors (Cool & McCabe, 1987) implies that they have not been perceived as important enough to justify a special focus. Finally, the literature is limited by the lack of a cultural framework in research on aging and spirituality which prevents scholars from understanding the influence of cultural traditions on elders’ construction of a sense of self and of coherent meanings from life course experiences (Moody, 1986). Overall, both measurement deficits and lack of adequate conceptualizing have contributed to deficits in religion and aging studies. Conceptual Frameworks Symbolic Interactionism This project was grounded in symbolic interactionist and feminist theory, both of which imply a particular and complementary approach to the research act. Symbolic

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interactionism is a social-psychological perspective that assumes the existence of a socially constructed symbolic universe and proposes that this symbolic reality is discovered, not created, by human beings (Berger, 1967; Kimble, 1990). The focus is on the inner or experiential aspects of human behavior because symbolic interactionists believe that individuals order their world by a process of negotiation and re-negotiation. People make reflexive use of symbols to elicit and interpret meaning in their lives–they do not simply react to stimuli (LaRossa & Reitzes, 1993). Gerontologists interested in questions of meaning have increasingly recognized the suitability of qualitative work using symbolic interactionism as its organizing domain (Payne, 1990). For our focus on spirituality and its contributions to resilience, this theory was conceptually rich and uniquely compatible with the research design, including the cross-cultural framework, religious subject matter, and feminist ideology. Feminism Feminist theories challenge conceptions of human experience that validate men’s understandings alone and ignore those of women. Feminists attach central importance to using women’s experiences as a valid basis for knowledge and embrace diversity in theory, method, and political viewpoint (Fonow & Cook, 1991; Randour, 1987). Central, too, are emphases on human relationships, emotional experiences, and questions of meaning (Langer, 1942; Randour, 1987). It is not surprising, then, that spirituality has become a popular

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theme in feminist writings (Eller, 1991; Yates, 1983) nor that feminist scholars are particularly interested in providing women opportunities to give voice to their own interpretations of their own experiences (Belenky, Clinchy, Goldberger, & Tarule, 1986; Gilligan, 1993). Symbolic interactionism is highly compatible with feminism because both address agency and action, use interpretive frameworks, and deconstruct traditional patterns of thought (Osmond & Thorne, 1993). Design Implications Cross-cultural perspective. Symbolic interactionism and feminism both highlight the value of taking a cross-cultural research stance, for both recognize that people create the conditions of their own existence within the context of nonverbal and verbal cultural symbols, albeit within some limits outside their control (Amoss & Harrell, 1981). Designing this study to include a cultural element also enabled us to critique the devaluation of older persons and their spirituality in Western culture. For example, the glorification of the youthful, competitively self-reliant and action-oriented “Pepsi Generation” in America presents a set of core values that are potentially harmful to the self-esteem of older persons (Sokolovsky, 1990). In Germany, older people’s cultural reality includes the distant events of World War II but also the more recent fall of the Berlin wall. The conceptual frameworks informing this research focused our perceptual lenses on ways that historical and cultural events influence the development of meaning and interpretations of experiences, including matters of spirituality (Geertz, 1973; Frankl, 1969).

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Denominational specificity. At the same time that we embraced cultural diversity, we recognized the need to pursue in-depth understanding of spirituality within the context of one religious denomination, rather than glossing over nuances of religious practice and belief. Denominational identity is an important part of understanding an individual’s spirituality, both by itself and in interaction with factors such as historical era, education, age, gender, and social class (Simmons, 1992). Because this project was exploratory, with goals that pointed toward the future, we did not attempt to tie neatly together in advance our theory, ideology, and hopes for advocacy. At the same time, we did recognize the need for a controlled yet flexible methodology that would hold the most promise for fruitful data and simultaneously reflect disciplined, scholarly vigor. Methods In this study, the desire to emphasize listening (rather than measuring), a focus on religious meanings and cultural diversity, and our theoretical roots in symbolic interactionism and feminism all required degrees of creativity and sensitivity available only with qualitative methodology. This approach recognizes that knowledge is constructed, not received, and that often more than one explanation is compatible with the evidence (Lythcott & Duschl, 1990). As implied above, our goal in using qualitative methods was not to oppose traditional, quantitative approaches, but rather to seek, in the stories of the participants’ lives, fresh categories of meaning that quantitative studies may not have discovered.

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Participants The sample selection for this research was purposive, convenient, and theoretical (Strauss & Corbin, 1990). Women who participated were all at least 65 years old, lifelong members of the Lutheran Church, and living in small communities in the southeastern United States or in northwestern Germany (see Ramsey & Blieszner, 1999, for other demographic details). Interviews were conducted by the second author, JLR. She recruited 15 focus group members from a parish in each location and solicited help from the two pastors for identifying four spiritually mature (McFadden, 1985) women from each group for in-depth biographical interviews. These “spiritual nominees” (after Baltes’s use of “wisdom nominees” Baltes, Staudinger, Maercker, & Smith, 1995), were women who were able to articulate their spiritual faith and were known to have done so in the past, either in private conversations with their pastors or in the process of participating in their church’s ongoing ministry. Thus, they were the best possible sources of insight into the expression and meaning of spirituality in older women’s lives. This technique exemplifies the “testing the limits” approach to research on human potential (Lindenberger & Baltes, 1995). Procedures After obtaining informed consent from all participants, data collection began with one-hour focus groups conducted at the two churches. During these sessions, the participants discussed ways in which their faith had been helpful in coping with life’s challenges. They reacted to each other and built upon the responses of

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other group members, creating a synergistic effect that resulted in ideas and categories of spirituality being expressed that might not have otherwise emerged (Stewart & Shamdasani, 1990). The discussions were tape-recorded and transcribed verbatim in the native language of the speakers. These meetings not only provided data that were coded in service of answering the research questions, they also enabled the participants and JLR to become acquainted, fostering greater comfort between them and preparing the way for the subsequent in-depth interviews. The second phase of data collection involved two or three interviews (1 to 2.5 hours each) with the spiritual nominees. These interviews were guided by a prepared set of questions covering the general significance of spirituality in the women’s lives, but the women quickly set their own agenda for the discussions according to more specific themes of their own life stories. These long interviews were at the heart of a research process designed to identify categories of spiritual experience and structures of meaning attached to them. They permitted understanding of the categories and logic by which the women themselves view and interpreted their experiences (McCracken, 1988). As with the focus groups, the interviews were tape recorded and transcribed verbatim in the speakers’ languages. Throughout the research process, another source of data was retrieved through the use of researcher as self (Krieger, 1991). This source was tapped through the coding of personal journals written during the conceptualization of the project, collection and analysis

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of data, and verification of interpretations with study participants. Interaction with the study participants in their own activities, such as focus groups, worship services, and social functions, constituted a participant observation aspect of data collection. This approach allowed for the meanings and interpretations of the women to become evident, making it unnecessary to rely solely on preconceived theoretical notions about meanings of spirituality (Detzner, 1992). Analysis of observer experiences, along with the taped transcripts, helped to develop the properties and categories of the women’s spiritual experiences and to place those experiences concretely into the context of the women’s lives. Data Analysis Data analysis began with reading and reviewing, on multiple occasions, the field notes from participant observations, the transcripts from focus groups and individual interviews, and the journal entries. A process of searching for categories and the relationships among them ensued, with a consistent focus on the women’s understandings of their spirituality. The analysis proceeded along a stage process, modified for cross-cultural research, as suggested by McCracken (1988). Each statement was treated on its own terms, not only examined in relation to other statements. Repeated auditory review of the tapes also occurred to reinforce the unique qualities of the women’s voices and expressions. Key terms in the transcripts were coded, the list of codes was refined, the transcripts were re-coded, the codes were tabulated, and the transcripts were

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evaluated. We searched for both frequencies of codes and for more encompassing themes across the data. The Ethnograph(r) software was used to expedite the tabulation, exploration, and comparison of the data. Only after this vigorous analysis did we indulge in a cultural and denominational interpretation of themes and categories. After the data were analyzed and interpreted, five university professors with expertise in gerontology, religious studies, and qualitative research methods reviewed the research report and assessed the plausibility of the interpretations and conclusions in relation to the themes and categories identified. In addition, we supplied the women who had completed in-depth interviews with sections of the report pertaining to themselves. We then visited with the women to discuss our interpretations of the interview transcripts and enable them to comment as they wished. The women’s responses indicated that we had depicted their experiences accurately; they also confirmed the authenticity of our interpretations and conclusions. Methodological triangulation enabled us to see spiritual themes from several angles and to go back and forth among the data sources, suggesting overarching themes and filling in details. Moreover, this approach enabled us to distinguish between first- and second-order constructs, as it is important when working qualitatively (Daly, 1992). In this study, first-order constructs arose from the words and meanings of the women informants and second-order constructs arose from the analytic interpretation of their words. Being careful to preserve

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the participants’ own meanings and categories and being sensitive to aspects of their experiences that differed from our own helped us avoid both a confusion of voices and a false objectivism. These could have occurred had our own perspectives been subtly substituted for those of the women informants (Denzin, 1970). Findings and Discussion: Implications from Theory and Method Our theoretical orientation and methods not only enabled us to achieve the research goals, they also enriched the results. Repeatedly we found that the original assumptions we held about strong older women and their faith were too simplistic, for wise women are complex and fascinating creatures. This complexity was apparent in all three categories constituting the three primary results, namely, the importance of community, affect, and relationality in older women’s spiritual resiliency. In this section, we highlight some of the ways our conceptual approach and design expanded the findings beyond what might have occurred in a more traditionally-grounded study. We refer readers to other reports for more detailed analysis and discussion of the findings themselves (Ramsey & Blieszner, 1999, 2000). Community Lovey [American, speaking about feeling connected to all Christians, living and dead]: Well, I don’t know, just the love you have for them I guess. Because you have love for your parents,… your grandparents and all, they mean so much to you … People [who have died] that I remember–now, B.D. just passed away–well, I knew

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them too and they seemed close to me. Just like I told a girl yesterday on the bus, I said, “You all just feel like my sisters. I’m still close to every one of you and I love all of you.” Although results of this research are consistent with quantitative studies in which researchers have reported group religious participation to be highly important to old persons, it would have been impossible to capture the flavor of Lovey’s affection for her church friends, for example, without actually listening to her in a long interview. So long as categories of spiritual resiliency and aging are still in the discovery stage, a traditional, quantitative approach is most likely inadequate to discover the nuances of spirituality in the real lives of old people. We found that community in the participating women’s lives is more intricate than can be conveyed by a measurable indicator such as frequency of church attendance. Community-related concepts of spirituality emerging from our data included friendship, practical and religious assistance, love, safety, acceptance, affirmation, comradeship, and social justice. We further believe that discovery of this complex sense of community was facilitated by the denominational specificity of our study. By conducting research within one particular Christian denomination, one can attend to the importance of that group’s symbols and beliefs. It also becomes possible to honor the unique language of spiritual experience, recognizing traditional patterns of meaning within a given group. Most importantly, it avoids confusing one denomination’s spirituality with that of another. This includes, for example, these subtle

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but important distinctions: the salvatory emphasis on good works versus grace; the significance of ritual, liturgy, or spontaneous confessions of faith; the extent to which scripture is interpreted as the literal Word of God; and the redemptive meanings given to suffering. For example, a Presbyterian woman might remain resilient in the face of suffering because she sings hymns in a worship service that emphasize the sovereignty of God’s plan, whereas an Episcopalian would more likely find strength in participating in a Eucharist, wherein she hears the Words of Institution refer to Christ’s own suffering. We believe that community is an aspect of religion and aging studies needing more exploration, particularly through qualitative work. Most investigators of well being who have examined its connection to spirituality have tended to reduce questions about spirituality to secular and individualistic inquiries. As Simmons (1991) noted, previous studies have ignored the collective systems in which faith is grounded. Affect Anna [German, speaking about the birth of her first child in 1940 while her soldier husband was away from home]: And this child! If I had to answer the question, “What is happiness?” ah, that was indeed a happy moment, and then God was totally close by. Then one was secure, and one prayed, and one thanked, and one thought oh that sweet child, born so healthy, and in spite of the constant uncertainty with the war, this was a sign that all was well and good and that God is love … 86

Our second category of results might not have been discovered without careful qualitative coding and the use of The Ethnograph(r) program. Here our own categories of thought were challenged and corrected by our methods; we discovered that “feelings” were far more than the by-products of very emotional interviews. As we read and reread the interviews, keeping in mind the frequency with which we coded passages revealing affect, we began to realize that the women were not just being emotional as they discussed their faith and told their life stories–rather, their rich emotional lives are interwoven with and crucial to their spiritual lives. We believe that both the use of a technological research tool and the disciplined rereading of qualitative data forced us to develop a new category of thinking about faith in old women, namely, that in their lives, emotion and faith are deeply intertwined. Feminist theory also facilitated this discovery. In the history of spirituality, much has been written, taught, and preached by men. Perhaps for that reason, the affective aspect of religious experience has often been ignored in the writings of world religions. It has also been largely ignored in sociology of religion studies, perhaps because sociology has difficulty incorporating either faith or emotion, even when they are dealt with separately. Seeing them together may be twice as difficult in this discipline, where positivism still dictates what many scholars believe to be acceptable practices for research methods and data interpretation. We view our study of older women, along with other recent work, as contributing to a corrective movement in understanding how persons know God by both mind and heart.

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Although not often emphasized, a strong role for emotion in spiritual life also seems consistent with the symbolic interactionist approach to religious studies. This theory typically emphasizes the cognitive processes by which people create and reinvent themselves and their world, but it can also help with understanding how people, as actors, can creatively integrate their affective experiences with other aspects of their lives, especially through the use of religious symbols. Humans use these symbols to create community roles, build up a sense of self, and interpret their lives both individually and within groups. Symbolic interactionism also helped us to make a connection between two of our primary results, emotion and community. It alerted us to the truth that it is within community that the “worlds of meaning” (Berger, 1967) that so strongly affect our individual emotional lives are created. In turn, the specific symbols of the community arise out of the emotional lives of individual group members. This back-and-forth movement between emotion and community is evident far beyond the results of our research project and is an interfaith phenomenon, creating rituals and religious observances that have sustained people for thousands of years. Thus, for example, mourners at an African American funeral cry aloud and shout “Amen” while Jews bring food and sit Shiva in the days after a death, comforting each other quietly. The focus group in Germany was an excellent example of the intersection of community and affect. The highly emotional discussion that occurred within that meeting

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set a tone for three of the individual interviews that were conducted later, and the community’s formulation of the issue in the days that followed led to on-going meetings of this group long after the researchers withdrew. Affect functioned not only to energize but also to influence the discussions, roles, and ongoing dialogues that have continued within the German community. Relationships The results of this research, as revealed by a careful examination of the focus group and interview transcripts, emphasize the importance of relationships with friends and family for older women of faith. However, here again we found results that are more complex than the literature has suggested. Scholars such as Gilligan (1993) and Wood (1994) have raised the question, Do women make important decisions on the basis of interpersonal relationships or on the basis of abstract principles? We found a balance between these two poles. These women often spoke of human relationships and priorities while discussing their faith, but they also used theological beliefs to organize their narratives. As we studied the data, we came to wonder if false alternatives had not been set up, because both personal relationships and abstract thinking seemed vitally important to religiously strong old women. A methodology that lacked theoretical grounding and creativity might have pulled apart relational and theological elements, trivializing and dichotomizing the wise personalities of the participants. The respect we displayed as feminists also helped us to avoid this pitfall, for we were determined not to force the women into preconceived theoretical categories.

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Because we listened deeply, we recognized this tension between abstract belief and human relationships in the conversation of one of the interviewees, Emma. Generally quite orthodox in her Lutheran theology, she was reconsidering infant baptism for relational reasons, namely, her concern about faith development among German young people. She noted that so often they are brought to church to be baptized and then not seen there again until their wedding day. Emma continued, Recently I’ve actually been in some ways vacillating over infant baptism and adult baptism; I’ve come to the point where I don’t fully know what is right. Here in our church the infants are baptized. Baptism is certainly from God, and a bringing of the child to God, or of a human being to God.… However, the infant can’t grasp that. And, when there is no Christian rearing, whether baptism has a meaning overall, that I don’t know. The level of Emma’s theological profundity is not the point here, but rather that she is demonstrating the importance to her of both belief and people. Both enter into her thoughts as she wrestles with questions of religious practice, and it is difficult to imagine how this subtle tension, between principle and human relationships, could have been captured by a survey instrument. Questions of Meaning Questions of meaning are often emphasized in recent religion and aging research, particularly by scholars who have been influenced by Viktor Frankl (Kimble, 1990). Our focus groups and interviews were permeated by 90

meaning questions that arose in the women’s lives, and here again, symbolic interactionism served us well. In his work on culture from a symbolic interactionist perspective, Geertz (1973) stated that although meaning problems are not the basis of faith, they frequently drive people to belief. This became evident in the research. War, death, problems with children, economic losses, and physical limitations are only some of the life experiences these women have had that led, eventually and inevitably, to problems of meaning. For example, one woman at the German focus group raised a theodicy (meaning of suffering) question, asking the group where, in the face of suffering, is the loving God? We found that resilient older women have not escaped persistent and profound problems of meaning. Rather, they are considered by their pastors and friends to be resilient and spiritually mature precisely because they have navigated those struggles. In the language of symbolic interactionism, they have, with varying degrees of consciousness, been able to create for themselves life stories that take into account these existential questions. Implications for Future Research Exploratory Status of Current Findings This was an exploratory project, intended to expand upon previous quantitative investigations and to uncover new constructs. Much additional research is needed before our results can be generalized across populations of older adults or formulated into a comprehensive theory articulating the multi-faceted contributions of spirituality to resiliency. We intend to pursue in-depth

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interviews with older men, to provide comparative information about the connection between their spirituality and their well being. The concepts of community, affect, and relationality that we discovered require further elaboration. Our book (Ramsey & Blieszner, 1999) contains many thick descriptions of these constructs, and we hope they will inspire future researchers to explore their applicability to other faith traditions. Suggestions for Future Research on Spirituality In light of the importance of community for the older women we interviewed, future qualitative studies, grounded in theory and employing semi-structured interviews, could focus specifically on the meanings of older persons’ faith experiences within the larger community. Research questions might address, for example, how spiritually strong persons have worked out the inevitable tension between their own life history issues and the history, symbols, and rituals offered them by their faith community. More investigation of the connection between spirituality and affect is also needed. The research question might be asked, In what ways do spiritually resilient people incorporate the full range of human feelings, including love, joy, sorrow, and grief work, into their faith lives? Examining the ways in which those emotions are communicated and shared with others would also be a significant contribution in light of our findings about the importance of community.

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Research with other denominations is an obvious need, enabling this aspect of spirituality to be understood in a more general sense, and the strength of older women to be understood in its complexity. The language of the findings reported here differs from what one might hear from members of other Protestant groups or from Catholic, Jewish, Buddhist, or Muslim elders. Implications for Research on Successful Aging As shown by the narratives of the women we studied, the spiritually resilient life is lively and worthwhile. This research thus takes its place in the academy beside studies that emphasize the human capacity for adaptive competence (Baltes & Baltes, 1990) because of its two positive emphases: the conviction that later years offer opportunities and challenges along with problems and losses and the belief that elders are best viewed as resources for society rather than as problems to be solved. We visualize our research contributing to work on successful aging in two primary ways: through its positive emphasis on aging as opportunity and because of its contribution to the search for the “elusive” factors that contribute to optimal conditions of the aging experience (Baltes & Baltes, 1990, p. 4). However, the positive emphasis here is maintained along with recognition of the realities of the aging process. Losses, death, and the possibility of deep regret have not been ignored in this project because they were themes that could not be ignored in the women’s stories. Contributions of the Study’s Methods Listening

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The act of listening as the central research activity holding this project together allowed us to retain a focus on the emerging voices of the women themselves. We listened to their voices as we conducted the focus groups and interviews, played the tapes repeatedly, read the interview transcriptions, coded the data, and interpreted the results. Our feminist ideologies led us to continually strive for honesty and self-examination in this process. Repeatedly we asked ourselves, Are these the actual words and themes of the women themselves or are our own ideas getting in the way of hearing them? What else may be causing interference here? The use of a journal was an invaluable tool in keeping JLR’s own interior “sounds” in place as she conducted the first phase of the work and for both authors as they interpreted and confirmed the results during follow-up interviews with the women. Confirmation of our themes was also accomplished by playing and replaying particular sections of the tapes, always attempting to listen with open minds. Theory was secondary and results were tentative so long as this process continued. Denominational Specificity We believe that the denominational specificity of this study was also crucial to its success, and that future scholars need to pay far more attention to this design issue in religion and aging research. As explained earlier, too often denominational confusion leads to superficial or distorted results because of differences in theology, practice, and symbolism. Researchers working in the future need to understand how spirituality may vary from

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one population to the next and allow for these variations in their research designs and data interpretations. Triangulation of Methods The triangulation of methods felt right to us as we worked on this project. The focus groups and participant observations were especially helpful in getting started in each country. We appreciated the opportunity to become somewhat acquainted with most of the women through worshipping with them, attending their informal groups, and, especially, meeting with them for the focus groups before interviewing them. We felt welcomed into the community after those experiences, and in light of how important community turned out to be, we now see that without those experiences we might not have understood how community actually works in the women’s lives. Had we only met privately with the spiritual nominees, we would not have seen first hand the communal side of their faith. Journal keeping was challenging because JLR often felt very tired at the end of the interview day, especially in Germany where the language difference made such demands on concentration. But keeping the journal accomplished what was intended; it enabled her to gather up strong emotional reactions and place them in an appropriate “container,” so that she could focus on the interview process while meeting with the women. In both countries this was very important, but especially so in Germany where the adventure of visiting a different country and the powerful World War II stories she heard led to very high emotional involvement.

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Complexity of Results Results of this study are consistent with many past research findings in religion and aging, but in addition, they suggest that research designed along qualitative lines may be most fruitful in discovering the complicated picture of how aging and spirituality intersect. In a topic wherein questions of meaning and interpretation are central and theory is scarce, a period of listening to and interpreting elders’ own words is required and may be more fruitful than the use of formulated questionnaires. We believe that theoretical complexity and sensitivity in listening are necessary for fuller understanding of the significance of spiritual resiliency and its connection to quality of life and well being throughout the life span. If an appropriate metaphor for this listening exercise in religion and aging research is musical composition, then the total sound of spirituality coming from the women who participated in our research is definitely not a monotone or even a simple tune–it is a symphony. References Amoss, P.T., & Harrell, S. (1981). Introduction: An anthropological perspective on aging. In P.T. Amoss & S. Harrell (Eds.), Other ways of growing old: Anthropological perspectives (pp. 1-24). Stanford, CA: Stanford University Press. Baber, K.M., & Allen, K.R. (1992). Women and families: Feminist reconstructions. New York: Guilford Press. Baltes, P.B., & Baltes, M.M. (1990). Psychological perspectives on successful aging. In P.B. Baltes & M.M. 96

Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). New York: Cambridge University Press. Baltes, P. B., Staudinger, U. M., Maercker, A., & Smith, J. (1995). People nominated as wise: A comparative study of wisdom-related knowledge. Psychology and Aging, 10, 155-166. Belenky, M. F., Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1986). Women’s ways of knowing: The development of self voice, and mind. New York: Basic Books. Berger, P. (1967). The sacred canopy: Elements of a sociological theory of religion. New York: Doubleday. Cool, L. E., & McCabe, J. (1987). The scheming hag and the dear old thing: The anthropology of aging women. In J. Sokolovsky (Ed.), Growing old in different societies: Cross-cultural perspectives (pp. 90-112). Acton, MS: Copley. Daly, K. (1992). The fit between qualitative research and characteristics of families. In J.F. Gilgun, K. Daly, & G. Handel (Eds.), Qualitative methods in family research (pp. 3-11). Newbury Park, CA: Sage. Denzin, N.K. (1970). The research act in sociology. London: Butterworth. Detzner, D.F. (1992). Life histories: Conflict in Southeast Asian refugee families. In J.F. Gilgun, K. Daly, & G.Handel (Eds.), Qualitative methods in family research (pp. 85-102). Newbury Park, CA: Sage.

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Eller, C. (1991). Relativizing the patriarchy: The sacred history of the feminist spirituality movement. History of Religions, 30, 279-295. Fonow, M. M., & Cook, J. A. (1991). Beyond methodology: Feminist scholarship as lived research. Bloomington, IN: Indiana University Press. Frankl, V. E. (1969). The will to meaning: Foundations and applications of logotherapy. New York: World. Geertz, C. (1973). The interpretation of cultures. New York: Basic Books. Gilligan, C. (1993). In a different voice: Psychological theory and women’s development (2nd ed.). Cambridge: Harvard University Press. Hammond, P.E. (1988). Religion and the persistence of identity. Journal for the Scientific Study of Religion, 27, 1-11. Kaufman, S.R. (1986). The ageless self: Sources of meaning in late life. Madison, WI: The University of Wisconsin Press. Kimble, M.A. (1990). Aging and the search for meaning. Journal of Religious Gerontology, 7, 111-130. Kimble, M.A. (1993). A personal journey of aging: The spiritual dimension. Generations, 17, 27-28. Krause, N., & Van Tran, T. (1989). Stress and religious involvement among older blacks. Journal of Gerontology: Social Sciences, 44, 4-12.

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Krieger, S. (1991). Social science and the self: Personal essays on an art form. New Brunswick, NJ: Rutgers University Press. Langer, S. (1942). Philosophy in a new key. New York: Harcourt Brace & World. LaRossa, R., & Reitzes, D.C. (1993). Symbolic interactionism and family studies. In P.G. Boss, W.J. Doherty, R. LaRossa, W.R. Schumm, & S.K. Steinmetz (Eds.), Sourcebook of family theories and methods: A contextual approach (pp. 135-163). New York: Plenum Press. Levin, J.S. (1989). Religious factors in aging, adjustment, and health: A theoretical overview. In W.M. Clements (Ed.), Religion, aging and health: A global perspective (pp. 133-142). New York: The Haworth Press, Inc. Lindenberger, U., & Baltes, P.B. (1995). Testing-the-limits and experimental simulation: Two methods to explicate the role of learning in development. Human Development, 38, 349-360. Lythcott, J., & Duschl, R. (1990). Qualitative research: From methods to conclusions. Science Education, 74, 445-460. McCracken, G. (1988). The long interview. Newbury Park, CA: Sage. McFadden, S.H. (1985). Attributes of religious maturity in aging people. Journal of Religion & Aging, 1, 39-48.

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Moody, H. (1986). The meaning of life and the meaning of old age. In T. R. Cole & S.A. Gadow (Eds.), What does it mean to grow old? Reflections from the humanities (pp. 9-40). Durham, NC: Duke University Press. Payne, B. (1990). Spiritual maturity and meaning-filled relationships: A sociological perspective. Journal of Religious Gerontology, 7, 25-39. Osmond, M.W., & Thome, B. (1993). Feminist theories: The social construction of gender in families. In P. G. Boss, W.J. Doherty, R. LaRossa, W.R. Schumm, & S.K. Steinmetz (Eds.), Sourcebook of family theories and methods: A contextual approach (pp. 623-626). New York: Plenum Press. Ramsey, J.L., & Blieszner, R. (1999). Spiritual resiliency in older women: Models of strength for challenges through the life span. Thousand Oaks, CA: Sage. Ramsey, J.L., & Blieszner, R. (2000). Community, affect, and family relations: A cross-cultural study of spiritual resiliency in eight old women. Journal of Religious Gerontology, 11, 39-64. Randour, M. L. (1987). Women’s psyche, women’s spirit: The reality of relationships. New York: Columbia University Press. Simmons, H.C. (1991). Religious instruction about aging and old age: What the journals are saying. The Living Light, 17, 254-263.

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Simmons, H.C. (1992). In the footsteps of the mystics: A guide to the spiritual classics. New York: Paulist Press. Simmons, H.C. (1993). Discovering the public/private world: A research note. Journal of Psychology and Theology, 4, 39-322. Sokolovsky, J. (Ed.). (1990). The cultural context of aging: Worldwide perspectives. New York: Bergin & Garvey. Stewart, D.W., & Shamdasani, P.N. (1990). Focus groups: Theory and practice. Newbury Park, CA: Sage. Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage. Witter, R.A., Stock, W. A., Okun, M. A., & Haring, M. J. (1985). Religion and subjective well-being in adulthood: A quantitative synthesis. Review of Religious Research, 26, 332-342. Wood, J.T. (1994). Who cares? Women, care, and culture. Carbondale, IL: Southern Illinois University Press. Worthington, E.L. (1989). Religious faith across the life span: Implications for counseling and research. The Counseling Psychologist, 17, 555-612. Wuthnow, R.J. (1988). Sociology of religion. In N. Singer (Ed.), Handbook of sociology (pp. 473-501). Newbury Park, CA: Sage.

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Yates, G.G. (1983). Spirituality and the American feminist experience. Journal of Women in Culture and Society, 9, 59-79. Rosemary Blieszner is affiliated with the Department of Human Development, Virginia Polytechnic Institute and State University. Janet L. Ramsey is Associate Professor of Congregational Care Leadership, Luther Seminary, St. Paul, MN. Address correspondence to: Rosemary Blieszner, Department of Human Development, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061 (E-mail: [email protected]). Revised version of a paper presented in S. H. McFadden (Chair), Epistemological Stirrings in the Study of Spirituality and Aging, 54th Annual Scientific Meeting of the Gerontological Society of America, Chicago, November 16, 2001. [Haworth co-indexing entry note]: “Uncovering Spiritual Resiliency Through Feminist Qualitative Methods.” Blieszner, Rosemary and Janet L. Ramsey. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 1, 2002, pp. 31-49; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 31-49. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service

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[1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Spiritual Issues in Health and Social Care: Practice Into Policy? Harriet Mowat, PhD Desmond Ryan, PhD Summary. The paper introduces an action research initiative called Spirited Scotland, an embryonic movement seeking to restore spirituality to an appropriate place in health and social care. It locates the initiative in the changing social and spiritual circumstances of post-industrial Scotland and identifies some challenges it faces associated with the prevailing understandings of health, becoming ill, and successful ageing. The paper also considers some policy and practice challenges raised by Spirited Scotland, in terms both of content and process. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Website: © 2002 by The Haworth Press, Inc. All rights reserved.] Keywords. Successful aging public policy spiritual care chaplaincy action research Scottish National Health Service This paper presents the work of Spirited Scotland and considers its relevance to older people. Spirited Scotland is an independent development initiative which since 1998 has sought to foster greater awareness of and practical work with spiritual issues in health and social 104

care. In the years 2000 to 2002 it received funding from the Scottish Executive, the executive body of the recently revived (1999) Scottish Parliament, which allowed it to become an action research project. The project has focused on raising the collective profile of a number of spirituality-aware groups in the broad field of health care, through networking, conferences, carrying out and promoting research, and a newsletter. Although from the outset the definition of what is meant by “spiritual need” has tantalized the participants, responding practically to perceived need has allowed the Spirited Scotland initiative to evolve without an agreed definition. The themes of this paper are (a) the way in which partnership between independent social movements and responsive devolved government allows ideas arising from practice to move into the policy-making arena and (b) the potential for an initiative of this kind to impact on older people. Background There is a growing interest in spiritual aspects of health and social care in Scotland. The age of individualism that has characterised the latter part of the twentieth century has expressed itself in the pursuit of meaning both of self in society and of self in relation to a higher being. This pursuit tends to be described as the search for the spiritual. In health and social care the awareness of the spiritual has become part of a general increase in the complexity of response to ill health, distress and feelings of disharmony. Among other things, the increased use of complementary/alternative therapies, the public acknowledgement of religious diversity, and

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the mixing of religious traditions (Sutcliffe & Bowman, 2000) have reinforced this tendency towards greater complexity. These social trends bring with them challenges to the traditional place of spirituality in our society in Scotland. This has historically been located within a predominantly Christian religious observance (Brown, 1990). As elsewhere in the Western world, the distinctions among faith, religion, and spirituality are becoming at once more salient and more elusive: elusive because the social contexts in which such terms had agreed meanings have now gone; and salient in that the new imperative for the individual to seek self-fulfillment (Puttick, 2000) has foregrounded spirituality as an issue also in non-religious spheres, including leisure, business and, especially, health care (Graber & Johnson, 2001). One consequence of the decrease in the holding power of the traditional institutions and authority structures with socio-economic change is that many Scottish people are becoming more inner-directed (Riesman, 1950). They are taking more responsibility for exploring the spiritual dimension, intuitively sensing that there is something important missing in their experience of personal health and social care (Drane, 1999). This spiritual exploration and expression of spiritual need is happening in the context of declining formal religious observance (Storrar, 1999). As people eschew the formal places of worship which have traditionally housed the spiritual elements of life in Scotland (Bruce, 2000), so they seem to be developing “alternative” spiritual lives. Since these religious lives are less public and more exploratory, we

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can no longer rely on measures of religious attendance as indicators of spiritual practice. Paradoxically, just as people in private become more open to the unknown, the health and social care culture in Scotland has become more insistent on working only with what is known to be effective: “evidence-based practice” (Sackett, Richardson, Rosenberg, & Haynes, 1997; Cochrane, 1972; Grahame-Smith, 1995). In an evidence-based culture any single intervention or procedure is supported by scientific evidence of its effectiveness and its efficiency. In principle, that which cannot be measured using scientifically acceptable and recognizable methods cannot be supported. Basing service and professional decision-making on published trials of clinical effectiveness helps hard-pressed health and social care agencies to manage limited resources in the face of potentially unlimited demand. It also provides a mechanism of defence for responsible medical practitioners in a litigious climate. However, developing pace-for-pace with evidence-based practice in medicine, there has been a needs-led approach to health and social care. This emphasizes that it is the needs of the user of services that are supposed to drive service provision. The needs-led focus is written into the 1990 and 1993 UK community care legislation. While the legislation begs the question of the nature of need, it has raised the likelihood of irreconcilable gaps between the expressed needs of a service user (which are rarely clinically clear-cut) and a professional response tied to the published evidence base (where clinical precision is the norm).

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The promise of the evidence-based paradigm depends on the accepted linkage between specific interventions/ procedures and established diagnostic categories. In other words, it is professional led. Spiritual need, on the other hand, is patient led, and based on the subjective experience of the patient. It is not tied to an accepted diagnosis (pace spiritual needs protocols), nor can it be assimilated to categorical systems. To this extent, therefore, it is not accessible to the evidence-based paradigm, nor to pre-categorized measurement systems (e.g., psychometrics). If the spiritual journeys of today’s individuals are subjective and informal (rather than manifesting themselves in churches, synagogues or mosques), and we wish to make some provision to support people on these journeys, then establishing exactly what is needed and how that need might be met become the primary tasks. The challenge for healthcare organizations is to provide support for the individual on their spiritual journey and to offer, particularly within institutions of health and social care, systems that acknowledge the importance of the spiritual being. However, Spirited Scotland assert that this brings with it a supplementary challenge: Healthcare organizations’ staff need to be treated no less holistically than staff are required to treat patients. For how can people who themselves have no experience of being treated as whole persons give whole-person care? Spiritual care needs to be institution wide. These, then, are some of the contradictions within the current health and social care policy setting, with which direct-care practitioners can only struggle. Any projected movement, whether from ideas to policy, practice to

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policy, or from policy to practice, is fraught with turbulence when issues are so complex, definitions so unclear. The Spirited Scotland Initiative It is within this context that the Spirited Scotland initiatives have developed. Spirited Scotland has developed a number of strands, some of which have become part of an action research programme (Whyte, 1991; Hudson & Bennett, 1997) sponsored by the Scottish Executive. “Confidence with Spiritual Issues…”: Courses for Practitioners The starting point for Spirited Scotland was the early educational work of the authors, undertaken while both were working in the University of Dundee. In 1997 a course entitled “Confidence with spiritual issues in health and social care” was set up. Sensitive to the challenge to staffs capacity to give holistic care mentioned above, the intention of the course was to facilitate the exploration of spiritual issues by health and social care professionals of all kinds, including complementary practitioners in private practice. Its underlying assumption was that meeting the spiritual needs of patients could only be done by professionals who were in touch with their own spirituality and thus enabled, at the least, to distinguish spiritual distress from other aspects of patient need. The perceived context for National Health Service (NHS) professionals to become more spiritually aware was seen as not auspicious: faced as they were by ever pressing and often unmeetable

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demands from the bureaucracy, by rising patient expectations, and in the context of the paradoxes and contradictions described above, staff in health and social care settings were really struggling to maintain their own sense of self-worth. The course proved to be very successful in its stated aim of building confidence amongst health and social care staff to discuss and address spiritual issues with patients and each other. Other outcomes were: (a) increased multi-professional links; (b) a greater understanding of various professional demands; (c) a number of spiritual issues groups which formed and met as part of their continued professional development; and (d) research projects looking at specific areas and professional groups’ response to spiritual issues. Reasons given for the effectiveness of the course were its strongly participatory character, the emphasis on personal safety in respect of intimate discussion material, and the great diversity of participant backgrounds (complementary practitioners, hospital and community nurses, family doctors, chaplains, social workers). The course continued to be developed over subsequent years; on each occasion its content was negotiated, within broad parameters, between the course participants and the course tutors. It thus loosely conformed to educational action research where curriculum is developed by dialogue between teacher and pupil. Learning need is responded to by change and development on the part of the teacher. Scottish Executive-Funded Action Research Project

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It was clear from the course feedback that a need had been identified. While still in Dundee, the authors commissioned a fact-finding study on the feasibility of disseminating the course to the remaining health and social care organizations in Scotland, on a cost-recovery subscription basis. The study concluded that while there was growing interest in spirituality in healthcare (less so in social care), the proposed simple transfer of the course from Dundee to other areas was not a viable option. The evidence was that healthcare executives were already hard-pressed to meet their organizational objectives. Most executives did not see spiritual care as part of their responsibility but as a delegated responsibility of the Hospital Chaplaincy Committee of the Church of Scotland Board of National Mission. It was with this evidence that the authors approached the Scottish Executive. A combination of timely meetings, sympathetic listeners and an overlap of interests resulted in the “Spirituality in Health and Social Care Project.” This initiative proposed that the healthcare scene in Scotland could be transformed by a more explicit focus on spirituality in research, education, and policy. The lead worker was to be Dr. Ryan, supported by Dr. Mowat, and all aspects of the work were to be underpinned by an action research assumption (as described by Hart & Bond, 1995). Research Initially a survey was to be conducted to discover the extent and nature of the spiritual need and means of meeting such need available both in the NHS and in wider social care arenas. The survey of spiritual need

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and response in the NHS and social care settings immediately became difficult since definitions of spiritual need and spiritual work were unclear. If “spirituality” was left undefined, responses would probably continue to equate “spiritual” care with “religious” care, thereby pushing it back to chaplaincy care, the quality of which was not at issue. On the other hand, by pre-defining the nature of spiritual need and spiritual work the survey would potentially rule out individually or culturally valid responses that did not fit the definitions. Furthermore the group or person to whom the survey questionnaire should be sent became increasingly unclear. Who would know what actual spiritual care was taking place in the wards, in the corridors and coffee rooms, and, of increasing importance with an ageing population, outside the hospital in community settings? Our earlier attempts to survey the Trusts had mostly resulted in the survey form ending up on the desk of the hospital chaplain. Whilst information from the chaplains was vital, it was clearly not the whole picture. A more creative method was sought which would capture the variety of spiritual care being practiced, and anchor it in the evolving social context which was generating such a geological shift in attitudes to spirituality. As with the well-known dictum in palliative care “Pain is what the patient says it is,” the definition of spirituality was given sufficient latitude to accommodate its use in practice. A qualitative approach to the survey sought to explore both spiritual care and need; definition was sought from the data, rather than imposing it. This

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method allowed for the emergence of ideas, and prompted deepening lines of connecting questions and conceptual thinking. As the present UK government has committed itself to improved inter-departmental working through “joined-up government,” such an integrating approach was accepted by the Scottish Executive’s steering group for the project. The inductive theorizing led to important redefinitions of the scope of spirituality (e.g., to the recognition of unexpressed spiritual need as a public health issue), and resulted in Dr. Ryan being invited to join a strategic discussion group of Scotland’s lead public health policy institution. As is commonly the case in emergent policy fields (Weiss, 1978), it is likely that these reconceptualisations (e.g., Ryan, 2002), rather than the data from the interview survey, will become the major instigators of change. The project has so far led to one associated research initiative, arising out of a contact made during the interview survey, and bridging to an earlier project supported by the NHS Executive to promote culturally-competent care for ethnic minorities. This is a study of the relation between spiritual need and spiritual care in stroke patients, with a particular concern with their experience after discharge from the acute management phase. Developed from a stroke incidence study by its project manager, a qualified healthcare chaplain, the project has a comparative slant, in that the experience of patients and carers in the Scottish Borders, a rural area with small dispersed settlements and a net outflow of population, will be compared with that of ethnic minorities in Glasgow, Scotland’s major, now largely post-industrial conurbation. In the first stage, this

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empirical work is exploring the variety of spiritual needs and responses to stroke amongst groups of patients. The second stage of the work will develop and test ways of responding to spiritual need, hopefully generalisable to other disabling conditions besides stroke, which can then be offered as a mechanism of support to NHS spiritual care. Conferences The importance of supporting change as well as introducing it is clear. Part of the action research model is to provide practical resources to support the sought-for change. As part of the action research cycle of information gathering and exchange a conference was held in November, 2001, designed jointly by the NHS Executive and Dr. Ryan, and funded by the Executive. The purposes of the conference were: • to signal the new importance being attached to spiritual care as an intrinsic part of patient-centred care in the NHS (the signal being a speech from the responsible Scottish Executive minister); • to inform all those with interests in the chaplaincy and spiritual care field that local Health Boards and Trusts were in the future to be responsible for spiritual care, but that its delivery had to be underpinned by an Executive-approved policy. A Report of a specially commissioned working group of chaplains and faith community representatives was the point of departure for these discussions;

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• through commissioned papers from leading researchers, to raise awareness of how the social and healthcare contexts for spirituality were changing. At the time of writing, a second conference is under discussion between Spirited Scotland and the NHS Executive. This would concern itself with spirituality and health in community settings, to draw attention to the significance of spiritual well being as a possible factor in illness prevention, and to emphasize the potential health contribution made by community-based spiritual and religious organizations and by complementary practitioners working in the market. At the November, 2001, conference a growing mismatch between need and provision was pointed out: virtually all the NHS resources for spiritual care are concentrated in the acute sector, whereas most of the need (especially with (a) increasingly short stays by acute sector admissions, and (b) the rise in chronic illness associated with an ageing population) is located in the community (including nursing/residential homes). Networks and Newsletter One of the features of spirituality in the Scottish health context, which emerged clearly both from the first Spirited Scotland course and from the research interviews, is the relative isolation of those with an interest in it. Healthcare staff wishing to respond to spiritual need often feel caught between a biomedically-dominated clinical tradition which still does not regard spirituality as scientifically addressable and the residual expectation that every case of spiritual

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need should be referred to the chaplain (Cobb & Robshaw, 1998). One of the agreed objectives for the action research project was to build up the confidence of those interested in spiritual issues by creating a critical mass of those actively involved. To this end, in addition to Scotland-wide conferences, the project is also compiling a comprehensive database, to serve as the basis for a projected Spirituality in Health and Social Care Newsletter, the first issue of which will be produced by Dr. Ryan in the Spring of 2002. More specific interest groups will be supported by networking arrangements. The first network, for those doing research on spirituality in Scotland, has already been started. The second, for those interested in education, is being organized at the time of this writing (January 2002). While not part of the agreed deliverables of the project, a dedicated website may be a cost-effective mechanism for networking with/feeding back to the overall constituency, reducing material costs associated with a paper newsletter, and providing news and information as it comes up, as against every three or four months. Healthcare Chaplaincy The development of the Spirited Scotland initiative has unfolded in parallel with an increase in support from the NHS Executive for healthcare chaplains. Historically, the National Health Service in Scotland has provided some kind of full-time chaplaincy service (see their journal, The Scottish Journal of Healthcare Chaplaincy) usually appointed through, if not from, the Church of Scotland denomination. Historically, too, there have

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always been guidelines for the support of the spiritual needs of patients in the NHS (these are what the above-mentioned policy revision will be working to update). The Scottish Executive have for some time been seeking to remodel this role to accommodate our increasingly multicultural society and to embrace an interfaith perspective. Thus chaplains, too, are trying to respond to the seismic changes in religious membership and spiritual involvement in the Scottish population, changes with clear implications for their practice. Concretely, the Executive funding is supporting a Development and Training Chaplain for two years, and also a projected policy development advisor reporting to him, whose role will be to provide drafting support for the local policy revision requested by the Executive. Apart from the presentation of the Working Group Report on Chaplaincy and Spiritual Care at the Spirited Scotland conference, there is also a working partnership between the chaplains and Spirited Scotland in the area of research, with an initial enquiry into professional supervision. Challenges to Healthcare Policy Arising from the Spirited Scotland Project Scotland is a very unhealthy society: Statistically our heath performance is on a par with Greece and Portugal (Hanlon et al., 2001), and a man from Glasgow is likely to die ten years earlier than a man from Dorset, England. Improved investment in the health service has done little to improve these disparities. Could there be a spiritual involvement in this ill-health?

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It is not unreasonable to hypothesize that some of Scotland’s excess morbidity derives from psycho-spiritually mediated patterns of consumption and behaviour. On this view, people are not objectively “infected” so much as subjectively “self-sickened” (e.g., from negative self-judgements, from unrewarding personal relationships and/or from poor future prospects in a backwashed economy). Effective short-term health protection would therefore come from strengthening “immunological” resistance to excessively demanding life circumstances, pending reformation of those circumstances by collective social action. When it is not possible to eradicate “infection,” the only alternative is to raise “resistance.” The large-scale challenge for policy, therefore, is to move beyond the reactive national sickness service to a preventive national health system. This entails shifting the emphasis from clinical care of patients (where sickness is accepted as inevitable) to a systematic care of health (insisting thereby that health is possible). For this move to be possible, what is required is a qualitative jump (currently being discussed as a “step-change”) in how “health” and “illness” are perceived. Part of that would be accepting that spirituality is a public health issue, in the same way as water supply finally became accepted as a public health issue in the nineteenth century (Goubert, 1989) and diet in the twentieth (Coid & Ryan, 1999). With the step-change in perception would come a step-change in management, enabling the shift from caring for the sick

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to also looking after health-health itself, not just bodies; health as relishing life, not just taking more exercise. Managing this new function would require a system transition: When new high-level functions emerge, unless there is a transition to a qualitatively different system, the new function cannot take on its appropriate directive functions. If pathogens are societal, the response has to be societal. Thus the hypothesis suggests we need a pro-health agency able to work at the societal level. In other words, all healthcare initiatives would have added to them, as an indispensable objective: the protection of health (environmental, physical, moral, psychological, and spiritual). This would raise the general level of resistance: “immunology,” in its broadest sense. These are the kinds of issues we look forward to raising with our partners in policy making and with attentive publics. While necessarily hypothetical, this is the sort of thinking that follows from taking spirituality seriously as an inherent dimension of being human, as an energizing current that can be compromised by the loss of valuing human support and failure to protect the positive core of the self. The self is social, just as the spiritual is relational. If the spiritual is part of health, it has to become part of the health system. Challenges to Programmes for Older People Successful Ageing, Disengagement, Developmental Life Stages The challenge of refocusing attention towards holistic well being and a system of health care rather than 119

sickness care also requires us to examine the theories in gerontology that dominate the literature and research endeavour. David Moberg (2001) notes that these theories have generally ignored spirituality and religion and have tried to explain old age in terms of the degree to which old age can be held back and converted. The current emphasis on successful ageing which is linked with the rejection of the idea of disengagement (Cumming & Henry, 1961) takes as axiomatic the importance of activity and of outgoing efforts to maintain and develop, albeit through adaptation and compensation, a lifestyle that is consistent with a fully functioning adult in the cultural setting relevant to that person (Baltes & Baltes, 1990). The definition of successful ageing is most often expressed as a freedom from both physical and cognitive impairment (Simmons, 1999). Wilson (2000) has pointed out that the definition of ageing itself is determined by the degree of dependence of the individual. Those who maintain their independence are not considered to be old. Becoming old is linked to disability and decline. Research driven by the theory of successful ageing is turning its attention to the development of indicators that might explain and predict successful old age. A number of factors are already well known to promote well being, for instance regular exercise, cognitive stimulation, friendships and the presence of a confiding relationship. However, any holistic view of health would require the spiritual to be incorporated into the idea of successful ageing. Little attention has been paid in the description of successful ageing to the inward journey. “Success,” like spirituality, remains

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a concept that is fraught with difficulties. Smith (1976) showed that much depends on whose opinion is sought and what definition is agreed to. “Successful ageing” is an attractive concept but it still suffers from definitional difficulties (Baltes, 1996). As of now, therefore, successful ageing can be characterized by two rather opposing positions, each of which has implications for the pursuit of holistic health. One perspective is that successful agers are those older people who can emulate youth and remain youthful in word, deed and appearance, despite chronology. Youthfulness and longevity are seen as valid, desirable and attainable goals that co-exist. This is ultimately an embattled definition, placing as it does the impossible goals of youthfulness and activity as markers of success and adulthood. An alternative view is that successful agers are those who glide noiselessly away from the mainstream of social life, disengaging with the main social set-ups. Cumming and Henry (1961) developed the idea of disengagement from a functionalist perspective; the disengagement is seen as functionally desirable for both individual and society. Common to both positions is that this process should be trouble free and unchallenging to other members of society and the social structures on which they rely. “Noisy” ageing is problematic for society. Noisy ageing is interpreted as pathological and is dealt with by the increasing removal of rights to the full range of societal opportunities. The danger of using successful ageing as a concept is that it can be constructed as a normative prescription rather than as an empirical description. Lack of

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adherence to the successful ageing formula is then interpreted by groups and individuals as a failure. Society’s projected image of the successful ager can be detrimental to the individual’s struggle with the inevitable losses and vicissitudes of old age, demoralizing those who deviate from the prescription, who then see themselves as deviant, pathological. This definition of success is located in society’s structures and suits society, not the agers. Successful ageing is arguably therefore a socially constructed phenomenon, characterized by lack of “noise,” maintenance of youthful status until death, and a dogged engagement with social structures which appear almost as if designed to discourage the engagement of older people (Bytheway, 1995; Kuypers & Bengtson, 1973). However, there could be another way. Successful ageing could be defined as a journey which is more spiritual than physical; as a process of reconciliation within the individual self, working towards an end-point of becoming content, satisfied, and reconciled. The process could be recognized for what it often actually is, a noisy and difficult one. This view is supported by the psychological theories of human development where stages of growth and change are identified as part of a journey into maturity and old age. Some of these do in fact see the successful ager as one who takes on the imperatives of reconciliation, coherence and location within a spiritual world. There are parallels both conceptually and empirically between integrity, identified by Erikson (1982) as a positive goal of the final stages of life, and spirituality. The search for spiritual integrity is a solitary process which does not

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have the neat outcome measures of lower morbidity, high engagement and robust self esteem. It may indeed be a painful process that sits uncomfortably with the current view that the purpose of health and social care is to reduce pain and discomfort. There may be a healthy pain which is an intrinsic part of holistic health for older people: “declining pains,” like “growing pains.” “Success” may be painful. Policy Issues Within the UK policy arena, there have been movements towards a community care approach for older people, culminating in legislation that requires the community based care of all but the most seriously frail. Recently, in the face of continued difficulties around collaboration, a plan entitled Joint Future has been published. This plan requires local authorities, who both purchase and provide social services, and Health Care Trusts, who are responsible for the delivery of health care, to set up mechanisms by which care can be delivered jointly at local levels. Cornerstones of the joint future initiatives are directives for single assessment, short break provision, augmented home care, intensive care management, and joint management and financing. The Scottish Executive also require adherence to time scales to meet these goals and local agreements between providers and the executive based on outcome measures. Seen in the light of the Spirited Scotland project, this policy initiative offers the potential for reconsidering the importance of spiritual space within the care packages and plans, for instance the opportunity within the single assessment to identify spiritual needs which go beyond

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nominating a religious affiliation. But step-changes are indicated even here, for instance in research. While research is identifying active religious practice as beneficial to the older person (Johnson, 1995), with lower morbidity and higher self esteem and life satisfaction associated with a formal religious life, the research has hitherto been largely survey work, and thus external and working with researcher-defined categories. There is little research that enquires into the personal undertaking of the solitary and inevitable journey at the end of life and then derives categories and themes from the respondents themselves. Such “user-led” research might lead to a re-thinking of individuals’ actual service needs, and could inform the setting up of training and management regimes to meet them. The drive towards maximising independence, which is embedded in the community care ethos, could be reviewed in the light of the spiritual dimension of individuals. Through this more relation-focused lens, finding mechanisms for promoting inter-dependence might be seen as more appropriate than extending independence. Elizabeth MacKinlay (2001) has pointed out the importance in old age of the transition from doing to being. These ideas, building on work by Eric Fromm (1979) and Viktor Frankl (1984), are also to be found in religious traditions, and in the idea of stages of life (Erikson, 1965). The being in question is not to be seen as solitary, self-imprisoned. One of our transcendental tasks as individuals is the giving up of self in order to re-find self as part of a system involving (a) higher being. This may well be one of the most

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important aspects of growing older; it is certainly one that requires courage and patience. Maximising the possibility for meaningful rather than token relationships offers older people the opportunity to act as fully functioning adults despite physical decline. A social and health care system that accepts holistic health as possible rather than sickness as inevitable will necessarily focus on a broader definition of well being; one which includes working for spiritual health. If this work is a fundamental task for remaining well in one’s declining years, it needs to be supported at practice level by health and social care staff. For example, a holistic system of health and social care delivery for older people would take into account the importance of making the pace of bed and body tasks acceptable to each older person as an individual. Services are too often organized for the convenience of the delivery system, a system which is driven by the assumption of sickness, and by the assumption of doing. This brings us full circle back to the idea of educational initiatives that support the growing confidence of individuals in speaking about and working with spiritual issues in health and social care. Conclusions and Summary This paper has introduced an initiative called Spirited Scotland. It has identified the challenges with the initiative that are fundamentally located in issues of definition and of refocusing of the ideas of health and sickness. It has considered the initiative in relation to issues for older people, in particular to the successful ageing theories that are currently popular. It has also

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considered some policy and practice implications of the Spirited Scotland programme. The Scottish Executive require a spiritual care policy in the National Health Service via the Health Boards and NHS Trusts who organize the service in different geographical areas in Scotland. The mechanism by which the Scottish Executive moves health policy forward is to issue directives (Health Department Letters–HDLs) that require an active response from Health Care Trusts. It has been assumed by the Scottish Executive that the Spirited Scotland initiative will contribute to change, and that this change will involve developing current systems of support in the National Health Service for the spiritual aspects of care, and also developing new ones. The precise nature of the support in each of the different areas and Trusts will be a matter for negotiation. However, it will include chaplaincy, holistic care, interfaith liaison and staff training. This negotiation is to be informed by concepts and data generated by the Spirited Scotland programme which will offer models of spiritual support based on existing practice found both individually and organizationally. We conclude that a new understanding of health needs to be established that acknowledges both the sociopathic origins of much of today’s ill health and the importance of spiritual dimensions to well being. In order that this redefinition can occur a step-change must occur at the professional and policy levels. This step change can include an enlargement of successful ageing to incorporate a spiritual aspect. In its turn, this may make the idea of a good old age at once more realistic and

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more challenging, stimulating professionals, policy-makers and scholars to reconsider the appropriateness of a maintenance model of health in old age. References Baltes, M.M. (1996). Successful aging. In S. Ebrahim and A. Kalache (Eds.), Epidemiology in old age (pp. 162-168). London: BMJ Publishing Group. Baltes, P. B. & Baltes, M. M. (1990). Successful aging: Perspectives from the behavioural sciences. New York: Cambridge University Press. Brown, C.G. (1990). Religion, class and church growth. In W. H. Fraser and R.J. Morris (Eds.), People and society in Scotland: Volume II-1830-1914 (pp. 310-335). Edinburgh: John Donald. Bruce, S. (2000). The New Age and secularization. In S.J. Sutcliffe and M. Bowman (Eds.), Beyond New Age: Exploring alternative spirituality. Edinburgh: Edinburgh University Press. Bytheway, B. (1995). Ageism. Buckingham: Open University Press. Cobb, M., & Robshaw, V. (Eds.). (1998). The spiritual challenge of health care. Edinburgh: Churchill Livingstone. Cochrane, A. (1972). Effectiveness and efficiency. London: Nuffield Provincial Hospitals Trust. Coid, D., & Ryan, D. (1999). Historical novel. Health Service Journal, 109, 28-29. 127

Cumming, E., & Henry, W. E. (1961). Growing old. New York: Basic Books. Drane, J. (1999). What is the New Age still saying to the Church? London: HarperCollins. Erikson, E.H. (1965). Harmondsworth: Penguin.

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Erikson, E.H. (1982). The life cycle completed: A review. New York: W.W. Norton. Fromm, E. (1979). To have or to be? New York: Harper & Row. Frankl, V.E. (1984). Man’s search for meaning. New York: Washington Square Press. Goubert, J.P. (1989). The conquest of water: The advent of health in the industrial age. Cambridge: Polity Press. Graber, D.R., & Johnson, J.A. (2001). Spirituality and healthcare organizations. Journal of Healthcare Management, 46, 39-50. Grahame-Smith, D. (1995). Evidence-based medicine: Socratic dissent. British Medical Journal, 310, 1126-1127. Hart, E., & Bond, M. (1995). Action research. Oxford: Oxford University Press. Hudson H., & Bennett, G. (1997). Action research: A vehicle for change in general practice. Promoting teamwork in Primary Care. London: Arnold. Johnson, T. (1995). The significance of religion for aging well. American Behavioral Scientist, 39, 186-208. 128

Kuypers, J.A., & Bengtson, V.L. (1973). Social breakdown and competence: A model of normal aging. Human Development, 16, 181-201. MacKinlay, E. (2001). Ageing and spirituality. London: Jessica Kingsley. Moberg, D. (Ed.). (2001). Aging and spirituality: Spiritual dimensions of aging theory, research, practice, and policy. Binghamton: The Haworth Press, Inc. Public Health Institute of Scotland (2001). Chasing the ‘Scottish Effect’: Why Scotland needs a step-change in health if it is to catch up with the rest of Europe. Glasgow: Author. Puttick, E. (2000). Personal development: The spiritualisation and secularisation of the Human Potential Movement. In S. J. Sutcliffe & M. Bowman (Eds.), Beyond New Age: Exploring alternative spirituality. Edinburgh: Edinburgh University Press. Riesman, D. (1950). The lonely crowd: A study of the changing American character. New Haven, CT: Yale University Press. Ryan, D. (in press). Spirituality as a Scottish health issue. Scottish Journal of Healthcare Chaplaincy. Sackett, D. L., Richardson, W.S., Rosenberg, W., & Haynes, R. B. (1997). Evidence-based medicine: How to practice and teach EBM. Edinburgh: Churchill Livingstone.

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Simmons, H.B. (1999). Men: The scientific truth about their work, play health and passions. Scientific American Presents, 10, 2. Smith, G. (1976). The meaning of success in Social Policy: A case study. Public Administration, 56, 263. Storrar, W. (1999). From Braveheart to Faint-Heart: Worship and culture in postmodern Scotland. In B. Spinks & I. Torrance (Eds.), To glorify God, pp. 69-84. Edinburgh: T. & T. Clark. Sutcliffe, S. J., & Bowman, M. (Eds.). (2000). Beyond New Age: Exploring alternative spirituality. Edinburgh: Edinburgh University Press. Weiss, C. H. (1978). Improving the linkage between social research and public policy. In L. E. Lynn (Ed.), Knowledge and policy: The uncertain connection (pp. 23-81). Washington, DC: National Academy of Sciences. Whyte, W.F. (1991). The social sciences in the university. Part of a special issue on: Visions of society. American Behavioral Scientist, 34, 618-633. Wilson, G. (2000). Understanding old age: Critical and global perspectives. London: Sage. Dr. Harriet Mowat is Deputy Director, Centre of Gerontology and Health Studies, University of Paisley, Scotland. Dr. Desmond Ryan is Senior Research Fellow, Spirituality in Health and Social Care Project, Department of Nursing Studies, University of Edinburgh, Scotland.

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Address correspondence to: Dr. Harriet Mowat, Deputy Director, Centre of Gerontology and Health Studies, University of Paisley, Paisley PA1 2BE, Scotland (E-mail: [email protected]). Presented as part of symposium at the 2001 meeting of the Gerontological Society of America. Some of the work referred to in this paper received funding from the National Health Service, Scotland. The views expressed are entirely the authors’ own. [Haworth co-indexing entry note]: “Spiritual Issues in Health and Social Care: Practice Into Policy?” Mowat, Harriet and Desmond Ryan. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 1, 2002, pp. 51-67; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 51-67. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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A Mighty Fortress Is Our Atheism: Defining the Nature of Religiousness in the Elderly Allen Glicksman, PhD Summary. This article considers current trends in research on religion and aging. By considering the perspective of classical sociology, the author argues that we need to understand religion as a belief system with a particular function, rather than a belief system that necessarily contains certain specific beliefs or behaviors. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2002 by The Haworth Press, Inc. All rights reserved.] Keywords. Religious diversity religious beliefs theocratic religion non-theistic faith religion and science In the past few years, the topic of religion has emerged from relative obscurity and become a subject matter of great interest to researchers in aging (Koenig, McCullough, & Larson, 2001). The study of religion and aging, like the study of health behaviors, has focused on the potential benefits of this domain on the physical and emotional well being of older persons. In order to test these potential benefits, numerous scales have been devised to measure its effects. An excellent example of this can be found in “Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research” published by the Fetzer Institute (1999).

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This last development is curious since we do not seem to have a consensus on definitions of the term “religiousness,”1 a term that refers to the state or character of an individual’s belief. Although most scales designed to measure this domain assume a definition of religion as a formal system of belief in a supernatural deity, there seems to be no consensus on how to define or measure the strength of any individual’s faith in such a system. Although, each scale carries with it an implicit definition of the term through the questions asked to measure the domain, clear, specific, and well-developed definitions of the term “religiousness” are frequently absent. The problem is made more complex by the attempt to separate the concepts of “religion” and “spirituality” into distinct categories. Whether one can have a spiritual life that is independent of a specific religious belief system or a mix of belief systems is an interesting question in itself, but will not be dealt with explicitly in this paper. These scales designed to measure religiousness carry another, untested, assumption. If these scales are designed for use in research studies along with scales designed to measure other conditions and behaviors, then there is an implicit assumption that they are not specific to any individual faith or belief system. The unstated presumption is that they can be used with persons of any religious background. That is, the same measure can be used with individuals whether they are Hindu, Jewish, Southern Baptist or members of any other community of believers that we generally recognize as a religion. This presumption has also not been carefully examined. The argument goes that these scales “work” because

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respondents can understand and answer the questions on the scale. The fact that people are able to understand and respond to the question does not mean that the question is a valid measure of religiousness in any given group. In fact, the respondents may be answering a very different question than the one being asked. The problem can be stated in the following manner. If we wish to be able to measure religiousness (or any other domain for that matter), we need to be able to “operationalize” the term in the form of specific beliefs or behaviors that together form a measure of the underlying concept. So, for example, when we want to measure functional health, we list a series of health behaviors (the ability to walk a flight of steps or to stand up without assistance). It is the same when we want to measure beliefs that might affect psychological well being (such as feeling good about oneself). In the research and clinical communities, there exists a broad consensus on what constitutes appropriate operationalizations of many aspects of physical and mental health. How can we operationalize the concept of religion? What specific beliefs or behaviors are common to all faith systems? This question becomes more complex when we remember that such scales must of necessity not contain a very large number of questions. To be truly universal measures of religiousness, the behaviors and beliefs on such scales must be core to all religious systems. Questions that contain assumptions of a single God are useless in polytheistic faiths. Questions that assume the primacy of private over public behavior will

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miss the mark when used among persons whose faith systems stress the community over the individual. Questions that treat ritual as secondary to belief will fail to capture deep religious faith among those for whom ritual is the highest expression of belief. Questions that address God as a “he” will be difficult for those who worship female divinities. Therefore, even if the respondent can understand the question and respond to it, we cannot assume that the question is correctly measuring the particular domain, religiousness for example, in that individual unless we understand that particular individual’s faith tradition. The problems described here are not limited to attempts to understand the relation between religious belief and health status. They extend to all attempts to comprehend the relation of religious belief and any aspects of human behavior. Defining Religion Students of history and religion, and those with a classical training in the social sciences, usually take a different approach to understanding the role of religion in human behavior. Perhaps the best-known example of such a study is Max Weber’s classic analysis, The Protestant Ethic and the Spirit of Capitalism (1930/ 1992). In this approach, the researcher must examine the total belief system, such as Reform Judaism or Presbyterianism, and then attempt to define the personal and social consequences of such systems. Looking at each belief system as a unique set of beliefs and behaviors makes systematic (and especially quantifiable) comparisons difficult.

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However, this approach allows the researcher to better understand specific religious traditions. A deep understanding of specific religious traditions leads to a clear understanding of why defining a common set of beliefs and behaviors that could form a scale is so difficult, if not impossible. For example private Bible reading, something encouraged in many Protestant groups and an item that appears on some scales and measures, is not encouraged in traditional Judaism. In Judaism, study with a chevrusa, a study partner, is encouraged because it is seen as raising the spiritual experience of the believer. The different perspectives on whether the reading of scripture is best done in public or private raise yet another issue. This difference extends to the way we consider public versus private expressions of religiousness. Therefore, if in some religious traditions the assumption is made that what is done in a social context is of a higher spiritual value than that which is done in private, then scales of religiousness that give greater weight to acts done in private cannot have universal validity. If religious traditions vary so widely that it is difficult to find commonalities between them, how can we find a common definition that allows us to discuss the concept of religion in a meaningful way? Is there a starting point for a scientific discussion of religion? Such classic thinkers as Marx, Durkheim and Freud focused most of their attention on the function of religion in society (Yinger, 1970). Rather than focusing their analyses on specific beliefs or behaviors, these thinkers considered the function that religion served for specific social groups. Although Durkheim and Freud did speculate on

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the origins of religious belief, it was Max Weber who most systematically examined the origins of religious belief in order to define the term. Weber began his discussion of the nature of religion by describing the role of magic in the ancient world, describing how belief in magic evolved into theistic belief systems, with the priest replacing the magician. The creation of these theistic belief systems, while providing a comprehensive worldview, also created a problem, perhaps most acutely felt in monotheistic systems where a single deity is all powerful. If indeed there is an all-powerful deity, why is there suffering in the world? This question, which Weber called “theodicy” and which is usually referred to as the theodicy of bad fortune, is, according to Weber, at the heart of any religious system. In fact, it is the hallmark of systems of belief Weber considered “religious.” In The Sociology of Religion (1963) Weber wrote: “In one form or another, this problem belongs everywhere among the factors determining religious evolution and the need for salvation” (p. 139). In fact, he argued that only by understanding the meaning religion has for the believer (especially around issues of theodicy) can we understand religion from a scientific perspective. Weber’s theory allows us to understand religion as a specific class of belief systems without requiring us to assume that specific religious systems must share the same interpretations of the theodicy of bad fortune. Each religious system, depending on its specific interpretation of the meaning of suffering, develops its own set of

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specific beliefs and behaviors. Weber argued that religions must also answer questions concerning the theodicy of good fortune. His classic work The Protestant Ethic (1930/1992) is in part a study of the way that the Reformed Christian tradition understood the theodicy of good fortune and the consequences of that belief on modern history. Weber’s definition of religion allows us to go further than saying that systems of belief, to be considered a religion, do not need to share specific beliefs and behaviors. A system of belief can also be a religion without requiring a belief in a supernatural deity. Although Weber acknowledged that most religious systems include a belief in some supernatural power, this was not a prerequisite for a belief system to function as a religion. Can a belief system that does not include a supernatural element really function in the same way as those systems we normally call “religions”? Although Weber suggested that this is possible in theory, is it true in fact? We feel that the answer to that question is “yes.” To illustrate our point, we will use the example of socialism, which for some serves as a religious system in the sense described above. The following quote is an excellent example of what is meant by the assertion that socialism can function as a religion. It is excerpted from a statement entitled “Socialism, My Temple” by Yosef Hayim Brenner. I am a socialist. To me Socialism is the holy of holies. The ideal of ideals. All other ideals have no warrant except when bound up with Socialism. What value is 138

there in beauty and art at a time when all humanity is sinking in a swamp of ugliness and degradation? What sense is there to science and moral preaching to deep emotion and exalted concepts at a time when there are tens of thousands of human beings that live on moldy bread without a ray of light or hope; at a time when human dignity is being crushed by the iron heel when a man’s thoughts can be bought for money when human tears flow like flood waters, and the slaughter of human beings is like the dying of the flies in the fall. In the light of all this what value is there to man’s conquest of nature, to advancement of culture, to poetry, philosophy and the like? And what meaning can there be to all human existence, to all of man’s spiritual strivings and ideals? It is only my faith in socialism, my hope in a free and bright future, that give value and meaning to human existence, social progress, and cultural development.… Socialism is my temple, my comforter in everyday experience, that creates harmony out of the chaos of the world and protects all that is dear to me and close to my heart. Only in the field of Socialism do I find basis to my cultural activities and life, aware that through my work, together with thousands and tens of thousands of others do I bring nearer the day of redemption. Only through the consciousness that my life is as a tiny grain in the giant mountain, the name of which is The “Socialist Movement,” can I find my peace of mind … (Hashomer Hatzair, 1963) Listen to the words. “Socialism is my temple, my comforter in everyday experience, that creates harmony

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out of the chaos of the world and protects all that is dear to me and close to my heart.” In that it provides answers to ultimate questions, this statement is as religious and spiritual in terms of the meaning of that system to this individual as any by a believing Christian, Jew, or Muslim. Within it, both explicitly and implicitly, we find the causes for human suffering, the identities of the sufferers, and the solution to their suffering. It gives meaning to his life, purpose to his existence and inextricably binds him to the present, past and perhaps most importantly, to the future. By becoming part of a larger whole that will live on after his death, he also is promised a form of immortality. In the case of Yoseph Haim Brenner, socialism was more than a political or economic philosophy. For Brenner it was a religion. Just as certain familiar theocratic systems such as Catholicism and Judaism are good examples of what we mean by religion, some political ideologies can be excellent examples of non-theocratic religions. Although there have been socialists who also believed in supernatural deities, we are interested in those individuals whose political beliefs also functioned as religious beliefs. As with theocratic religion, a non-theistic faith can provide meaning to life even when the individual is suffering. This was the case with an older woman with a lifelong commitment to socialism. As she was dying of cancer, she continued to organize both patients and staff in the hospital. In doing so she showed her own commitment to something

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larger than herself: a value system that would survive her own passing and which might change the world. It even gave meaning to her illness because it provided her an opportunity to organize in an environment from which she would have otherwise been excluded (Glicksman, 2000). Perhaps one of the best examples of the role non-theocratic religion can play is in the stories of Jewish resistance to the Nazis during the Second World War. Members of socialist youth movements constituted the vast majority of the Jews organized resistance to the Nazis. These movements, including Zionist-Socialist, Social-Democratic, and Communist Jewish youth, understood full well that they stood no chance of defeating the Nazis. Nonetheless, their ideological commitments moved them to demand heroic behavior from themselves and from the other Jews who were under Nazi rule. Their hope was to die with dignity, and to inspire others. It was a form of martyrdom, secular in nature but no less based on spiritual concerns than more traditional religious martyrdom. Secular religion can therefore not only define the way one lives one’s life, it can also define the way one ends one’s life (Tzur, 1998). One could argue that secular ideologies such as socialism are unlike belief systems we usually consider religious because the truths of such ideologies can be tested, whereas religious claims of an afterlife cannot be subjected to scientific investigation. There is some truth to this claim. However, even faith in traditional religious belief systems such as Christianity can be tested on a subjective level. If a believer feels that God is behaving

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unjustly, he or she may feel the same challenge to their worldview that a follower of a secular religion might feel if betrayed by their ideology. In addition, even shattered faiths can still provide a moral compass. Two parallel cases provide an example. In the first, a devout older Presbyterian man lost an eighteen-year-old daughter to cancer. In an interview, he described how the event caused him to lose his faith. But he continued to try to show a “stiff upper lip,” and continued to live by the norms set for him by his faith. He did not have another way of living, of viewing the world, so his Presbyterian world view continued to define his own sense of appropriate and inappropriate, of right and wrong (Glicksman, 2000). In the second case, an interview was conducted with an older woman who had immigrated to the United States from the former Soviet Union. When asked about whether she participated in activities at the senior club, she answered: “As far as the senior club, I like it there, very much so. It is very pleasant. But, you understand, the women come there only to show off their jewels, their clothes. I am sorry, but I tell you what I feel. I am interested in your opinion. Perhaps, that’s how it should be done. The life does not stop. Perhaps, it’s because my age is different. But I have never worn anything in my life. It was not the norm when I was part of Komsomol.” The Komsomol was the organization for adolescents run by the Communist Party in the former Soviet Union. That system had betrayed this woman, by turning on the Jews, and then it had collapsed. Nonetheless, it remained as her only moral compass, the only base on which she could make decisions about what was appropriate and

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inappropriate, about right and wrong (Glicksman & Van Haitsma, 2002). By enabling us to examine a variety of such systems, studying political movements that function as religion allows us to better understand the impact of religious belief systems. The study of these non-theistic systems of religious belief also enables us to examine the negative effects of religious belief on individuals, families, and social networks. It is very difficult to discuss the negative effects of belief systems when we are discussing mainstream faiths. We have grown accustomed to viewing such faiths as beneficial, and only consider negative effects when there is deviant behavior (such as sexual misconduct, theft, etc.). However, religious traditions can cause negative consequences or conflict for a number of reasons. People can feel that their God has turned against them, or religion can be a source of friction between generations. Some religious traditions may teach that suffering is a punishment, or that certain medical procedures are against God’s will. The implications of this go beyond research. We also need to be cognizant of the potential negative role of religion in clinical situations. To use but one example, suggesting that physicians pray with their patients may also be asking for the implied approval of the patient’s religious beliefs. Is that always a benefit to the patient or to the relationship between the patient and physician? Although we cannot explore this issue in depth, in the context of this article, we can point out that the issues raised here are as important in the clinical setting as they are in research design and analysis.

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The American Context For most American readers, the notion of political ideologies functioning as a religion will seem strange. Religion has played a fundamentally different role in American history than it has in European history (Ahlstrom, 1975). In the United States, almost all movements for social and political change either originated in or have been strongly supported by a Christian church. Abolition, temperance, women’s rights, and the debate over the war in Vietnam are merely a few examples of national debates in which clergy spoke out on both sides of these issues. The separation of church and state in American life was designed to allow various forms of religious expression to develop freely, not to prevent religion from having a voice in national affairs. In Europe, the Christian churches have often supported the status quo and so opposition to the current regime has often been intertwined with opposition to clerical authority. The reasons for this are complex and cannot be discussed here. Nonetheless, it can be said that the unique role of Christian faith in the founding of the United States has made it a “common language” for all points on the political spectrum, rather than the supporter of only certain political movements. While it might not come as a surprise that religious figures like Jerry Falwell and Pat Robinson support a conservative political agenda, it is the equally strong presence of religious leadership for liberal and left wing causes that is quintessentially American. For example, of the three most important socialist leaders in the 20th Century, one (Norman Thomas) was a Presbyterian minister and another

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(Michael Harrington) emerged from the Catholic Workers movement. With some small but important exceptions, in the United States, the ideologies of the left and the right have been intimately intertwined with religious belief and expression. Does this mean that researchers and clinicians can safely assume that Americans are in fact “religious” in the common meaning of the term? In truth, because of the importance of religion, Americans often cloak ethnic or other identities with a religious garb. One of the best examples of this can be found in the American Jewish community. In 1990, a national Jewish population study was sponsored by the Council of Jewish Federations (now United Jewish Communities) to examine the state of American Jewry. In that data set the respondents, a nationally representative sample of American Jews, were asked if being Jewish was a religion, an ethnicity, a culture, or a nationality. Among older (65+) American Jews, religion came in dead last, after culture, ethnicity, and nationality. For respondents under the age of 65, religion came in third, slightly before nationality. Nonetheless, most American Jews see the synagogue as the basic institution in American Jewish life. American civilization has defined the Jews as a religious community, while the Jews themselves see being Jewish as primarily a cultural/ethnic identity. This complex form of Jewish identification is lost when the Jews are treated only as a religious group for studies designed to gauge the meaning of their identification to their views of the world and to issues of health and illness. For older Jews, being Jewish is the most important dimension of

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identity. At the same time, they might express that identity more in ethnic terms (such as in concerns about the State of Israel) than in their theological beliefs (Glicksman & Koropeckyj-Cox, 1997). Religion and Science If we accept the Weberian definition of religion, we find it difficult to accept the approaches to the study of religion and aging that are popular at the moment. For example, in the current craze for controlled studies of the relation between prayer and healing, some researchers claim that study participants for whom prayers were offered experienced more favorable health outcomes than those for whom no prayers were offered. This research is based on the assumption that there are forces, or that there is “A Force,” driving those findings. Using the Weberian definition of religion, how can we evaluate this type of research? We cannot view such research as scientific because religious claims cannot be tested scientifically. The basic claim of any religious system is truth, the truth of why some suffer and others prosper. Such questions arise because science cannot answer them. Any claims for instrumental (and therefore measurable) value in affecting quality of life is indeed “icing on the cake.” As scientists, we can measure the effects of believing in a particular system, such as the effects of following a religiously prescribed diet. In the end, as Weber states in “Science as a Vocation,” one of the basic expectations of scientists is that future generations of scientists will make new discoveries that will replace previous understandings (Weber, 1946). The core claims of

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religion are eternal and cannot be changed by scientific discoveries. For example, even though the Catholic Church has seen some of its beliefs change over time, especially since the Second Vatican Council, its core claim concerning Jesus’ death and resurrection is not subject to change depending on new research in either textual studies or archeology. This does not mean that in some way religious belief is inferior to scientific knowledge because of its claim of eternal truth; it is only different. A set of religious beliefs can provide a base for critiquing the technological innovations that emerge from scientific investigation. For example, many religious leaders have commented on the use of nuclear weapons. It is simply important to be able to distinguish between scientific knowledge, such as our understanding of atomic energy on the one hand and the moral and ethical systems, including religion, which assign values to such innovations, on the other. According to The Skeptics Dictionary (Carroll, 2002), “Science is concerned only with naturalistic explanations of empirical phenomena.” This definition excludes studies designed to measure the efficacy of prayer from the realm of science. Some proponents of the prayer studies use the weak explanation that they are looking for auras, or energy patterns or something similar. However, a more thoughtful discussion of the prayer studies by a trustee of one of the foundations supporting this line of inquiry gives another explanation. While acknowledging that a positive outcome from the studies is not conclusive evidence that God exists, he goes on to say that “… we have to examine, as objectively as we

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can, a whole range of experience–a multitude of diverse indications–whatever happens to be on offer [sic]. We have to ask: given the totality of the data presented to us by our experience of life, does it make better sense in the light of the God hypothesis? Does it all hang together better if we assume there is a God? If so, what kind of God are we dealing with?” (Stannard, 2000, pp. 36-37). In other words, the prayer experiments alone cannot prove the existence of God, but can be part of a large collection of data that allows us not only to know if God exists but what kind of God we are dealing with. The meaning of that second statement is not clear. Does it mean that we might be able to scientifically test for which religion (Judaism, Presbyterianism, Hinduism, etc.) is correct? If one accepts the assumption that the prayer experiment can test for the existence of God, why not take the research agenda a step further and determine which God is most effective at responding to prayers? The prayer study issue tells us less about beneficent (or not so beneficent) deities than it tells us about the lack of understanding of what constitutes scientific investigation. The use of methodologies created for scientific purposes (such as double blind studies) does not make an effort scientific. For those who have read Gould’s classic work The Mismeasure of Man (1981) it is clear how the use of numbers can obfuscate the question of whether a research project is actually scientific. Prayer studies belong with creationism and other pseudo-scientific approaches that have used scientific methods and ideas to try to justify religious belief. What makes the prayer studies unscientific is not the attempt to understand the role of prayer in human

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life. Attempts to understand the role of prayer in the lives of individuals and communities is a critical part of the scientific study of religion. We can also study the effect of prayer in terms of the way individuals and groups react to being prayed for (or being prayed against, as in prayers for the defeat of an enemy). An excellent example is the study of the prayer for healing in a synagogue where most of the members of the congregation are elderly (Glicksman, G., in press). When studies claim the ability to test the efficacy of prayer as a way of asking whether God answers prayers, we have crossed into an area that cannot be subject to scientific investigation, even if the method is also used in scientific research because the research does not base itself on a naturalistic explanation of the phenomena being observed. Implicit in some of the research on religion and aging is the idea that the supernatural component of religion is responsible for better health. It is certainly true that membership in certain groups can have a health effect. Whether the effect is positive or negative depends on the beliefs and behaviors of the group. For example, a recent article reported that physician psychoanalysts live longer than other physicians (Jeffery, 2001). Although psychoanalysis has been accused of functioning as a “religion,” it is not one. Nonetheless, membership in this group seems to have an effect on longevity. Although we will not delve into the possible reasons for this relationship, it does help demonstrate that membership in particular groups can have a health effect even if they are not organized around a supernatural belief.

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Conclusions What should be our agenda in further research on religion, health, and aging? There are several parts to the agenda. The items include both rethinking our theoretical assumptions and the way we conduct our research. First, we must understand living religious traditions. We cannot continue to treat religion as something that exists outside of specific, living expressions of faith. The highest expressions of spirituality in Judaism are not the same as in Catholicism, and we must understand these differences if we are to fully appreciate the lives of older persons. Second, we must reassess our assumptions about the ability to create scales and measures that can tap religiousness across religious traditions. Can we really identify beliefs and behaviors that are so universal that they accurately measure religiousness across all traditions? Third, we must reacquaint ourselves with the definition of science. We cannot become involved in the 21st century’s version of “counting the number of angels that can dance on the head of a pin.” Science is a meta-method, a way of explaining the causes of events in the natural world. Although science may seem boundless in the areas explored and the number of questions scientists ask, there are limits on the types of questions that can be answered. Some of those limits are set by the level of our current knowledge, and those limits will be broken in the future. Other limits are set by the nature of scientific inquiry, and so, some questions, such as the

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meaning of suffering, will always exist beyond the capability of science to explain. Fourth, we need to be able to study the effects, both positive and negative, of specific religious traditions. This means that we must remove the “sacred cow” aspect of the study of religion and aging. Finally, we need to rediscover the classical scientific study of religion. Weber, Durkheim, Freud and others still offer us the best opportunity to understand the role of religious belief in human affairs. A rediscovery of the classic works on religion will also help us put into perspective the attempt to use scientific methods for non-scientific purposes. We must also be careful about what we ask clinicians to do when it comes to religion in the clinical setting. Understanding the religious beliefs of patients and clients is an important goal because these beliefs underlie values and norms that will come to influence the way an older person responds to advice and requests from professionals. The religious values of the elder’s family can be as important. Except in certain specific circumstances, the involvement of a professional, whether social worker, physician, psychologist, nurse, etc., in the religious life of the patient can create a complex set of problems that would be difficult to resolve. We do recognize the fact that some patients want their physician to pray with them, and that this presents real challenges. If a physician does not believe in the power of prayer, can he or she still recommend it, if it seems

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that it would provide solace and comfort to the patient? On an individual level, it is as inappropriate for a physician to argue against religious belief as it is for the physician to encourage such belief. On a societal level, if health care professionals recommend prayer to the individual patient but do not attempt to deal with the root cause of many of the problems in the health care system (the lack of adequate care for the poor, the financial rewards for providing less that optimal care in some managed care systems), then those health care professionals are confirming the opinion of another classical theorist, Karl Marx, that religion is indeed the “opiate of the people.” In this case, however, that opiate is “by prescription.”2 Religion, in the Weberian sense, is at the heart of the human experience. How we understand the suffering around us defines us as human beings. For many, traditional religious systems such as Catholicism or Judaism can help make sense of a world that is often in turmoil. For some, non-theistic religious systems can also be a “mighty fortress,” providing comfort and meaning when facing life’s challenges. We owe it to our respondents, subjects, clients and patients to try to fully understand the meaning of their religious beliefs in their lives. Notes 1. For the purposes of this paper, we are using the term “religiousness” to mean the character of one’s religious belief. It is this domain that most scales of “religion” are attempting to measure. We selected this term because “religiosity” can sometime have a negative connotation, 152

and the term “spirituality” is often used to mean something different that what we mean here. 2. The observation that Marx’s opiate is now available by prescription was made by Dr. Willy DeCreamer, S.J. Professor (and Father). DeCreamer taught the sociology of religion for many years in the Department of Sociology at the University of Pennsylvania, and served on the author’s dissertation committee. References Ahlstrom, S.E. (1975). A religious history of the American people. Garden City, New York: Image Books. Carroll, R.T. (2002). Science. Skeptics dictionary. Retrieved March 12, 2002 from http://www.skepdic.com/science.html. Fetzer Institute (1999). Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging working group. Kalamazoo, MI: Fetzer Institute. Glicksman, A., & Koropeckyj-Cox, T. (1997). Gender, class, and the construction of Jewish identity among the American Jewish aged. In D. M. Gordis and D. P. Gray (Eds.), American Jewry: Portrait and prognosis (pp. 341-358). West Orange, NY: Behrman House and the Susan and David Wilstein Institute for Jewish Policy Studies. Glicksman, A. (2000). Style versus substance: The cross-cultural study of well being. In R.L. Rubinstein,

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M. Moss, & M.H. Kleban (Eds.), The many dimensions of aging (pp. 129-139). New York: Springer. Glicksman, A., & Van Haitsma, K. (2002). The social context of adaptation to traumatic events: Soviet Jews and the Holocaust. Journal of Clinical Geropsychology, 8, 227-237. Glicksman, G.G. (in press). It couldn’t hurt: An ethnographic study of a ritual for healing. In C. Messikomer, J. Swazey, & A. Glicksman (Eds.), Society and medicine: Explorations of their moral and spiritual dimensions. New Brunswick, NJ: Transaction Press. Gould, S.J. (1981). The mismeasure of man. New York: Norton and Company. Hashomer Hatzair, H. (1963). 50 years of Hashomer Hatzair. Inside back cover. New York: Author. Jeffery, E.H. (2001). The mortality of psychoanalysts. Journal of the American Psychoanalytic Association, 49, 103-111. Koenig, H.G., McCullough, M.E., & Larson D.B. (2001). Handbook of religion and health. New York: Oxford University Press. Pargament, K.I. (in press). The bitter and the sweet: An evaluation of the costs and benefits of religiousness. Psychological inquiry. Stannard, R. (2000). The prayer experiment. Second Opinion, 2, 26-37. Tzur, E. (1998). From moral rejection to armed resistance: The youth movement in the ghetto. In R. 154

Rohrlich (Ed.), Resisting the Holocaust (pp. 39-58). New York: Berg Press. Weber, M. (1992). The Protestant ethic and the spirit of capitalism. Translated by Talcott Parsons, introduction by Anthony Giddens. New York: Routledge Press. Weber, M. (1963). The sociology of religion. Translated by Ephraim Fischoff, introduction by Talcott Parsons. Boston: Beacon Press. Weber, M. (1946). Science as a vocation. In H. Gerth & C. W. Mills (Eds.), From Max Weber: Essays in sociology (pp. 129-156). New York: Oxford University Press. Yinger, J.M. (1970). The scientific study of religion. New York: Macmillan Publishing Company. Allen Glicksman is Director of Research and Evaluation at the Philadelphia Corporation for Aging. Address correspondence to: Allen Glicksman, PhD, Director of Research and Evaluation, Philadelphia Corporation for Aging, 642 North Broad Street, Philadelphia, PA 19130-3409 (E-mail: [email protected]). The author would like to acknowledge the help of two anonymous reviewers whose comments greatly strengthened the paper. He would also like to thank Dr. Gail G. Glicksman for her thoughtful reading of the manuscript. Finally, thanks to Ms. Judith Dickman for sharing a copy of “Socialism My Temple” that the author remembered seeing years ago but could not find.

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[Haworth co-indexing entry note]: “A Mighty Fortress Is Our Atheism: Defining the Nature of Religiousness in the Elderly.” Glicksman, Allen. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 1, 2002, pp. 69-83; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 69-83. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Practical Philosophies: Interpretations of Religion and Spirituality by African American and European American Elders Holly B. Nelson-Becker Summary. This study explored practical philosophies, religious and spiritual definitions articulated by 42 African American and 37 European American low-income community dwelling older adults in a convenience sample (N = 79). The European American group was predominantly Jewish (89%). The purpose of this research was to uncover how older adults view the role of religion and spirituality in their daily lives. Religion was described primarily as beliefs, while spirituality was primarily identified as a feeling in the heart. Neither interpretation was exclusive to one of the two domains. Unique descriptors of religion included heritage, basic principles, a way of thinking, and duty. Unique descriptors of spirituality included connection with God, relationships with other people, communication with nature, and choice. African Americans were less likely to make a distinction between the two concepts, while European American respondents were more likely to separate them. Results suggest that individual interpretations of religion and spirituality are an indicator of their value to older adults. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website:

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© 2003 Haworth Press, Inc. All rights reserved.]

by

The

Keywords. Low-income older adults spirituality definitions religion definitions African Americans Jewish older persons In the last decade, mental health professionals have become increasingly aware of the powerful effects religion and spirituality may have in the lives of older adults (Levin, 1988; Koenig, 1994; McFadden & Gerl, 1990; Pargament, 1997). These domains are important to many older adults and have provided meaning and purpose in difficult life circumstances. Their minimization or neglect in the standard assessment process of clinical practice may result in the omission of a potentially important source of aid, support, or comfort. Exploring the various ways that older adults think about both religion and spirituality is a useful beginning task in understanding how each dimension may be expressed in their lives. Religion and spirituality have many meanings. Some are personal, such as forming a relationship with a transcendent power. Others are social, such as giving or receiving support in the context of a religious fellowship. Just as there are different types of intelligence and learning styles (Gardner, 1993), individuals respond differently to components of religion and spirituality. Although value is often appraised positively, religion too may hold bitter kernels of social disapprobation (Spilka,

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1986) where an elder may have experienced lack of communal acceptance or where rigid interpretations of sacred texts may have been the source of guilt or shame. Still other meanings are infused through the deep background of explicit and implicit sanctions of a culture historically influenced by Judaism and Christianity. Beliefs about religion and spirituality are thus shaped by individual attributes, by life experience and personal problem-solving history, and by the larger societal context in which one matures. A study by Zinnbauer et al. (1997) considered the ways individuals characterize themselves in regard to spirituality and religion as well as how they define the terms “religiousness” and “spirituality.” They found that the terms appear to describe different concepts but have some overlap. Though they interviewed 346 individuals in eleven different groups, response rates varied from 25% in a “New Age” group to 98% in a Christian liberal arts college. Low response rates limited some analyses in their convenience sample, but the authors suggested that considering the system of beliefs and worldviews was necessary to accurately measure religiousness and spirituality. Polling and Miller (1995) define practical theology as a “critical and constructive reflection within a living community about human experience and interaction, involving a correlation of the [religious] story and other perspectives, leading to an interpretation of meaning and value, resulting in everyday guidelines and skills …” (p. 62). One task of a practical theological approach is to

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correlate interpreted theory of a religious philosophy with the interpreted theory of the contemporary situation (Browning, 1991). Spiritual philosophies may be more salient for individuals who have not chosen religious pathways. The concept of a practical philosophy may incorporate both. A practical philosophy is a system of fundamental or motivating principles, a basis of action or belief that serves a useful purpose. Practical philosophies are thus personal viewpoints or beliefs that affect behavior and emotion. This search to uncover the meanings of religion and spirituality highlights the relationship of faith or belief to the empirical challenges of ordinary living. The significance and interpretations two groups of diverse community dwelling elders (European American and African American) ascribe to religion and spirituality in their daily lives is the focus of this paper. Definitions of Religion and Spirituality Spirituality is a term that is gaining popularity in societal discourse. Reviews of literature in the disciplines of social work, psychology, psychiatry, and medicine indicate that investigators have renewed interest in this topic (Canda, 1998; Canda & Furman, 1999; Carroll, 1998; Jackson, Chatters & Taylor, 1993; Koenig et al., 1995; McFadden & Gerl, 1990). Many younger and middle-aged adults have sought alternatives to the structure of institutionalized religion. Spirituality has offered one alternative. Is spirituality a concept that also holds meaning for older adults who have been grounded in religious traditions?

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Ideas about what constitutes religion and what then distinguishes spirituality from religion are very diverse. Sociologist Peter Berger has argued that religion can be defined substantively as the beliefs, practices, and ethical values associated with a particular religious tradition. He also delineates a functional definition, as in the ways religion serves as a mediator of experience and to meet needs (Berger, 1974). Religion has been defined as feelings and emotions toward the divine (James, 1902) and a system of powerful symbols (Bellah, 1970). Pargament (1997) calls religion a “process, a search for significance in ways related to the sacred” (p. 34). All of these definitions capture some truth about the nature of religion, but language appears insufficient to capture the complete essence. Spirituality, like religion, encompasses that which is regarded as sacred. In the social work literature spirituality has been defined as connections with a power, purpose, or idea that transcends the self (Canda, 1988; Joseph, 1988). Some individuals distinguish spirituality as the personal search for meaning that may lie outside of religion, while religion is associated with institutionalized belief and behaviors or rituals. Carroll (1998) proposes a distinction between possible key interpretations centered in the word spirituality. It may be but one dimension among the biological, psychological, and social spheres of being or it may be viewed conversely as the core of the person. Spirituality may be perceived as a subset of religion or it may be the overarching dimension that includes religion as one expression among many others. For the purpose of this study, I wanted to discover the meaning for participants

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rather than impose a definition or meaning, so I did not share these definitions, but asked them for their own perception. Method Sample This study used a convenience sample of 79 low-income coramunity-dwelling older adults. Thirty-seven individuals participated from two predominantly Jewish European American sites and 42 from two African American sites. Eighty-nine percent of the European American sites was Jewish and 11% represented other ethnic backgrounds. The four sites were nearly racially segregated: one respondent in the African American sites was Jewish and one respondent in the European American sites was African American. Most respondents were women (66) with 13 men, evenly distributed across sites. Ages ranged from 58-92, with a median age of 78. Median educational level was 12 years. Ninety percent of the entire sample earned less than $15,000 per year at the time of the interview. Ten percent of European American participants earned more than $15,000 per year while none of the African American respondents exceeded that level. Patterns in synagogue/church attendance varied. Eight percent of European American respondents attended synagogue/church weekly or more while 50% of African Americans attended religious activities weekly or more. Fifty-four percent of European American respondents never attended synagogue/church; 17% of African Americans never attended church. Religious affiliation

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of the total sample included 16% Baptist and 24% Jews who attended synagogue. Twelve denominations were represented, including African Methodist Episcopal (AME), Catholic, and Buddhist. Procedures The interviews were part of a larger study about life challenge and responses of older adults. Interviews commenced with an open-ended question to distinguish life challenges faced and to determine if religious or spiritual coping mechanisms were identified. A similar technique had been used previously by Koenig et al. (1995), who asked a sample of veterans how they coped with stress. Questions were administered orally and interviews ranged in length from one to two-and-one-half hours. Participants in the study were asked demographic questions that included religious affiliation and frequency of church attendance. They were asked to define religion, the perceived importance of religion, and the extent to which it was used in their own life to help solve problems. The same questions were asked about spirituality as well as whether there is a distinction between religion and spirituality. Scores on standardized measures, the Geriatric Depression Scale and the Life Satisfactions Index, were also assessed (Nelson-Becker, 1999). Data were reconstructed into categories as emerging patterns developed using constant comparative analysis in the grounded theory approach of Glaser and Strauss (1967). Results

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Self-Descriptors About Religion and Spirituality In response to the question, “In your own life, to what extent is religion important?”, 87% of older adult participants endorsed the importance of religion and another 78% endorsed the importance of spirituality (see Table 1). Nineteen percent of the total sample placed themselves solely in the religious or spiritual category. The designation spiritual-only captured 5% of European Americans and no African Americans. Thus, European Americans (predominantly Jewish in this sample) may have a more differentiated definitional concept of religion and spirituality, reflected by the broader range in which they characterize the importance of these terms. When asked if there was a difference between the concepts of religion and spirituality, 46% of these older adults affirmed that they were distinct. The remainder of this paper will explore distinctions and similarities understood by these groups. Table 1. Participant Ratings of the Importance of Religion and Spirituality in Their Lives

What Is Religion? Table 2 lists a summary of older adult responses to the question, “What is religion?” Items noted were also offered in response to the question seeking to elicit

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interpretations of spirituality. The number in parentheses is the number of respondents who offered a similar response for spirituality and signifies a lack of distinction between the two terms. Table 2. Participant Descriptions of Religion

a

This item was also identified in response to the question, “What is spirituality?” The number in parentheses is the number of responses.bRounding error. Belief. Many participants (38%) described religion in relation to belief. One African American respondent addressed the issue like this: I suppose believing in basic principles that develop your heart, mind, soul and body. Religion is something you believe in strongly and get satisfaction out of practicing. That’s about as deep as I can go. I believe there are so many different faiths and I get something out of all of them that I have intertwined with … I don’t believe there 165

is any perfect one. If you believe in something, it helps give you satisfaction. You treat people better. You have peace within yourself and peace and harmony among people. The importance of religion for this respondent was the personal outcome, the response one makes. If believing gives one satisfaction, then it serves a vital purpose in creating a feeling of peace. Inner processes. Other respondents (18%) identified religion as enriching one’s inner self. Not necessarily expressed in public institutional affiliation, religion has the capacity to draw one inward to private consciousness. “Religion is something that comes from your own soul that has nothing to do with Bibles and temples and magnificent churches,” asserted one European American woman. Religion for her was a manifestation of the world of inner experience more than any outward physical structure. An African American respondent expressed her view, “You ask for God’s help and he will be there to help you.” A second African American respondent maintained, “You’ve got to believe in something that is greater than man [sic]. That I know is God.” Belief functioned as her sextant, a device that allowed her to find her position relative to the stars at times when earth, sea, and sky threaten to implode in the face of nearly overpowering problems. Religion is thus both inner process and transcendent connection. Responsible action and moral code. Monitoring one’s own actions to be consistent with religious belief was

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also articulated. Some participants discussed times when responsible action meant placing the needs of others ahead of their own, as in caregiving for a spouse or other family member. “Religion is a way of life,” declared one European American participant. “Religion is being a good person and being good to others as much as you can.” An African American suggested, “I think you are not put here on earth for yourself–you are here to help other people.” Religion is thus linked to a sense of life purpose that can only be achieved in community living. The rules espoused by many religions are the glue that ties society together for other respondents. Religion represents a moral code or guide that one can return to. “Religion is just a set of God’s laws that we live by, that we must live by–by morality. We must have religion in our lives. God’s laws for us, living our lives as decent people, good people.” For this European American man, there was a sense that society is under God’s order, whether people acknowledge that or not. Religion is the formal process whereby one learns what God’s order may be. Negative influences of religion. Some respondents denoted myth-like qualities to religion. Two African American individuals highlighted their sense that the reality religion teaches is a different reality than the one they experience in their own lives. Religion was seen as a “make-believe story that anybody can write” or a “con game … but a good con game.” In the attempt to provide comfort for those who espouse religious faith, religion may lead individuals to misplace trust. That can have positive outcomes if they feel good about themselves and

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their life meaning, negative outcomes if it keeps them from fulfilling their potential. A European American respondent emphasized the historical capacity of religious faith to create barriers between groups: In the name of religion, more people have been killed than in any other cause on the face of the earth. It’s an excuse for money, power, and to keep people mollified. I do not believe in any omnipotent being. I never will. It’s all right here. Make the best of it. This respondent deplored the power of the institution to harm others when used for personal aggrandizement. She also questioned religion as a force leading people to focus on promises of a better future rather than to live fully in the present. What Is Spirituality? Although most respondents had an understanding about the place religion personally held for them, spirituality was a more difficult concept to articulate. Many elders were steeped in a religious context that sent roots deep into society’s ground. Spirituality has not been equally present in landmarks for these older adults. “I don’t know what spirit is; religion was built into me from day one,” puzzles one European American woman. Table 3 represents responses to the question, “What is spirituality?” Table 3. Participant Descriptions of Spirituality

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a

This item was also identified in response to the question, “What is religion?” The number in parentheses is the number of responses. By far, the largest percentage of respondents (28%) thought this question was too difficult. They were unfamiliar with the term, it had no relevance in their daily experience, or they were at a loss to form a description. But for a few, faith traditions had provided a framework in which to recognize spiritual benefits. One Russian Jewish immigrant rediscovered her religious and spiritual faith when she searched for her genealogical heritage as she waited seven years to emigrate. “It is my soul,” was her eloquent explanation. An African American woman explained that spirituality touches the emotions and “comes from the heart.” Some older adults were quite clear that spirituality was an area distinct from religion: “Spirituality is embedded in your being. You feel this way. It’s good for you. But I see other people practicing a religion that is expected by society. What some people call religion is society.” This 169

is a similar distinction to one often made in social work between spirituality and religion (Carroll, 1998). Spirituality is viewed by Carroll as all encompassing, a capacity possessed by all that may or may not produce behavioral expression; religion is a subset of this expressed through institutional and community connections. An African American respondent who also was a minister in a store front church gently taught, “Religion is a big word; spirituality is something within. As you know we’re made up of three parts: spirit, soul, and body. The body is the outer appearance; the temple of God is within you.” Speaking out of her ministerial role, she clarified that spirituality strikes to the heart in ways religion may not. Spirituality as relationship with a personal deity. Spirituality is often linked by respondents to inward being and developing a relationship with a personal deity. A frequent response was that spirituality is a feeling inside (18%), something each person recognizes or chooses not to recognize in his/her own manner. Spirituality is what you think in your mind and the way you think. We each one of us come along with a different spirit and a different life. I can’t get angry at you because you believe in this religion and I believe in that one. There is but one God. We have to turn around and say, Hey, ain’t but one God so we all got to depend on Him because He’s the one who’s made this world and made it so beautiful for us to live in. Some mornings I get up and look out

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there with all those beautiful colors. Man didn’t do that. God did it. So we’ve got to be thankful. Maybe I might not be thankful this morning, but I’ve got to get to it this afternoon. This African American respondent chose to be thankful even when her own physical condition was difficult. She suffered from debilitating pain at times, yet chose to look past this to find soul-restoring beauty in her environment. Spirituality for her was interpreted as a connection with God, a connection she found within. Spirituality as belief. As with religion, spirituality is identified with belief by some respondents. “Spirituality is a teaching, a learning, a self-feeling, your beliefs,” contributed an African American woman. “Spirituality is how you express what you believe in,” adds another. “Spirituality is belief in God and doing what you can,” contributes a European American male. Spirituality as relationship with nature and other people. Spirituality was recognized not only in connections with a transcendent force but also in connections with humanity and nature. A European American respondent considered spirituality to carry a significance that for her religion did not. This woman was a concentration camp survivor who had emigrated many years ago from France. She credits her survival to having a friend who she supported and who in turn supported her. Afterwards, she found herself alone in society without a profession, her family murdered, her friends gone. She experienced penetrating alienation. She rejected the concept of a God who would allow the unspeakable

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horror of the camp, but she found profound grace in nature. Spirituality is more being in touch with nature, the soul, the better part of a human being. Being whole and not necessarily having a religious belief, being in tune with nature. Nature gives me a lift. What I see out my window [Lake Michigan] gives me a sense of eternity and my place in it. This respondent valued connections with nature above all else. It is in the realm of nature that she perceived a peace that had been absent from the other markings of her life. The connections she made with other people and with nature provided her a concrete understanding of spirituality. Spirituality as choice. It is the freedom to live one’s life in a way that adds meaning, which may not be the way a neighbor might choose. It is individual expression. Each one of us feels something spiritual and there have been times that I’ve felt something was guiding me in making these choices; why I turned left instead of right. The Jewish joke if Moses had turned left instead of right we’d have got the oil, the Arabs would have got the sand. So we make choices. That’s what I consider spirituality. Spirituality is above all else the freedom to search for, configure, and express one’s own self. This is not done alone, but through relationships with friends, family, nature, or God. The transcendent quality of individuals gives them the ability to respond to both crises and 172

chronic challenges with wisdom deeper than most ordinary living confers. Summary Although there were distinctions, there was also considerable overlap between definitions of religion and spirituality for these study participants. Religion and spirituality were both described as belief, a feeling in the heart, and how one acts or lives. Some individuals may view religion as the larger domain encompassing spirituality (a larger circle surrounding a smaller circle), while others may view this in the opposite way with spirituality the larger circle encompassing religion. Still others, especially those who rated religion or spirituality–only as important, view these concepts as two non-intersecting circles of equal size. Discussion Limitations This sample provided some interesting findings about the ways older adults conceptualize religion and spirituality, but it would be inappropriate to generalize these findings because this sample is limited by race, ethnicity, and denominations represented. Even within the European American and African American groups, saturation may not have been attained. There is no way of knowing how representative a convenience sample is, but even for a low-income community-dwelling sample, there are likely to be absent perspectives. Another problem occurred in the data collection procedure. When older adults were asked to provide a

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definition of religion, they were not aware they would be asked separately about spirituality. Had this distinction been made earlier in the interview with respondents, it is possible that the duplication of responses in definitions of religion and spirituality would have been smaller. It is clear that question order may have influenced responses. By asking about religious definitions first in this set of questions, individuals were primed to think about all of the meanings in the term religion, of which spirituality may be one. A third issue is that some of the open-ended questions were abstract and difficult to answer. Had similar questions about the definition (meaning) of religion and spirituality been posed later in the interview or in a second follow-up interview, respondents may have responded in a different way. A second interview would have provided an opportunity to validate individual responses, provide a member check of the first account, and thus strengthen overall trustworthiness of the study. Trustworthiness is important to establish in qualitative studies for credibility. Prolonged engagement with respondents and remaining as a presence in the context over two months at each general location helped to confirm this. Triangulation with multiple sources (friends, family) would have provided additional trustworthiness. Interview notes, audiotapes, and a journal provided an audit trail. Implications Religion and spirituality evoked strong feelings, images, and ideas in the minds of many older adults who

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participated in this study. Some definitions were woven together with the ways religion and spirituality served as daily tools for coping. If this is the case with this small sample, then it is clear that spiritual and religious assessment questions should be addressed routinely in clinical conversations with older adults. Personal religious traditions and rituals should be explored as well as how religion or spirituality may be engaged to offer support. Practical philosophies develop largely because they work; they are effective in meeting a need or purpose. These same practical philosophies then may suggest strengths that older adults can summon in meeting life challenges. Conclusions This portion of a dissertation study was an investigation of how older adults think about religion and spirituality, and it explored the roles these spheres play in their lives. This research sought to build a thick description of these terms. Spirituality clearly is a concept that holds meaning for some older adults as does religion. The definitions illustrated for religion and spirituality point to the practical functions they serve. Older adults consider religion to provide peace of mind and rules for living. They also view it as belief, something within, faith, and heritage. Spirituality is a feeling in the heart, being connected to God, and managing relationships with others. While these somewhat philosophical questions could have been difficult to answer, people interpreted them within the lens of their daily life. They located experiences they had

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managed–ways they had thought, felt, and acted– and used these to understand religion and spirituality. Zinnbauer et al. (1997) found that for their overall sample, self-rated spirituality was higher than self-rated religiousness among all 11 groups except for conservative Catholics. Even their nursing home resident group (N = 20) showed a higher rating of spirituality. In the current study of a relatively healthy sample of older adults in independent living, religion was rated as important more often than spirituality. If one can assume that a high percentage of Zinnbauer et al.’s 20 nursing home residents were older adults, then the findings here are quite different. Zinnbauer et al.’s (1997) definitional content categories were not shown by group, so the data are difficult to compare. However, across their overall sample, personal belief was the most often mentioned definition of religion as it was here. Spirituality was described as feeling or experience of connectedness/relationship with God/Higher Power and equally often as personal beliefs. In the current study, a feeling inside or in the heart was most often cited, followed by connection with God, and thirdly beliefs. The findings of this older adult study support the content analysis categories developed by Zinnbauer et al. and suggest that primary definitions of religion and spirituality may be stable across some groups. In this research, African Americans, for whom the church has served a powerful historical and social role, viewed religion as a part of the rhythm of life. Definitions of religion were easily accessible and were

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discussed with personal examples. For European Americans, religion was viewed in complex and sometimes conflicting ways. For both groups, spirituality was not always easy to describe. It may be that for this older adult cohort raised in a culture politically and socially influenced by religion and spirituality, these domains may be more integrated into the texture of life than for future older adult cohorts whose ventures into understanding religion and spirituality will be more difficult to categorize. Future research may answer this question. For now, it is certain that religion and spirituality are not seen as passive approaches to life, but rather as active responses, freely chosen, which provide meaning and purpose to many. References Bellah, R.N. (1970). Beyond belief: Essays on religion in a post-traditional world. New York: Harper & Row. Berger, P. L. (1974). Some second thoughts on substantive versus functional definitions of religion. Journal for the Scientific Study of Religion, 13, 125-133. Browning, D.S. (1991). A fundamental practical theology: Descriptive and strategic proposals. Minneapolis: Fortress Press. Canda, E.R. (Ed.). (1998). Spirituality in social work: New directions. NY: The Haworth Pastoral Press. Canda, E. R. (1988). Conceptualizing spirituality for social work: Insights from diverse perspectives. Social Thought, 14, 30-46.

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Canda, E. R., & Furman, L. D. (1999). Spiritual diversity in social work practice. New York: Free Press. Carroll, M. M. (1998). Social work’s conceptualization of spirituality. Social Thought, 18, 1-13. Gardner, H. (1993). Multiple intelligences: The theory in practice. New York: Basic Books. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter. Jackson, J. S., Chatters, L. M., & Taylor, R. J. (1993). Aging in Black America. Newbury Park, CA: Sage Publications. James, W. (1902). The varieties of religious experience: A study in human nature. New York: Modem Library. Joseph, M. V. (1988). Religion and social work practice. Social Casework, 69, 443-452. Koenig, H.G. (1994). Aging and God: Spiritual pathways to mental health in midlife and later years. New York: The Haworth Press, Inc. Koenig, H.G., Cohen, H.J., Blazer, D.G., Kudler, H.S., Krishnan, K.R., & Sibert, T.E. (1995). Religious coping and cognitive symptoms of depression in elderly medical patients. Psychosomatics, 36, 369-375. Levin, J.S. (1988). Religious factors in aging, adjustment and health: A theoretical overview. Journal of Religion and Aging, 4, 133-146.

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McFadden, S.H., & Gerl, R.R. (1990). Approaches to understanding spirituality in the second half of life. Generations, 14, 35-38. Nelson-Becker, H. B. (1999). Spiritual and religious problem solving in older adults: Mechanisms for managing life challenge (Doctoral Dissertation, The University of Chicago, 1999). Dissertation Abstracts International, 60 (08), 3138. Pargament, K. (1997). The psychology of religion and coping. New York: The Guilford Press. Polling, J.N., & Miller, T.C. (1995). Foundations for a practical theology of ministry. Nashville: Abingdon Press. Spilka, B. (1986). Spiritual issues: Do they belong in psychological practice? Yes-But! Psychotherapy in Private Practice, 4, 93-100. Zinnbauer, G.J., Pargament, K.I., Cole, B., Rye, M.S., Butter, E.M., Belavich, T.G., Hip, K.M., Scott, A.B., & Kadar, J.L. (1997). Religion and spirituality: Unfuzzying the fuzzy. Journal for the Scientific Study of Religion, 36, 349-365. Holly B. Nelson-Becker is affiliated with The School of Social Welfare, University of Kansas. Address correspondence to: Holly B. Nelson-Becker, The School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS 66044 (E-mail: [email protected]).

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The author wishes to acknowledge the Council for Jewish Elders (CJE) for permission to interview residents in supported housing and the reviewers of this article for their helpful comments. These results were presented at the 2001 Annual Meeting of the Gerontological Society in Chicago, IL. They were part of a larger dissertation study completed in 1999. [Haworth co-indexing entry note]: “Practical Philosophies: Interpretations of Religion and Spirituality by African American and European American Elders.” Nelson-Becker, Holly B. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 85-99; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 85-99. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Part II Approaches to the Definitional Dilemma

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Dwelling and Seeking in Late Adulthood: The Psychosocial Implications of Two Types of Religious Orientation Paul Wink Summary. This article summarizes quantitative findings and presents two illustrative case studies showing how religious dwelling and spiritual seeking evolve over the adult life course and relate to psychosocial functioning in late adulthood. The data come from the Institute of Human Development (IHD) longitudinal study of men and women. Religious dwellers tend to emphasize traditional forms of religious behavior whereas spiritual seekers emphasize innovative religious practices. In the IHD study, the religious involvement of the dwellers tended to be highly stable over the life course whereas spirituality gained in salience in the second half of adulthood. In late adulthood, religious dwelling was associated with maintaining close and warm relations with others and communal involvement, and during times of adversity, religiousness served as a buffer against the loss of life satisfaction. Spiritual seeking was associated with an emphasis on personal growth, creativity, and acquiring new knowledge. Spiritual growth was particularly characteristic of introspective individuals who in early adulthood experienced stressful life events. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Website: © 2003 by The Haworth Press, Inc. All rights reserved] 182

Keywords. Religiousness spirituality longitudinal study religious development spiritual development generativity life satisfaction Over many generations, Americans have defined their relation to God in the context of organized religious institutional practices. Since the 1960s in the U.S., this pattern has changed as a result of the emergence of alternative ways of questing and the seeking of spiritual connection outside conventional places of worship (Marty, 1993). Consequently, while just a few decades ago it made little sense to differentiate between religiousness and spirituality, such a distinction has now become part of everyday discourse. Nonetheless, there is little consensus or clarity about the meaning of the two terms and their interrelation. For some, the quest for the sacred associated with spirituality is also the hallmark of religion and, therefore, spirituality becomes subsumed under a religiousness that emphasizes both personal and institutional concerns (Pargament, 1999). For others, spirituality refers to the universal human yearning for a sacred connection; an impulse that is much broader than any specific religious tradition or institution (Atchley, 2000). Once the concept of spirituality is broadened to include any kind of existential concern or striving for meaning, whether or not it is focused on the sacred, spirituality falls outside the domain of religion and thus yields two partially overlapping constructs (Stifoss-Hanssen, 1999). Among some sociologists, the emergence of a self-oriented spiritual seeking that is detached from other-oriented religious dwelling has raised concerns 183

about the growing narcissism in American culture that has the potential to undermine the fabric of social relations (e.g., Bellah, Madsen, Sullivan, Swidler, & Tipton, 1985). Many psychologists, on the other hand, have embraced spirituality with its emphasis on personal autonomy, self-growth, and feelings as well as its secular potential (e.g., Elkins, 1995), leading to a concern over polarization between the putatively “good,” dynamic, and individual spirituality versus the “bad,” static, institutional religiousness (Pargament, 1999). In any case, there appears to be very little consensus regarding the characteristics that distinguish religiousness and spirituality (Zinnbauer, Pargament, & Scott, 1999). There is no easy solution to the conceptual ambiguity in the relation between spirituality and religiousness largely because both terms have a multiplicity of meanings (Wulff, 1997). For example, the term spirituality applies equally aptly to a pious individual who expresses his or her devotion within the context of a traditional religious institution, a New Age individual who seeks a connection with a transcendent being by borrowing elements of Western and Eastern religions, and a person who is prone to mystical experiences. The nature of the relation between spirituality and religiousness obviously shifts depending on the definition of spirituality under consideration. In our research, we have conceptualized religiousness and spirituality as two distinct albeit partially overlapping religious types or orientations (e.g., Dillon & Wink, in press-a). In mapping this typology we have drawn on the sociological research of Robert

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Wuthnow (1998) and Wade Clark Roof (1999) and the psychological theories of Erich Fromm (1950; 1976). Robert Wuthnow (1998) has distinguished between religious dwellers whose relation to the sacred is mediated by traditional forms of religious authority, and spiritual seekers for whom individual autonomy appears to take precedence over external authority. In other words, the dwellers find it comforting to inhabit a space that is created for them by established religious institutions and one that is steeped in centuries of tradition. In contrast, the seekers are explorers who are most comfortable in occupying a space that is largely of their own creation although the materials used to construct and demarcate this space are typically borrowed from various existing religious traditions. Whereas dwellers are concerned about the freedom to exercise individual conscience within the framework of an established organized religious institution (e.g., Dillon, 1999), seekers place an emphasis on the freedom to choose among the various religious strands that span Western and Eastern traditions. Unlike religious dwellers, spiritual seekers place a greater emphasis on personal growth and healing, emotional self-fulfillment, and finding the sacred in everyday life (e.g., Moore, 1992). Wuthnow (1998) offers the concept of a “practice” oriented spirituality as a way of insuring that spiritual seeking preserves the discipline and commitment associated with traditional forms of religiousness. While Roof (1999) endorses Wuthnow’s distinction between dwelling and seeking, his study of aging baby boomers’

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spirituality has focused more on showing how the expansion of the American “spiritual market-place” has resulted in the proliferation of different religious orientations among middle aged Americans. Roof thus appears to conceive of dwelling and seeking as parallel types of religious involvement rather than seeing spirituality as a cultural successor to traditional religiousness. Following Roof, we argue that dwelling and seeking are two equally valid and partially overlapping ways of being religious. The boundaries between the two constructs, however, are not clear-cut. As argued by Zinnbauer et al. (1999), seeking a personal relation with the divine does not occur in a vacuum. Many seekers embark on their spiritual quest using tools, techniques, and practices derived from traditional religious frameworks and their journey frequently takes place within the confines of organized religious institutions (e.g., Roof, 1999). Conversely, individuals who choose to stay within an established religious tradition may do so reflexively and with a critical selectivity (Dillon, 1999) and may prize the opportunity to grow and mature in faith (Batson, Schoenrade, & Ventis, 1993). Similarly, many members of the evangelical movement discuss their faith in highly personal terms, yet they also tend to emphasize a literal interpretation of the Bible and endorse traditional religious values and beliefs (Roof, 1999). Clearly, therefore, religiousness and spirituality are overlapping and interrelated rather than polarized constructs. To adapt a metaphor offered by Anne Patrick (1999), dwelling and seeking are like two rivers flowing in the same fertile valley. Each has many tributaries,

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several of which feed water into both rivers, indicating the complex ecology of the religious landscape. A distinction between two types of religious orientation based on dwelling and seeking is not new. As early as 1950, Erich Fromm argued for a differentiation between authoritarian and humanistic religion based on whether an individual’s faith involved embracing religious teachings offered by traditional religious institutions or whether the faith was derived from the individual’s subjective experiences and was the result of a process of self-creation. Subsequently, Fromm (1976) reformulated this distinction in terms of having faith and being in faith. Although Fromm’s views were in many ways prophetic, it is unfortunate that the labels he chose to denote the two types of religious orientation (authoritarian and humanistic) are clearly evaluative in tone and reflect a bias in psychology against tradition, conventionality, and dwelling in favor of innovation, unconventionality, and seeking. Human society, however, needs both conservers and creators in order to preserve equilibrium between stability and growth. Both dwelling and seeking can result in a deep sense of connection with the sacred and a vital involvement in life, although, as we shall show, the nature of this connection and involvement differs for the two types. The aim of this article is to present evidence supporting the analytical and practical usefulness of conceptualizing religiousness and spirituality in terms of dwelling and seeking. I will first summarize findings from my recent collaborative research on how religious dwelling and

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spiritual seeking change over the adult life course and how they related to psychosocial functioning in late adulthood (Dillon & Wink, in press-a, in-press-b; Wink & Dillon, 2001, 2002, under review), and then present two case studies of individual lives to elaborate the pattern of quantitative findings. Sample The sample consists of 185 men and women (over 90% of the available sample) who were born in either Berkeley or Oakland, California in the 1920s and who are members of the Institute of Human Development (IHD) longitudinal study. The participants were studied intensively in childhood and adolescence and interviewed four times in adulthood: in early (age 30s), middle (age 40s), late middle (late 50s/early 60s), and late (age 70s) adulthood. Most of the participants were White and Christian: 75% were raised as Protestants and 16% were raised Catholic, while 59% of the participants (or their spouses) were upper middle class professionals or executives, 19% were lower middle class, and 22% were working class. In late adulthood, the majority of the participants was in good physical health (89%) and living with their spouse or partner (71%). The median household income was $55,000. See Clausen (1993) and Wink and Dillon (2002) for further description of the study. Measures of Religiousness and Spirituality Religiousness and spirituality were assessed reliably (all Kappas > .60) by two independent raters who used 5-point scales to rate the two constructs from a discrete

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section on religious and spiritual beliefs and practices in open ended interviews conducted with the participants in early, middle, late middle, and late adulthood. Following Wuthnow (1998) and Roof (1999), Religiousness was defined in terms of the importance of traditional or institutionalized religious beliefs and practices in the life of the individual. Highly religious individuals are those for whom belief in God and the afterlife and organized religion (e.g., church attendance) play a central role in life; they are dwellers whose religious practices and experiences are based on derived and habitual forms of religious behavior typically performed in a communal setting. Spirituality was defined in terms of the importance of non-traditional religious beliefs in the life of the individual. Highly spiritual individuals are those for whom a personal quest for a sense of connectedness with a sacred Other (e.g., a Divine Being or nature) plays a central role in life; they are seekers who engage in practices aimed at deriving meaning from, and nurturing a sense of interrelatedness with, a sacred Other. In the IHD sample, the average intercorrelation between the ratings of religiousness and spirituality across the four adult times of assessment was moderate (mean r = .34). Results Summary of Quantitative Findings Broad empirical trends pertaining to religiousness and spirituality for the IHD sample are highlighted in this section. The focus is on the life course trajectories of religiousness and spirituality and their patterns of association in late adulthood with generativity,

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involvement in everyday life tasks, and life satisfaction in times of adversity. Development over the life course. The IHD data showed considerable stability and predictability in the way religiousness unfolded over time. As a group, the IHD participants dropped by one fifth of a standard deviation in religiousness from early to middle adulthood, reflecting perhaps the historical decline in religiousness from the 1950s to the 1970s and/or the fact that with their children no longer at home they were less constrained by religious socialization pressures (Wink & Dillon, 2001; Dillon & Wink, in press-a). Nonetheless, the study participants subsequently increased by one fifth of a standard deviation in religiousness from middle to late adulthood, a pattern that may be a function of the diminution in social roles coinciding with the postretirement period. The overall level of religiousness in the sample remained consistently high with over 50% of the participants indicating in older adulthood that religion was either important or very important to them. Evidence showing a high level of rank order stability (correlation) between religiousness in early and late adulthood (mean r = .76) meant that participants who were more religious than their peers as young adults tended to remain so as older adults (Wink & Dillon, 2001). In other words, after the age of 30, relatively few of the study participants experienced either a sudden decline in religiousness or a newfound faith, although there were some exceptions. By contrast with religiousness, spirituality showed a very different pattern of development, tending to have

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prominence in the lives of the IHD participants only from midlife onwards (Wink & Dillon, 2002a). This trend may reflect adult maturational processes (McFadden, 1999), or the impact in individual lives of the cultural changes of post 1960s America (Roof, 1999), or may in fact be due to the interaction of maturational and cultural forces. The IHD participants as a group increased in spirituality by almost two thirds of a standard deviation between middle adulthood (40s) and late adulthood (70s) (Wink & Dillon, 2002a). Unlike religiousness, spirituality showed a relatively low level of rank order stability throughout adulthood (mean r = .44) until the period between late middle (age 50s) and late adulthood (age 70s) (r = .64) (Wink & Dillon, 2002a). Since the IHD individuals showed considerable variability in their spiritual interests early on in adulthood, it begs the question of what are the significant longitudinal predictors of spirituality in late adulthood? Our research findings suggest that the modal spiritual older adult was a woman who in early adulthood was introspective and somewhat religiously involved, and who between early and middle adulthood experienced personally stressful life events (Wink & Dillon, 2002a). Influence on psychosocial functioning in late adulthood. Our research on the relation of religiousness and spirituality to psychosocial functioning in late adulthood has been guided by the premise that because religious dwelling places an emphasis on tradition and communal involvement, whereas spiritual seeking emphasizes self-expression, both orientations express two basic personality constellations characterized by other-versus self-directedness (Blatt & Shichman, 1983; Wink, 1991).

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As argued by Blatt and Shichman (1983), an other-directed individual’s chief concerns have to do with intimacy, giving and receiving, cooperation, and dependability. In contrast, self-directed persons place a greater stress on self-definition, identity, autonomy, and a critical appraisal of the world. As a result, although we expected that both would be associated with successful functioning in late adulthood, we also anticipated that religiousness and spirituality would be characterized by different dispositions toward the self and social participation. We investigated the relation between religiousness, spirituality, and generativity (defined by Erikson, 1963, as selfless concern for the welfare of future generations) using self-report (the Loyola Generativity Scale; McAdams & de St. Aubin, 1992) and observer-based (the CAQ, Generativity Scale; Peterson & Klohnen, 1995) measures of the construct (Dillon & Wink, in press-b). We found that both religiousness and spirituality were positively related to generativity in late adulthood. As anticipated, however, the generative concerns associated with religiousness showed a greater other-directed emphasis on giving and interpersonal care, whereas those related to spirituality were more strongly expressed in terms of a self-directed concern with having an impact on others and leaving a legacy that would outlive the self (Dillon & Wink, in press-b). Befitting an approach to religion that emphasizes dwelling over seeking, religiousness was positively associated with the Norm-Favoring scale of the California Psychological Inventory (CPI; Gough &

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Bradley, 1996), meaning that high scorers on religiousness tended, for example, to accept traditional rules of social conduct. Religiousness was also positively related to a measure of well being via positive relation with others (Ryff, 1989) and to scores on Harlow and Cantor’s (1996) measure of everyday involvement in social activities with family and friends and in community service (Wink & Dillon, under review). Befitting an approach to religion that emphasizes seeking over dwelling, spirituality was positively related to the CPI’s Self-Realization scale, meaning that highly spiritual individuals tended, for example, to emphasize the importance of self-actualization (Wink & Dillon, under review). Spirituality was also positively related to Ryff’s (1989) measure of well being via personal growth and to scores on Harlow and Cantor’s checklist of involvement in creative and knowledge building activities. Despite a focus on the self and personal growth, spirituality was not related to narcissism (measured using Wink and Gough’s (1990) CPI Narcissism scale) (Wink & Dillon, under review). Notwithstanding concerns, therefore, about the selfish and egocentric aspects of spirituality (e.g., Bellah et al., 1985), in late adulthood both religiousness and spirituality were associated with generativity and a purposeful engagement in everyday activities, what Erikson (1963) saw as hallmarks of successful aging. Moreover, the concurrent pattern of association between religiousness and measures of other directedness in late

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adulthood could be predicted equally well with measures of religiousness scored in early adulthood, a time interval of close to 40 years. The concurrent pattern of association between spirituality and self-directedness in late adulthood could be predicted from measures of spirituality from middle adulthood (a time interval of 15 years) but not before, reflecting perhaps the fact that, as indicated, spirituality was primarily a post mid life phenomenon in the IHD sample (Wink & Dillon, under review). Religiousness as a buffer against adversity. Because late adulthood accelerates the inevitable prospect of interpersonal losses and declining health, there is interest in knowing whether religiousness and spirituality buffer the individual’s self-esteem against adversity. We explored this question by investigating the interrelation between religious orientation, poor physical health, and life satisfaction for the study participants in late adulthood (age 70s) (Wink & Dillon, 2001). In the sample as a whole, we did not find a direct relation between religiousness and life satisfaction, measured with the Life Satisfaction Index (LSI) of Neugarten, Havighurst, and Tobin (1961); the correlation between the two constructs was close to zero. However, when we divided the IHD participants into four groups based on whether or not they had a serious chronic illness and whether or not they were high in religiousness, a more complicated pattern emerged. As expected, among individuals in good physical health variation on religiousness did not impact life satisfaction; both groups showed very high levels of satisfaction. Among individuals who had chronic physical problems,

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however, being religious did make a difference to life satisfaction. Whereas religious individuals in poor health did not differ in life satisfaction from healthy individuals, non-religious individuals who were in poor physical health were significantly lower in life satisfaction than the rest of the sample. The same pattern of results was obtained in longitudinal analyses substituting religious involvement scored in late middle (age 50s) rather than late adulthood (age 70s) (Wink & Dillon, 2001). Preliminary analyses indicated that spirituality does not have the same buffering effect as religiousness in times of ill health. If further substantiated, this finding suggests that whereas spirituality may increase in response to negative events (Wink & Dillon, 2002), it may not buffer against the experience of negative affect in the face of life’s adversities. It may be perhaps that highly spiritual individuals who are open to experience are freer to admit or explore feelings of personal distress than are religious individuals. In turn, the experience of these negative feelings may have the long-term benefit of stimulating personal growth. Dwelling and Seeking in Individual Lives This section presents two case studies from the IHD study exploring the relation between religiousness and spirituality. To assure that they were representative of our quantitative findings, the two cases were selected from among participants who scored above the sample mean on measures of generativity, life satisfaction, and a summary index of involvement in seven life tasks of everyday life. Whereas Anne1 received the highest

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possible score of 5 on religiousness and a low score on spirituality, Melissa received the highest possible score of five on spirituality and a low score on religiousness. Typical of the sample as a whole, both women come from an upper class background. Anne. Anne was born into a “seriously religious” Mormon family with a strong emphasis on family life and unity. When interviewed in her 30s, Anne recollected with great warmth the first seven years of her life playing with her sister and brother to whom she was close both emotionally and in age. Anne’s father was a successful accountant and devoted family man. Anne felt that she had a special relation with him based, in part, on their joint appreciation of classical music but marred somewhat by Anne’s relatively poor grades and lack of academic ambition. Anne’s mother was a serious scholar of Mormon scripture and an active church member who carried the weight of her children’s religious socialization. The main source of discomfort in the family, especially for the children, was that they lived with their grandmother, who was described by Anne as depressed and overtly critical of others. Adolescence was a more conflicted time for Anne whose budding sexuality posed a serious challenge to her internalized moral strictures. Although a regular church attendee and a member of a Mormon youth group, Anne’s interest in religion was somewhat superficial. For example, at age 17, although she expressed an interest in going on a mission after finishing high school, she seemed quite unaware of what this commitment actually entailed.

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Anne disappointed her father by completing only two years of college before taking a secretarial job at a brewing company, a position she held for six years. While at college, Anne became engaged to a young man with whom she had a very tempestuous, albeit platonic, relationship that oscillated between “spasms of ecstasy and despair.” Eventually Anne married Charles, a much more stable, down to earth, and mature young man who was also favored by Anne’s parents. Charles subsequently became a well-respected nuclear engineer, a lay leader in the Mormon Church, and a writer of books on near death experiences. Anne experienced some problems in adjusting to married life. She missed having space of her own, felt guilty over sex, and, after the birth of her son, was lonely for the company of her colleagues at work. After the birth of twin boys three years later, however, Anne’s sense of well being improved dramatically. With a new sense of confidence and poise, Anne became an active member of her congregation, leading a women’s church group, and canvassed for local politicians. While her four children were still living at home (she had a daughter several years after the twins), Anne and Charles became temporary foster parents to four children, a practice encouraged at the time by the Mormon Church. In 1977, Anne and her family moved to Utah where Anne continued her involvement in various social, communal, and religious activities. Reflecting her belief that “there is nothing more important than people” (Anne at age 54), Anne worked hard to maintain a good relationship with all of her four children and in her 60s

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was proud of the fact that her three daughters-in-law considered her to be their best friend. Anne and Charles set aside one day every year for a shared birthday celebration of their 15 grandchildren. As stated by Anne, one of her goals in life was to reciprocate toward others the love and compassion she experienced from her parents. When interviewed at the age of 68, Anne continued to express her commitment to maintaining positive relations with others. She had also developed an active outdoor sports life, enjoying skiing and biking. When asked about how she had changed as a person, Anne commented that she had become less selfish and had developed a broader view on life. She was thus able to accept her daughter’s premarital cohabitation even though it clearly contravened her religious ethics. Unlike in early adulthood, Anne’s behavior was no longer driven by rigid moral rules and feelings of guilt. Her religious outlook had broadened so that she was accepting of the validity of diverse religious beliefs, while her own deep belief in the afterlife, supported by her husband’s research on the phenomenology of near death experiences, was helping her to live her remaining years to the fullest. With her consistently high level of religious involvement, a strong emphasis on maintaining warm and close relations with others, communal involvement, and a concern for younger generations, Anne illustrates very well the life course trajectory and psychosocial correlates of religiousness. The only exceptional feature is that Anne did not experience the mid life decline in

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religiousness that was observed for the sample as a whole. The stability of Anne’s religiousness, however, should not obscure the fact that the character of her religious beliefs changed over time. Whereas her behavior as a young adult was largely governed by guilt and rather rigid moral rules, in late adulthood Anne had developed a more nuanced view of the sacred as highlighted by her increased tolerance. These qualitative changes in religiousness that are central to Fowler’s (1981) notion of progressive stages in faith development are not easily discernible, however, in behaviorally anchored measures of religion as such as, for example, frequency of church attendance. Melissa. Unlike Anne, Melissa did not have fond childhood memories. She describes growing up in a conflict-ridden family masked by a facade of social conformity, politeness, and good manners. Melissa’s father, who had a managerial position with a Bay Area public utility company, displaced many of his insecurities onto his daughter, who lived in fear of his anger and the threat of physical abuse. Melissa’s mother was controlling and critical, and negated her daughter’s need for independence, insisting, for example, that Melissa should never close her bedroom door. Melissa’s younger brother dealt with family conflict by siding with his parents, leaving Melissa as the family scapegoat. The family was not particularly religious. Melissa was baptized at the age of 8 or 9, but otherwise, did not attend church services. During each of the four adulthood interviews, Melissa’s memory of family life centered on a pivotal scene that

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occurred when she was in college: Coming back home after a date, she was locked out of the house by her mother who saw and disapproved of Melissa kissing her boyfriend good night. For Melissa this was the final episode in a long series of family betrayals, and following the incident, she married her boyfriend, Kevin, despite some serious misgivings. Not unexpectedly, the marriage turned out badly with her environmentalist husband lacking the capacity to create a nurturing environment for his wife and two children. When interviewed at age 30, the “rock bottom” in her adult life, Melissa was depressed, felt alienated from her husband and incapable of taking adequate care of her son and daughter. Following her realization that she was beginning to mistreat her daughter just as her mother had mistreated her, Melissa entered therapy, and thus began a slow journey of self-discovery and spiritual growth. After a long separation, Melissa divorced Kevin, who subsequently lost his job, squandered a substantial inheritance, and died destitute. Living on her own with two children, Melissa obtained credentials as an adult education teacher and was thus able to supplement her income from selling pottery by teaching art classes to children and adults. Melissa benefited considerably from psychotherapy as she developed insight into the feelings of passivity and lack of assertiveness that had contributed to her troubled interpersonal relations. After entering psychotherapy, Melissa started attending different Protestant churches, including a Unitarian one. Because “(organized) religion was such a social thing,” Melissa said she soon realized

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that it was largely irrelevant to her spiritual needs. In her 40s, she entertained the possibility of some kind of a living force but felt that its ways were unknown, and she seriously entertained the possibility of reincarnation. Melissa had a vision of the world as a total eco-system with all of its living organisms equally sacred; thus for Melissa, cutting down trees was an equally “irreligious” act as killing other living beings. By age 54, Melissa had found an outlet for her spiritual needs. She was attending meditation groups, getting involved in Jungian psychology, had embarked on Shamanic journeys, and was involved in a drumming circle. She has also attended an Indian Ashram, a small Zendo with a traditional Japanese monk, and the Episcopal Mission in the town where she currently lives. From the early 1970s onward she developed the habit of writing down her dreams and treating them like a “running commentary” on her life that tapped the archetypical forces within her psyche. Melissa’s spiritual journeys led her to have out-of-body experiences that were very similar to those reported by Anne’s husband, Charles, in his books on near death experiences. Similar to Anne, Melissa used these encounters as confirmations of life after death, heaven, and in Melissa’s case, reincarnation. When interviewed at age 68, Melissa was retired and lived a contented life on a four-acre coastal property she inherited from her parents. She maintained close relations with her adult children and continued to find satisfaction from doing senior peer counseling, square dancing, gardening, and giving financial support to

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environmental causes. Her artistic endeavors continued unabated although their focus had changed from ceramics to mosaics. She maintained her interest in finding out “what is true versus illusion” and used as her motto the phrase “consider possibilities, believe nothing.” Melissa interpreted this aphorism not as a sign of nihilism or of skepticism but as a reminder to keep an open mind and to try to experience different points of view. Before her father’s death in 1989, Melissa confronted him about his abusive behavior toward her. This profoundly cathartic experience allowed Melissa to integrate her childhood experiences as an inevitable part of her life cycle and thus successfully complete the process of life review (Butler, 1963). At age 68, Melissa’s only source of dissatisfaction was the absence of a romantic partner but she was hopeful that one day soon she would have a new companion in her life. In sum, Melissa illustrates well the nature of spirituality in late adulthood and how it differs from religiousness. Like other highly spiritual individuals, Melissa enjoyed creative activities, she had a strong interest in personal growth and self-realization, and constantly sought to expand her knowledge of the self and the world. Despite her emphasis on self-directedness, it is not the case that Melissa was uninterested in others; after all she maintained positive relations with her children, valued friendship, and participated in social functions. Rather, her interpretation of these activities and the meaning that she derived from them made her different from Anne.

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For example, in contrast to Anne’s concern for the welfare of the women in her church group, Melissa cared about the health of the global eco-system. While her work as a peer counselor was clearly driven by altruism, Melissa also used it as an opportunity to continue her own process of self-growth. Even Melissa’s propensity to see the sacred in everyday life had a certain air of reflection or premeditation. Nonetheless, Melissa crystallizes the ability of spiritual seekers to bring to fruition the quest of the medieval alchemists to convert base metal into gold-as argued by Carl Jung (1965), the search for spiritual rather than material riches had always been the true object of the alchemist’s quest. Conclusions Recent years have witnessed a growth of interest in the relation between religiousness and spirituality and their impact on functioning in late adulthood. Attempts to study the empirical relation between these two constructs have been hampered, however, by uncertainty about issues of definition and measurement. In our research, following Fromm (1950), Wuthnow, (1998), and Roof (1999), we have use the metaphors of dwelling and seeking to operationalize these two constructs and study their concurrent and longitudinal implications for psychosocial functioning in late adulthood. In doing so, we do not claim to have captured all the meanings or facets of religiousness or spirituality. Nonetheless, we found the distinction between traditional and non-traditional religious beliefs and practices useful in mapping two successful, yet quite distinct, ways of psychosocial functioning in late adulthood.

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On a theoretical level our findings enhance the understanding of the differences between religiousness and spirituality, and show the value of conceptualizing their implications for psychosocial functioning in terms of other- and self-directedness. The relative stability of religiousness over the life course supports the view of adulthood as a time of little personal change. Yet, the fact that spirituality gains in salience beginning with middle adulthood adds weight to the idea of older age as a time of growth in, and development of, characteristics that are distinct to this phase of the life cycle. Our findings also have practical implications for health professionals and gerontologists. It is important to know, for example, that in late adulthood highly religious individuals are likely to benefit more from having a strong social support network than are highly spiritual individuals. On the other hand, because of their interest in personal growth and introspection, highly spiritual individuals are likely to gain more from reviewing their lives than are individuals who are high on religiousness. Religiousness, but not spirituality, appears to act as a buffer against the loss of life satisfaction resulting from poor physical health. In contrast, only spirituality tends to grow in response to the experience of negative life events. Although different, it is clear that both religiousness and spirituality offer valuable resources for successful psychosocial functioning in older age. Note 1. All names in this section are pseudonyms. References 204

Atchley, R. C. (2000). Spirituality. In T. R. Cole, R. Kastenbaum, & R. E. Ray (Eds.), Handbook of the humanities and aging (2nd ed., pp. 324-341). New York: Springer. Batson, C. D., Schoenrade, P. A., & Ventis, W. (1993). Religion and the individual: A social psychological perspective. New York: Oxford Press. Bellah, R., Madsen, R., Sullivan, W., Swidler, A., & Tipton, S. (1985). Habits of the heart. Berkeley, CA: University of California Press. Blatt, S. J., & Shichman, S. (1983). Two primary configurations of psychopathology. Psychoanalysis and Contemporary Thought, 6, 187-254. Butler, R. N. (1963). The life review: An interpretation of reminiscence in the aged. Psychiatry, 26, 65-76. Clausen, J. (1993). American lives. New York: Free Press. Dillon, M. (1999). Catholic identity: Balancing reason, faith, and power. New York: Cambridge University Press. Dillon, M., & Wink, P. (in press-a). Religiousness, spirituality, and vital involvement in late adulthood. In M. Dillon (Ed.), Handbook of the sociology of religion. New York: Cambridge University Press. Dillon, M., & Wink, P. (in press-b). Religion, cultural change, and generativity in American society. In E. de St. Aubin, & D. P. McAdams (Eds.), The Generative

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Society. Washington, DC: American Psychological Association Press. Elkins, D. N. (1995). Psychotherapy and spirituality: Toward a theory of the soul. Journal of Humanistic Psychology, 35, 78-98. Erikson, E. H. (1963). Childhood and society (2nd ed). New York: Norton. Fowler, R. (1981). Stages of faith. San Francisco: Harper & Row. Fromm, E. (1950). Psychoanalysis and religion. New Haven, CT: Yale University Press. Fromm, E. (1976). To have or to he. New York: Harper & Row. Gough, H. G., & Bradley, P. (1996). CPI Manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press. Harlow, R., & Cantor, N. (1996). Still participating after all these years: A study of life task participation in later life. Journal of Personality and Social Psychology, 71, 1235-1249. Jung, C. G. (1965). Memories, dreams, and reflections. New York: Vintage Books. Marty, M. (1993). Where the energies go. Annals, ASPSS, 527, 11-26. McAdams, D. P., & de St. Aubin, E. (1992). A theory of generativity and its assessment through self-report, behavioral acts, and narrative themes in autobiography.

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Journal of Personality and Social Psychology, 62, 1003-1015. McFadden, S. H. (1999). Religion, personality, and aging: A life span perspective. Journal of Personality, 67, 1081-1104. Moore, T. (1992). Care of the soul. New York: HarperCollins. Neugarten, B. L., Havighurst, R. J., & Tobin, S. (1961). The measurement of life satisfaction. Journal of Gerontology, 16, 134-143. Pargament, K. I. (1999). The psychology of religion and spirituality? Yes and no. The International Journal for the Psychology of Religion, 9, 3-16. Patrick, A. (1999). Forum on American spirituality. Religion and American Culture, 9, 139-145. Peterson, W., & Klohnen, E. (1995). Realization of generativity in two samples of women at midlife. Psychology and Aging, 10, 20-29. Roof, W. C. (1999). Spiritual marketplace. Princeton, NJ: Princeton University Press. Ryff, C. (1989). Happiness is everything, or is it: Explorations on the meaning of psychological well being. Journal of Personality and Social Psychology, 57, 1069-1081. Stifoss-Hanssen, H. (1999). Religion and spirituality: What a European ear hears. The International Journal for the Psychology of Religion, 9, 25-33.

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Wink, P. (1991). Self- and object-directedness in adult women. Journal of Personality, 59, 769-791. Wink, P., & Dillon, M. (2001). Religious involvement and health outcomes in late adulthood: Findings from a longitudinal study. In T. Plante & A. Sherman (Eds.), Faith and health. New York: Guilford Press. Wink, P., & Dillon, M. (2002). Spiritual development across the adult life course: Findings from a longitudinal study. Journal of Adult Development, 9, 19-94. Wink, P., & Dillon, M. (under review). Religiousness, spirituality, and psychosocial functioning in late adulthood. Wulff, D. (1997). Psychology of Religion: Classic and contemporary. New York: Wiley. Wuthnow, R. (1998). After heaven. Berkeley, CA: University of California Press. Zinnbauer, B. J., Pargament, K. I., & Scott, A. B. (1999). The emerging meanings of religiousness and spirituality: Problems and prospects. Journal of Personality, 67, 889-919. Paul Wink is affiliated with the Department of Psychology, Wellesley College. Address correspondence to: Paul Wink, Department of Psychology, Wellesley College, Wellesley, MA 02481 (E-mail: [email protected]). The author would like to thank Michele Dillon and the two IHD participants featured in the case studies for their helpful comments. 208

The data from the IHD participants in late adulthood were collected with a grant from the Open Society Institute awarded to Paul Wink. [Haworth co-indexing entry note]: “Dwelling and Seeking in Late Adulthood: The Psychological Implications of Two Types of Religious Orientation.” Wink, Paul. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 101–117; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 101-117. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Widows’ Spiritual Journeys: Do They Quest? Edward H. Thompson, Jr. PhD Mary E. Noone, BA Amanda B. Guarino, BA Summary. Two studies examined the spiritual experiences of older women shortly after their husbands’ deaths. The central question was, in the process of becoming and being a widow, do the older women begin a reflective dialogue with existential questions and initiate spiritual journeys as recent widows? One study is based on the widows within a random sample of older adults. The second study involved in-depth interviews with 15 recent widows. Both studies included Batson’s measures of means, ends, and quest religious orientations. There was more evidence of an “ends” (intrinsic) orientation among the widows than “means” (extrinsic) for religious involvement; there was also no change over time in these orientations. Their quest orientation, however, became significantly less prevalent in the follow-up. It seems that women indeed quested, and by follow-up engaged their faith for religious consolation. Data from Study 2 revealed two themes: religious involvement provided a sense of continuity and direction, and through faith and prayer the women were able to (re)find meaning and purpose to life. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Website:

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© 2003 Haworth Press, Inc. All rights reseived.]

by

The

Keywords. Older women widows spirituality quest orientation religious coping religious consolation Researchers frequently report that older women are more religious than their brothers and husbands, no matter how religiosity is measured. Middle-aged and older women participate in religious ritual and private worship more often, profess more devout beliefs, espouse different religious motivations, testify that religious faith is connected to their everyday life activities, and identify more with “being religious” than do the men in their lives (cf. Batson, Schoenrade, & Ventis, 1993; Gallup & Lindsay, 2000; Levin, Taylor, & Chatters, 1994). As much as these patterns cue the importance of religious involvement in women’s lives, gender comparisons also homogenize women’s biographies and religious involvements and reveal only the aggregate. Although we know intuitively that there is great variation in women’s sense of spiritual integration and participation in religious life, that variation has not been thoroughly investigated. This article explores the spiritual journeys of women following the trauma of widowhood. The starting point is Helen Lopata’s studies of widowhood. Lopata (1979, 1996) reported that widows regularly manage the disconnection they experience by relying on their spiritual integration and association with religious organizations. Her finding raises a new tier of questions. As women face the realities of becoming and

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being a widow after many years of marriage, how do they draw on their spirituality and religious beliefs to regain a sense of meaning and purpose in life? Is a prior sense of spiritual integration an important underpinning to women’s ability to reorganize their lives? Or, is it possible for older widows draw strength from the existential moment? Listen to a few women. … when you have five kids, a farm, and a lot of things to do, you don’t always have the time to pray. I brought my children to church and taught them about God, but I didn’t have time to pray everyday. Now that I’m by myself, I have a lot of time, so I pray, talk to my husband … (Rita, 85 years old, widowed 10 months) To me, spirituality is comforting. It’s the relationship I had with my husband before his death and we continue to connect on a spiritual level. I talk to him and feel him often, sometimes in my home or in my car. It’s just so hard to believe that he is gone, but I know he is still here with me. (Barbara, 63 years old, widowed 11 months) After [my husband’s] death, I kept myself active. I volunteered a few hours a week at the Age Center and spent a lot of my time in the parish and culture center. I do it because I enjoy it. It makes me feel useful. My sisters always tell me that I do too much…. I don’t see it that way…. I choose to live [my life] this way, and I wish they’d just understand that. (Ginger, 79 years old, widowed 8 months) These comments were made while the three women discussed what helped them cope with being a widow.

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Their remarks call to attention the role of spirituality in helping them transform their personal and social lives. In view of the obvious importance of women’s spirituality to their management of the widowhood journey, this article first briefly reviews the literature on older widows’ religious coping and consolation, then extends prior work to examine women’s religious questing. We more closely examine older widows’ religiosity and experience of God. The Journey of Widowhood The onset of widowhood entails a dramatic shift in identity and biography, from being a spouse to being a widow. In many cases, the husband’s death also terminates the woman’s caregiver responsibilities. It is a decisive time, whittled by trial-and-error and framed with uncertainty. Even among the women who did not have a caring relationship with their husband, each woman faces the concrete challenges of engaging everyday life alone after years of being one-half of a couple. She also confronts the existential challenges associated with the change in life style and new biographic trajectory. The process of becoming a widow means that the older woman lives through the life-event that is defined as the most stressful of all life changes (Holmes & Rahe, 1967). Although she surely knows other widows and is conscious of the social expectations for widows, and although she might have anticipated grieving (Lopata, 1979), her own journey is uncharted. The research community has charted enough to know that each woman’s journey is complex, a series of

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intertwined processes influenced mostly by the context of the death, quality of the lost relationship, and her social involvements (Carr et al., 2000; de Vries, 1997; Stroebe & Schut, 2001). After an undetermined period of time the journey usually comes to an end on a new plateau, often involving recovery from grief (Wortman & Silver, 1989) and, maybe, a state of resolution where the loss is accepted (Parkes & Weiss, 1983). However, the journey does not necessarily end with all widows “working through” and “coming to terms” with their status of becoming a widow (de Vries, 1997; van den Hoonaard, 1999; Wortman & Silver, 1989). Some widows might be unable to find any meaning in their husbands’ death or their loss, especially in the first several years (Wortman & Silver, 1989, 1990). As the widow works to rebuild both her personal and social worlds (cf. Lopata, 1979, 1996), spirituality and religious involvements are typically mediators of the widow’s successful coping. Burris, Batson, Altstaedten, and Stephens (1994) outlined how religion can serve a threat- and loneliness-buffering function. Depending on the woman’s religious conviction, her faith and religious beliefs can initially influence her appraisal of the primary stressors of being a widow, and then her ability to cope with the emptiness of her home, defining herself as a widow, altered finances, religious doubts, and so on (cf. Gass, 1987; Park, Cohen, & Herb, 1990). Similarly, Payne and McFadden (1994) reviewed how spirituality and religious practice might ameliorate the loneliness of widowhood and transform lonesomeness into an intimacy with the divine. Studying 312 bereaved adults, Frantz, Trolley, and Johll (1996) found that

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three-quarters of the adults testified to the importance of their religious and spiritual beliefs as comforts to their grief. Based on focus groups and semi-structured interviews with a small sample, Ramsey and Blieszner (2000) underscored the empowering character of spirituality among older women and thus their ability to transcend significant losses. Not surprisingly, prayer and faith are routinely found to be the most common means older women use to cope with distressing events (Arcury, Quandt, McDonald, & Bell, 2000; Dahl, 1999; McCrae, 1984; Neill & Kahn, 1999); and, bereaved women are more likely to contact clergy rather than other professionals (cf. Caserta & Lund, 1992; Neighbors, Musick, & Williams, 1998). It is in turbulent times that people often rely on their faith in a greater power and engage in religious coping (Koenig, George, & Siegler, 1988; McCrae, 1984; Pargament et al., 1990). Their coping “reaches out to preserve, maintain, or transform values of importance in the face of negative life experience … It is a search for significance in stressful times” (Pargament, Van Haitsma, & Ensing, 1995, p. 48). Not yet known, however, is whether the “life event” of becoming a widow principally triggers religious coping. Does the older woman draw upon her religious faith and church community for a sense of continuity and assurance? Or, is the journey of widowhood also testing a woman’s sense of spiritual integration and providing grounds for religious questing (Balk, 1999; Batson et al., 1993; Golsworthy & Coyle, 1999)? Past research asked whether or not the widow turns inward to her spirituality

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and outward to her church as a foundation to rebuild (e.g., Dahl, 1999; Rosik, 1989), and often found is how religious beliefs and spirituality predict adaptive coping. As much as religious coping seems to ameliorate the journey of becoming a widow (Pargament et al., 1990, 1995; Park et al., 1990), the trauma of losing a husband may also facilitate religious questioning and an open-minded search for meaning and purpose (Fry, 2000; Futterman, Dillon, Garand, & Haugh, 1999; Ramsey & Blieszner, 2000). Thus, rephrasing our primary question: Is the journey of becoming a widow and facing the uncertainties and challenges managed, largely through meditation, prayer and other stress-reducing behaviors; or, does her journey into widowhood include a personal search for meaning involving religious questing and private dialogue, a spiritual journey? Quest Religiosity One approach to detecting widows’ search for meaning is the way Batson and his colleagues conceptualize “quest religiosity” (Batson & Schoenrade, 1991a; Batson & Ventis, 1982; Batson et al., 1993). Conceptualized as a reflective journey involving existential questioning and doubts about dogmatic answers, the effects of questing on adaptation to widowhood should be distinct from the effects of either “intrinsic” or “extrinsic” religious orientations. That is, intrinsic religiousness regards faith as a supreme value in its own right and religion as an end in itself (Allport, 1966, pp. 454-455); women’s religious faith and spiritualities would serve as a framework within which they live their lives before and

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after their husbands’ deaths (cf. Burris et al., 1994). Extrinsic religiousness entails an instrumental use of religion to obtain comfort, solace, and other needs (Allport, 1966, p. 455); women’s participation in religious worship and rituals are means to an end; they are the means to cope with the assaults and uncertainties of widowhood (cf. Neill & Kahn, 1999). This ends-means framework can be extended to include the contemplative, quest orientation that is triggered by the tragedies of life. Quest religiousness is a third type of religious orientation, involving an inquisitive, reflective stance toward one’s spirituality and beliefs. It is an “orientation that involves honestly facing existential questions in all their complexity, while resisting clear-cut, pat answers” (Batson & Ventis, 1982, p. 149). The ends-means-quest framework has most often been assessed with samples of college students. Burris, Jackson, Tarpley, and Smith (1996) experimentally affirmed that induced confrontation with tragedy is predictive of higher levels of quest orientation. Krauss and Flaherty (2001) also found that exposure to tragedy in an experimental context stimulated a quest orientation, especially among women. Several studies have proposed that a quest orientation is likely to be evident among either youths or older adults who face identity issues and a search for meaning (e.g., Watson, Howard, Hood, & Morris, 1988). The observed correlations among the ends-means-quest measures are usually low but not always orthogonal (Burris, 1994). Among Catholic undergraduates the intrinsic and extrinsic religious orientations were found to be positively related (Park et al., 1990); their religious culture defines meaning in the

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form of rituals, stories and symbols, prayer, music, and service to others. Religion-as-an-ends and religion-as-a-means seem to be parts of a whole for younger Catholics. There is also some evidence to suggest that among older Catholics, the ends and means orientations are also positively correlated, whereas a quest orientation appears independent of intrinsic and extrinsic orientations (Futterman et al., 1999). Observing different patterns among the ends-means-quest orientations for each religious denomination is a recommendation for researchers to not ignore religious denomination and, if possible, study religious denominations separately. Quest Religiosity and Bereavement If not obscured by “blind faith” in religious dogma and traditions, a spiritual quest could arise from the journey into widowhood. It could either involve a religious journey rooted in seeking religious consolation or a quest orientation. Ferraro and Kelley-Moore (1999, p. 221) proposed that religious consolation is the seeking of “religious or spiritual meaning, comfort, and/or inspiration when faced with personal problems or difficulties. Religious consolation is a form of coping with stressors that incorporates religious, spiritual, or transcendent meaning systems.” It differs from a spiritual journey into the paradoxes “of life’s meaning, of death, and of relations with others” (Batson & Schoenrade, 1991b, p. 430). Thus, if some older women’s journeys into widowhood include an open-minded search for meaning and reveal the women’s engagement of the existential moments of

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feeling hollow, these journeys would stand in sharp contrast to other widows’ use of religious traditions for solace or consolation. Study 1 For this study, the participants were the 103 widows within a larger sample of 342 older, community-dwelling adults. Participants were living in Worcester, MA in 1993 to 1994, more than 65 years of age, and able to complete the interview. All participants gave their informed consent to participate in the study. The larger sample comprised two subsamples: a random sample of 262 older adults and a “snowball” sample of 80 older African Americans (see Futterman et al., 1999, for a more thorough description). The two have small differences in the ages of the widows (the African American sample is younger, average age 71 vs. 77) and their incomes (the African American sample has somewhat greater income), yet no differences in the women’s educational background (typically a high school diploma) or years living in Worcester (on average, 57 and 55 years for the random and “snowball” samples, respectively). All but two women reported some denominational affiliation, and as noted in Figure 1 nearly half were Catholic.1 Figure 1. Denominational Composition of Widow Sample, Worcester Aging Project, 1993-1994, N = 103

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Religious orientation was assessed using Batson’s conceptualization of means, end, and quest religiosity (Batson et al., 1993; Batson & Schoenrade, 1991a, 1991b). The “religion as a means” orientation identifies the extent to which the person may use religion in a self-centered way. Defined by the Allport and Ross Extrinsic scale, this 11-item measure indexes an extrinsic orientation that is utilitarian and useful to the self (α = .79 in this study). The “religion as an end” orientation isolates the sentiment that faith is a supreme value. Intrinsic orientation was defined by the 15 items in the Batson, Schoenrade and Ventis Internal and External scales (α = .81; cf. Batson et al., 1993, pp. 168-177). “Religion as a quest” was measured with the 12-item Batson et al. (1993) Quest Scale, (e.g., “Questions are far more central to my religious experience than are answers”). The scale has adequate internal consistency (α = .70), and three reliable .

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subdimensions within the Quest orientation scale have been identified (Batson & Schoenrade, 1991b; Futterman et al., 1999): a readiness for face existential questions, an openness to change, and a perception of religious doubt as positive. The end-means-quest orientation scales statistically average scale items and range from 1 (disagree) to 9 (agree). To determine the extent to which widows engaged in private devotion, a single 5-point Likert-scaled item asked, “How often do you spend time in private devotion?” Responses ranged from “never” to “once a week or more.” Findings. At Time 1 (T1), the widows in the sample (N = 103) reported high levels of private devotion (M = 4.09, SD = 1.53, range 1-5). Two-thirds testified that they spent time once a week or more in private devotion, and just 15% reported that they never engaged in private devotion. The widows also had a high “means” (extrinsic) orientation (M = 5.43, SD = 1.64), similar to what Burris (1994) found among undergraduates (M = 4.93) or Batson et al. (1993) reported for young adults (M = 4.24). Widows’ even higher “ends” (intrinsic) orientation (M = 6.79, SD = 1.37) is also quite comparable to the young adults and seminarians Batson et al. (1993) studied. Typically the means-ends orientations are unrelated (Batson et al., 1993), and in this study the widows’ means-ends orientations were found minimally correlated (r = .11). Their ends orientation was strongly allied with the time they spent in private devotion (r = .50); and not surprisingly, the widows’ means orientation was unrelated to time spent in personal devotion (r = .03).

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The older widows also show moderate levels of a quest orientation (M = 4.51, SD = 1.31, range 1-9), a bit lower than levels reported by Batson and Schoenrade (1991b, p. 437) for two samples of undergraduates (Ms = 5.04 and 4.95, respectively). Internal analysis of the quest orientation measure reveals that the widows more strongly endorsed the four items suggesting greater self-criticism and a perception of religious doubt as positive (M = 5.17, SD = 1.94) than the items that suggest openness to change in religious outlook (M = 4.20, SD = 1.26) or readiness to face existential questions (M = 4.12, SD = 2.12). On average, the widows agreed that religious doubt can be positive, were of mixed opinions about their openness to change, and were of even more mixed opinion about their willingness to confront the existential challenges triggered by widowhood. The widows, for example, disagreed most strongly with two items suggesting their disinterest in religion (“I was not very interested in religion until I began to ask questions about the meaning and purpose of my life” and “God wasn’t very important for me until I began to ask questions about the meaning of my own life”). On average, these older widows’ quest orientation was reliably correlated with their means orientation (r = .38). By contrast, their quest orientation was neither associated with time spent in private devotion (r = − .09) nor the strength of their ends orientation (r = .08). Summarized in Table 1 are the mean scores for several subgroups within the sample. Differences in means tests comparing African Americans and whites reveal that the African American widows had higher scores on both the ends and quest orientations (ts (100) = 2.35 and 2.52,

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respectively, p < .05). Comparing Catholics and non-Catholics also disclosed that the Catholic widows spent more time in private devotion (t (101) = 3.52, p < .001), scored higher on the ends orientation (t (101) = 2.35, p < .05) but lower on the quest orientation (t (101) = 2.22, p < .05). Table 1. Mean Scores on Four Measures of Religiosity: Community-Based Sample of Worcester, Massachusetts, 1993-95 (N = 103)

a

p < .10; bp < .05; cp < .01; dp < .001

Follow-up. The widows within the random sample were re-interviewed one year later. For Time 2 (T2) follow-up, the 65% response rate provides data on 51 widows. To determine the extent to which the follow-up sample might differ from the 52 widows that were not followed into T2, a series of t-tests was computed on comparable T1 data. The widows followed were all white, slightly older (77.7 vs. 75.0 years old, t (101) = 1.92, p < .10) and somewhat more educated (t (101) = 1.99, p < .05).

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For the four dependent variables, the two groups of widows did not differ on the amount of time they spent in private devotion, or the level of their ends and quest orientations. The older women followed from T1−T2 did, however, have a lower means orientation score at T, than the widows not followed (Ms = 5.08 and 5.78, respectively, t (99) = 2.21, p < .05). Included in Table 1 are the T1T2 mean scores for the 51 widows followed for the year. As noted, these older women showed no change in their means and ends orientations; however, the paired t-tests affirmed that they endorsed a significantly lower quest orientation at follow-up (t (50) = 4.81, p < .001) and tended to spend greater time in private devotion (t (50) = 1.89, p < .10). On closer inspection, when the three sub-dimensions within the measure of quest orientation were analyzed, the T1T2 scores reveal that the widows’ overall lesser questing at T2 was not because they changed their willingness to face existential questions. They were never eager to begin deep spiritual journeys. Rather, they remained cautious about religious questing. The average score clustered near the midpoint. The growing disagreement with quest is revealed in the way that they became less open to change (t (50) = 4.10, p < .001) and less likely to perceive religious doubt as positive (t (50) = 4.08, p < .001). Further analyses that are not tabulated also show that the continuities of the means and ends orientations over time and the lessening of widows’ quest orientation held true for Catholics and non-Catholics alike. Study 2

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The objective of beginning new, in-depth interviews was to determine if older widows’ experience of being a widow forced a spiritual journey. We sought to better know if their spiritual journey included the expected encounter with existential questions about the meaning of a person’s life (cf. Batson et al., 1993). Having uncovered in our secondary analysis an empirical pattern that widows’ quest orientation hovered near the midpoint on the Quest scale and only showed movement toward less questing as the women lived through the experiences of being a widow, we want to engage widows in a more fluid conversation about their spiritual journeys. The participants were 15 widows whose husbands had died six to eight months preceding the interviews. Most women were located from summer 2000 obituaries published in the Worcester Telegram & Gazette. Each widow was sent a personal letter of introduction in winter 2001, and then telephoned to arrange a face-to-face interview. All the widows interviewed were more than 60 years old, living alone, and cognitively able to be interviewed. The average age of the group is 78.6 years. Interview schedules focused on the women’s journeys into widowhood and, in particular, their spiritual journeys to find meaning following their husband’s death. The interviewers guided the widows through a discussion of how they manage their aloneness (Payne & McFadden, 1994) and whether or not they engaged in religious questing as they ‘lived’ their journeys into widowhood. Close attention was paid to widows’ comments about their spirituality as they journeyed into widowhood, and whether or not becoming a widow challenged the woman’s sense of spiritual integration and prompted some type of religious 225

questing. We also included in the interview schedule Batson’s 26-item assessment of ends and quest religiousness, Allport’s (1966) measure of extrinsic orientation, and Ainlay and Smith’s measure of personal religious behaviors. Selected are three cases as exemplars of the qualitative data. First is Barbara, the youngest widow interviewed. She is 64 years old, Catholic, employed full-time, and introspective throughout the interview. When asked about her husband, she immediately converted the question into an opportunity to retell the moments before his death and describes her ongoing involvement with her dead husband. I will never forget [that] moment for as long as I live. I was in another room in the house when I heard a loud thud. I ran into the living room to find my husband lying on the floor … I knew he was gone and there was no reviving him. My son tried mouth-to-mouth, but I told him there was no use. Dad was dead…. Barbara’s longing for a continued relationship with her husband is deeply rooted in 47 years of what she called a “glorious” marriage as well as her lost plan to retire early and begin late life with her husband, who just retired. “I never thought it was going to end this way. I thought we’d still have years together to do things after I retired, but it didn’t happen that way. Right now I don’t understand.” She admits to feeling depressed and has begun pharmaceutical treatment (her “happy pill”) for her symptoms of clinical depression. When asked if her

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spirituality makes her feel comforted or connected, she reported “comforted.” Ironically, what she conveyed throughout the interview was her spiritual connection to her husband, and that connection provided the comfort. At great length, Barbara discussed the importance of faith and spirituality in her life. As much as Barbara has a keen sense of spiritual connectedness and believes that everything happens for a reason, she has doubts. For Barbara, the widowhood journey has triggered spiritual and religious journeys into the meaning of her unanticipated separateness. She is spiritually questing, seeking to better understand the paradoxes raised by the existential moments of being alone; and, she seems to actively explore her religious faith. Of the widows interviewed, she has the second highest score on Batson’s measure of religion-as-a-quest; as revealed by the sub-dimensions of a quest orientation, Barbara had the highest score on readiness to face existential questions. She unequivocally agreed with the items “I am constantly questioning my religious beliefs” and “My life experiences have led me to rethink my religious convictions.” She also strongly disagreed with the statement “I do not expect my religious convictions to change in the next few years.” Despite Barbara’s openness to change and existential questioning, she does not fundamentally doubt what it means to be religious. She had a lower-than-average score on a perception of religious doubt as positive. Also, when asked at one point if she could experience doubts and still feel committed to her faith, she replied: “Yes, but only to a degree.”

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The follow-up question asked, “Has your husband’s death affected your faith?” and Barbara musingly commented, “No, it hasn’t changed my faith… but, I think it has made it stronger…. My relationship with God helps me, but I would say that it doesn’t stop me from feeling lonely. It just can’t fill that gap. I really don’t enjoy being alone.” As her scores on the quest orientation measure and her comments convey, Barbara continues to search for an explanation for her status as a new widow, for the logic of her husband’s death, and for her emptiness. Certainly, Barbara is engaged in a spiritual journey, searching for meaning, purpose and explanation, and she seems to be equally engaged in an uncomfortable religious quest. Maria, 85 years old, follows a very different spiritual trajectory. She is an exemplar of an “old country” Catholic immigrant living within the Portuguese community in Fall River, MA. Interviewed in Portuguese, she had been in an arranged marriage. When I was growing up, my mother took me to church and told me how important it is to have God in my life. Sunday was the day that the whole family went to church. This was the only day that I saw my father and the other men in the village pray. It was the same for my husband … I spent many years with my husband, so losing him was very hard on me. After his death, I never thought I could be happy again. But I know that God would take care of me because my husband couldn’t. I would pray every day that my husband was in heaven with God… and if he wasn’t I’d pray that he’d get there.

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And I pray, too, that God will take me soon so that I can be with my husband. Maria is a “true believer” whose social world is intimately canopied by her church and religious convictions. She uses prayer as consolation, as well as a medium for engaging in conversation about her husband. Her prayers keep him as a part of her life, and she seems comfortable with him nearby. Simply stated, Maria’s private devotion and participation in her faith’s religious traditions remain her anchors, and they are a means for Maria to cope and hope that she will soon be united with her husband. Maria’s scores on the measures of means, ends, and quest orientations are among the highest for a means orientation and among lowest for questing, especially the dimension assessing a perception that religious doubting can be positive. Madeline is an 86-year-old and an exemplar of the Catholic who has an ends orientation to her religious involvement. She is a retired Catholic school teacher, and Madeline sees herself as privileged: “My parents worked very hard and my mother worked very hard, especially, to send me to Catholic, private school [and college], which was unheard of for an Italian girl sixty-five years ago.” She continued, blending together early and late biographic details: “I always attended Catholic schools. I think it was part of my life all the time. Not so much holding a rosary bead kind of thing, but more in trying to do what we were taught was the right thing to do. I think I went through different phases. When I was busy with my five children, I didn’t have time to be as religious in the sense of going to

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church every day and all of that. Now, I try to do what is right in my own way.” Soon after, she added: “I was devoted to school and I tried to carry out by helping; well, I don’t know if you call it spirituality, but I think in a sense it is. There were times when the school needed that extra, and I thought in that way I was helping to do what I thought was my role.” Madeline responded to a query about when she feels spiritual: “When I am helping others. I thought I was being spiritual even though I was not always on my knees. I think that most people should feel this way. To be spiritual means to be doing the spirit of the Church, not really just praying.” She describes herself as “very Catholic.” Her strong orthodox faith means, for her, that she simply cannot engage in serious religious doubts, because it is a sin. Asked if she had ever experience spiritual doubt, she promptly replied: “No, I never have. I have questioned, maybe, the conduct of some religions. But then I say to myself, listen…” However, the reality of the widowhood journey triggered religious uncertainties as well as a reflective spiritual journey: My husband used to say that he wasn’t so sure there was such a place as heaven. He said that it won’t make any difference because “I did the best that I could, so maybe this is heaven” … I feel the same way. All the things I have done I am happy that I did them and I am hoping that I did the best that I could….That is all I try to do. I do the best that I can and, for all that it is worth, maybe there is a place. It would be nice, but I’m happy to know, maybe because I am not so bright, that I did the best I could…. [And as] I said before, he was the one that

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would say that he wasn’t so positive there is such a place as heaven, but what’s the difference whether there is or not. This is heaven. I think this is one of the reasons why I get along so well because I think if you are happy with your husband and your life and your surroundings and you don’t move from it when they pass away … I just look around and have so many happy memories … I mean, I have cried now and then, but I think of all the happy things I had. As I said, my husband was never a strong man and to see how peacefully he went–he had it made. When directly asked if her husband’s death affected her faith or changed it, Madeline replied: “No, if anything more so.” Not surprisingly, Madeline had the lowest Batson quest score of the widows interviewed and one of the lowest “doubt” scores on the sub-dimensions within a quest orientation. Her ends orientation is at odds with an openness to change or a marked reconsideration of the meaning of life. Discussion The older widows, who Tom Brokaw (1998) would identify as members of “the greatest generation,” may have less difficulty dealing with widowhood and its traumas than previous research would predict. Among the women of this generation, loss may be a poor way to envision the impact of the death of their husband. Unlike the type of “severance of connections” that Belenky, Clinchy, Goldberger, and Tarule (1986) say that women might make in their quest for self and meaning, the older widows in both samples did not choose to “walk away from their pasts” (p. 77). Rather, many widows seem to 231

actively maintain their marriages in a spiritual sense, and most upheld their religious identity while they embarked on their spiritual journeys. The widows most often revealed a continuity in their experience of God. There was little evidence of anger, nor an indication of turning away from their faith. Most continued to be active religious participants, sometimes attending daily prayer services, other times turning to religious programming on television. Most also integrated their experience as widows into their spiritual lives. The existential moments triggered within the widowhood journey did prompt many to quest, but not doubt. “Spiritual growth transforms the loneliness into a creative solitude imbued with the knowledge that even the aloneness of a venture into the valley of the shadow of death does not separate one from God” (Payne & McFadden, 1994, p. 24). The implications arising from the finding that widows do quest, but do not fundamentally doubt their faith, are several. Spirituality is a direct, personal experience. It has to do with feeling both integrated and connected. Spiritual journeys are ongoing searches for meaning, the processes through which the women try to put together the significance of being widows. Clergy should be mindful that questing is ordinary, and perhaps short-lived. The longitudinal data and the qualitative study both disclosed a lessening of widows’ quest orientation over time, whereas there was more continuity in their means and ends orientations over time. This quest-ends-means pattern could be a cohort effect and not something descriptive of widowhood per se. That is, it might be characteristic of

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the age of the women who grew up with WWII and spiritual journeys triggered by war losses. The question we initially raised, “Are most widows engaged in a spiritual journey involving a religious experience and religious questing?” requires further investigation. The spiritual journeys lived by the older women we studied were, for the most part, inclusive of religious involvement and spiritual quests. The two studies reported in this article demonstrate that most widows were on a spiritual journey that precluded them from falling apart. Their journey engaged and stopped them from experiencing deep distress. That is, the journey itself is both controlling and comforting, and arising from the process most women find a new sense of spiritual integration. For some, the journey is ameliorated by their religion-as-a-means orientation; they use their faith (and church community) for solace and support. Their spiritual journey includes religious involvement as a means for coping. For other widows, the journey is channeled by their religion-as-an-ends orientation, and again we find that religious faith eases the personal encounter with being a widow. Still other widows, fewer than theorized, revealed an openness to change and a willingness to tackle the non-positivist questions that arise in spiritual journeys involving the self and soul. Yet, as the longitudinal data showed, this questing orientation is not long lived, and it seems to be replaced by greater private devotion and a stronger ends orientation. These conclusions must be framed by the limitations of our research. The community-based sample was

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comprised of older women in a large New England city that has stable neighborhoods and little “outmigration.” The women have a sense of place, and with it comes social support. The mean length of time the widows in both the random and snowball samples had lived in the city was more than 55 years; the median was 67 years for the women in the random sample and 60 years for the African Americans in the snowball sample. Second, although nearly half were Catholic, the sample in Study 1 was comprised of women from a variety of religious denominations. This further complicates the ease of generalizing the findings of this study to widows living elsewhere. For example, the T, data showed that Catholics spent more time in private devotion and were both more ends oriented and less quest oriented than non-Catholics. This is an important observation. Part of this pattern surely involves an interaction of race and religious denomination. That is, the African American widows were more quest oriented than the white widows, and no African American was Catholic. Thus, race partly accounts for our observation that Catholics were less quest oriented. But race does not account for Catholics reporting a higher ends orientation or more time in private devotion at T1, because African Americans were even more ends oriented that whites. This gnarled summary is simple evidence of the value of studying both race and religious denomination and not presuming that the findings of one study clearly explain older widow’s spiritual journeys. The widows followed in the longitudinal study were white, and nearly half were Catholic. The longitudinal

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data revealed a lessening of widows’ quest orientation. Finding less evidence of a quest orientation and more time spent in private devotion at T2 is testimony that widows did, in fact, lessen their questing over time. Whether this is evidence of recovering from grief and “working through” their loss remains unknown and needs to be systematically studied. Whether it is also evidence of a decrease in widows’ existentially-oriented spiritual journeys and an increase in their faith-based spirituality also needs to be systematically studied. Note 1. In the state of Massachusetts, the Catholic (53%) and Jewish (4.5%) populations are greater than national averages. Our sample has slightly fewer Catholic widows than might be expected from a random sample but a greater proportion of Jewish widows. The majority of the widows in the sample were white (80%); nonetheless, because of the “snowball” subsample, the “whiteness” of the sample is much less than the demographics of older adults in Massachusetts (94% of adults aged 60 and older in 1995 were non-Hispanic white; Massachusetts Executive Office of Elder Affairs, 2000). References Allport, G. W. (1966). The religious context of prejudice. Journal for the Scientific Study of Religion, 5, 447-457. Arcury, T. A., Quandt, S. A., McDonald, J., & Bell, R. A. (2000). Faith and health self-management of rural

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older adults. Journal of Cross Cultural Gerontology, 15, 55-74. Balk, D. E. (1999). Bereavement and spiritual change. Death Studies, 23, 485-493. Batson, C. D., & Schoenrade, P. A. (1991a). Measuring religion as quest: (1) Validity concerns. Journal for the Scientific Study of Religion, 30, 416-429. Batson, C. D., & Schoenrade, P. A. (1991b). Measuring religion as quest: (2) Reliability concerns. Journal for the Scientific Study of Religion, 30, 430-447. Batson, C. D., & Ventis, W. L. (1982). The religious experience. New York: Oxford University Press. Batson, C. D., Schoenrade, P. A. & Ventis, W. L. (1993). The religious experience: A social-psychological perspective. New York: Oxford University Press. Belenky, M. F., Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1997). Women’s ways of knowing: The development of self voice, and mind. New York: Basic Books. Brokaw, T. (1998). The greatest generation. New York: Random House. Burris, C. T. (1994). Curvilinearity and religious types: A second look at intrinsic, extrinsic, and quest relations. International Journal for the Psychology of Religion, 4, 245-260. Burris, C. T., Batson, C. D., Altstaedten, M., & Stephens, K. (1994). “What a friend…”: Loneliness as a

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Fry, P. S. (2000). Religious involvement, spirituality and personal meaning for life: Existential predictors of psychological well being in community-residing and institutional care elders. Aging and Mental Health, 4, 375-387. Futterman, A., Dillon, J. J., Garand III, F., & Haugh, J. (1999). Religion as a quest and the search for meaning in later life. In L. E. Thomas & S. A. Eisenhandler (Eds.), Religion, belief and spirituality in later life (pp. 153-177). New York: Springer. Gallup, G., & Lindsay, M. (2000). Surveying the religious landscape: Trends in U.S. beliefs. New York: Morehouse Publishing. Gass, K. A. (1987). Health of conjugally bereaved older widows: The role of appraisal, coping and resources. Research in Nursing and Health, 10, 39-47. Golsworthy, R., & Coyle, A. (1999). Spiritual beliefs and the search for meaning among older adults following partner loss. Mortality, 4, 20-40. Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213-225. Koenig, H. G., George, L. K., & Siegler, I. C. (1988). The use of religion and other emotion-regulation coping strategies among older adults. The Gerontologist, 28, 303-310. Krause, S. W., & Flaherty, R. W. (2001). The effects of tragedies and contradictions on religion as a quest. Journal for the Scientific Study of Religion, 40, 113-122. 238

Levin, J. S., Taylor, R. J., & Chatters, L. M. (1994). Race and gender differences in religiosity among older adults: Findings from four national surveys. Journals of Gerontology: Social Sciences, 49, S137-S145. Lopata, H. Z. (1979). Women as widows: Support systems. New York: Elsevier. Lopata, H. Z. (1996). Current widowhood: Myths and realities. Thousand Oaks, CA: Sage. McCrae, R. R. (1984). Situational determinants of coping responses: Loss, threat, and challenge. Journal of Personality and Social Psychology, 46, 919-928. Massachusetts Executive Office of Elder Affairs. (2000). Highlights of the Massachusetts elderly population. Retrieved June 15, 2001 from the World Wide Web: . Neighbors, H. W., Musick, M. A., & Williams, D. R. (1998). The African American minister as a source of help for serious personal crises: Bridge or barrier to mental health care? Health Education and Behavior, 25, 759-777. Neill, C. M., & Kahn, A. S. (1999). The role of personal spirituality and religious social activity on the life satisfaction of older widowed women. Sex Roles, 40, 310-329. Payne, B. P., & McFadden, S. H. (1994). From loneliness to solitude: Religious and spiritual journeys in late life. In L. E. Thomas and S. Eisenhandler (Eds.), Aging and the religious dimension (pp. 13-27). Westport, CT: Auburn Press. 239

Pargament, K. I., Ensing, D. S., Falgout, K., Olsen, H., Reilly, B., Van Haitsma, K. et al. (1990). God help me: (I): Religious coping efforts as predictors of the outcomes to significant negative life events. American Journal of Community Psychology, 18, 793-824. Pargament, K. I., Van Haitsma, K. S., & Ensing, D. S. (1995). Religion and coping. In M. A. Kimble et al. (Eds.), Aging, spirituality, and religion: A handbook (pp. 47-67). Minneapolis: Augsburg Press. Park, C., Cohen, L. H., & Herb, L. (1990). Intrinsic religiousness and religious coping as life stress moderators for Catholics and Protestants. Journal of Personality and Social Psychology, 59, 562-574. Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books. Ramsey, J. L., & Blieszner, R. (2000). Community, affect, and family relations: A cross-cultural study of spiritual resiliency in eight old women. Journal of Religious Gerontology, 11, 39-64. Rosik, H. G. (1989). The impact of religious orientation in conjugal bereavement among older adults. International Journal of Aging and Human Development, 28, 251-260. Stroebe, M. S., & Schut, K. (2001). Models of coping with bereavement: A review. In R. O. Hansson (Ed.), Handbook of bereavement research: Consequences, coping, and care (pp. 375-403). Washington, DC: American Psychological Association.

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van den Hoonaard, D. K. (1999). No regrets: Widows’ stories about the last days of their husbands’ lives. Journal of Aging Studies, 13, 59-72. Watson, P. J., Howard, P., Hood, R. W., Jr., & Morris, R. J. (1988). Age and religious participation. Review of Religious Research, 29, 271-280. Wortman, C. B., & Silver, R. C. (1989). The myths of coping with loss. Journal of Consulting and Clinical Psychology, 57, 349-357. Wortman, C. D., & Silver, R. C. (1990). Successful mastery of bereavement and widowhood: A life-course perspective. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 225-264). New York: Cambridge University Press. Edward H. Thompson, Jr., is Professor of Sociology and Director of the Gerontology Studies Program, College of the Holy Cross. Mary E. Noone and Amanda B. Guarino are recent graduates, 2001, College of the Holy Cross. Address correspondence to: Edward H. Thompson, Jr., PhD, Department of Sociology & Anthropology, College of the Holy Cross, 1 College Street, Worcester, MA 01610 (E-mail: [email protected]). The data used in Study 1 was partially supported by a grant to Andrew Futterman, Department of Psychology, College of the Holy Cross, from the National Institute of Aging, #AG11438. [Haworth co-indexing entry note]: “Widows’ Spiritual Journeys: Do They Quest?” Thompson, Edward H. Jr., 241

Mary E. Noone, and Amanda B. Guarino. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 119-138; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 119-138. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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The Role of Social Context in Religion Linda M. Chatters, PhD Robert Joseph Taylor, PhD, MSW Summary. A vast research literature examines how religion has been defined and assessed, the inter-relationships of these measures, and their associations with psychological and social well being in later life. This article considers the advantages and disadvantages of various measurement strategies, with particular emphasis on the importance of diverse social contexts in defining, measuring and interpreting religious phenomena. The concept of social context is discussed as being pivotal for how religion is defined and for appreciating the various mechanisms and pathways through which religion is thought to affect well being. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Website: © 2003 by The Haworth Press, Inc. All rights reserved.] Keywords. Religion social denomination race culture

context

well

being

This article focuses on the importance of diverse social contexts in defining, measuring and interpreting religious phenomena, with a particular emphasis on the implications for various measurement strategies that have been employed in research on religion and health 243

and well being. We argue that the concept of social context is intimately tied to definitional issues in this area of research and, further, is important for appreciating the various mechanisms and pathways through which religion is thought to affect well being. We also briefly introduce three distinct themes in the religious research literature that are a source of continued discussion in the field-conceptualization and measurement issues, psychosocial mechanisms, and causal pathways and models. While the full exploration of these issues is beyond the scope of this article, the reader is referred to the work of Ellison and Levin (1998), Levin and Chatters (1998), Chatters (2000), Chatters, Taylor and Lincoln (2001), The Fetzer Institute/NIA (1999) and other references noted throughout this article. Within the social and behavioral sciences, the notion of context has been proposed as a way to understand how biological, personal, cultural, and social environments combine to influence behavioral and social phenomena. The notion of context suggests that multiple and interdependent levels of theory and analysis (i.e., biological, psychological, sociocultural, behavioral) are important for understanding human behavior and development (Anderson & McNeilly, 1991; Brofenbrenner, 1977). As applied to issues of religiosity, the notion of context suggests that these interdependent environments or systems are important for understanding the nature and meaning of these phenomena, as well as their relationships to one another. Accordingly, a contextual perspective or analysis focuses attention on

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specific factors that may: (1) transform fundamental definitions and understandings of religion, (2) pattern the expression of religion, and (3) moderate their impact on well being outcomes. In sum, a contextual perspective provides important information as to the meaning and significance of religion, as well as how, under what conditions, and in what specific manner they are related to well being outcomes. Two distinct but related approaches to contextual perspectives are found in the literature. The first approach suggests that a contextual perspective provides a better understanding of the essential meaning of a given construct such as religion when manifested in diverse groups and settings (e.g., contextual perspectives on religion within racial and ethnic minority communities). This approach involves a fundamental analysis and critique of accepted and dominant conceptualizations of social, behavioral and health constructs. A second approach to contextual perspectives focuses more squarely on questions of how religious effects are modeled in relation to health outcomes. This approach suggests that the relationship between an independent and outcome variable is dependent upon an additional factor(s) that exerts a moderating influence on the association of interest. For example, the relationship between religion and health outcomes may differ substantially by race and cultural groups. These two types of contextual perspectives, while different with respect to scope, emphasis, and approaches, bear an important relationship to one another. Evidence of a contingent relationship between religion and well being (e.g., the relationship varies dependent upon race and

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cultural groups) may require a re-examination of the fundamental meaning of religion within particular race and ethnic groups. Ellison and Levin (1998) observe that the detection of a significant association between religion and well being among African Americans residing in the South is difficult because of almost universally high levels of religion within this subgroup. The generally high levels of religion among African Americans may signal the enhanced significance and meaning of these issues among this group as compared to whites. An appreciation of the fundamental meaning and functions of religion within Southern black communities promotes a more subtle understanding of potential contingent relationships involving religion and health outcomes. Ideally, adequate theoretical and conceptual frameworks and a competent understanding of the nature and meaning of religion and health within various groups would guide the development of analytic models of these associations, including contingent relationships. Social Context and World Views Contextual factors in religion and well being associations are represented in the literature in several ways. For the purposes of this discussion, we focus on contextual factors as representing: (1) distinctive worldviews or ecological perspectives and (2) as embodying differences in social location. The worldview or ecological perspective suggests that contextual factors comprise the overall worldview or “ecological” framework from which notions of religion emerge. This perspective owes its intellectual origins to the work of

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Brofenbrenner (1977) on the ecological validity of the research context. The use of the term “ecological” is meant to imply that religion and health and their interrelationships are the dynamic products of a particular set of informal groups, social institutions, and broader environmental circumstances in which individuals are embedded (Johnson et al., 1995). The worldview or ecological perspective acknowledges that the particulars of religious expression occur within distinctive social, historical, and cultural contexts that are consequential for understanding religion-health associations (Ellison, 1995). Religious expression is meaningful when viewed within these primary contexts (i.e., ecologies) and as products of interactions among the various groups, agencies, and institutions that operate within them. The world view or ecological perspective suggests that contextual factors are important both for providing fundamental definitions of what constitutes religion and health, as well as in specifying the manner in which the two constructs are related to one another. Contextual factors defined in this manner may characterize broad cultural groups (e.g., U.S. culture) as well as subgroups within a given population (e.g., distinctive religious and cultural groups). Constructs such as race, culture and denomination are often depicted as examples of broad contextual factors that embody unique perspectives and give rise to distinctive concepts of religion. The long tradition of work on African American religion embodies an inherent ecological perspective (Lincoln & Mamiya, 1990). Among the several themes represented

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in this literature is the role of historical, political, social, and cultural factors in shaping religious expression among this group. Several scholars (e.g., Frazier, 1974) acknowledge that because of their position within a hostile social environment, the tenor of black religious expression and thought frequently embodied themes of group as well as individual salvation and liberation (a precursor to liberation theology). Within this context, the explicit functions of religion and its institutions were to ameliorate and eradicate those societal conditions that were detrimental to the physical and emotional well being of African Americans and their communities. Questions of ultimate meaning and concern were framed within the context of the immediate life circumstances facing blacks. As a consequence, their religious expression reflected an emphasis on both spiritual matters as well as the more secular concerns of emancipation, enfranchisement, civil and human rights, and social and economic justice (Lincoln & Mamiya, 1990). Given their extreme societal marginalization and political and legal disenfranchisement (i.e., Jim Crow laws), African Americans lacked basic access to the major societal institutions and organizations that provide education, health care, and social welfare needs. Black religious bodies filled this void and were instrumental in the development of alternative cultural institutions (e.g., education, health care, social welfare) that explicitly served the needs and interests of black communities. For example, at various points in the past two centuries, black churches were instrumental in developing organizations that were charged with caring for the

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physical and economic needs of groups such as emancipated slaves and new arrivals from the South as part of the Black Migrations. The long tradition of Historically Black Colleges and Universities (HBCUs) that have educated countless numbers of African Americans owe their beginnings to various black churches and affiliated groups. The black church is also the site of activity for numerous health boards, health ministries, and health education efforts that attend to the physical well being of church members. Finally, Lincoln and Mamiya (1990) suggest that because of this rich historical context and its continuing legacy (particularly within Southern communities), public, institutional and private religious activity and sensibilities remain important to African American life. In keeping with this line of reasoning, they further argue that across various settings (e.g., regional, urban, city) and social circumstances (e.g., socioeconomic position) there is significant variability in the extent to which secular and religious institutions are differentiated from one another. As a consequence, the influence of the black church as a center of community life and religious values and sensibilities varies within the black population across factors such as age (i.e., as a reflection of cohort differences) and place (i.e., regional variation). Evidence from the National Survey of Black Americans (Taylor, Thornton & Chatters, 1987) indicates that black American perceptions of the historical role of the church vary by age and region. Although over 80% of respondents indicate that the black church has been beneficial

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to the condition of blacks in America, older persons and those residing in the South (as well as women and persons with more years of education) are more likely than their counterparts to endorse this sentiment. Lincoln and Mamiya (1990) argue that for Southern blacks (and particularly, rural residents) the black church remains a central community institution. Respondents indicate that the contemporaneous black church provides a number of valued services including social support (emotional and material assistance), help during illnesses, childcare, transportation, and job-related assistance (Taylor & Chatters, 1986, 1988). Importantly, the emergence of regional variation alerts us to the fact that although black Americans demonstrate high levels of religious involvement, there is important and significant variation due to social location and status characteristics within this population. If we consider religious denomination using an ecological or worldview perspective, we find that religious preference encompasses important distinctions with respect to core religious beliefs and attitudes (i.e., theologies and other systems of belief) and in the centrality of various forms of religious expression (i.e., ritual, confession, private vs. public devotional activities) that are important in terms of how religion is conceptualized and measured. Of particular importance for research on the connections between religion and health, many religious denominations provide clear guidelines as to issues of lifestyle behaviors and practices (e.g., prohibitions against the use of alcohol, specific dietary practices) that are consequential for health outcomes.

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The body of research evidence clearly links denominational preference with health outcomes, including morbidity and mortality indicators, as well as overall well being (Fetzer Institute/NIA, 1999). Unfortunately, because the measurement of religious denomination has been problematic, a full appreciation of its relationship to health and well being outcomes may be obscured. Research examining denomination effects often employs very broad categories to distinguish religious traditions (e.g., Jews, Protestants, Catholics). This practice is problematic for two reasons. First, religious denomination is a favorite variable to include in studies due to its ease in administration, and a number of investigations do report significant findings. Unfortunately, it is often the case that other than post-hoc explanations, little effort is invested in understanding the particular pathways through which denomination influences outcomes. Second, the use of nominal categories of this type ignores significant within-denomination variation in the centrality and meaning of religious phenomena and their relationships to health outcomes (Levin & Vanderpool, 1987) and assumes that groups within the category represent homogenous entities with respect to underlying religious factors (i.e., behavior, beliefs, and attitudes). This practice effectively ignores important information about how constituent groups (for example, Reform, Conservative, and Orthodox Jews) differ with regards to religious beliefs, practices, and institutional structures, all of which may be consequential for health and well being. Even so-called discrete denominational categories (for example Baptist or Lutheran) encompass significant within-group variability (e.g., Southern Baptist 251

Convention, American Baptists) that may be important for health and other outcomes (Woodberry & Smith, 1998). In situations where denominational information is fairly well specified, researchers often classify respondents on the basis of configurations of religious factors (e.g., belief systems, congregational climate, worship styles, organizational structures) that distinguish religious cultures (e.g., mainline Protestant, conservative Protestant). This strategy clusters denominations into distinctive and meaningful categories that serve as proxies for the relevant underlying traits or beliefs (see for example, Ellison, Gay & Glass, 1989; Ellison & George, 1994). These approaches, however, are not without problems (see Woodberry and Smith, 1998 for a discussion) because specific factors that are particularly relevant for well being (i.e., functional mechanisms) may not easily captured using even these frameworks (Ellison, 1999; Woodberry & Smith, 1998). For example, religious groups that appear similar with respect to beliefs, values and behaviors could endorse very different views on specific issues that are pivotal for well being. Used sensitively, however, these classification strategies provide alternative methods of categorizing religious groups in terms of relevant beliefs, community characteristics, and attitudes, irrespective of denominational labels. Finally, denominational contrasts are based on an implicit assumption that comparisons across groups are valid because the religious factors of interest have the same meaning across groups and are associated with

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well being outcomes in a similar manner. For example, behavioral indicators of religious involvement (e.g., service attendance) demonstrate significant denominational variation with respect to norms for involvement, as well as the type, experience, and meaning of public religious participation. Across denominational categories, public religious participation may have vastly different meanings and, consequently, may be related to well being outcomes in different ways. Social Context and Social Location Contextual factors are also described in terms of aspects of social location (e.g., socioeconomic status, race, culture) variables that describe how particular social arrangements operate to pattern religious expression and well being outcomes. As such, this perspective is not so much distinctive from the worldview or ecological perspective, as it reflects an approach to conceptualizing how aspects of social groups and their relative position within the social order influences individual and group status and behaviors. In contrast to the world view or ecological perspective, this perspective often views contextual factors as “… a set of autonomous individual characteristics, unrelated to living and working conditions and independent of the broader political and social order” (Johnson et al., 1995, p. 602). This work, often involving investigations of differences in religious involvement based on social location, has amassed a body of findings indicating the presence of significant group differences in religious involvement. Research on gender differences in religious involvement is representative of work along these lines. For example,

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research on gender differences consistently reports greater religious involvement for women, across a number of diverse data collections and samples. However, we know very little about the specific reasons or mechanisms for these differences and their significance for health and well being outcomes. It may be the case that the specific relationships that exist between religious involvement and well being outcomes vary as a function of social location (e.g., gender differences in the relationship between church attendance and well being). In this case, gender would be said to moderate the relationship between these factors (e.g., a gender interaction). However, it may be that, underlying the observed moderating effect, gender is significant in affecting the mechanisms through which religion and health and well being are associated. For example, if women are more religiously involved, they may also be more effective in marshalling support from their fellow congregants which, in turn, has an impact on well being (i.e., mediated effects of gender on outcomes). This suggests that a clearer understanding of gender differences in religion and health relationships should take into account possible underlying differences between women and men in levels of religious involvement and church-based support. Despite the importance of both contingent and mediated relationships involving social location factors and religion and well being relationships, they are often neglected in research (Ellison & Levin, 1998). Psychosocial Mechanisms

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Several explanatory models have been proposed that identify the mechanisms by which religious factors impact well being (Ellison & Levin, 1998; Ellison, 1994; Hummer, Rogers, Man, & Ellison, 1999; Levin & Chatters, 1998; Levin & Vanderpool, 1989; Pargament, 1997). Several broad categories of factors are addressed including: (a) lifestyle and health behaviors, (b) social resources, (c) coping resources and behaviors, and (d) attitudes, beliefs, and emotional states and feelings. With respect to lifestyle and health behaviors, religion is instrumental in shaping behaviors (e.g., risk and protective factors) that are consequential for physical and mental health. This includes direct proscriptions against specific behaviors that are health risks (e.g., dietary restrictions, prohibitions against the use of alcohol and tobacco), as well as encouraging behaviors that are conducive to health (e.g., regular exercise). Additionally, religious adherents may have reduced risk for non-normative stressful life circumstances and deviant behavior because religious teachings embody general guidelines for behavior (e.g., moderation, conformity) that discourage individual deviance and encourage interpersonal harmony. Religious institutions and clergy may function as gatekeepers with respect to individual help-seeking behaviors and health resource utilization and encourage or discourage the use of formal health services. Participation in religious groups confers a number of benefits in terms of enhanced social resources (e.g., social network size, frequency of interactions, actual and anticipated support, exchanges of instrumental, socioemotional, appraisal assistance). Various aspects of

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religious groups (e.g., group norms, characteristics, and functions) may facilitate the provision of support, reinforce perceptions of assistance, and provide members with an enriched sense of their value and worth as individuals (e.g., sense of being cared for and loved by others). Further, because members share similar frames of reference and meaning, religious groups provide a unique context within which to interpret problematic life situations and proffer needed assistance. Individuals may use religious resources to actively cope with problematic life situations. Religious coping can involve different arenas (e.g., individual approaches, support from congregation members and clergy) and types of coping strategies (e.g., religious reframing, religious control orientations). Investigations of the specific content of religious coping suggest that it is multidimensional, serves a variety of purposes (e.g., emotional comfort, meaning and purpose, personal control), and involves a diverse array of strategies such as religious reappraisals and attempts to secure spiritual support (see the work of Pargament, 1997, and Fetzer Institute/NIA, 1999, for a discussion of this research). Individuals may combine religious (e.g., religious problem solving) and non-religious (e.g., instrumental problem solving) coping strategies to resolve problems. Also, the tenor of religious coping can be described as being positive (e.g., during personal difficulties the person seeks strength and comfort in God) or negative (e.g., in the face of personal problems, the person feels punished, abandoned, or angry at God). Religious doctrines and beliefs may support positive views of

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human nature and the self that engender attitudes and emotional states that are associated with better physical and mental health outcomes. Belief in the intrinsic value and uniqueness of each individual may promote feelings of self-esteem. Religious injunctions may shape interpersonal behaviors and attitudes towards others in ways that emphasize a variety of positive and prosocial goals (e.g., interpersonal warmth and friendliness, love, compassion, harmony, tolerance, forgiveness) and that reduce the likelihood of noxious and stressful interpersonal interactions. Religious ritual (e.g., prayer, communion, confession) may be important for instilling positive emotional states (e.g., joy, ecstatic experiences) and/or generating more global beliefs and worldviews that are associated with better health (e.g., optimism, forgiveness). Causal Models and Pathways The investigation of relationships between religion and well being has been predominated by direct effects models, particularly the effects of behavioral (e.g., affiliation, church attendance) and attitudinal measures of religious involvement on well being. Much less attention has been devoted to examining alternative models of religion and well being relationships, specifically those that incorporate various mediating factors and stress components and reflect different theoretical and conceptual linkages among religious factors, well being and the functional mechanisms (e.g., social support) thought to be responsible for these effects (Ellison & Levin, 1998; Levin & Chatters, 1998). Complex analytic models reflecting different

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associations among stress, religion, mediating factors, and well being outcomes (e.g., suppressor, health effects, distress-deterrent model or counterbalancing, moderator, and prevention) have been described (see Ellison & Levin, 1998). These analytic models of the theoretical linkages among religion, stress, and well being suggest additional levels of complexity with respect to the role of contextual factors in these relationships. For example, the prevention model suggests that religion has both direct and indirect protective effects. Aspects of religious involvement may benefit well being directly such as possible stress-reducing aspects of religious devotion and prayer. Religious involvement may also benefit well being indirectly by virtue of its influence in shaping positive lifestyle and health behaviors that result in reductions in risk for particular conditions that may compromise well being, as well as lower exposure to stressful circumstances (e.g., interpersonal conflicts). Further, known differences between women and men with respect to rates and patterns of religious involvement, as well as differences in lifestyles and health behaviors, suggest that gender status itself may be an important determinant of these components. In addition to the potential direct and indirect (via lifestyle and health behaviors) preventive effects of religious involvement on well being, religious involvement and lifestyles and health behaviors are, in part, determined by gender status. Given that women have higher rates of both religious participation and health promoting behaviors and lifestyles, we might expect that the

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association between religious involvement and well being would be stronger for women. However, despite the significance of religion for particular groups (e.g., older persons, African Americans), religious effects on well being may be absent if there is limited variability on these factors (Ellison & Levin, 1998). The consideration of contextual factors in these analytic models, while introducing increasing levels of complexity, also provide for more nuanced understandings of these relationships and mechanisms. Conclusions This brief article attempted to address the state of research on religion and its relationship to well being outcomes. The central focus of this argument was that the concept of social context is an important lens through which to assess various conceptual, methodological and analytic issues in current research. Two meanings of social context were explored-worldview or ecological perspective and social location. Race and culture and denominational affiliation were discussed as examples of how social context is important for understanding the fundamental meanings of religion and potential differences in its relationship to well being measures within diverse groups of the population. The explication of the meaning of social context and the mechanisms and pathways through which religious factors potentially affect health and well being suggests several considerations in the area of measurement. It is clear that because the meaning and centrality of religious institutions and activities vary within the population, we must employ measurement strategies that allow for a full

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expression of those differences. Past practices that rely on single-item, behavioral reports of public religious practices (i.e., attendance) or affiliation (i.e., religious denomination) will not provide the type of information that is required to fully understand how religion and health are related. At the very least, both public and private religious activities should be assessed, as well as attention to behaviors and religious beliefs and sentiments. A number of recent efforts have attempted to develop multi-item approaches to the measurement of several domains of religious experience and attitudes. Notable among them is the work of the Fetzer Institute/National Institute on Aging Working Group’s “Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research” (1999). Represented domains include: private religious practices, religious/spiritual coping, religious preference, religious support, and organizational religiousness, among others. The availability and use of multiple measures of diverse religious phenomena provides information that informs our thinking about the functional mechanisms through which religious factors affect health and well being. In addition, in circumstances in which a group demonstrates particularly elevated levels (i.e., ceiling effects) of religious involvement (e.g., church attendance), the availability of multiple measures of religious factors helps to gain a broader picture of their involvement across several indicators. Ultimately, however, it has been argued here that the interpretation of religious findings must take into

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consideration the broader context of a group’s unique experiences with religion as a way of giving meaning to their world and how that might be reflected in responses to particular religious items and observed relationships to health and well being. In this regard, a social context perspective is invaluable because it helps to identify and clarify issues concerning: (1) the conceptualization and measurement of religious involvement, (2) the psychosocial mechanisms involved, and (3) the nature of causal pathways and models involving religion and well being. In doing so, a social context perspective effectively positions critical aspects of the research process (such as conceptualization, measurement, analysis and interpretation) in the lives and experiences of individuals and communities. References Anderson, N.B., & McNeilly, M. (1991). Age, gender, and ethnicity as variables in psychophysiological assessment: Sociodemographics in context. Psychological Assessment, 3, 376-384. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513-530. Chatters, L.M., Taylor, R.J., & Lincoln, K.D. (2001). Advances in the measurement of religiosity among older African Americans: Implications for health and mental health researchers. Journal of Mental Health and Aging, 7, 181-200.

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Chatters, L.M. (2000). Religion and health: Public health research and practice. Annual Review of Public Health, 21, 335-367. Ellison, C.G. (1995). Race, religion involvement, and depressive symptomatology in a southeastern U.S. community. Social Science and Medicine, 40, 1561-1572. Ellison, C.G. (1994). Religion, the life-stress paradigm, and the study of depression. In J.S. Levin (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 78-121). Thousand Oaks, CA: Sage. Ellison, C.G., Gay, D.A., & Glass, T.A. (1989). Does religious commitment contribute to individual life satisfaction? Social Forces, 68, 100-123. Ellison, C.G., & George, L.K. (1994). Religious involvement, social ties, and social support in a southeastern community. Journal for the Scientific Study of Religion, 33, 46-61. Ellison, C.G., & Levin, J.S. (1998). The religion-health connection: Evidence, theory and future directions. Health Education & Behavior, 25, 700-720. The Fetzer Institute & National Institute on Aging Working Group. (1999). Multidimensional measurement of religiousness/spirituality for use in health research. Kalamazoo, MI: Fetzer. Frazier, E.F. (1974). The Negro Church in America. New York: Schocken Books.

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Hummer, R.A., Rogers, R.G., Nam, C.B., & Ellison, C.G. (1999). Religious involvement and U.S. adult mortality. Demography, 36, 273-85. Johnson, K.W., Anderson, N.B., Bastida, E., Kramer, B.J., Williams, D.R., & Wong, M. (1995). Panel II: Macrosocial and environmental influences on minority health. Health Psychology, 14, 601-612. Levin, J.S., & Chatters, L.M. (1998). Research on religion and mental health: An overview of empirical findings and theoretical issues. In H.G. Koenig (Ed.), Handbook of religion and mental health (pp. 34-50). San Diego: Academic Press. Levin, J.S., & Vanderpool, H.Y. (1987). Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Social Science and Medicine, 24, 589-600. Levin, J.S., & Vanderpool, H.Y. (1989). Is religion therapeutically significant for hypertension? Social Science and Medicine, 24, 69-78. Lincoln, C.E., & Mamiya, L. (1990). The black church in the African American experience. Durham, NC: Duke. Pargament, K.I. (1997). The psychology of religion and coping: Theory, research, practice. New York: Guilford. Taylor, R.J. & Chatters, L.M. (1986). Church-based informal support networks among elderly blacks. The Gerontologist, 26, 637-642.

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Taylor, R.J. & Chatters, L.M. (1988). Church members as a source of informal social support. Review of Religious Research, 30, 193-203. Taylor, R.J., Thornton, M.C., & Chatters, L.M. (1987). Black Americans’ perceptions of the socio-historical role of the church. Journal of Black Studies, 18, 123-38. Woodbury, R.D., & Smith, C.S. (1998). Fundamentalism et al: Conservative Protestants in America. Annual Review of Sociology, 24, 25-56. Linda M. Chatters is affiliated with the Department of Health Behavior and Health Education, School of Public Health and Program for Research on Black Americans, Institute for Social Research, University of Michigan. Robert Joseph Taylor is affiliated with the School of Social Work and Program for Research on Black Americans, Institute for Social Research, University of Michigan. Address correspondence to: Linda M. Chatters, Department of Health Behavior and Health Education, School of Public Health, and Program for Research on Black Americans, Institute for Social Research, University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109 (E-mail: [email protected]). This article was supported in part by grants from the National Institute on Aging (AG 18782, L.M. Chatters, Principal Investigator, AG 14749, N. Krause, Principal Investigator and AG 10135, R.J. Taylor, Principal Investigator) and the National Institute for Mental Health (MH58565, J.S. Jackson, Principal Investigator).

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This article is based, in part, on an earlier manuscript: Chatters, L.M. & Taylor, R.J. Contextual factors in religion/spirituality and health. Invited paper, National Institute of Health Panel, Spirituality, Religion and Health, Office of Behavioral and Social Sciences Research. October 26-27th, 1999. [Haworth co-indexing entry note]: “The Role of Social Context in Religion.” Chatters, Linda M. and Robert Joseph Taylor. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 139-152; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 139-152. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Why Believe? The Effects of Religious Beliefs on Emotional Well Being Julie Hicks Patrick, PhD Jennifer M. Kinney, PhD Summary. This study tested the roles of age, religious beliefs and organizational religiosity in the prediction of depressive symptoms and positive affect. Data provided by 129 younger and older adults were used to test a path model in which both direct and indirect effects of age and beliefs on well being were hypothesized. Both age and religious beliefs were positively and significantly associated with organizational religiosity. Individuals who reported more frequent participation in organizational religiosity reported fewer depressive symptoms and higher positive affect. Neither age nor religious beliefs, however, exerted direct effects on the outcomes. Results of the current investigation suggest that a better understanding of the content and function of religious beliefs may add to our understanding of well being and aging. Moreover, we advocate the further investigation of religiosity and positive emotional experiences. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2003 by The Haworth Press, Inc. All rights reserved.]

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Keywords. Religious beliefs emotional well being aging Thirty years ago, Heenan (1972) characterized the research on religion and aging as an “empirical lacunae.” A decade ago, Payne (1990) characterized the growing literature as lacking an explicit, guiding theoretical framework. Significant progress has since occurred. In the past decade, researchers have conducted sophisticated epidemiological studies (e.g., Koenig et al., 1999; McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000; Strawbridge, Cohen, Shema, & Kaplan, 1997) that demonstrate that religious participation is associated with decreased depression, decreased morbidity, and increased longevity. More recently, researchers have turned their attention toward developing a richer understanding of the ways in which religiosity affects adult development. As part of this effort, several fundamental issues have emerged. One such issue is that in addition to examining how religiosity buffers against negative physical and emotional effects, the field must focus on the ways in which religiosity bolsters or enhances positive emotional experiences. Adapting frameworks developed from a variety of disciplines, researchers are increasingly interested in how people continue to adapt and grow throughout adulthood. As part of the emerging ‘positive psychology’ movement, it has been suggested that religiosity is one of many potential pathways to growth (Frederickson, 2001). Significant work that investigates the ways in which prayer and other religious behaviors influence well being is well underway (e.g., Ai, Peterson, Bolling & Koenig, 2002). One area of religiosity that has 267

received less empirical attention (McFadden, 1996), but which can be examined within the positive psychology framework, is the role of religious beliefs. We agree with Ellison and Levin (1998) who suggest that a more in-depth examination of religious beliefs can provide insight into the function of religiosity in the lives of both younger and older adults. As one of the first studies to explicitly examine the role of religious beliefs and positive outcomes, we limited our inquiry to better understand the robust association between organizational religiosity and emotional experiences. Thus, we address two general research questions: (1) how do age and religious beliefs relate to organizational religiosity? and (2) how do age and religious beliefs relate to emotional well being? Religiosity and Well Being Most research that addresses emotional well being and religiosity adopts multidimensional views of each construct. Well being is typically characterized by high levels of positive emotions and experiences and infrequent negative emotions and experiences (Diener, Suh, Lucas & Smith, 1999). Age differences often emerge in studies of well being, with the trend for more temperate emotional experiences in later adulthood than in younger adulthood (Mroczek & Kolarz, 1998; Muntaner & Barnett, 2000). For example, in a recent study using the Center for Epidemiologic Studies of Depression index (CES-D; Radloff, 1977), Muntaner and Barnett (2000) found that 38.2% of the college-aged adults, 32.5% of those ages 25 to 54, and 20.8% of

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adults ages 55-64 scored highly enough to be considered at risk for clinical depression. Similar to well being, religiosity is multidimensional; it includes elements of organizational participation, private behaviors and subjective assessments (McFadden, 1996). Of the different facets of religiosity, the most widely investigated are the organizational measures of denomination and the frequency of attending services (McCullough et al., 2000). Results of these investigations indicate that although older adults exhibit higher levels of organizational religiosity than do younger adults (Johnson, 1995; Payne, 1990), attending religious services is associated with well being benefits across age groups (Koenig et al., 1999; McCullough et al., 2000; Strawbridge et al., 1997). Specifically, people who report higher levels of organizational religiosity report fewer depressive symptoms than those who do not identify a denominational affiliation or attend services regularly (Braam, Beekman, van Tilburg, Deeg, & van Tilburg, 1997; Krause, Ingersoll-Dayton, Ellison, & Wulff, 1999; Levin & Chatters, 1998). However, this evidence is neither strong nor unequivocal. When significant associations emerge, organizational religiosity explains less than 15% of the variance in psychological measures (e.g., Koenig, Krale, & Ferrel, 1988; Krause et al., 1999). Recently, researchers have begun to examine the ways in which religiosity affects positive, as well as negative, emotional outcomes (Braam et al., 1998; Krause & Van Tran, 1989; Levin & Chatters, 1998). As is the case with depressive symptoms, the relations between religiosity

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and positive emotions are mixed. Krause and Van Tran (1989) used mastery and self-esteem as indicators of positive psychological well being, and found varying effects of religiosity. Levin and Chatters (1998) found that religiosity did not impact life satisfaction. More recently, Braam et al. examined mastery among a large sample of older Dutch adults. Although denominational differences emerged for depressive symptoms, no such differences emerged for mastery. Religious Beliefs and Well Being Early research used religious denomination as a proxy for religious beliefs (Bardis, 1961), noting that denominations often differ in their beliefs about the nature of the divine, the role of prayer, the metaphysical, acceptable and expected behaviors, and doctrines. Carefully comparing the doctrines and historical context of Calvinists and Roman Catholics, Braam et al. (1998) interpreted group differences in the process of how religiosity affects psychological outcomes. In addition to mean denominational differences, different constructs mediated the relation between religiosity and depressive symptoms. Among Catholics, self-esteem buffered against depressive symptoms, whereas among Calvinists, high social integration served as a buffer. Braam et al.’s results contribute to our understanding of how religiosity may operate differently across denominations. However, we agree with Johnson (1995): Denominational affiliation is a poor proxy for religious beliefs. In fact, intra-denominational differences may be as great as those that exist between denominations.

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Recent forays into resiliency and positive psychology embrace an expansive view of well being (Frederickson, 2001). A key component to this line of inquiry is a focus on the function that specific beliefs and behaviors have in relation to well being. This emerging perspective has the potential to advance our understanding of religiosity and aging. That is, in order to understand the mechanisms whereby religiosity influences adult development, researchers may need to focus more directly on the content and function of religious beliefs (Blazer, 1991; Hill et al., 2000; Krause et al., 2002; Levin, 2001; McFadden, 1996). As Krause et al. (1999) stated: “without belief… things like prayer and participation in religious services would have little meaning” (p. 525). Indeed for many individuals, belief is a necessary condition for organizational religiosity to exert positive effects (Huddleston, 1995). Due to their individualistic and multidimensional nature (Blazer, 1991; Krause et al., 2002), however, religious beliefs are often difficult to operationalize. The multidimensionality of religious beliefs extends across cultures and religious denominations (Krause et al., 2002; Mehta, 1997), further complicating their operationalization. However, although not static, religious beliefs are thought to be relatively stable from young adulthood through old age (Overcash & Calhoun, 1996). Moreover, the relations between religious beliefs and organizational behavior may be similar across age groups, with the strength of religious beliefs predicting organizational religiosity among both younger (Roberts, Koch, & Johnson, 2001) and older adults (Hill et al., 2000). Religious beliefs are also associated with attitudes

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and psychological processes. In fact, it has been suggested that the main functions of religious beliefs are to guide behavior and decision making (Ai et al., 2002; Mehta, 1997), provide a mechanism through which to cope with adverse life events (Overcash & Calhoun, 1996; Koenig, Kvale, & Ferrel, 1988), and to increase one’s positive emotional experiences (Frederickson, 2001). Given their multidimensional nature, specific religious beliefs may exert different effects on an individual. For example, among Christians (Golsworthy & Coyle, 1999) and non-Christians (Krause et al., 2002; Mehta, 1997), belief in an afterlife is associated with better adjustment to bereavement. Religious beliefs that focus on the presence of the divine in nature are associated with stronger endorsements of environmental and animal rights causes (Peek & Konty, 1997; Schultz, 2000). In one of the few studies to explicitly link age and religious beliefs to well being, Krause et al. (1999) examined the effects of religious doubt. They found that in contrast to younger adults, religious doubt exerted minimal effects on the well being of older adults. Thus, the content and strength of religious beliefs are important aspects of religiosity that must be considered, as should potential age differences. The Current Study Despite the significant progress that has occurred in recent years, relatively little is known about the content and function of adults’ religious beliefs. The literature is further limited by its focus on negative emotions. In

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order to identify the ways in which religious beliefs relate to both negative and positive emotions, we developed the model shown in Figure 1, and the following hypotheses were posed. Figure 1. Theoretical Model

1. Age was expected to be positively associated with organizational religiosity (Johnson, 1995; McCullough et al., 2000). 2. Age was expected be associated with emotional well being. Specifically, given that emotional experiences become more temperate with age (Muntaner & Barnett, 2000), we expected young adults to report higher levels of depressive

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symptoms and higher levels of positive affect than older adults. 3. Religious beliefs were expected to be positively associated with organizational religiosity (Hill et al., 2000; Roberts et al., 2001). 4. Religious beliefs were also expected to exert direct effects on well being. Specifically, we expected that those individuals endorsing stronger religious beliefs would report lower levels of depressive symptoms (Ai et al., 2002; Braam et al., 1998; Mehta, 1997) and higher levels of positive affect (Frederickson, 2001). 5. Higher levels of organizational religiosity were expected to be associated with fewer depressive symptoms (Braam et al., 1997; Levin & Chatters, 1998; Strawbridge et al., 1997) and higher levels of positive affect (Krause et al., 1999; Levin & Chatters, 1998). Method Procedure Data for these analyses were provided by adults who completed a self-administered survey (Personality, Spirituality, and Well Being in Adulthood) in March 2000. Sixty-six younger adults were recruited from undergraduate students at a large mid-Atlantic university and were eligible to receive extra-credit in a psychology course for their participation. Seventy-eight older adults identified from a volunteer pool were also invited to participate. Older adults received no compensation for their assistance. All participants signed an informed consent form. In accordance with institutional review 274

board policies, participants were advised that they did not have to answer any questions they did not want to answer. The analyses that follow are based on the responses from 129 adults who provided complete data on the measures of interest. Sample The current sample included 64 younger adults (M age = 22.56, range 18 to 25; SD = 4.9) and 65 older adults (M age = 74.77, range 66 to 90; SD = 6.3) Forty-six percent of the participants were male, although the sample over-represented younger women and older men. The average educational attainment was 13.8 years, with a range of 4 to 20 years (MDN = 14.0). Approximately two-thirds of the sample (67.5%) was Protestant, similar to the percentage reported for the nation (Williams, 1994). Approximately 21.4% were Catholic, 1% were Jewish, 4% reported some other affiliation, and 6.3% reported having no religious affiliation.1 More specific information regarding denominational affiliation was not requested. Sample means are presented in Table 1. Table 1. Descriptive Statistics (N = 129)

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Note: a

Center for Epidemiologic Studies of Depression Index (Radloff, 1977) b

Philadelphia Geriatric Center Positive Affect Scale (Lawton et al., 1992) Measures Religious beliefs were measured using a scale created for this study. Respondents endorsed eight beliefs using a 4-point scale (Strongly Agree, Agree, Disagree, Strongly Disagree). Based on the conceptual and statistical associations, five were used to form a scale of religious beliefs,2 including: (1) My faith is the most important source of comfort in my life, (2) God wants us to be content with what He has provided for us, (3) God helps those who help themselves, (4) Those who suffer in this life will be rewarded in Heaven, and (5) I have experienced religious doubt (reverse scored). Items were scored such that a high score reflected stronger beliefs. A scale mean of 13.97 (SD = 3.40) was obtained; coefficient alpha was .72. Organizational religiosity was indexed using a 4-item scale that tapped the frequency (4 = Often, 3 = Sometimes, 2 = Almost never, 1 = Never) of attending worship services, belonging to religious organizations, contributing money to religious organizations, and attending religion-based meetings. The scale had a mean of 10.78 (SD = 3.71) and a coefficient alpha of .91. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression index (CES-D;

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Radloff, 1977). The CES-D is a 20-item scale developed as a screen for community-dwelling adults at risk for serious depression. The sample mean was 14.05 (SD = 12.09) and coefficient alpha was .92. This scale typically employs a cut-off score of 16 to identify individuals who may be at risk for clinical depression. More than one-third (34.9%) of the sample scored above this cut-off. In a recent epidemiological study conducted in the same geographic region as the current study, CES-D scores were higher than for the nation in general, with younger adults scoring particularly high (Muntaner & Barnett, 2000). Positive affect was assessed using five items from the Philadelphia Geriatric Center Positive and Negative Affect Scale (Lawton, Kleban, Dean, Rajagopol, & Parmelee, 1992). Using a 5-point response scale (Never, Rarely, Sometimes, Frequently, and Very Frequently), respondents indicated how often during the past week they felt: happy, interested, warm-hearted, content, and energetic. In the current sample, a mean of 19.16 (SD = 2.98) was obtained. Coefficient alpha was .80. Analytical Strategy With our focus on the associations among five constructs (i.e., age, religious beliefs, organizational religiosity, positive affect, depressive symptoms), sample size and model complexity raise important questions regarding power. Cohen and Cohen (1988) state that as few as five subjects per degree of freedom can be used in statistical modeling, provided that the standard errors of the measures are small. As shown in Table 1, our data meet

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this requirement. An additional rule of thumb suggests a minimum of 10 participants per free parameter (Byrne, 2001). Counting the error terms (n = 3), regression paths (n = 6), covariances between measures (n = 1), exogenous variables (n = 2), and endogenous variables (n = 3) in the model results in 15 parameters, 12 of which are estimated. Thus, our sample size of 129 is adequate. Results Preliminary Analyses Due to the sample’s over-representation of younger women and older men, we investigated the effects of gender before completing the major analyses. Mean comparisons between men and women controlling for age (available from the first author) revealed no significant gender differences for the number of religious beliefs, strength of religious beliefs, organizational religiosity, depressive symptoms or positive affect. Thus, for the sake of parsimony and statistical power, gender was not included in the current model. As an additional preliminary analysis, univariate associations were examined by inspecting the correlation matrix shown in Table 2. Table 2.Correlations Among Model Constructs

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*p < .01 Mean Age Differences Using independent samples t-tests for continuous variables and chisquare tests for categorical measures, we examined age differences on demographic characteristics, religious beliefs, organizational religiosity, depressive symptoms, and positive affect. These results are shown in Table 3. Significant age differences emerged for denomination [X2(df = 4; N = 129) = 26.16, p < .001], with more older adults reporting a Protestant affiliation (88.7%) than did younger adults (46.9%). In contrast, fewer older adults (9.7%) reported being Catholic compared to younger adults (32.8%). Similarly, only 1.6% of the older adults, but 10.9% of the younger adults, reported having no religious affiliation. Table 3. Mean Age Differences

*p < .01; **p < .001

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Despite the observed differences in denominational affiliation, when corrected for multiple comparisons (p < .005) younger and older adults did not differ in the number of religious beliefs endorsed nor in the strength of their beliefs. Older adults did, however, report higher levels of organizational religiosity than younger adults. Thus, there is support for Hypothesis 1. In terms of CES-D scores, the expected age differences emerged, with younger adults reporting more depressive symptoms than older adults. When examining those exceeding the cut-off for risk of serious depressive symptoms, more younger adults than older adults would be considered at risk [43.9% and 26.2%, respectively; X2(df = 1, N = 129) = 4.40, p < .05]. Age differences were not observed for positive affect. Thus, partial support for Hypothesis 2 was obtained. Our remaining hypotheses were tested within the framework of the path analysis. Relations Among the Variables The AMOS (Arbuckle, 1995) program was used to test the fit of the data to the hypothesized model. AMOS estimates path models through variance-covariance matrices and reads a path diagram as input. Maximum likelihood estimates (MLE) are tested for statistical significance using the Critical Ratio (CR = MLE/Standard Error of MLE). CRs greater than 1.96 are interpreted as statistically significant at the p < .05 level (Arbuckle, 1995; Byrne, 2001). To evaluate the fit of the path model, multiple indexes of fit were used, including an overall chi-square, the Tucker-Lewis Index (TLI), the Comparative Fit Index (CFI), and the Root

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Mean Square Error Approximation (RMSEA). To assess model stability, we used Hoelter’s Critical N (CN), for which values greater than 200 times suggests stability. The hypothesized paths in Figure 1 were tested simultaneously. The summary statistics present mixed information regarding the fit of the data to the model (X2(1)= 2.013, p = .156; TLI = .905; CFI = .990; RMSEA = .089; CN > 200). The chi-square and the CFI suggest acceptable fit; supportive trends are suggested by the TLI and RMSEA. Moreover, the model accounted for only 11.4% of the variance in depressive symptoms and 5.9% of positive affect. Standardized and unstandardized regression weights (MLEs) and critical ratios (CRs) are presented in Table 4. Age (Hypothesis 1) and religious beliefs (Hypothesis 3) were associated with higher levels of organizational religiosity. The paths from organizational religiosity to depressive symptoms (Hypothesis 5) and from organizational religiosity to positive affect (Hypothesis 5) reached significance, as did the hypothesized covariance between the two measures of emotional well being. However, four of the hypothesized paths failed to reach significance (i.e., CR < 1.96). As shown in Table 4, the paths from beliefs to depressive symptoms (Hypothesis 4), beliefs to positive affect (Hypothesis 4), and from age to both well being outcomes (Hypothesis 2) failed to reach significance, although the path from age to depressive symptoms approached significance. Table 4. Results of Structural Model Testing (N = 129)

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Exploratory Analyses Although expert opinion differs with regard to the value of modifying a theoretical model based on statistical evidence (Byrne, 2001), we sought to identify the most parsimonious model for testing in future research studies. Thus, we undertook exploratory analyses in which non-significant paths were deleted one at a time and model fit was re-evaluated following each deletion (Arbuckle, 1995). Thus, we deleted the paths in the following order: (1) beliefs to depressive symptoms, (2) beliefs to positive affect, and (3) age to positive affect. Removing these three non-significant paths from the model resulted in better fit, as assessed by the summary statistics [X2(df = 4, N = 129) = 2.184, p = .702; TLI > 282

.99; CFI > .99; RMSEA < .01]. Significant paths emerged from belief to organizational religiosity, age to organizational religiosity, age to depressive symptoms, organizational religiosity to depressive symptoms, and organizational religiosity to positive affect. Stability of the model was confirmed using Hoelter’s CN, which was greater than 200. Discussion The goal of the current study was to provide a more in-depth understanding of the associations of age and religious beliefs with organizational religiosity and two indices of well being. We focused on organizational religiosity for both conceptual and methodological reasons, and extended much of the earlier research by examining religious beliefs as a predictor of organizational religiosity. In addition, we included indicators of both positive and negative well being. We posed two general questions: How do age and beliefs relate to organizational religiosity? and How do age and beliefs relate to well being? In terms of age differences, our data suggest that younger and older adults share many of the same beliefs and endorse them to similar degrees. That older adults exhibit a higher mean level of organizational religiosity, then, should not be interpreted as differences in the beliefs or values between age groups. Rather, younger adults may choose different behavioral expressions of their religious beliefs (Payne, 1990).

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Both age and religious beliefs were related to organizational religiosity, although neither directly affected depressive symptoms nor positive affect. Examination of the MLEs reveals that age and religious beliefs exerted similar magnitude of effects on organizational religiosity, and that they exerted equivalently sized indirect effects on well being. In the path analysis, religious beliefs exerted indirect effects on emotional well being. Interestingly, age, religious beliefs, and organizational religiosity exerted similar effects on depressive symptoms and positive affect, accounting for very little variance in either outcome. Only in our exploratory analyses did age demonstrate a direct association with depressive symptoms; the relation was inverse, with younger adults more likely to report higher levels of depressive symptoms. This age effect is interesting, and is consistent with recent reports (Muntaner & Barnett, 2000). The current study is among only a few empirical tests to examine the ways in which religious beliefs are related to emotional outcomes. It is noteworthy that beliefs did not exhibit a direct effect on well being. We encourage independent validation of this finding. However, future investigators are advised to include a richer measure of religious beliefs, one that reflects the multidimensional and often idiosyncratic nature of religious beliefs (Blazer, 1991; Krause et al., 2002; McFadden, 1996). In our study, we chose five beliefs that were conceptually related and that correlated moderately well, tapping a construct that might be labeled “beliefs regarding the comfort of religion.” Given our focus on

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religion as comfort, it is surprising that beliefs did not directly affect well being. Future studies may need to develop measures of the perceived effectiveness of specific religious beliefs within a longitudinal design. The effects of specific beliefs on well being may reflect a dynamic process that can not be captured in a cross-sectional design. Using richer measures of religious beliefs will facilitate an examination of the function and content of specific religious beliefs. Thus, it will permit an explicit test of that which many researchers suspect: The reasons one engages in religious behaviors directly influence the effects of one’s experiences. We encourage such additional research. Cataloging the effects of specific beliefs has the potential to create bridges among several areas of investigation, including attitude formation, well being, and gerontology. Such an interdisciplinary scope can only add to our understanding of how religiosity affects adults. Moreover, we recommend that future research identify life contexts in which the effects of religious beliefs are moderated. At least four caveats limit our findings. First, the name of the study might have influenced who volunteered to participate, as persons willing to answer questions about spirituality may hold particularly strong beliefs. Indeed, anecdotal evidence suggests that the respondents took the survey questions very seriously, writing rich statements in the margins and including “chapter and verse” references to back up their endorsement or rejection of specific religious beliefs.

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A second limitation to our analyses concerns the small of amount of variance explained. Similar to the results of other studies (e.g., Koenig et al., 1999; Krause et al., 1999), our model accounts for less than 15% of the variance in depressive symptoms and positive affect. One explanation for the low amounts of explained variance may relate to the cross-sectional nature of our data. As Ellison and Levin (2001) and Krause et al. (2002) have discussed, the field needs prospective studies of the effects of religiosity. Future studies need to directly explore the reasons that religiosity exerts benefits for the health and vitality of the body but exhibits small and inconsistent effects on emotional experiences. As Braam et al. (1998) demonstrate, religiosity may not exert the same effects across individuals. Exploring how specific religious beliefs interact across contexts, including age, will further explicate this complex relation. A third limitation is regarding the measures that were not included in the tested model. Specifically, there is strong evidence that private religiosity, including prayer, is an important consideration (McFadden, 1996). Due to our relatively small sample, we chose to focus our analyses within the context of organizational religiosity. However, religious beliefs are likely to influence the nature and intensity of private religiosity as well. Larger samples will be required to test the associations of age, beliefs, and organizational and private religiosity with both positive and negative emotions. Finally, although our path model fit the data well, caution should be exercised when interpreting the

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modifications we made to the model (Byrne, 2001). Additional religious beliefs may demonstrate direct effects on either depressive symptoms or positive affect. We suggest that our initial model be tested in larger and diverse samples in order to validate that religious beliefs do not directly affect well being. Despite these limitations, our results contribute to an understanding of how religious beliefs function in the lives of both younger and older adults. Moreover, several exciting lines for future research are suggested. First, there is much to be learned regarding religious beliefs. Although our measure is limited in its scope, we have provided a conceptually driven, empirically refined measure of religion as comfort. The descriptive statistics related to this composite are in and of themselves interesting. Additional research will certainly lead to a fuller understanding of the varieties of religious beliefs. A second finding that should be pursued in further research is the suggestion that younger and older adults choose different behavioral expressions of their religious beliefs. Such an interpretation calls for the examination of other factors that influence behavior. Guided by strong theoretical frameworks, and utilizing rigorous measures and methods, research on religion and aging is poised to make significant contributions to our understanding of adult development. Notes 1. When adjusting for multiple comparisons, no significant differences emerged between Protestants and other religious affiliations.

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2. The excluded items focused on the experience of religious visions, perceived benefits of discussing personal problems with a pastor or minister, and the belief that bad things should not happen to good people. References Ai, A.L., Peterson, C., Bolling, S.F., & Koenig, H. (2002). Private prayer and optimism in middle-aged and older patients awaiting cardiac surgery. The Gerontologist, 42, 70-81. Arbuckle, J. (1995). AMOS: Analysis of moment structures user’s guide. Chicago: Small Waters Corp. Bardis, P. (1961). A religion scale. Social Science, 36, 120-123. Blazer, D. (1991). Spirituality Generations, 15, 61-65.

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Braam, A.W., Beekman, A.T.F., Knipscheer, C.P.M., Deeg, D.J.H., van den Eeden, P., & van Tilburg, W. (1998). Religious denomination and depression in older Dutch citizens: Patterns and models. Journal of Aging & Health, 10, 483-503. Braam, A.W., Beekman, A.T.F., van Tilburg, T.G., Deeg, D.J.H., & van Tilburg, W. (1997). Religious involvement in older Dutch citizens. Social Psychiatry and Psychiatric Epidemiology, 32, 284-291. Byrne, B. (2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Mahwah, NJ: Lawrence Erlbaum.

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Cohen, J., & Cohen, P. (1988). Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum. Diener, E., Suh, E.M., Lucas, R.E., & Smith, H.L. (1999). Subjective well being: Three decades of progress. Psychological Bulletin, 125, 276-302. Ellison, C.G., & Levin, J.S. (1998). The religion-health connection: Evidence, theory and future directions. Health Education & Behavior, 25, 700-720. Frederickson, B.L. (2001). The role of positive emotions in positive psychology. American Psychologist, 56, 218-226. Golsworthy, R., & Coyle, A. (1999). Spiritual beliefs and the search for meaning among older adults following partner loss. Mortality, 4, 20-40. Heenan, E.F. (1972). Sociology of religion and aged. Journal of Scientific Study of Religion, 17, 359-379. Hill, P.C., Pargament, K.I., Hood, R.W., Jr., McCullough, M.E., Swyers, J.P., Larson, D.B., & Zinnbauer, B.J. (2000). Conceptualizing religion and spirituality: Points of commonality, points of departure. Journal for the Theory of Social Behavior, 30, 51-77. Huddleston, M.A. (1995). Springs of spirituality. Liguori, MO: Triumph Books. Johnson, T. R. (1995). The significance of religion for aging well. American Behavioral Scientist, 39, 186-208. Koenig, H.G., Hays, J.C., Larson, D.B., George, L.K., Cohen, H.J., McCullough, M.E., Meador, K.G. & 289

Blazer, D.G. (1999). Does religious attendance prolong survival?: A six-year follow-up study of 3,968 older adults. Journal of Gerontology: Medical Sciences, 54A, M370-376. Koenig, H.G., Kvale, J.N., & Ferrel, C. (1988). Religion and well being in later life. The Gerontologist, 28, 18-28. Krause, N., Ingersoll-Dayton, B., Ellison, C.G., & Wulff, K.M. (1999). Aging, religious doubt, and psychological well being. The Gerontologist, 39, 525-533. Krause, N., Liang, J., Shaw, B.A., Sugisawa, H., Kim, H.-K., & Sugihara, Y. (2002). Religion, death of a loved one, and hypertension among older adults in Japan. Journal of Gerontology: Social Sciences, 57B, S96-107. Krause, N., & Van Tran, T. (1989). Stress and religious involvement among older Blacks. Journal of Gerontology: Social Sciences, 44, S4-13. Lawton, M.P., Kleban, M.H., Dean, J., Rajagopal, D., & Parmelee, P. A. (1992). The factorial generality of brief positive and negative affect measures. Journal of Gerontology: Psychological Sciences, 47, P228-237. Levin, J.S. (2001). God, faith, and health: Exploring the spirituality-healing connection. NY: Wiley. Levin, J.S., & Chatters, L.M. (1998). Religion, health, and psychological well being in older adults: Findings from three national surveys. Journal of Aging and Health, 10, 504-531. McCullough, M.E., Hoyt, W.T., Larson, D.B., Koenig, H.G., & Thoresen, C. (2000). Religious involvement and

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mortality: A meta-analytic review. Health Psychology, 19, 211-222. McFadden, S.H. (1996). Religion, spirituality, and aging. In J.E. Birren & K.W. Schaie (Eds.), Handbook of the psychology of aging (4th ed., pp. 162-177). NY: Academic Press. Mehta, K.K. (1997). The impact of religious beliefs and practices on aging: A cross-cultural comparison. Journal of Aging Studies, 11, 101-114. Mroczek, D.K., & Kolarz, C.M. (1998). The effect of age on positive and negative affect: A developmental perspective on happiness. Journal of Personality and Social Psychology, 75, 1333-1349. Muntaner, C., & Barnett, E. (2000). Depressive symptoms in rural West Virginia. Journal of Health Care for the Poor and Underserved, 11, 284-300. Overcash, W.S., & Calhoun, L.G. (1996). Coping with crises: An examination of the impact of traumatic events on religious beliefs. Journal of Genetic Psychology, 157, 455-464. Payne, B.P. (1990). Research and theoretical approaches to spirituality and aging. Generations, 14, 11-14. Peek, C.W. & Konty, M.A. (1997). Religion and ideological support for social movements: The case of animal rights. Journal for the Scientific Study of Religion, 36, 429-439.

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Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. Roberts, A.E., Koch, J.R., & Johnson, D.P. (2001). Religious reference groups and the persistence of normative behavior: An empirical test. Sociological Spectrum, 27, 981-988. Schultz, P.W. (2000). A multinational perspective on the relation between Judeo-Christian religious beliefs and attitudes of environmental concern. Environment & Behavior, 32, 576-591. Strawbridge, W.J., Cohen, R.D., Shema, S.J., & Kaplan, G. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87, 957-961. Williams, D.R. (1994). The measurement of religion in epidemiologic studies: Problems and prospects. In J.S. Levin (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 125-148). Thousand Oaks, CA: Sage. Julie Hicks Patrick is affiliated with the Department of Psychology, West Virginia University. Jennifer M. Kinney is Professor, Department of Sociology, Gerontology, and Anthropology, Scripps Gerontology Center, Miami University, Oxford, OH. Address correspondence to: J.H. Patrick, POB 6040, West Virginia University, Morgantown, WV 26506-6040 (E-mail: [email protected]).

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[Haworth co-indexing entry note]: “Why Believe? The Effects of Religious Beliefs on Emotional Well Being.” Patrick, Julie Hicks, and Jennifer M. Kinney. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 153-170; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 153-170. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Part III The Fruits of the Religious Life

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Coping with the Uncontrollable: The Use of General and Religious Coping by Caregivers to Spouses with Dementia Jennifer M. Kinney, PhD Karen J. Ishler, MA, LSW Kenneth I. Pargament, PhD John C. Cavanaugh, PhD Summary. Using a transactional model of stress and coping, we examined the general (i.e., Problem-Focused, Emotion-Focused) and religious (i.e., Self-Directing, Collaborative, Deferring) coping strategies used by 64 caregivers to spouses with dementia to cope with their most significant, albeit uncontrollable, caregiving hassle over a two-month period. With respect to general coping, we hypothesized that caregivers who used Emotion-Focused coping would demonstrate fewer Depressive Symptoms at Month 2 after controlling for Depressive Symptoms at Month 1. With respect to religious coping, we hypothesized that caregivers who used Deferring Coping would also demonstrate fewer Depressive Symptoms. Results revealed interesting patterns between caregivers’ use of general and religious coping strategies. Contrary to our hypotheses, caregivers who used Emotion-Focused and Collaborative coping reported greater Depressive Symptoms. Implications for the empirical study of stress and coping and directions for future research are discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

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Keywords. General coping religious coping dementia care spousal caregivers depressive symptoms The stress and subsequent consequences of caring for a family member with dementia have been amply documented over the course of the past two decades. The majority of this research has relied on transactional models of stress (e.g., Lazarus & Folkman, 1984; Pearlin, Mullan, Semple, & Skaff, 1990). Early investigations highlighted the role of individuals’ appraisals, rather than objective events, and emphasized the importance of coping as a mediator in the stress process. The purpose of this research was to extend initial attempts (e.g., Vitaliano, DeWolfe, Maiuro, Russo, & Katon, 1990) to identify and characterize the specific context-dependent factors that influence caregiver adjustment. Specifically, we examined the general (i.e., Problem-Focused, Emotion-Focused) and religious (i.e., Self-Directing, Collaborative, Deferring) coping strategies used by 64 caregivers to spouses with dementia to deal with their most significant and uncontrollable caregiving hassle over a two-month period. Two waves of data enabled us to examine coping and Depressive Symptoms at Month 1 as predictors of Depressive Symptoms at Month 2. General Coping

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Folkman, Lazarus, Gruen, and DeLongis (1986) define coping as the constantly changing “cognitive and behavioral efforts to manage (reduce, minimize … or tolerate) the internal and external demands of the person-environment transaction that is appraised as taxing or exceeding the person’s resources” (p. 572). Lazarus and Folkman (1984) identify two types of coping–Problem-Focused and Emotion-Focused. Problem-Focused coping is planful and involves attempts to modify/change the problematic situation. In contrast, Emotion-Focused coping is aimed at regulating the emotional distress that arises from a stressful person-environment relationship, and includes such strategies as denial, wishful thinking, and the expression of emotion. Mixed findings regarding general patterns of coping efficacy have led some researchers to a microanalysis of coping effectiveness. Drawing on the transactional framework of stress and coping, some researchers have proposed a hypothesis of fit (e.g., Forsythe & Compas, 1987; Vitaliano et al., 1990). As used here, this hypothesis refers to whether an individual “matches” his/ her coping response to his/her cognitive appraisal of a situation, and the consequences of a “fit” or “match” between appraisal and coping (Vitaliano et al., 1990). Simply put, if individuals use an appropriate coping strategy, based upon their cognitive appraisals of the demands of the situation, they are more likely to experience success in their efforts to manage the situation. Use of an inappropriate coping strategy, one that does not “fit” an individual’s cognitive appraisal of an event, will likely be met with failure. The hypothesis

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of fit is illustrated in the Serenity Prayer made popular in 12-step programs: “God, grant me the serenity to accept the things I can not change, the courage to change the things I can, and the wisdom to know the difference.” As reflected in the prayer, individuals attempt to match their coping strategies to the demands of a particular situation; the ability to match coping to a situation constitutes wisdom. The appraisal of the controllability of a situation (i.e., secondary appraisal) offers an appealing opportunity for a substantive test of the hypothesis of fit. The appraisal of a situation as one that is controllable would lead to the selection and use of coping strategies directed toward changing the situation, whereas evaluation of the situation as uncontrollable would lead to the use of strategies aimed toward acceptance and perhaps attempts to regulate the emotional impact of the situation. Indeed, appraisals of situations as controllable have been tied to the use of strategies that emphasize an active, problem-solving approach, and appraisals of situations as uncontrollable have been linked to coping strategies that emphasize a palliative, emotion-regulating approach (e.g., Folkman & Lazarus, 1980; Forsythe & Compas, 1987). With respect to general coping, only two studies (Forsythe & Compas, 1987; Vitaliano et al., 1990) have directly tested the hypothesis of fit. Among college students coping with major life events, Forsythe and Compas (1987) found that better fit between appraisal and coping strategy was associated with decreased psychological symptomatology. Similarly, Vitaliano et

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al. (1990) found lower levels of depression among individuals with non-psychiatric conditions (Alzheimer’s caregivers, chronic pain patients, and camp counselors) who used problem-focused coping in response to controllable stressors. Thoits (1991) reported that both Problem- and Emotion-Focused coping were associated with self-reported positive outcomes, but only under conditions evaluated as uncontrollable. Two additional studies that provided indirect tests of the hypothesis of fit (Felton & Revenson, 1984; Vitaliano, Maiuro, Russo, & Becker, 1987) offered no evidence that stressor controllability impacts coping effectiveness. The diversity of results across these studies suggests that the strength of observed appraisal-coping-outcome relationships might be a function of the specific stressor being measured, the subject population being studied, and the specific outcomes being measured. Religious Coping Despite its typical omission from transactional models of stress, religion is an additional resource in coping. Pargament (1997) proposed that religious coping efforts can be conceptualized at a level analogous to the general coping efforts identified by Lazarus and colleagues (e.g., Lazarus & Folkman, 1984). He also reviewed empirical studies that show that religious coping predicts adjustment to major life crises above and beyond the effects of nonreligious coping. Pargament and colleagues identified three general “styles” of religious coping: Self-Directing, Deferring, and Collaborative (Pargament et al., 1988). In Self-Directing coping, individuals take responsibility for defining the problem, generating

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alternatives, and implementing a solution independent of God’s input (e.g., “God doesn’t put solutions to my problems into action, I carry them out myself”). This style should not be construed as anti-religious; rather, God is seen as having given people the power and resources to direct their own lives. Individuals who adopt a Deferring style perceive that God is responsible for defining the problem, generating solutions, and implementing those solutions (e.g., “When I have a problem I try not to think about it and wait for God to tell me what it means”). Finally, individuals with a Collaborative religious coping style view themselves as sharing responsibility for solving problems with God (e.g., “When faced with a question, I work together with God to figure it out”). Studies of the efficacy of the religious coping styles identified by Pargament et al. (1988) have been mixed. Both Self-Directing and Collaborative coping have been shown to be positively associated with measures of psychosocial adjustment, whereas Deferring coping has been associated with lesser psychosocial competence (e.g., Hathaway & Pargament, 1990; Pargament et al., 1988). Kaiser (1991) found that Collaborative and Deferring coping were positively associated with feelings of guilt, whereas Self-Directing coping was negatively associated with guilt. Schaefer and Gorsuch (1991) have described negative relationships between anxiety and the Collaborative and Deferring styles, although, in contrast, individuals utilizing a Self-Directing style were found to display greater anxiety. In a recent review, Pargament (1997) notes that

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the majority of studies suggest positive associations between Collaborative coping and adjustment; however, the findings concerning Self-Directing and Deferring coping have been equivocal. Religious Coping and the Hypothesis of Fit Pargament and his colleagues (1988) have suggested that appraisal of the controllability of a stressor may influence relationships between the three styles of religious coping and outcome measures. Two studies, Friedel (1995) and Bickel et al. (1998), examined the relationship between such appraisals and the three styles of religious coping. Although neither conceptualized their research in terms of the hypothesis of fit, their results are consistent with such a conceptualization. In a study of emergency health care professionals coping with negative events in the workplace, Friedel (1995) reported higher levels of Self-Directing coping to be associated with greater well being and job satisfaction when the stresses were appraised as controllable. Both Collaborative and Deferring coping were observed to be more helpful in response to events appraised as less controllable. Bickel et al. (1998) surveyed congregational members coping with recent life stressors. Under generalized perceptions of uncontrollability, Self-Directing coping was associated with greater depressive symptoms and Collaborative coping was linked to less depressive affect. Although cross-sectional in nature, both studies provide evidence to support the application of the hypothesis of fit to the realm of religious coping. Purpose of the Present Study

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The present study employed a transactional framework of stress and coping to examine the relationships between coping and outcomes in a stressful situation appraised as uncontrollable. The effectiveness of both general coping and religious coping strategies was examined among a sample of caregivers coping with the hassles of providing care to spouses with dementia. Specifically, we examined the impact of general and religious coping strategies used in the face of caregivers’ most significant uncontrollable hassle in caregiving on the negative affect component of depression. Depressive Symptoms, general coping and religious coping at Month 1 were examined as predictors of Depressive Symptoms at Month 2. Consistent with the hypothesis of fit, with respect to general coping, we hypothesized that caregivers who used Emotion-Focused coping would demonstrate fewer Depressive Symptoms (specifically, the negative affect component of depression). With respect to religious coping, we hypothesized that caregivers who used a Deferring style would also demonstrate fewer Depressive Symptoms. Because we examined coping with an uncontrollable stressor, no a priori hypotheses were made concerning the direction of associations involving Problem-Focused general coping, Self-Directing or Collaborative religious coping. Method Participants Sixty-four spousal caregivers who participated in a larger study of the stress, appraisal, coping, and

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adaptation process of caring for a spouse with dementia constituted the sample for the present study. Participants were recruited from adult day programs and caregiver support groups located in metropolitan areas in the Midwest and the mid-Atlantic regions. Printed material describing the research was distributed to potential participants. Those who were interested in the project contacted a member of the research team, who reviewed the purpose of the research and the requirements for participation. Prior to the start of data collection, participants signed a consent form. Measures reported here were collected via questionnaires. Almost three-fourths of participants (73.8%) were women (n = 45) and 86% were Caucasian (n = 52); African American (10.9%), Hispanic (1.6%), and those of other ethnic backgrounds (1.6%) were represented among participants in small numbers. Almost 85% of caregivers had graduated from high school, and 21.9% had graduated from college. Caregivers had an average age of 68.66 (SD = 7.84; range = 43-91) and their spouses were somewhat older (M = 71.39; SD = 7.79; range = 56-91). Couples had been married for an average of 43.11 years (SD = 11.44; range = 10-69). On average, participants had functioned as the primary caregiver for their spouses for an average of 5.31 years (SD = 3.55; range = 1-23). Dementia Rating Scales (Mattis, 1976) administered to care-recipients by trained interviewers at Month 1 revealed an average score of 62.18 (SD = 38.27; range = 0-118), indicating moderate to severe levels of cognitive impairment.

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Caregivers characterized themselves as “moderately” or “fairly” religious; the average rating of religiosity was 3.68 (SD = 1.23) on a scale ranging from 1 (not religious) to 5 (very religious). One-half of participants were Protestant (50%). The remainder reported their religious affiliation as Catholic (31.3%), Jewish (7.8%), Other (6.3%), or no religious affiliation (4.7%). Most participants attended religious services on a regular basis, averaging 33.81 times in the past year (SD = 25.58). Independent Variable Measures (Assessed at Month 1) Most Significant Caregiving Hassle. The Caregiving Hassles Scale (CHS) asks caregivers to indicate which of 42 events occurred during the past week and the extent to which each was a hassle (1 = It wasn’t; 2 = Somewhat; 3 = Quite a bit; 4 = A great deal) (Kinney & Stephens, 1989a). After completing the CHS, caregivers were presented with the events grouped into five hassle domains: (1) care-recipient’s behavior; (2) care-recipient’s cognitive status; (3) assisting with activities of daily living (ADLs; e.g., bathing, dressing, eating); (4) assisting with instrumental activities of daily living (IADLs; e.g., preparing meals, managing finances, transporting care-recipient to doctor/other places); and (5) hassles stemming from caregiver’s social network. For each domain, caregivers were asked to indicate which item constituted their most stressful hassle. Caregivers were asked to examine the five hassles they had identified and indicate the single most significant hassle during the past week. Subsequent appraisal and

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coping measures were then completed with respect to the most significant hassle nominated by the caregiver. Appraised Controllability of the Hassle. The appraised controllability of caregivers’ most significant hassles was examined using one secondary appraisal item from the Stress Questionnaire (Lazarus & Folkman, 1984). Caregivers were asked to indicate the extent to which they agreed with the following statement: “The situation was one that you could change or do something about.” Ratings were made on a five-point Likert-type scale (1 = Strongly disagree; 2 = Disagree; 3 = Neutral; 4 = Agree; 5 = Strongly Agree). Only respondents who either disagreed or strongly disagreed with the item (i.e., who appraised the situation as one they could not change or do something about) are included in this sample. The largest percentage of caregivers (50%) nominated a Cognitive hassle (e.g., “spouse declining mentally”) as their most significant caregiving hassle. Approximately one-fifth of participants (19%) reported that their most significant caregiving hassle was behavioral in nature (e.g., “spouse hiding things”). Fewer caregivers reported the most significant hassle to be providing assistance with ADLs (15%) or IADLs (14%), and only 2% of caregivers nominated a hassle related to their social network (e.g., “not receiving caregiving help from family”) as the most significant hassle during the past week. General Coping. General strategies used by caregivers to cope with their most significant caregiving hassle were measured by the 42-item revised version of the Ways of Coping Checklist (WCCL-R; Vitaliano, Russo, Carr,

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Maiuro, & Becker, 1985). Caregivers were asked to indicate the degree to which they used each coping strategy on a 5-point, Likert-type scale (1 = Does not apply/Never use it; 5 = Always use it). Problem- and Emotion-Focused coping subscales (Vitaliano et al., 1990) were used in the current analysis. Because raw scale scores have been shown to be biased by the number of items comprising each scale (cf. Vitaliano et al., 1987), mean item scores were used. Internal consistency estimates for the Problem- and Emotion-Focused scales in the present study were .90 and .86, respectively. Religious Coping. Caregivers’ religious coping efforts in response to their most significant caregiving hassle were assessed using the short form (18-item version) of the Religion and Problem-Solving Scales (RPS) developed by Pargament et al. (1988). The RPS was developed to reflect three styles of religious problem solving: Self-Directing, Collaborative, and Deferring. Factor analysis of the RPS revealed three distinct factors (corresponding to the three hypothesized problem-solving styles), generating strong support for the construct validity of the scale (Pargament et al., 1988). The short-form RPS scales have been found to have high internal consistency (alphas = .91, .93, and .89, respectively). The RPS has typically been used as a dispositional, or trait, measure of religious coping styles. As a result, the scale was modified for use in this study to reflect caregivers’ situational religious coping strategies. Caregivers were asked to rate the frequency with which they used each strategy in response to their most

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significant caregiving hassles (1 = Never to 5 = Always). In the present study, internal consistency estimates for the three scales were high (Self-Directing = .95, Collaborative = .95, Deferring = .93). Mean item scores for each scale were calculated in order to facilitate comparisons of participants’ religious and general coping strategies. Dependent Variable Measures (Assessed at Months 1 and 2) Depressive Symptomatology. The Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977) is a 20-item scale that assesses depressive symptomatology such as dysphoric mood, sleep and appetite disturbances, loss of energy, and feelings of guilt, worthlessness, and hopelessness. Caregivers were asked to indicate how often they experienced each symptom during the past week on a 4-point scale (0 = Less than 1 day; 1 = 1-2 days; 2 = 3-4 days; 3 = 5-7 days). Scores on the CES-D range from 0-60; higher scores reflect the presence of more depressive symptoms. The CES-D has been shown to possess good internal consistency; ranging from .85 to .92 in the general adult population (Radloff, 1977), and from .85 to .91 in older adult samples (Himmelfarb & Murrell, 1983). Because of research documenting a single, higher-order factor in the CES-D (Tanaka & Huba, 1984a, b), principal components and maximum likelihood factor analysis were conducted on responses to CES-D items in this data set. The result was an 8-item factor that accounted for 54.63% of the variance. The items

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comprising the factor (items 3, 6, 7, 9, 10, 14, 16, 18) are indicative of a negative affect component of Depressive Symptoms (e.g., “I felt that I could not shake off the blues even with help from my family and friends”; “I felt depressed”; “I thought my life had been a failure”). Cronbach’s alpha for the 8-item version of the CES-D used in this research was .89. Possible scores ranged from 0-24. The mean score at Month 1 was 5.23 (SD = 4.71; range = 0-19) and at Month 2 was 7. 15 (SD = 5.28; range = 1-20), and the correlation between Depressive Symptoms at Month 1 and Month 2 was .67 (p < .001). Results Caregivers’ Use of General and Religious Coping Strategies: Preliminary Analyses Table 1 presents the mean item scores, standard deviations, and ranges for general (Problem-Focused, Emotion-Focused) and religious (Self-Directing, Collaborative, Deferring) coping strategies employed by caregivers in response to their most significant uncontrollable hassle. As the table reveals, caregivers tended to use Collaborative and Problem-Focused coping the most, and Emotion-Focused coping the least. Table 1.Descriptive Statistics for the Mean Item Coping Scores (N = 64)

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Table 2 contains a matrix of the zero-order correlations among the independent and dependent variables. The very high positive correlation between Collaborative and Deferring religious coping suggests that caregivers tended to use these strategies simultaneously. In contrast, both Collaborative and Deferring coping strategies were strongly and negatively correlated with Self-Directing religious coping. As can be seen in the table, patterns also emerged between caregivers’ use of general and religious coping strategies. Problem-Focused coping was positively correlated with Collaborative coping and Deferring coping, whereas no statistically significant correlation emerged between Emotion-Focused coping and any of the religious coping strategies. Table 2. Bivariate Correlation Matrix of Independent and Dependent Variables

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Note. Gender (0 = Female, 1 = Male); Mattis DRS (lower = more impaired); CES-D (higher = more symptoms). *p < .05 **p < .01 Due to the high intercorrelations among the three religious coping strategies, partial correlation coefficients were calculated to more fully examine the nature of the relationships between the religious and general coping strategies. Partial correlation coefficients reveal the degree of association between two variables while controlling for a third variable; higher-order partial correlations control for two or more other variables. Of the six second-order coefficients calculated, two were statistically significant. Consistent with the finding reflected in the zero-order correlations, Collaborative religious coping remained strongly positively correlated with Problem-Focused general coping after removing the effect of Self-Directing and Deferring coping (r = .34, p < .01). The second-order correlation between Deferring

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religious coping and Problem-Focused coping did not reach significance, however (r = −.0003). Another notable difference between the zero- and second-order correlations emerged in the correlations between Self-Directing religious coping and the two general coping strategies. Zero-order correlations suggested a lack of a relationship, however, after variance associated with Collaborative and Deferring coping was partialled out. Self-Directing religious coping was found to be positively related to Emotion-Focused general coping (r = .31, p < .01). General and Religious Coping Strategies as Predictors of Change in Well Being Linear regression was used to examine general and religious coping strategies as predictors of Depressive Symptoms at Month 2. In this analysis, Depressive Symptoms at Month 1 were entered in the first step of the equation. In the second step, the two general and three religious coping strategies were entered. The overall model was significant (F (6, 54) = 10.79; p < .001), and accounted for 54.5% of the variance in Depressive Symptoms at Month 2. Depressive Symptoms at Month 2 accounted for 42.9% of the variance (F (1, 59) = 44.34; p < .001) and the coping strategies accounted for an additional 11.6% of the variance (F (5, 54) = 2.76; p < .03). Results of this analysis are presented in Table 3. Table 3. General and Religious Coping Strategies as Predictors of Depressive Symptoms

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As can be seen in the table, and as would be expected, Depressive Symptoms at Month 1 were positively and significantly related to Depressive Symptoms at Month 2. In addition, caregivers who used higher levels of Emotion-Focused general coping and Collaborative religious coping reported significantly more Depressive Symptoms at Month 2. Discussion One of the most important findings from this research is the pattern of associations between caregivers’ use of general and religious coping strategies to deal with an uncontrollable hassle in caregiving. Zero-order correlations revealed significant positive associations between Collaborative and Deferring religious coping and Problem-Focused general coping. However, when second-order partial correlations were calculated, only Collaborative religious coping remained significantly associated with Problem-Focused general coping. This finding suggests that the observed zero-order correlation between Deferring religious coping and Problem-Focused general coping was spurious. Given that both strategies involve efforts to actively manage a situation, it is not surprising that 312

caregivers used Collaborative religious coping and Problem-Focused coping in tandem. This finding supports Pargament and Park’s (1995) warning against stereotyping all religious coping efforts as passive or Emotion-Focused in nature. Second-order partial correlations also revealed a significant association between Self-Directing religious coping and Emotion-Focused general coping. Pargament (1997) has speculated that Self-Directing coping may reflect an individual’s anger at God and subsequent desire to solve the problem independently. For example, in response to feeling rejected by God, a caregiver might become angry, adopt a Self-Directing style of coping, and use Emotion-Focused coping to regulate the emotional turmoil that results from adopting a Self-Directing coping strategy. Taken together, these findings suggest that, among caregivers included in this research, religion is an important coping mechanism that can be conceptualized at a level analogous to general coping. More to our surprise were the findings with respect to the relationships between religious coping and Depressive Symptoms. The hypothesis that Deferring coping would be associated with lower Depressive Symptoms was not supported. Examination of the zero-order and partial correlations suggests the possibility that the relationship between Deferring coping and Depressive Symptoms may have been obscured by the interrelatedness, and high co-occurring use of, Collaborative and Deferring coping. The finding that Collaborative coping was associated with higher

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levels of Depressive Symptoms is less easily explained, and warrants additional exploration. Contrary to our hypothesis regarding general coping, caregivers who used greater levels of Emotion-Focused coping to deal with an uncontrollable hassle in caregiving reported higher, rather than lower, levels of Depressive Symptoms. For many of the caregivers in the present research, their most significant hassle was associated with their spouse’s cognitive status, something over which they have virtually no control. Haley, Brown, and Levine (1987) have indicated that, relative to other caregiving hassles that derive from assisting a family member with ADLs and IADLs, hassles stemming from a family member’s cognitive status and challenging behaviors are often times not predictable and, therefore, can be especially irritating. Further, Kinney and Stephens (1989b) suggest that cognitive and behavior hassles can serve as reminders of a family member’s changing personhood. Thus, use of Emotion-Focused coping may be a result of the distress associated with the absence of control, rather than a strategy to regulate distress associated with the hassle. The levels of Depressive Symptoms reported by these caregivers were relatively low. As a result, statements regarding associations between coping and well being should be made with some caution, because the levels of depressive symptomatology reported by caregivers in the present research may be of questionable clinical significance. In addition, it is possible that the increase in caregivers’ Depressive Symptoms at Month 2 is not a reflection of ineffective coping, but rather is the result of

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progression of the spouse’s dementia and/or an increase in caregiving hassles. Whatever the explanation, inconsistency between these findings and those of previous investigations (e.g., Forsythe & Compas, 1987; Friedel, 1995) offer further evidence of the situation-specific effectiveness of both general and religious coping. Thus, it is likely that caregiving to a spouse with dementia may actually elicit forms of coping, or a complex combination of coping efforts, that are unique to that situation. Further, it is important to acknowledge that, by virtue of the highly stressful, chronic nature of caregiving, other components of the transactional framework (e.g., appraisals and reappraisals, coping efficacy, adaptation) may be more context-dependent than originally thought. As such, generalization of these findings to non-caregiving populations is probably inappropriate. Although we did not find support for the hypothesis of fit, we did employ a stringent analysis to examine the effects of general and religious coping on Depressive Symptoms one month later. That both Emotion-Focused and Collaborative coping explained statistically significant portions of variance, after accounting for Depressive Symptoms at Month 1, has conceptual/ theoretical significance, and highlights the importance of incorporating both general and religious coping strategies in investigations of the stress, appraisal, coping, and adaptation process. Limitations of the Present Study

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There are several limitations associated with the present study. First, this research relied on a relatively small convenience sample of caregivers to a spouse with dementia. As a result, the sample is biased in ways that are typical of, although not desirable in, much of the caregiving literature. The sample is neither ethnically nor racially diverse, and does not contain substantial variation in socioeconomic status. Second, the present study relied on a single appraisal item (i.e., “changeability”) to identify caregivers who perceived their most significant caregiving hassle as being uncontrollable. Folkman (1984), among others, has suggested that perceived controllability may be more appropriately conceptualized as a multidimensional construct. Similarly, the present research employed a single, unidimensional indication of well being, the negative affect component of depression. It is possible that different patterns of relationships would have been observed if a wider array of outcomes were considered. Finally, although caregivers were specifically instructed to respond to coping and appraisal measures with respect to the most significant caregiving hassle they experienced, the extent to which they complied with these instructions is unclear. It is possible that caregivers’ responses were shaped more by the general nature of the caregiving situation, rather than their identified most significant caregiving hassle. Suggestions for Future Research

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Perhaps the most important conceptual implication derived from this research is the need to include both general and religious coping in future research on stress and coping among family caregivers. The frequent use of religious coping by this group of caregivers suggests that incorporating religious constructs into the extant stress and coping paradigm will significantly enhance our empirical understanding of the coping process. In addition, findings regarding the relationships between caregivers’ religious and general coping strategies highlight the importance of using more sophisticated analytic procedures (e.g., partial correlations) to investigate the complex relationships between the two types of coping. The importance of exploring controllability appraisals and both general and religious coping among more diverse groups of caregivers cannot be underestimated. To the extent that researchers incorporate multidimensional measures of appraised controllability in future investigations, understanding of the relationship between coping and controllability appraisals is likely to be enhanced. Such research may reveal different patterns of relationships between coping strategies and various dimensions of control. For example, Thompson, Sobelew-Shubin, Galbraith, Schwankovsky, and Cruzen (1993) found that cancer patients’ faith was an important strategy for maintaining emotional control. Similar processes may underlie successful coping and adaptation among caregivers to a spouse with dementia. The present study was undertaken in an attempt to enrich our understanding of the stress and coping process, and

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to explore the hypothesis of fit among both general and religious coping strategies. The findings illustrate the utility of the transactional framework for studying stress and coping processes within the context of religious and general coping. These findings also contribute to our understanding of the relative effectiveness of coping with the hassles of spousal caregiving. Because of limitations associated with the sample used in this research, we could not conduct a full assessment of the hypothesis of fit among caregivers to a spouse with dementia. Such work remains to be done, and offers the potential to both inform theory and contribute to the development of interventions to minimize distress associated with family caregiving. References Bickel, C.O., Ciarrocchi, J.W., Scheers, N.J., Estadt, B.K., Powell, D.A., & Pargament, K.I. (1998). Perceived stress, religious coping styles, and depressive affect. Journal of Psychology and Christianity, 17, 33-42. Felton, B.J., & Revenson, T.A. (1984). Coping with chronic illness: A study of illness controllability and the influence of coping strategies on psychological adjustment. Journal of Consulting and Clinical Psychology, 52, 343-353. Folkman, S. (1984). Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology, 46, 839-852. Folkman, S., & Lazarus, R.S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21, 219-239. 318

Folkman, S., Lazarus, R.S., Gruen, R.J., & DeLongis, A. (1986). Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology, 50, 571-579. Forsythe, C.J., & Compas, B.E. (1987). Interaction of cognitive appraisals of stressful events and coping: Testing the goodness of fit hypothesis. Cognitive Therapy and Research, 11, 473-485. Friedel, L.A. (1995). The impact of controllable and uncontrollable negative events in the work environment: The role of religious and non-religious coping strategies. Unpublished master’s thesis, Bowling Green State University, Bowling Green, OH. Haley, W.E., Brown, S.L., & Levine, E.G. (1987). Family caregiver appraisals of patient behavioral disturbance in senile dementia. Clinical Gerontologist, 6, 25-34. Hathaway, W.L., & Pargament, K.I. (1990). Intrinsic religiousness, religious coping, and psychosocial competence: A covariance structure analysis. Journal for the Scientific Study of Religion, 29, 423-441. Himmelfarb, S., & Murrell, S.A. (1983). Reliability and validity of five mental health scales in older persons. Journal of Gerontology, 38, 333-339. Kaiser, D.L. (1991). Religious problem-solving styles and guilt. Journal for the Scientific Study of Religion, 30, 94-98. Kinney, J.M., & Stephens, M.A.P. (1989a). Caregiving hassles scale: Assessing the daily hassles of caring for a 319

family member with dementia. The Gerontologist, 29, 328-332. Kinney, J.M., & Stephens, M.A.P. (1989b). Hassles and uplifts of giving care to a family member with dementia. Psychology and Aging, 4, 402-408. Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. Mattis, S. (1976). Mental status examination for organic mental syndrome in the elderly patient. In L. Bellak & T.B. Karasu (Eds.), Geriatric psychiatry: A handbook for psychiatrists and primary health care physicians (pp. 79-121). New York: Grune & Stratton. Pargament, K.I. (1997). The Psychology of religion and coping: Theory, research, practice. New York: Guilford Press. Pargament, K.I., Kennell, J., Hathaway, N., Grevengoed, N., Newman, J., & Jones, W. (1988). Religion and the problem-solving process: Three styles of coping. Journal for the Scientific Study of Religion, 27, 90-104. Pargament, K.I., & Park, C.L. (1995). Merely a defense? The variety of religious means and ends. Journal of Social Issues, 51, 13-32. Pearlin, L.I., Mullan, J.T., Semple, S.J., & Skaff, M.M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583-594.

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Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measures, 3, 385-401. Schaefer, C.A., & Gorsuch, R.L. (1991). Psychological adjustment and religiousness: The multivariate belief-motivation theory of religiousness. Journal for the Scientific Study of Religion, 30, 448-461. Tanaka, J.S., & Huba, G.J. (1984a). Confirmatory hierarchical analyses of measures of psychological distress. Journal of Personality and Social Psychology, 46, 621-635. Tanaka, J.S., & Huba, G.J. (1984b). Structures of psychological distress: Testing confirmatory hierarchical models. Journal of Consulting and Clinical Psychology, 52, 719-721. Thoits, P.A. (1991). Patterns in coping with controllable and uncontrollable events. In E.M. Cummings, A.L. Greene, & K.H. Karraker (Eds.), Life-span developmental psychology: Perspectives on stress and coping (pp. 235-258). Hillsdale, NJ: Lawrence Erlbaum. Thompson, S.C., Sobelew-Shubin, A., Galbraith, M.E., Schwankovsky, L., & Cruzen, D. (1993). Maintaining perceptions of control: Finding perceived control in low-control circumstances. Journal of Personality and Social Psychology, 64, 283-304. Vitaliano, P.P., DeWolfe, D.J., Maiuro, R.D., Russo, J., & Katon, W. (1990). Appraised changeability of a stressor as a modifier of the relationship between coping

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and depression: A test of the hypothesis of fit. Journal of Personality and Social Psychology, 59, 582-592. Vitaliano, P.P., Maiuro, R.D., Russo, J., & Becker, J. (1987). Raw versus relative scores in the assessment of coping strategies. Journal of Behavioral Medicine, 10, 1-18. Vitaliano, P.P., Russo, J., Carr, J.E., Maiuro, R.D., & Becker, J. (1985). The ways of coping checklist: Revision and psychometric properties. Multivariate Behavioral Research, 20, 3-26. Jennifer M. Kinney is affiliated with the Department of Sociology, Gerontology, and Anthropology and Scripps Gerontology Center, Miami University. Karen J. Ishler is affiliated with the Mandel School of Applied Social Sciences, Case Western Reserve University. Kenneth I. Pargament is affiliated with the Department of Psychology, Bowling Green State University. John C. Cavanaugh is affiliated with Provost and Vice Chancellor for Academic Affairs, University of North Carolina at Wilmington. Address correspondence to: Jennifer M. Kinney, Scripps Gerontology Center, 396 Upham Hall, Miami University, Oxford, OH 45056 (E-mail: [email protected]). The authors are grateful to Eric F. Dubow and Carlla S. Smith who provided helpful suggestions regarding this research. This work was initiated when all authors were at Bowling Green State University, and was supported by

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the National Institute on Aging (AGO9265) and the AARP/Andrus Foundation. An earlier version of this study served as the master’s thesis of the second author. [Haworth co-indexing entry note]: “Coping with the Uncontrollable: The Use of General and Religious Coping by Caregivers to Spouses with Dementia.” Kinney, Jennifer M. et al. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 171-188; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 171-188. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Effects of Religiosity and Spirituality on Depressive Symptoms and Prosocial Behaviors Karri Bonner, BA Lesley P. Koven, MA Julie Hicks Patrick, PhD Summary. Evidence demonstrates salubrious effects of religious participation on health-related outcomes. Results from studies relating its effects to psychosocial outcomes have been equivocal. However, many psychosocial outcomes have not been examined. The current study sought to address these limitations by testing the degree to which religious behaviors and subjective spirituality are associated with depressive symptoms and prosocial behaviors. Data from 68 older adults were used to test two linear regression models in which public religious behaviors, private religious behaviors, and subjective spirituality were used to predict depressive symptoms and prosocial behavior. This set of regressors accounted for significant amounts of variance in both out-comes, although a divergent pattern of prediction emerged. More public religious behaviors and fewer private religious behaviors were associated with lower levels of depressive affect, whereas higher reports of subjective spirituality were associated with increased prosocial behavior. The need to broaden the investigation of the effects of religiosity to include more specific predictors and an inclusion of psychosocial outcomes are both discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 324

1-800-HAWORTH. E-mail address:

Website: © 2003 by The Haworth Press, Inc. All rights reserved.] Keywords. Nonorganizational religiosity organizational religiosity subjective spirituality prosocial behavior depressive symptoms Most Americans report that religious beliefs and practices are important to them, with 95% reporting a religious or spiritual affiliation (Plante, Yancey, Sherman, & Guertin, 2000). In addition to being valued, religiosity exerts direct and indirect effects on well being. To index religiosity, most researchers adopt a multidimensional definition that includes organizational behaviors and nonorganizational aspects. Organizational religiosity is typically indexed by one’s membership and participation in formal religious services. Nonorganizational religiosity often includes various components such as prayer, devotional reading, and subjective experiences (Krause & Van Tran, 1989; McFadden, 1996; Taylor & Chatters, 1991). It is important to distinguish among these aspects because each exerts different effects on well being (Kennedy, Kelman, Thomas, & Chen, 1996; Koenig et al., 1999; Taylor & Chatters, 1991). Although there is strong evidence that religiosity is directly associated with decreased morbidity and mortality (McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000; Strawbridge, Cohen, Shema, & Kaplan, 1997), the evidence linking religiosity to psychosocial indicators of quality of life is scant and

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ambiguous. In the present study, we extend the examination of the effects of religiosity by focusing on its association with depressive symptomatology and prosocial behavior. Moreover, we further differentiate among aspects of religiosity, by separating nonorganizational religiosity into private religious behaviors and subjective spirituality. Religiosity The most-studied aspects of religiosity include the organizational measures of denomination/membership and frequency of attending services (McCullough et al., 2000). The positive effects of attending services on decreasing one’s risk of mortality have been demonstrated among young, middle-aged (Strawbridge et al., 1997) and older adults (Koenig et al., 1999). Possible explanations for this effect include social support benefits of group membership, peer norms encouraging better adherence to health recommendations, and low levels of health-risk behaviors such as smoking and excessive alcohol consumption due to peer-held prohibitions. Even when demographic characteristics, health conditions, health-promoting behaviors, and social resources are controlled, however, those who attend religious services at least once a week experience significantly lower risk of mortality (Koenig et al., 1999; McCullough et al., 2000). Organizational religiosity predicts psychological well being (Koenig, 1993; Worthington, Kurusu, McCullough, & Sandage, 1996). Specifically, positive effects of organizational religiosity have been reported

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for life satisfaction (Levin, Taylor, & Chatters, 1994), morale (Koenig, Kvale, & Ferrel, 1988), positive affect (Krause, Ingersoll-Dayton, Ellison, & Wulff, 1999), and self-esteem (Krause & Van Tran, 1989). In addition, attendance is associated with lower levels of depression (Kennedy et al., 1996) and lower negative affect (Krause et al., 1999). Nonorganizational religiosity, typically measured by subjective perceptions, frequency of prayer, and devotional reading, has received considerably less empirical attention than organizational forms of religiosity (Taylor & Chatters, 1991). Only a few studies have specifically examined the effects of nonorganizational religiosity on psychosocial outcomes, and results have been inconsistent. However, in general, most studies indicate that nonorganizational religiosity is only weakly related to depression (Koenig, McCullough, & Larson, 2001). Koenig, George, and Peterson (1998) found that the frequency of private religious activity was not related to speed of remission of depression among medically ill older adults. In contrast, Koenig et al. (1988) reported significant associations between measures of nonorganizational religiosity and various subscales of the Philadelphia Geriatric Center (PGC) Morale Scale. The magnitude of these correlation coefficients, however, was small, ranging from .11 to .20. In regression analyses, nonorganizational religiosity accounted for only 8% of the variance in psychological well being. Koenig et al. (2001) argue that, in cross-sectional studies that show no association or a positive association between nonorganizational religiosity and depression,

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one must remember that people often increase their prayer or other private religious activities in response to negative life situations (Ai, Peterson, Bolling, & Koenig, 2002). When the crisis resolves, such activities are often decreased, giving the false impression that nonorganizational religiosity is associated with poor mental health (Koenig et al., 2001). Few studies have simultaneously examined the effects of organizational and nonorganizational religiosity. Using structural modeling techniques, Levin et al. (1994) examined the effects of organizational and nonorganizational religiosity on physical and psychological well being. Although organizational religiosity affected both well being outcomes, nonorganizational religiosity was related only to physical well being. In contrast, Krause and Van Tran (1989) tested a structural model in which the path from nonorganizational religiosity to self-esteem emerged as significant. Although elegant, the generalizability of these findings may be limited because both studies utilized data from the National Survey of Black Americans. Ample evidence suggests that African Americans exhibit comparatively high levels of religiosity (Levin et al., 1994) and may interpret religious activities differently than other racial or ethnic groups (McFadden, 1995). Thus, an extension of these models to additional groups is necessary (Koenig, 1994; McFadden, 1995, 1996). Separating the Constructs Although it is clear that public religious behaviors are associated with decreased morbidity and mortality, the

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effects of nonorganizational religiosity are mixed. One reason that empirical tests of the effects of nonorganizational religiosity are inconsistent may be related to the way in which this construct has been operationalized. Often, definitions of nonorganizational religiosity include specific behaviors that may be performed either publicly or privately, such as reading religious materials and prayer. Thus, these “nonorganizational” behaviors may actually be performed in the context of organizational participation. A second issue related to the operationalization of nonorganizational religiosity is that current measures include both behaviors and subjective experiences. Although it is often assumed that people participate in religious behaviors as a function of their spirituality, an underlying belief or faith is neither necessary nor sufficient for explaining religious behaviors. Non-spiritual reasons for engaging in religious behaviors may include increased social prestige, maintained social support, enhanced feelings of self-esteem (Freund & Smith, 1999) and tangible benefits (Chatters & Taylor, 1994; McFadden, 1995, 1996). Although not examined empirically, participation in religious behaviors may also be a function of family and peer expectations. Thus, measures of nonorganizational religiosity must separate private behaviors from subjective experiences. Subjective Spirituality Most researchers include indices of subjective experience when investigating the effects of religiosity (McFadden, 1996). Until recently, however, few

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psychometrically sound scales were available for research use, with researchers relying on single-item indicators of subjective spirituality. To improve the quality of measurement in the field, a multidimensional and psychometrically sound index of spirituality has recently been developed (Fetzer, 1999). The Fetzer Multidimensional Measure includes items indexing subjective closeness to God, harmony with others, and a sense of coherence. From Belief to Action Across multiple areas of gerontology, relatively little empirical work has attempted to link subjective responses derived from paper-and-pencil measures to intended or actual behavior in the real world (Landauer, 1989). The exception, however, includes the areas of social and everyday problem solving. These studies tend to use hypothetical vignettes that feature some agent facing a particular problem and ask respondents to suggest ways in which the agent might solve the problem (e.g., Cornelius & Caspi, 1987; Denney & Pearce, 1989). In the area of religiosity, the seminal study was conducted by Darley and Batson (1973) who asked seminary students to indicate their likelihood of helping a person who was featured in a hypothetical vignette. The study is noteworthy for including a behavioral assessment of actual helping behavior. Results indicated that neither the degree of religious faith nor anticipated likelihood of helping related to actual helping behavior. However, recent evidence suggests that subjective assessments do predict attitudes and behavior. Eisinga and Billiet (1999) present evidence that the effects of

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organizational religiosity and religious beliefs on prejudicial attitudes are moderated by authoritarianism and nationality, with some residents of Christian nations reporting high levels of prejudice. A more positive view has been offered by Park, Meyers and Czar (1998). Their results suggest that subjective spirituality predicts both prosocial attitudes and behavior, as well as predicting greater physical health and a higher sense of well being. Through spirituality, but not necessarily religious faith, one may “more easily recognize their unique potentials, gain personal fulfillment and self-worth, and experience higher levels of self-actualization” (Park et al., 1998, p. 550). Summary Despite the growing literature supporting an association between public religiosity and physical morbidity, the empirical base examining links among public religiosity, private religiosity, and subjective spirituality to psychosocial functioning is limited. Therefore, the current study directly assessed these relations among a group of older adults. The study was guided by the question of whether public religiosity, private religiosity, and subjective spirituality were associated with broad indicators of quality of life. We focused on two main outcomes: depressive symptoms and prosocial behavior. We chose these two outcomes because both are conceptually related to quality of life and are intimately related to several Jewish and Christian belief systems. Based on the literature with health-related outcomes, we expected that public religiosity and subjective spirituality would be associated with fewer depressive symptoms.

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However, based on Park et al.’s (1998) study, we expected that higher subjective spirituality would be positively associated with prosocial behavior. Methods Recruitment and Procedures Ninety-six older adults, drawn from a participant registry developed by the third author, were invited to participate in the current study. Each person was mailed two informed consent forms (one for their records, one to be returned), a self-administered survey and a postage-paid return envelope. The survey included measures of personality, spirituality, religiosity, and psychological resources. In addition, several social problem-solving vignettes were included. Although the survey included a variety of measures, only those of interest to the present study are included in the current report. A total of 78 surveys were returned (81.3% response rate); missing data on the items of interest resulted in useable data from 68 adults. Participants Data for these analyses were provided by 68 older adults (M age = 74.7; SD = 6.4; range: 66–90). The sample included 23 men (34%) and 45 women (66%) who reported a median of 12.0 years of education (M = 13.5; SD = 2.8; range 7-20). All participants resided in a rural mid-Atlantic state that is predominantly Caucasian and Christian in religious affiliation. Thus, most of the participants (84.3%) were Protestant, although 8.6% were Catholic and 7.0% reported no religious affiliation. More specific information regarding denominational 332

affiliation was not requested from participants. The racial composition of the sample was limited, with 98.6% being Caucasian. The median annual income of the sample was in the $25,000 to $30,000 range. Approximately half (55.9%) were married, 29.4% were widowed, 8.8% were divorced, and 5.9% had never been married. Using a single item to assess global subjective health, 70% of the sample reported good to excellent overall health; only 6% rated their health as poor. Measures Public religiosity was measured using a 4-item scale derived from Kenney, Vaughan, and Cromwell’s (1977) early work. Two items assessed the frequency of attending services and the frequency of attending religious meetings (4 = Often, 3 = Sometimes, 2 = Almost never, 1 = Never). The scale also included two comparative assessments that assess frequency of attending services relative to age-peers and relative to members of the same religious group (3 = more than others, 2 = about the same, 1 = less than peers). The scale had a mean of 7.96 (SD = 2.5) and a coefficient alpha of .89. Private religiosity was indexed using a 5-item scale that indexed the frequency with which individuals prayed in general and about specific aspects of their lives (e.g., health, finances, family and friends, and society). Responses were made using a 4-point scale that ranged from Never (1) to Often (4). The sample had a mean of 14.48 (SD = 3.5) and internal consistency was high (alpha = .87).

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Subjective spirituality was assessed using the 16-item Fetzer Multidimensional Measure (Fetzer, 1999). Responses use a 6-point Likert type scale of frequency that ranges from several times a day (6) to never (1). Items include: “I feel God’s presence,” “I feel deep inner peace or harmony,” and “I desire to be closer to God or in union with Him” (Fetzer, 1999). The scale had a mean of 62.71 (SD = 19.6); Cronbach’s alpha was .96. Depressive symptoms were indexed using the 20-item Center for Epidemiologic Studies of Depression Index (CES-D; Radloff, 1977). Not intended as a diagnostic measure, the scale was developed as a screen for depressive symptomatology among community-dwelling adults. People receiving a score of 16 or above are at risk of serious depression. In the current sample, a mean of 11.26 (SD = 9.7) was obtained, with approximately 29% scoring above the cut-off of 16. Coefficient alpha was .87. Prosocial behavior was indexed based on responses to hypothetical vignettes. Participants read two different vignettes in which helping the person described would result in negative consequences (either not having a medical claim filed by a physician or being evaluated as lower intellectual capacity) for the respondent. The kinds of help needed by the target person in the vignette included needing directions and needing to borrow a pencil. Participants used a 6-point scale ranging from “Definitely would not help” to “Definitely would help” to indicate their response. Structurally, the vignettes were similar in that (a) the respondent’s failure to help would not be known by the target person, (b) failure to

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assist would result in negative outcomes for the target, (c) the level of assistance needed was rather small, and (d) the personal costs to the respondent extending from helping the target person were rather high, such as inhibiting them from filing a medical claim or reducing their score on an intelligence test. Responses across the two vignettes were combined to form a single index (M = 8.40; SD = 2.8). Coefficient alpha for the 2-item scale was .69. Analytic Approach We used both standard linear regression analysis and stepwise regression analyses to examine the inter-relations among the variables. Standard regression allows an assessment of the unique contributions of each variable, controlling for shared variance among the predictors. Thus, it allows an assessment of the unique contributions of each regressor, beyond that explained by the shared variance among the regressors. Stepwise procedures attribute the shared variance of the predictor set to the strongest predictor. Subsequently entered variables must account for additional variance to emerge as statistically significant. Stepwise procedures have an advantage in that the effects of multicollinearity can be directly assessed. In the following analyses, we utilize three indices of collinearity: (a) the tolerance, which is equivalent to [1-R2] and for which a value less than .20 is acceptable; (b) the variance-inflation factor (VIF) which is the reciprocal of tolerance. VIF values greater than 4.0 indicate instability of the regression weights due to high intercorrelation among the regressors; and (c) condition

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indices which relate to the proportion of variance that multiple variables account. Values greater than 15 indicate possible collinearity problems, whereas values in excess of 30 suggest serious problems with collinearity (Garson, 2001). Due to concerns related to suppressor effects, we chose to use a backward elimination procedure in which all the variables are initially entered in the equation and the weakest predictors are removed (Cohen & Cohen, 1983). Finally, given our modest sample size, we were concerned about our ability to detect meaningful effects within the sample. Therefore, we conducted a power analysis using the G-Power software (Faul & Erdfelder, 1992); with three regressors, we had sufficient power (> .80) to detect medium-sized effects (f2 = .17; p < .05). Results Preliminary Analyses Due to the lack of information regarding the ways in which the examined constructs relate to each other and whether demographic variables moderate these associations, our initial approach to the data involved examining zero-order and partial correlation coefficients. To examine the univariate associations among the measures, we computed Pearson correlation coefficients. As shown in Table 1, age was not significantly associated with any other measures; therefore, we did not include it in the planned regression analyses. Gender, however, was significantly associated with subjective spirituality and private religiosity. In both instances, men reported higher levels than women (Ms = 69.43 men,

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58.44 women; t (66) = 2.25, p < .05; Ms = 15.78 men, 13.80 women; t (66) = 2.17, p < .05, respectively).1 Dichotomized marital status failed to be significantly related to the measures of interest. In exploratory regression analyses, we entered age, gender and marital status as independent variables for each of the study outcomes. These demographic variables failed to account for significant variance in both depressive symptoms (F (3, 64) = 1.22, p = .31) and prosocial behavior (F (3, 58) = 0.32, p = . 81). Table 1. Sample Means and Correlations (N = 68)

Note: *p < .05;**p < .01;***p < .001;+n = 62. The measures of public religiosity, private religiosity, and subjective spirituality were positively and significantly associated with each other. We examined these relations using partial correlations between pairs, controlling for the effects of the third measure. The 337

magnitude of association was greatly reduced in these analyses (range of partial r = .34 to .46). Finally, no significant overlap was observed between depressive symptoms and prosocial behavior, with a non-significant correlation coefficient (r = .02). Regression Analyses Our main goal was to examine whether public religiosity, private religiosity and subjective spirituality accounted for significant variance in the two outcomes. To examine this question, we conducted linear regression analyses, entering all three variables in a single step for both psychosocial outcomes. As shown in Table 2, the three regressors accounted for significant variance in CES-D scores (F (3, 64) = 6.10, p = .001), explaining 22.2% of the variance. However, only public religiosity and private religiosity contributed significantly to the variance explained in CES-D scores. People who reported higher levels of public religiosity and those who reported less private religiosity reported fewer depressive symptoms. Table 2. Linear Regression Symptoms (N = 68)

Predicting

Depressive

F(3, 65) = 6.15, p =.001; R2 = .221 To further examine these relations, we conducted a stepwise regression with backward elimination. Results 338

were virtually identical to the standard regression. At the second step, only subjective spirituality was removed from the predictor set. The reduction in R2 was not significant (Fchange (1, 66) = 1.99, p = .16), and the equation retained its significance (F (2, 65) = 5.34, p < .01). Although related to each other, diagnostic statistics indicated that collinearity among the predictor set was not problematic (tolerance > .20, VIF < 4.0, Condition Index < .15). To examine the effects of public religiosity, private religiosity and subjective spirituality on prosocial behavior, we conducted a standard linear regression using the score derived from the vignettes as the dependent variable. As shown in Table 3, the 3-regressor equation reached significance (F(3, 59) = 2.76, p = .05). However, only 12.3% of the variance was explained. Only subjective spirituality emerged as significant, with people who reported higher levels of spirituality being more likely to help another in the social vignettes. Table 3. Linear Regression Behavior (N = 62)

Predicting

Prosocial

F(3, 59) = 2.76, p = .05; R2 = .123 Using stepwise regression with backward elimination revealed additional information about the ways in which private religiosity, public religiosity, and subjective spirituality are associated with prosocial behavior.

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Specifically, private religiosity was removed from the predictor set without significantly reducing the amount of variance explained (Fchange (1, 60) = 1.51, p = .23). Thus, in contrast to the standard regression results in which only subjective spirituality emerged as significant, the stepwise regression showed that both public religiosity and subjective spirituality contributed to the increased variance explained in prosocial behavior. Discussion The literature strongly demonstrates the benefits of organizational religiosity on measures of morbidity and mortality (McCullough et al., 2000) and psychological well being (Krause et al., 1999; Krause & Van Tran, 1989; Worthington et al., 1996). However, these examinations are limited by a near-exclusive focus on public behaviors. A more thorough examination of the effects of religiosity requires an explicit focus on its multidimensional nature and the inclusion of a broader range of outcome measures. To this end, we conceptualized religiosity as being comprised of public behaviors, private behaviors, and subjective spirituality. Our primary goal was to determine whether public religious behaviors, private religious behaviors, and subjective spirituality were differentially associated with psychosocial outcomes. We expanded the typical range of outcomes investigated to include prosocial behaviors in a group of healthy “typical” older adults. An intriguing gender difference emerged in our sample, with older men reporting higher levels of public religiosity and higher levels of subjective spirituality.

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These differences were robust, and were not attributable to the oft-seen gender differences in marital status or subjective health. Although our data preclude more in-depth examinations for the causes of these unusual gender differences, several possibilities exist. The older men in the current sample may be particularly religious and spiritual as a function of their rural status. Relatively few studies have explicitly addressed gender differences among rural older adults. However, there is some evidence (Patrick, Cottrell, & Barnes, 2001) that rural environments might lead to stronger gender differences than commonly observed. Another possible explanation for the unusual gender effects might relate to the use of self-administered surveys. Several large-scale examinations of religiosity among older adults have utilized telephone and personal interviews. Among older men, the privacy of self-administered surveys may enable them to disclose higher levels of religiosity and spirituality. Given the highly personal nature of such issues, future research should directly examine the effects of different data collection methods on the mean levels of religiosity and spirituality. The current results also address the multidimensional nature of religiosity. Despite the overlap among our three measures, unique contributions were observed. Public religiosity was associated with fewer depressive symptoms. Higher levels of private religiosity were associated with higher levels of depressive symptoms. Finally, subjective spirituality and public religiosity were significantly associated with prosocial behaviors. Higher subjective spirituality and lower public religiosity were

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associated with an increased likelihood of helping another person portrayed in the vignettes. That our results indicate a negative association between participation in organizational aspects of religiosity and prosocial behaviors is intriguing. Although much of the research on religiosity and prosocial attitudes and behavior has been conducted with young adult samples (e.g., Darley & Batson, 1973), our results echo those of Eisinga and Billiet (1999): Age does not appear to mediate the associations between religiosity and behavior. The robustness of this apparent age invariance requires more intensive examination. Although regression equations for both psychosocial outcomes were significant, relatively modest amounts of variance were explained. This is particularly true for the equation predicting prosocial behavior. This may be due, in part, to the nature of the measure we used. Despite an acceptable level of internal consistency, our measure was derived from only two scenarios. Given that the effects of spirituality and religiosity may be situation dependent, a more explicit focus on the kinds of situations in which these constructs influence behavior is warranted. Adoption of the everyday problem-solving methodologies, however, may significantly advance this area of inquiry. We believe that this is an especially important area for future studies because most Jewish and Christian philosophies advocate the application of religious beliefs into concrete prosocial behaviors (Huddleston, 1995). In terms of accounting for variance in depressive symptoms, the three regressors accounted for little more

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than 20% of the variance. Although modest, this is consistent with larger studies of the effects of public and private religiosity on psychological well being (Krause & Van Tran, 1989). Thus, it appears that religiosity should be considered among the multiple correlates of well being for older adults. Whether religiosity exerts similar effects of similar magnitude among other age groups remains an important empirical question for future studies. The generalizability of our results is limited by concerns related to the sample size and the cross-sectional nature of the data. Despite the small number of participants in the current study, however, we did have sufficient statistical power to detect medium-sized effects. The failure of subjective spirituality to emerge as a significant associate of depressive symptoms and the failure of private religiosity to account for variance in prosocial behavior may be related to a subtle influence that we were unable to detect. Future investigations, using larger samples, will be able to directly assess the magnitude of these associations. A more potent limitation to our study is the cross-sectional nature of the data. It is likely that the associations among various indicators of religiosity, spirituality and psychosocial outcomes are more dynamic than our design suggests. Future investigations will require multiple points of measurement to disentangle the temporal relations among these constructs. This limitation is especially pertinent to interpreting the positive association between private religiosity and depressive symptoms observed in our

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sample. This association may be a function of our cross-sectional investigation. As suggested by Koenig et al. (2001), it is likely that people who participate in high levels of prayer may actually be doing so in order to alleviate some of their depressive symptoms. Thus, multiple times of measurement must be used to better describe this process. In addition, future investigations of the association between prayer and specific outcomes should include more precise items to index prayer. Our scale of private religiosity included the frequency of prayer related to several domains. Although we did not specify the nature of the prayer, whether individuals were praying to ask for assistance in these areas or whether they were offering prayers of gratitude, it is likely that many adults interpreted the items to reflect petitionary prayer. The nature of one’s prayer probably matters (Ai et al., 2002). If one prays for solutions to one’s problems versus asking for the strength to cope versus offering praise and gratitude, the effects on emotional well being may be very different. Thus, future investigations of the effects of prayer on emotional well being need to include greater specificity regarding the nature and content of the prayer. Despite these limitations, however, our results strongly support the utility of expanding current investigations of religiosity to include multiple aspects of religiosity and spirituality, as well as to include a broader array of outcome variables. That public religiosity is related to an increased quality of life is an important empirical finding. However, given its importance to adults, more empirical attention must be

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directed toward whether and in what ways religiosity and spirituality affect the quality of one’s life. Note 1. We explored these associations controlling for the effects of marital status and health; gender differences remained. References Ai, A.L., Peterson, C., Bolling, S.F., & Koenig, H. (2002). Private prayer and optimism in middle-aged and older patients awaiting cardiac surgery. The Gerontologist, 42, 70-81. Chatters, L.M., & Taylor, R.J. (1994). Religious involvement among older African-Americans. In J.S. Levin (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 196-230). Thousand Oaks, CA: Sage. Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences (2nd. ed.). Hillsdale, NJ: Lawrence Erlbaum & Assoc. Cornelius, S., & Caspi, A. (1987). Everyday problem-solving in adulthood and old age. Psychology & Aging, 2, 144-153. Darley, J., & Batson, D. (1973). From Jerusalem to Jericho: A study of situational and dispositional variables in helping behavior. Journal of Personality and Social Psychology, 27, 100-108.

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Denney, N.W., & Pearce, K.A. (1989). A developmental study of practical problem solving in adults. Psychology & Aging, 4, 438-442. Eisinga, R., & Billiet, J. (1999). Christian belief and ethnic prejudice in cross-national perspective: A comparative analysis of the Netherlands and Flanders (Belgium). International Journal of Comparative Sociology, 40, 375-393. Faul, F., & Erdfelder, E. (1992). GPOWER: A priori, post hoc, and compromise power analysis for MS-DOS (Computer program). Bonn, FRG: Bonn University, Department of Psychology. Fetzer (1999). Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research. Available via Internet at: . Freund, A.M., & Smith, J. (1999). Content and function of the self-definition in old and very-old age. Journals of Gerontology: Psychological Sciences, 54B, P55-67. Garson, G.D. (2001). Statnotes: An online textbook. Accessed via the World Wide Web, at: . Huddleston, M.A. (1995). Springs of spirituality. Liguori, MO: Triumph Books. Kennedy, G.J., Kelman, H.R., Thomas, C., & Chen, J. (1996). The relation of religious preference and practice to depressive symptoms among 1,855 older adults. Journal of Gerontology: Psychological Sciences, 51B, P301-308.

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Kenney, B.P., Vaughan, C.E., & Cromwell, R.E. (1977). Identifying the socio-contextual forms of religiosity among urban ethnic minority group members. Journal for the Scientific Study of Religion, 16, 237-244. Koenig, H.G. (1993). Religion and aging. Reviews in Clinical Gerontology, 3, 195-203. Koenig, H.G. (1994). Religion and hope for the disabled elder. In J.S. Levin (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 18-51). Thousand Oaks, CA: Sage. Koenig, H.G., George, L.K., & Peterson, B.L. (1998). Religiosity and remission from depression in medically ill older patients. American Journal of Psychiatry, 755, 536-542. Koenig, H.G., Hays, J.C., Larson, D.B., George, L.K., Cohen, H.J., McCullough, M.E., Meandor, K.G., & Blazer, D.G. (1999). Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults. Journal of Gerontology: Medical Sciences, 54A, M370-376. Koenig, H.G., Kvale, J.N., & Ferrel, C. (1988). Religion and well being in later life. The Gerontologist, 28, 18-28. Koenig, H.G., McCullough, M.E., & Larson, D.B. (2001). Handbook of religion and health. Oxford: Oxford University Press. Krause, N., Ingersoll-Dayton, B., Ellison, C.G., & Wulff, K.M. (1999). Aging, religious doubt, and psychological well being. The Gerontologist, 39, 525-533.

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Krause, N., & Van Tran, T. (1989). Stress and religious involvement among older Blacks. Journal of Gerontology: Social Sciences, 44, S4-13. Landauer, T. K. (1989). Some bad and some good reasons for studying memory and cognition in the wild. In L. W. Poon, D. C. Rubin & B. A. Wilson (Eds.), Everyday cognition in adulthood and late life (pp. 116-125). Cambridge: Cambridge University Press. Levin, J. S., Taylor, R. J., & Chatters, L. M. (1994). Race and gender differences in religiosity among older adults: Findings from four national surveys. Journal of Gerontology: Social Sciences, 49, SI37-145. McCullough, M.E., Hoyt, W.T., Larson, D.B., Koenig, H.G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19, 211-222. McFadden, S.H. (1995). Religion and well being in aging persons in an aging society. Journal of Social Issues, 57, 161-175. McFadden, S.H. (1996). Religion, spirituality, and aging. In J.E. Birren & K.W. Schaie (Eds.), Handbook of the psychology of aging: 4th ed. NY: Academic Press. Park, J. H., Meyers, L. S., & Czar, G. C. (1998). Religiosity and spirituality: An exploratory analysis using the CPI 3-vector model. Journal of Social Behavior & Personality, 13, 541-552. Patrick, J.H., Cottrell, L.E., & Barnes, K.A. (2001). Gender, social support, and emotional well being among the rural elderly. Sex Roles, 45, 15-29, 348

Plante, T.G., Yancey, S., Sherman, A., & Guertin, M. (2000). The association between strength of religious faith and psychological functioning. Pastoral Psychology, 48, 405-412. Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measures, 3, 385-401. Strawbridge, W.J., Cohen, R.D., Shema, S.J., & Kaplan, G. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87, 957-961. Taylor, R.J., & Chatters, L.M. (1991). Nonorganizational religious participation among elderly Black adults. Journal of Gerontology: Social Sciences, 46, S103-111. Worthington, E.L., Kurusu, T.A., McCullough, M.E., & Sandage, S. J. (1996). Empirical research on religion and psychotherapeutic processes and outcomes: A 10-year review and research prospectus. Psychological Bulletin, 119, 448-487. Karri Bonner is Doctoral Student in Life Span Developmental Psychology, Department of Psychology, West Virginia University. Lesley P. Koven is Doctoral Student in Adult Clinical Psychology, Department of Psychology, West Virginia University. Julie Hicks Patrick is Assistant Professor of Life Span Development, Department of Psychology, West Virginia University. Address correspondence to: Karri Bonner, Department of Psychology, West Virginia University, PO Box 6040,

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Morgantown, WV [email protected]).

26506

(E-mail:

[Haworth co-indexing entry note]: “Effects of Religiosity and Spirituality on Depressive Symptoms and Prosocial Behaviors.” Bonner, Karri, Lesley P. Koven, and Julie Hicks Patrick. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 189-205; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 189-205. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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Religiosity, Afterlife Beliefs, Adjustment in Adulthood

and

Bereavement

Shailagh M. Clarke Bert Hayslip, Jr. PhD Ricks Edmondson, PhD Charles A. Guarnaccia, PhD Summary. Research in gerontology and bereavement adjustment often fails to examine the effects of religiousness and beliefs in the afterlife on grief. It was hypothesized that religiosity and belief in life after death would play different roles for younger and older adults regarding bereavement adjustment. Sample characteristics suggested that the interaction effect between age and religiosity or age and belief in life after death on bereavement adjustment could not be tested. However, aspects of bereavement adjustment, in particular physical health and efforts to cope, were found to be influenced by age, religiosity, and cause of death. Implications and directions for future research and counseling are discussed [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HA WORTH. E-mail address:

Website: © 2003 by The Haworth Press, Inc. All rights reserved.] Keywords. Bereavement religiosity afterlife

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Traditionally, research has not explored the role of religion or spirituality in the human condition due to a historic tension between science and religion (Stuckey, 2001). For this reason, it is not surprising that until recently, issues of religion and spirituality have not been widely addressed in gerontology (McFadden, 1996). This study investigates the effect of religiosity on bereavement adjustment for younger adults and older adults. Defining and Measuring Religiosity and Spirituality Research on religiosity, spirituality, and psychological well being has been compromised by problems related to an uninformed conceptualization of religious indicators (Levin & Tobin, 1995) and a lack of consensus regarding definitions and measures of religiosity and spirituality (McFadden, 1996). Problems have arisen from treating religiosity as one amorphous construct including public behaviors, private behaviors, and subjective states or attitudes (Levin & Tobin, 1995). In addition to problems in measuring religiosity, a number of conceptual frameworks used in research regarding religion (Levin & Tobin, 1995) create an eclectic set of theoretical approaches rather than a cohesive theoretical base. One such framework that has been extended to include religiosity is the social stress or buffering model. In this light, Maton (1989) found that for highly stressed college students, spiritual support (perceived support from God) was significantly related to well being, wherein religiousness can be viewed as a resource for coping that can be nourished and sustained over the lifespan (Pargament, Van Haitsma, & Ensing,

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1995). In this context, for many older Americans, religion is the primary method of coping (Koenig, 1995). It is likely that the stress-buffering properties of religious coping affect how older adults experience both physical illness and mental distress (McFadden, 1995), which is especially important as religious involvement seems to change with age both in terms of religious behaviors, such as church attendance, and in terms of the meaning religion holds for an individual (Idler and Kasl, 1992). For older persons, beliefs may be especially important if access to more organized religious events is restricted, for example in the case of health problems or lack of transportation. Thus, religious beliefs may serve as a buffer to stress for older adults. While for older Americans it seems that religion is a primary method of coping (Koenig, 1995), there are, however, mixed results regarding whether older adults use religious coping methods more than their younger counterparts (Pargament, Van Haitsma, & Ensing, 1995). Studies of older adults mental health indicate that religious beliefs, attitudes, and coping behaviors contribute to higher levels of adjustment as indexed by levels of suicide rates, anxiety, and alcohol abuse (McFadden, 1996). Religious worship and prayer were found to create a wide variety of positive emotional experiences, including relaxation, hope, forgiveness, empowerment, catharsis, and love (McFadden & Levin, 1996), even offering some protection against depression (Stuckey, 2001). Finally, belief in life after death was found to be a discriminating predictor of well being (Steinitz, 1980).

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Religiosity and religious coping have also been found to be negatively associated with mortality and chronic illness (Idler & Kasl, 1992; Levin, 1994). Private religiousness (defined as being deeply religious and getting strength and comfort from religion) was found to have a short-term protective effect against mortality, suggesting that social support is not the only benefit of religiousness (Idler & Kasl, 1992). Religion is also related to perceptions of health, functional disability, hypertension, and the prevalence of cancer, smoking, and drinking behavior in older adults (Levin, 1994). As older adults attach a high value to their religious beliefs and behaviors (McFadden, 1996), religious beliefs that address issues surrounding mortality become more important. Religion and Bereavement Adjustment in Younger and Older Adults As the experience of loss tends to evoke a search for meaning among patients, families, and caregivers (Davidson, Doka, & Doka, 1999; McFadden, 1996), religion can provide meaning and comfort for those engaged in this search. Indeed, bereaved adolescents and adults acknowledge that grief leads them to search for meaning (Balk & Corr, 2001). For example, the presence of existential variables, such as personal meaning for life, religiosity, and spirituality were found to alleviate depression and anxiety in people who had lost their spouses (Fry, 2001). It has been hypothesized that the roots of hope are located in a belief that a supreme being has a plan and that there is a purpose and meaning for what seems otherwise painful

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and meaningless (Stuckey, 2001, p. 73). Religious rituals can also be helpful (Davidson, Doka, & Doka, 1999). For example, faith communities have traditionally helped mourners by providing ritual. Religious people may benefit more from funerals through the provision of a sense of closure and continuity, the affirmation of a connection with a religious community, and being able to acknowledge a construct that transcends loss (Davidson, Doka, & Doka, 1999). In the context of bereavement adjustment, religion and spirituality can be viewed as a coping strategy used to deal with loss, where religious coping is defined as the use of religious beliefs and behaviors to prevent or alleviate the negative emotional consequences of stressful life circumstances and to facilitate problem solving (Koenig, 1999, p. 139). Religious beliefs and behaviors are part of an orienting system of resources and burdens that influences the way a person interprets and deals with a stressful situation (Pargament, Van Haitsma, & Ensing, 1995, p. 49). Religion or religious devotion is an appropriate coping strategy for bereavement in that the death of a loved one is an unchangeable event, calling for a more emotion-focused coping mechanism (Ellison, 1994) rather than a coping strategy that is problem-focused, or action oriented. Positive religious coping is positively associated with a decrease in the amount of depressive symptoms and a better quality of life (Koenig, 1999). Religion and spiritual resources could serve as both a rationale for pain and suffering and a source of hope that current difficulties are temporary burdens when viewed

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in terms of the reward of an afterlife (Stuckey, 2001). Religious beliefs may also have a positive influence on the process of adjusting to the death of a loved one or family member (Pargament, Van Haitsma, & Ensing, 1995). For bereavement in particular, it has been hypothesized that belief in an afterlife is helpful, i.e., that thinking of an afterlife as a time to be reunited with loved ones attenuates the negative effects of bereavement-related stress (Wuthnow, Christiano, & Kuzlowski, 1980), and Smith, Ranger, and Ulmer (1992) found those with a stronger belief in an afterlife to recover better from bereavement. In general, it appears that religion can help in this respect indirectly, i.e., through positive reinterpretative coping–in helping people think of the death of a loved one in an adaptive way (Shaefer & Moos, 2001). The fact that loss stimulates a search for meaning and possibly the use of religion as a coping strategy raises the question of whether young adults who are religious or spiritual would have higher levels of bereavement adjustment after a loss than non-religious young adults. Purpose of the Present Study This study investigated the effect of religiosity and belief in the afterlife on bereavement adjustment in adulthood. It was hypothesized that religiosity would affect bereavement differently for younger adults and older adults. It may be that the resiliency associated with being in early adulthood (Balk & Corr, 2001) could mitigate the need to use religion as a coping strategy or source of meaning. Alternatively, the non-normative aspect of loss

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in early adulthood (Shaefer & Moos, 2001) and the lack of support from age peers (Balk & Corr, 2001) could create a more profound search for meaning and a need to lean on one’s spiritual beliefs. Religion may also act as a buffer from stress for young adults (see Maton, 1989). For older persons, the cumulative effect of more losses over the life span may enable one to develop more positive coping skills as well as enhance one’s acceptance of the realities of life and death (Moss, Moss, & Hansson, 2001; Shaefer & Moos, 2001). This may mitigate the role of religiosity in affecting bereavement adjustment, as through loss, persons would have sought private meaning. However, it could be that bereavement overload (Kastenbaum, 2001), interpersonal problems (lack of support), and health difficulties undermine older persons ability to cope with loss, supporting the buffering function of religiosity on bereavement adjustment, via its role as a source of personal meaning and social support. Method Participants The parent sample for this study consisted of 438 individuals (104 males, 334 females) all over the age of eighteen (M age = 35), who had experienced the death of a family member or friend within the past two years. The vast majority (90%) had experienced a loss within the previous year. Participants were recruited from various bereavement organizations such as Compassionate Friends, from local

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hospices, as well as from various sources in the community such as churches. The sample was purposefully heterogeneous regarding sociodemographic factors such as age, gender, ethnicity, religion, geographic location, and cause of death. The majority of the sample was Caucasian (n = 364), while the remainder was African American (n = 32), Hispanic (n = 21), Native American (n = 5), Asian (n = 11), or Other (n = 5). Nearly 52% of individuals reported their religious affiliation to be Protestant (n = 226), and most participants were single (n = 232). Fifty persons had experienced the death of a spouse, while 101 had lost a grandparent. Other losses included those of: grandchild (n = 1), mother (n = 40), father (n = 40), sister (n = 4), brother (n = 7), close friend (n = 77), aunt (n = 26), uncle (n = 18), son (n = 18), daughter (n = 8), and other (n = 66). Moreover, 121 individuals reported that their mother had died prior to the two-year period of time defined in this study, while 144 individuals reported that their father was previously deceased. Table 1 illustrates the demographic characteristics of the sample cross-sectionalized by age. Table 1. Demographic Characteristics of the Sample by Age Young Adults (N =Older Adults (N = 264) 90) Age

18-35 (M = 22.89, SD50-88 (M = 61.44, = 4.38) SD = 9.83)

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Young Adults (N =Older Adults (N = 264) 90) Education (Yrs)

1-16 (M = 12.76, SD =7-17 (M = 14.33, 4.26) SD = 1.92)

Male

26.5%

20%

Female

73.5%

80%

Race/ Ethnicity: Caucasian 76.1%

87.0%

African American

10.2%

12.2%

Native American

7.2%

--

Other

6.5%

1.1%

20.5%

20.0%

Protestant 42.0%

71.1%

Jewish

1.1%

3.3%

Other

32.2%

5.6%

Missing

4.2%

--

14%

35.6%

Religion: Catholic

Marital Status: Married

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Young Adults (N =Older Adults (N = 264) 90) Divorced

2.7%

6.7%

Separated .8%

1.1%

Single

5.6%

82.2%

Widowed .4%

51.1%

Annual Income: < 10k

17.4%

10.0%

10k-20k

9.5%

16.7%

20k-30k

9.8%

16.7%

30k-40k

15.2%

14.4%

40k-50k

11.7%

11.1%

50k-100k 25.8%

21.1%

100k +

8.0%

6.7%

Missing data

2.7%

3.3%

Mother Living

94.7%

16.7%

Father Living

90.2%

10.0%

Procedures

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Each individual either received the questionnaire in person, or was mailed a copy to complete, contingent upon having contacted the second author regarding his/ her interest in the study, advertised as examining individuals’ attitudes toward funerals. The questionnaire was preceded by an informed consent form wherein each volunteer’s rights and responsibilities regarding the study were clearly stated, each person was informed regarding the risks attendant to answering questions about the death of a loved one, and referral sources were provided those for whom answering such questions were troubling enough to seek professional help. Measures The short form of the Texas Revised Inventory of Grief (TRIG; Zisook & DeVaul, 1983) assessed bereavement adjustment. This eighty-fíve-item inventory includes two scales that examine the feelings and behaviors of the bereaved after the death of the loved one (Past Behaviors), as well as how persons presently feel in relation to the deceased (Present Feelings). This self-report Likert-type measure has established psychometric properties (alphas ranging from .74 to .89), with scores on the TRIG positively correlating with levels of grief resolution (Zisook & DeVaul, 1983). Higher TRIG scores index poorer adjustment. The short (24 item) version of the Bereavement Experience Questionnaire-Revised (BEQ-Revised) (Demi, 1984; Guarnaccia & Hayslip, 1998) is a self-report measure which assesses bereavement reactions to the deceased such as anger, guilt, stigma,

361

meaningfulness, isolation, and depersonalization. Its reliability is excellent (alpha = .95). The Bradburn Affect Balance Scale (Bradburn, 1969) assessed a dimension of bereavement adjustment focusing upon psychological well being, and reflects respondents experiences during the last few weeks. It is divided into two affective dimensions: positive (e.g., feeling on top of the world) and negative (feeling depressed and very unhappy). Lower scores indicate more positive emotional health. The alpha coefficient of these two independent dimensions ranges from .86 to .97 (Bradburn, 1969). The Coping Inventory (Horowitz & Wilner, 1980) assesses the number of strategies utilized to cope with significant life events. Participants are asked to endorse coping strategies used most often to cope with the loved one’s death. The alpha coefficient for this measure in the present sample was .76. Total scores, reflecting the intensity of efforts to cope with loss, were used here. Such scores have been found to vary over time (Hayslip, Allen, & McCoy, 2000) in samples of conjugally and nonconjugally bereaved persons, as well as to differentiate such persons by level of perceived resources and level of adjustment. The Hopkins Symptom Checklist (Derogatis, Lipman, Rickels, & Covi, 1974) is a fifty-eight item self-report inventory designed to measure psychological symptoms that have been experienced by the participant within the past seven days. Participants rate themselves on five symptom dimensions: somatization, obsessive-compulsiveness, interpersonal sensitivity,

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depression, and anxiety. Cronbach’s alpha coefficients for the five dimensions range from .84 to .87. Two self-report measures of health designed by Rider and Hayslip (1994) assessed the physical and emotional health of the bereaved individual over the past six months. Seven questions (alpha = .79) targeted physical health, to include physicians’ visits, illnesses that interfered with work or required hospitalizations, the use of prescription drugs to treat illnesses, overall rating of physical health, and changes in health over time. Twenty-three questions (alpha = .86) targeted mental and emotional health, e.g., self rated emotional health, feelings of depression, lack of energy, eating or sleeping difficulties, agitation, loss of energy, difficulty in concentration, lack of interest in pleasurable activities, thoughts of worthlessness, anomie, or suicide, anxiety, help-seeking for emotional difficulties, drug or alcohol consumption to deal with emotional difficulties. Design and Analysis Individuals were divided by age into Younger (ages 18 to 35 years) and Older (age 50 and older) adults. Within age group, individuals were further classified as More Religious and Less Religious groups as well as Belief and No Belief in the afterlife. More Religious participants were defined as those who answered “somewhat so” or “strongly so” to the item: “To what extent do you consider yourself a religious person?”. Those who answered “hardly at all,” and not at all” were placed in the Less Religious group. Participants in the Belief group answered “reasonably certain” and “strongly believe” to the item “To what extent do you

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believe in life after death?”. Participants who answered, “definitely do not believe” and “fairly certain there is no afterlife” were placed in the No Belief group; persons whose answers were neutral were excluded in each case. In subsequent exploratory analyses (see below), persons who were neutral regarding religiosity were included, however. A 3 × 2 between subjects multivariate analysis of covariance (MANCOVA) was used to analyze the effects of age (Young, n = 264 vs. Old, n = 90) and religiosity (More Religious, n = 275; and Less Religious, ns = 24-57, see below) on bereavement adjustment while controlling for the closeness of the relationship to the deceased and duration of time since death. An interaction between age and religiosity was predicted. Cell sizes varied, with the fewest (N = 4) subjects in the older non-religious group. Results Age and Religiosity Due to the smallness of the less religious, older subgroup, the effect of the interaction between age and religiosity for indices of bereavement adjustment could not be tested. However, a significant multivariate main effect was found for age (F (11,283) = 3.15, p = < .01. At the univariate level, this was particular to Physical Health (F (1,293) = 13.79, p = < .01, and suggested that older adults had more health problems than did younger adults (see Table 2). A multivariate main effect for religiosity was also found (F(11,283) = 2.90, p = < .01. This was particular to Coping (F (1,293) = 7.18, p = < .01) and Physical Health (F (1,293) = 5.83, p = < .02).

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Participants in the More Religious group endorsed more coping behaviors than those in the Less Religious group. Less Religious participants also reported more health problems than did More Religious participants (see Table 3). Table 2.Dependent Measures by Age1

Note 1: Participants with complete data for all measures. Table 3.Dependent Measures by Religiosity1

Note 1: Participants with complete data for all measures; “neutral” responses excluded (see text). Age and Afterlife Beliefs

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A similar two-way MANCOVA was carried out to analyze age (Young vs. Old) and belief in afterlife (Belief vs. No Belief). The cell defined by those older persons who did not profess a belief in the afterlife was exceedingly small (< 12), and thus the effect of the interaction for age and belief in an afterlife on bereavement adjustment was not explored. Though there were no significant main effects at the multivariate level for age or belief in an afterlife on bereavement adjustment, post hoc analyses revealed (see above) a univariate effect of age on Coping (p < .01) and Physical Health (p < .05). As above, older adults endorsed more coping behaviors than younger adults and also reported more health problems than did younger adults (see Table 2). When “neutral” responses were used to define the less religious group (n = 57), the main effects for age remained and indeed were extended to TRIG Past scores (p < .05), which were higher for young adults. The main effect for religiosity was however, attenuated. An additional set of exploratory analyses was conducted for four varieties of coping derived from the Coping Inventory (Logical, e.g., think of the death in some way that makes it more manageable [9 items, alpha = .68], Emotional, e.g., avoid the death or try to forget about it as much as possible [6 items, alpha = .56], Interpersonal, e.g., try to talk about the death with others [8 items, alpha = .57], or Spiritual/ Church-Related, e.g., participate in my church or temple, turn to my faith or philosophy of life [2 items, alpha = .54]). Crossing cause of death with religiosity yielded a multivariate effect for religiosity (F (4,350) = 7.85, p < .01). Main effects for religiosity were common to

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Spiritual/Church coping, where those who were More Religious utilized spiritual/church-related coping more often (F(1,353) = 29.91, p < .01) (adj M = 1.03 vs. adj M = .36), Logical coping (F (1,353) = 5.27, p < .05), and Interpersonal Coping (F (1,353) = 4.21, p < .05), each favoring those who were More Religious (adj Ms = 3.42 vs. 4.37; 2.4 vs. 2.99 respectively). Such effects remained even when “neutral” responses to define those who were Less Religious were utilized. Cause of Death, Religiosity and Bereavement Given the lack of findings for the hypotheses of interest, an exploratory analysis was conducted to examine the role of other factors on bereavement adjustment to determine whether there is a circumstance under which religiosity or belief in an afterlife each affect bereavement adjustment. In this respect, there is some evidence to suggest that the cause of death might influence bereavement adjustment (Hayslip, Ragow-O’Brien, & Guarnaccia, 1998). To explore this possibility, participants answered a question regarding the cause of death of the person who had died. Those answering that the death was accidental, violent, or sudden (e.g., accidents, drowning, murder, suicide) were placed in the Violent/ Sudden group (n = 144), and participants who responded that the death was from disease (e.g., cancer, diabetes, cardiovascular illness), was predictable, or was non-violent were placed in the Non-Violent/Expected group (n = 190). While no multivariate main effects or interaction effects were found regarding cause of death and afterlife belief,

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with regard to the test of the interaction between cause of death (Violent vs. Non-violent) and religiosity (More Religious vs. Less Religious) (controlling for closeness to the deceased and time since death), there was a main effect for religiosity at the multivariate level (F (8,331) = 2.64, p < .01). At the univariate level, this was specific to the Coping Inventory (F (1,338) = 7.82, p = < .01), where such scores were higher for participants in the More Religious group (M = 10.81) than in the Less Religious group (M = 8.87). When “neutral” responses to define less religiosity were included, the multivariate effects for religiosity disappeared, but the effects for the Coping Inventory remained statistically significant. When such neutral responses to the religiosity variable were included (defining the Less Religious), no interaction between cause of death and religiosity was found at the multivariate level. Importantly, however, post hoc tests revealed that there was a univariate interaction between cause of death and religiosity for the Coping Inventory (F (1,371) = 4.42, p = < .05). In this case, for the Less Religious group, those who reported that the cause of death was violent had higher scores on the Coping Inventory (adj M = 10.09) than those who reported the death to be non-violent (adj M = 7.94). Conversely, for the More Religious group, those who reported that the cause of death was violent had no higher coping scores (adj M = 10.44) than those who reported that the cause of death was not violent (adj M = 11.05). No interaction between the relationship to the deceased (close family member vs. distant family/friend) (see

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Bugen, 1979) and religiosity was also found for specific types of coping, though with regard to the interaction between relationship to the deceased and religiosity for physical health (F (1,323) = 9.01, p < .05), persons who were Less Religious whose relationship to the deceased was more distant had more such health difficulties than those whose relationship was less distant (adj M = 13.15 vs. adj M = 10.60). In contrast, More Religious persons who had lost a close family member reported more health problems than did those who had lost a more distant family member or friend (adj M = 12.74 vs. adj M = 9.40). Discussion While we predicted an interaction between age and religiosity for bereavement adjustment, such effects were not testable, due to the small number of older persons who did not consider themselves religious, undermining the statistical power of the analysis. This was also the case for the afterlife belief by age interaction. In this study, religiosity was associated with more active attempts to cope with loss. It may be that religious participants are making active efforts to cope and that those behaviors that center around religious ritual and obtaining support from the religious community are relevant. Though there is some concern over their lack of reliability, the exploratory analysis by coping subtypes bears this out. It may also be that less religious individuals may be making fewer overt attempts to cope with loss because they do not have a religious belief system to aid in making sense or finding meaning in the loss. As older adults who have lost more loved ones are

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more familiar with and more practiced at dealing with loss, this may explain the age effect on overall coping. To the extent that age and religiosity covary, the independent effects of each on health, coping, or bereavement distress must be viewed with some caution. Using neutral responses to define levels of religiosity, it was found that the circumstances of the death affected the bereavement adjustment of more religious and less religious people differently. For less religious participants, a violent death was associated with more active attempts at coping with loss, while for more religious participants, cause of death did not differentiate persons with regard to the number of active attempts to cope with loss. It may be that fewer coping behaviors seem necessary to individuals who are more religious because religious rituals, the social support of a religious community, or the belief that God will take care of them and their loved ones eliminate the perceived need to more actively manage their grief individually. An alternative explanation is that this may have been an artifact of the measure used to assess religiosity. For the most part, religious coping techniques were not uniquely identified, so the difference between the number of coping behaviors endorsed by more religious versus less religious participants could reflect a difference in type of coping behaviors chosen rather than the overall degree of active coping (see above). Among people who consider themselves less religious, having experienced a violent death was associated with more active efforts at coping. Indeed, it could be that for people who consider themselves more religious,

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religious ritual, the social support of a religious community, or religious beliefs act as a buffer against depression or isolation associated with the stigma and trauma of violent death. For such persons, less support from others may be needed and sought when death is not violent. In fact, a post hoc analysis of social support (assessed via two questions regarding the number of persons one could turn to in times of need and with regard to dealing with death) crossing cause of death and religiosity was significant (F (1,138) = 4.11, p < .05), where more religious participants reported more social support when the death was violent (M = 5.88, SD = 3.25), and less support when it was not violent (M = 4.7, SD = 2.89). For less religious people, this pattern was reversed. This suggests that for more religious individuals, loss due to a violent or sudden death may elicit support of the religious community, mitigating its effects on such persons. This, of course, would be consistent with the stress buffering properties that religion may have on persons who are bereaved. Additionally, an analysis of specific indicators of bereavement adjustment also suggested less religious people to report more physical health difficulties, suggesting that religion may also buffer the otherwise negative effects of bereavement on health. Several limitations of the current study should be noted. First, it is important to keep in mind its retrospective nature. Since participants were asked via self-report to recall details of events up to two years after they occurred, it may be reasonable to question the validity or accuracy of such reports. Additionally, perceptions of

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the loss may change over time as participants move further along in the process of grief work. Additionally, the participants sampled in this survey study may be a selective subgroup of bereaved individuals. Such individuals who are willing to complete a questionnaire about their attitudes and adjustment since the loss may be fundamentally different from other bereaved persons, in that they may be having a more difficult time adjusting to the loss than those who were not motivated to complete the survey. Further restriction of range was evident within the less religious group of older adults. There were only four individuals over the age of 50 who did not consider themselves religious, whereas there were 20 older adults who considered themselves religious, though this was a less serious issue when neutral responses to the religiosity question were included. This covariation and lack of statistical power may have contributed to the absence of findings regarding the interaction of religiosity (and afterlife beliefs) and age on bereavement adjustment. Overall, the sample was biased in that the participants were mostly religious and emotionally close to the deceased at the time of death. Interestingly, the selective nature of the sample enables one to study bereaved persons who were for the most part religious, and the sample’s homogeneity in this respect (as well as with regard to closeness to the deceased) may be viewed as a strength, analogous to purposefully sampling such persons and randomly assigning them to alternative cause of death conditions.

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Nevertheless, work with more heterogeneous samples is warranted. Importantly, the assessment of religiosity and belief in an afterlife was accomplished with single-item, but presumably face-valid measures. The use of a multi-item measure of these constructs may yield a greater role for religiosity and belief in an afterlife in affecting bereavement adjustment. In any case, it speaks positively to the role of religiosity in bereavement adjustment that such simple indicators of the constructs yielded effects at all in this study. It may also be that afterlife beliefs pertain more strongly to one’s own death, and thus may not be relevant to the loss of a family member or friend. Implications for Counseling The findings of the present study have several implications for individuals working with bereaved persons. Such persons should not be understood simply in terms of the fact that they have suffered the loss of someone who has died. Instead, grief reactions by bereaved individuals may covary with the cause of the death and the religiosity of the individual. In particular, grief counselors should consider loss in the terms of the age and developmental context of the bereaved individual. For example, it was found here that for older adults, grief and loss are experienced with other stressors, such as health problems, and their effects are an important aspect of grief for older adults. It may also be that the stress of loss in part contributes to increased health problems. Grief counselors working with older

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adults should therefore be sensitive to the overall health and resiliency of their clients. Religious beliefs may play varying roles in bereavement adjustment. While more religious individuals may be better able to rely on their religious beliefs and faith community for support in dealing with loss, less religious clients may be in need of concrete suggestions for resources and ways to cope with death, especially when the death is violent or sudden. These data also indicate that more religious clients might face additional issues surrounding the death of a loved one: They may be experiencing grief surrounding feelings of anger and betrayal toward God. Given the geographical location of this study, it is possible that the sample may have been more heavily populated with Fundamentalist Christian participants, though such information was unavailable here. Participants with a strong belief in a divine plan may find it particularly distressing to be unable to accept something they view as part of that plan. In these cases, exploring beliefs and processing feelings of anger or betrayal towards God may be especially helpful. Future research regarding the role of religiosity and beliefs regarding afterlife in bereavement adjustment should employ multi-item, validated measures of such constructs. For example, further clarifying the nature of religious beliefs and differentiating between organizational and non-organizational religiosity may more fully illuminate the role of religiosity in coping with loss in adulthood.

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Future research might also more carefully explore the functional value of coping among (non) religious persons. For example, for religious individuals who demonstrate fewer coping behaviors, the question remains whether religiosity itself acted as a coping mechanism, decreasing the need to find other ways to cope or provided a reason to avoid actively managing grief (e.g., God will take care of me). Future work may benefit from exploring feelings of betrayal, anger, and forgiveness related to God. Assessment of perceptions of God’s responsibility regarding loss of a loved one may help predict whether religiosity will minimize or exacerbate bereavement distress. Finally, though there are few older non-religious persons today, research on older non-religious persons may be more likely and more needed as newer cohorts who are less traditionally religious grow older. If religion does indeed aid in bereavement adjustment, less religious younger cohorts may be ill equipped to deal with the stress related to loss of a loved one. This is consistent with an age cohort difference in the perception of the helpfulness of funerals (Hayslip, Servaty, & Guarnaccia, 1999), wherein older adults found traditional funeral rituals to be more personally meaningful. Research regarding bereavement adjustment for older less religious persons could therefore be valuable as younger cohorts age and deal with loss. Religiosity may then become an end-of-life issue. Conversely, importance of non-religious coping for older adults may become more evident. References

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Balk, D.E. & Corr, C.A. (2001). Bereavement during adolescence: A review of the research. In Stroebe, M.S., Hansson, R.O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping and care (pp. 199-218). Washington, DC: American Psychological Association. Bradburn, N. (1969). The structure of psychological well being. Chicago: Aldine. Bugen, L. (1979). Death and dying: Theory, research, and practice. Dubuque, IA: Brown. Davidson, E., Doka, J.P., & Doka, K.J. (Eds.). (1999). Living with grief at work, at school, and at worship. Washington, DC: Hospice Foundation of America. Demi, A. (1984). Bereavement Experience Questionnaire. Unpublished manuscript, personal communication, 1990. Derogatis, L.R., Lipman, R.S., Rickels, R.J., & Covi, L. (1974). The Hopkins Symptom Checklist: A self-report symptom inventory. Behavioral Science, 19, 1-15. Ellison, C.G. (1994). Religion, the life stress paradigm, and the study of depression. In Levin, J.S. (Ed.), Religion in aging and health: Theoretical foundations and methodological frontiers (pp. 102-112). Thousand Oaks, CA: Sage. Fry, P.S. (2001). The unique contribution of key existential factors to the prediction of psychological well being of older adults following spousal loss. The Gerontologist, 41, 69-81.

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Guarnaccia, C.A., & Hayslip, B. (1998). Factor structure of the Bereavement Experience Questionnaire: The BEQ-24, a Revised Short Form. Omega: Journal of Death and Dying, 37, 303-316. Hayslip, B., Allen, S., & McCoy, L. (2001). The role of gender in a three-year longitudinal study of bereavement: A test of the experienced competence model. In D. Lund (Ed.), Mens grief. Amityville, NY: Baywood. Hayslip, B., Ragow-Brien, D., & Guarnaccia, C. A. (1998). The relationship of cause of death to attitudes toward funerals and bereavement adjustment. Omega: Journal of Death and Dying, 38, 297-312. Hayslip, B., Servaty, H., & Guarnaccia, C. (1998). Age cohort differences in attitudes toward funerals. In B. DeVries (Ed.), End of life issues (pp. 23-36). New York: Springer. Horowitz, M., & Wilner, N. (1980). Life events, stress, and coping. In L. Poon (Ed.), Aging in the 1980s: Psychological issues (pp. 363-370). Washington, DC: American Psychological Association. Idler, E.L., & Kasl, S.V. (1992). Religion, disability, depression, and the timing of death. American Journal of Sociology, 97, 1053-1079. Kastenbaum, R. (2001). Death, society, and human experience. Boston: Allyn and Bacon. Koenig, H.G. (1995). Religion and health in later life. In Kimble, M.A., McFadden, S. H., Ellor, J.W., & Seeber,

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J.J. (Eds.), Aging, spirituality, and religion: A handbook (pp. 9-29). Minneapolis, MN: Fortress Press. Koenig, H.G. (1999). The healing power of faith: Science explores medicines last great frontier. NY: Simon & Schuster. Levin, J.S. (1994). Religion and health: Is there an association, is it valid, and is it causal? Social Science and Medicine, 38, 1475-1482. Levin, J.S., & Tobin, S.S. (1995). Religion and psychological well being. In Kimble, M.A., McFadden, S.H., Ellor, J.W., & Seeber, J.J. (Eds.), Aging, spirituality, and religion: A handbook (pp. 30-46). Minneapolis, MN: Fortress Press. Maton, K.I. (1989). The stress-buffering role of spiritual support: Cross-sectional and prospective investigations. Journal for the Scientific Study of Religion, 28, 310-323. McFadden, S.H. (1995). Religion and well being in aging persons in an aging society. Journal of Social Issues, 57, 161-175. McFadden, S.H. (1996). Religion, spirituality, and aging. In J. E. Birren & K. Warner Schaie (Eds.), Handbook of the psychology of aging (4th ed., pp. 162-177). San Diego, CA: Academic Press. McFadden, S.H., & Levin, J. S. (1996). Religion, emotions, and health. In C. Magai & S. H. McFadden (Eds.), Handbook of emotion, adult development, and aging (pp. 349-365). San Diego, CA: Academic Press.

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Moss, M.S., Moss, S. Z., & Hansson, R.O. (2001). Bereavement and old age. In Stroebe, M.S., Hansson, R.O., Stroebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping and care (pp. 241-260). Washington, D.C.: American Psychological Association. Pargament, K.I., Van Haitsma, K.S., & Ensing, D. S. (1995). Religion and coping. In Kimble, M.A., McFadden, S.H., Ellor, J.W., & Seeber, J.J. (Eds.), Aging, spirituality, and religion: A handbook (pp. 47-67). Minneapolis, MN: Fortress Press. Rider, J., & Hayslip, B. (1994). Ambiguity of loss, anticipatory grief, and boundary ambiguity in caregiver spouses and parents. Paper presented at the annual meeting of the Gerontological Society of America, Atlanta, GA. Schaefer, J.A., & Moos, R.H. (2001). Bereavement experiences and personal growth. In Stroebe, M.S., Hansson, R.O., Stoebe, W., & Schut, H. (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 145-167). Washington, DC: American Psychological Association. Smith, P.C., Range, L.M., & Ulmer, A. (1992). Belief in afterlife as a buffer in suicidal and other bereavement. Omega, 24, 217-225. Steinitz, L.Y. (1980). Religiosity, well being, and Weltanschauung among the elderly. Journal for the Scientific Study of Religion, 19, 60-67.

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Stuckey, J.C. (2001). Blessed assurance: The role of religion and spirituality in Alzheimer’s disease, caregiving and other significant life events. Journal of Aging Studies, 15, 69-84. Wuthnow, R., Christiano, K., & Kuzlowski, J. (1980). Religion and bereavement: A conceptual framework. Journal for the Scientific Study of Religion, 19, 408-422. Zisook, S., & DeVaul, R.A. (1983). Grief, unresolved grief, and depression. Psychosomatics, 24, 247-256. Shailagh M. Clarke is Doctoral Student in Counseling Psychology, University of North Texas, Denton. Bert Hayslip, Jr., is Regents Professor of Psychology, Department of Psychology, University of North Texas, Denton. Ricks Edmondson is Adjunct Professor of Family Science, Department of Family Science, Texas Woman’s University, and Chaplain, Denton Regional Medical Center. Charles A. Guarnaccia is Associate Professor, Department of Psychology, University of North Texas, Denton. Address correspondence to: Bert Hayslip, Jr., PhD, Department of Psychology, P.O. Box 311280, University of North Texas, Denton, TX 76203 (E-mail: [email protected]). [Haworth co-indexing entry note]: “Religiosity, Afterlife Beliefs, and Bereavement Adjustment in Adulthood.” Clarke, Shailagh M. et al. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 207-224; and: New Directions in the Study of Late Life Religiousness and 380

Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2002, pp. 207-224. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Sendee [1-800-HAWORTH, 9:00 am – 5:00 p.m. (EST). E-mail address: [email protected]].

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Afterword: A “Conversation” Definitions, and Applications

About

Theories,

Susan H. McFadden, PhD Mark Brennan, PhD Julie Hicks Patrick, PhD As we edited this collection, communicating mostly by e-mail, we decided to pose questions to one another about some themes that we observed in the papers. Each of us asked one question, given below in italics, and then all of us provided a response to the three questions. We hope that our responses will encourage readers to consider how they would answer these questions. James Birren has often said that gerontology is “data rich and theory poor.” The same has been said about the psychology of religion. What are the implicit and explicit theoretical foundations of the papers in this collection and what are the implications of these theoretical perspectives for future developments in the study of aging, religion, and spirituality? SHM: Some of the papers in this collection fully engage with theory, while others simply hint at the theoretical foundation of assumptions about definition, methodology, and interpretation. This is not unlike what we find in the field as a whole. Since the heyday of the “grand theories” of the 19th and 20th centuries that claimed universal applicability, social scientists have become less inclined to make their theoretical assumptions explicit. When they do, they are more likely

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to ground their work in “theories of the middle range”, although that phrase itself has several meanings. For some, it can merely refer to theories that define more narrow domains–“minitheories” that are useful to researchers in explaining (not merely describing) their findings (Bengston, Rice, & Johnson, 1999). Another view of this kind of theorizing appears in an important essay on interpretive social science and its application to the study of religion, spirituality, and aging. In that essay, Steven Weiland (1995) noted Bernice Neugarten’s role in articulating the dynamic relationship between theory and method (a relationship most clearly illustrated in the contribution of Blieszner and Ramsey to this collection). As Weiland tells it, Neugarten took a postmodern stance on social scientific research, urging gerontologists to acknowledge the influence of cultural and historical influences on their scientific endeavors and to recognize the dialectical nature of change. She stated, “The goal is not to discover universals, not to make predictions that will hold good over time, and certainly not to control; but instead, to explicate contexts, and thereby to achieve new insights and new understandings” (cited in Weiland, 1995, p. 594). The entire enterprise of theory-building in the social sciences, and in gerontology, has been called into question in recent years by postmodern critiques of scientific epistemology. Nevertheless, human beings do theorize, whether explicitly or implicitly, for we are constantly seeking explanations for our observations of our own behavior and that of others. Scholars undertaking the study of the role of religion and spirituality in the lives of aging persons need to adopt a

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critical perspective on their own work, understanding how it is shaped by the historical moment, culture, and the particularities of the individual lives under examination. Once this has been accomplished, we may proceed cautiously with the development and testing of theories that explain these observations. MB: The psychology of religion, spirituality and aging is increasingly data rich and unfortunately, increasingly theory poor. There has been a well-documented explosion in research on the effects of religiousness and spirituality on physical health and psychological well being. However, the majority of these studies fail to address the conceptual underpinnings on which hypotheses are based, but typically posit that greater religiousness/spirituality will be associated with more positive outcomes. A number of theories have been proposed to explain the beneficial effects of religiousness and spirituality. Some have proposed that highly religious people have more positive health outcomes because of lifestyle choices based on denomination, i.e., prohibitions on alcohol or smoking. Ferraro and Koch (1994) discuss both the “social support hypothesis” and the “religious consolation hypothesis.” The first hypothesis posits that religious persons have better outcomes due to enhanced social support resources available to them through their affiliation with religious institutions. The second hypothesis credits religious belief with the association with positive outcomes, namely, these belief systems create perceptions that maximize gain and minimize loss. However, as discussed in many of the papers in this collection, we have only a limited understanding of the

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function of belief relative to outcomes and, to-date, have paid little attention to the content of such belief in our research. Thus, it is clear that one of the next major frontiers in the study of religion, spirituality, and aging is to better explore the content of religious and spiritual belief, to better understand the between- and within-denominational differences in the content of such belief, and finally, to discover how particular beliefs operate with respect to the health or psychological outcome under consideration. At the same time, we should be conscious of a larger goal–to develop a viable theory that ties together explanations of both the positive and negative aspects of religiousness and spirituality that can be subjected to empirical verification. JHP: To date, a majority of the research on religion, spirituality, and aging has adopted one of only a few theoretical frameworks. Naturally, the framework chosen is a function of how one operationalizes the constructs of religiosity and spirituality. When viewed as a means to adapt to life events, religiosity and/or spirituality have been tested within a stress-and-coping framework. When viewed as a personal characteristic, a general personality framework has been employed. Within these two frameworks, however, much work remains. Specifically, if religiosity and spirituality are viewed as coping resources, under which conditions are they most and least effective? To answer this question, Kinney et al. use a hypothesis of fit approach; additional research testing the specific ways in which religiosity and spirituality affect psychological outcomes will benefit from this approach. When viewed as a

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personal disposition, religiosity and spirituality ought to be directly related to attitudes, behaviors, and emotional well-being. Relatively few hypotheses have been tested that link these constructs to overt behavior. Although Bonner et al. begin to examine these issues, behavior-based and ecologically-valid work is necessary. What do we mean by the terms “religion” and “spirituality?”How can we reach a consensus on the meaning of these two very similar, but emotionally charged terms to advance our scientific pursuits? SHM: Can we expect to achieve consensus on the meanings of religion and spirituality? And what would consensus mean? Is it reasonable to assume that eventually researchers will devise definitions that can be applied universally across time and culture? Current scholarship leans toward saying this will not be achieved. Nevertheless, it remains important for both researchers and practitioners to consider carefully the meanings they attach to the words they use. Progress in understanding these phenomena is restricted when researchers employ varying definitions and measures, for then their observations cannot be easily compared. Definitions do matter because they influence the ways we measure and interpret human behavior. In addition to the debate over definitions themselves, we need also to examine the social and psychological forces that lead us to select the definitions we employ in our work. This has obvious implications for persons who develop and use various measuring instruments both in research and practice. For example, a chaplain in a long term care

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facility may be charged with conducting “spiritual assessments” to be included in residents’ records. But how can the chaplain know that her definition and understanding of spirituality matches that of the older person? Too often, in both research and practice, we impose our own definitions upon older adults whose education, life experience, and culture may have shaped very different understandings of these terms. We have become more sensitive to these concerns in recent years and this collection of papers demonstrates both the importance of the endeavor to find common ground and also the difficulties we face. MB: Religiousness and spirituality share obvious connections, but there is little consensus regarding their inter-relationships. Some feel that religiousness and spirituality are distinct. Thus, religiousness is defined as adherence to a set of ideological beliefs, ritual, and practices associated with a particular creed or denomination, and spirituality is seen as a personal sense of transcendence over one’s immediate circumstances, with feelings of inner-connectedness and purpose and meaning in life. But others posit that spirituality and religiousness are different aspects of the same construct, for example, defining spirituality as the search for the sacred, which comprises the central function of religion (Pargament, 1997). Although in a perfect world, science strives to be both objective and value-free, this is rarely the case, particularly when it comes to the science of religion, spirituality and aging. The current conceptual

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“fuzziness” surrounding religion and spirituality likely stems from the inability of most people involved in this research to be totally objective and to separate personal values from their scientific work. In other words, the myriad ways in which religion and spirituality are defined and operationalized in the sciences is a reflection of the various stances of belief (and nonbelief) we take toward these concepts in our everyday lives. For some, spirituality is inherently bound up in religious belief. Others, taking a more positivistic and “objectively” scientific view may be distrustful of the “superstitious” nature of religion, but be comfortable with a nondenominational spirituality that addresses humanistic and secular values. Both of these perspectives, though, represent only limited aspects of spirituality and religion. This is illustrated in the variety of ways these constructs are operationalized: i.e., religious orientation; spiritual well-being; spiritual self-efficacy; means, ends and quest religious motivation, formal and informal religious participation; and qualitative assessments, etc. But the question remains: How do we come to a consensus in the usage and measurement of the constructs of spirituality and religiousness? A major goal of this compilation is to start to come to such a consensus. To do this, we need to engage in a dialogue about what we mean by these terms and try to reach a common ground that is respectful of all the various traditions from which we come. At the same time, we must maintain conceptual clarity and measurement precision which are the hallmarks of science done well. Scientists working in the field need to also examine their own belief systems, whether staunchly religious or not,

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to determine how personal viewpoints may bias their work in this area. JHP: Despite the scientific call for consensus on operational definitions, the area of religiosity and spirituality may actually benefit from the fuzziness in definitions. Flavell, Miller, and Miller (2002) suggest that “the really interesting concepts of this world have the nasty habit of avoiding our most determined attempts to pin them down …” (p. 1). We must be careful, however, that our scientific thirst for consensus does not hinder our systematic investigation of religiosity and spirituality. Researchers should be cautious not to push for consensus simply for the sake of our comfort. The constructs of religiosity and spirituality are complex, and interesting. Arriving at consensus too early in the research enterprise may result in the lines of inquiry being changed in both subtle and obvious ways, suppressing further exploration of the meaning of these constructs. How do older adults incorporate issues of religion and spirituality into their lived experiences? What are the implications of this question and the answers we might provide? SHM: A number of the papers in this collection examine the ways older persons integrate their religiousness and spiritual awareness into their everyday experience. Two papers specifically address the devastation of loss of loved ones to death. Others observe elders coming to terms with failing health, caring for spouses with dementia, and other challenges to well-being in later life.

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This is a good beginning but more work on this question is needed. As many of these papers show, much of the research on this topic has focused on physical and mental wellbeing. Sometimes there is a practical reason for this in that people offering spiritual services to older people need to respond to administrators who demand “objective” data on the effects of these services. However, more scholarship and research is needed if we are to truly understand the ways religious beliefs affect human activities like decision-making, social behavior, and emotion regulation. We are only now beginning to inquire about how a spiritual sense of transcendent meaning and connectedness with the holy transforms attitudes about everyday joys and frustrations. Recognition of the importance of social support has contributed to research on religion and well-being but we still have much to learn about how a feeling of “belongingness” (Baumeister & Leary, 1995) within a faith community shapes an older person’s life story and anticipation of the future. Studies like that of Bonner et al. in this collection examining “prosocial behavior” and religiousness represent an important research direction but much remains to be learned about how religious beliefs translate into significant human phenomena like generativity, forgiveness, gratitude, humility and hospitality. This is a topic of enduring interest to psychologists of religion who typically have not focused their research spotlights on the end of the life cycle. Their work on religiosity and altruism, prejudice, and authoritarianism needs now to be examined within a life span developmental perspective

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and the domain of behaviors studied needs to be expanded. MB: In the sciences, reification occurs when we begin to regard the abstract and conceptual as something “real” and tangible. In the scientific study of religion, spirituality, and aging we face the opposite problem–rarefaction. In our efforts to define, operationalize, measure and analyze spirituality and religion, we face the danger of taking something very vital and dynamic in the lives of older people, and draining the very life from it in our efforts to maintain scientific objectivity and precision. It is important for our scientific endeavors, for example, to reach some kind of conceptual clarity regarding definitions of religiousness, spirituality and their associated beliefs. However, this should be balanced by approaches that allow the personal meaning of religion and spirituality to surface. Such an approach is illustrated by Blieszner and Ramsey’s qualitative methodology that permits new ideas and questions to emerge in the context of well-defined goals in understanding the role of these forces in older people’s lives. We can also learn much about the perspective of older adults regarding spirituality and religion by following the recommendations of Chatters and Taylor by paying greater attention to the contextual elements that embed these various belief systems. JHP: This idiographic approach to understanding religiosity and spirituality can be observed in Blieszner and Ramsey’s qualitative work. Indeed, focusing on how lay persons view the constructs of religiosity and

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spirituality may significantly enrich our understanding and hence, strengthen our scientific investigations. Adopting an expertise or wisdom framework to study spirituality and religiosity may be one particularly helpful approach. Similar to Smith and Baltes’ (1990) work on wisdom, quantitative studies could examine differences in the way spiritually-expert adults approach and solve social dilemmas. Additional studies examining the ideas of self-transcendence (Csikszentmihalyi & Rathunde, 1990) as a developmental task may also further our understanding of religiosity, spirituality, and aging. A Final Word to Our Readers As you can tell from the “conversation” above, the ideas set forth in this collection are neither fixed nor immutable. Each of the editors has a particular perspective on theories, definitions, and applications that arise in the study of late life religiousness and spirituality. Nevertheless, it is also clear that our ideas converge in several respects. The experience of aging is changing rapidly in our times as a new cohort moves into later life. New technologies that support longer, healthier lives are intersecting with new attitudes about possibilities for late life meaning and purpose. All of this will have a shaping influence on aging people’s engagement with faith communities and their own spiritual development. Researchers and practitioners need to continue to be in conversation about their quest for deeper understanding and appreciation of the ways that aging motivates people to seek significance that transcends the exigencies of material existence.

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References Baumeister, R.F., & Leary, M.R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 777, 497–529. Bengston, V.L., Rice, C.J., & Johnson, M.L. (1999). Are theories of aging important? Models and explanations in gerontology at the turn of the century. In V.L. Bengston & K.W. Schaie (Eds.), Handbook of theories of aging (pp. 3–20). New York: Springer. Csikszentmihalyi, M. & Rathunde, K. (1990). The psychology of wisdom: An evolutionary interpretation. In R. J. Sternberg (ed.), Wisdom: Its nature, origins, and development (pp. 25–51). Cambridge: Cambridge University Press. Ferraro, K.F., & Koch, J.R. (1994). Religion and health among black and white adults: Examining social support and consolation. Journal for the Scientific Study of Religion, 33, 362–380. Flavell, J.H., Miller, P.H., & Miller, S.A. (2002). Cognitive Development, 4th ed. Upper Saddle River, NJ: Prentice-Hall. Pargament, K.I. (1997). The psychology of religion and coping: Theoty, research, practice. New York: Guilford. Smith, J. & Baltes, P.B. (1990). Wisdom-related knowledge: Age/cohort differences in response to life planning problems. Developmental Psychology, 26, 494–505.

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Weiland, S. (1995). Interpretive social science and spirituality. In M.A. Kimble, S.H. McFadden, J.W. Ellor, & J.J. Seeber (Eds.), Aging, spirituality, and religion: A handbook (pp. 589–611). Minneapolis: Fortress. Susan H. McFadden is affiliated with the Department of Psychology, University of Wisconsin-Oshkosh. Mark Brennan is affiliated with Arlene R. Gordon Research Institute, Lighthouse International. Julie Hicks Patrick is affiliated with the Department of Psychology, West Virginia University. Address correspondence to: Susan H. McFadden, Department of Psychology, University of Wisconsin-Oshkosh, 800 Algoma Boulevard, Oshkosh, WI54901 (E-mail: [email protected]). [Haworth co-indexing entry note]: “Afterword: A ‘Conversation’ About Theories, Definitions, and Applications.” McFadden, Susan H., Mark Brennan, and Julie Hicks Patrick. Co-published simultaneously in Journal of Religious Gerontology (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 14, No. 2/3, 2003, pp. 225–232; and: New Directions in the Study of Late Life Religiousness and Spirituality (ed: Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2003, pp. 225–232. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. – 5:00 p.m. (EST). E-mail address: [email protected]].

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395

Index Action(s), belief to, 193-194 Adversity, religiousness as buffer against, 109 Affect, positive, 161 African American elders, interpretation of religion and spirituality by, 85-99 study of discussion of, 96-97 implications of, 97 limitations of, 96-97 method of, 88-90 participants in, 88-89 procedures in, 89-90 results of, 90-96, 91t, 94t African Methodist Episcopal (AME), 89 Afterlife beliefs, 207-224 Age as factor in afterlife beliefs, 216-217, 216t as factor in religiosity, 215-216, 216t, 217t Aging, successful challenges to programmes for, 61-63 research on, implications for, 45 396

Allport and Ross Extrinsic scale, 125 Altstaedten, M., 122 AME. See African Methodist Episcopal (AME) American Jewish community, 77 American Jews, elderly, 77 AMOS program, 14, 162-163 Analysis of variance (ANOVA), 13 ANOVA. See Analysis of variance (ANOVA) Application(s), “conversation” about, 225-232 Assumption of multivariate normality, 23-24 Barnett, E., 155 Batson, Schoenrade and Ventis Internal and External scales, 125-126 Batson, C.D., 122, 123, 126, 127, 193 Baumert, J., 22 Behavior(s), prosocial, religiosity and spirituality effects on, 189-205. See also Prosocial behaviors, religiosity and spirituality effects on Belenky, M.F., 133 Belief(s) to actions, 193-194

397

afterlife, adjustment in adulthood, 207-224. See also Afterlife beliefs, adjustment in adulthood religious, 90-91, 91t spirituality as, 94t, 95 BEQ-Revised. See Questionnaire-Revised

Bereavement

Experience

Bereavement adjustment in adulthood, 207-224 study of analysis of, 215 design of, 215 discussion of, 219-221 results of, 215-219, 216t, 217t cause of death and, 217-218 process of, counseling during, 221-222 quest religiosity and, 124-125 Bereavement Experience (BEQ-Revised), 214 Berger, P., 88 Bickel, C.O., 175 Billiet, J., 193-194, 201 Birren, J., 225

398

Questionnaire-Revised

Black Migrations, 143 Blatt, S.J., 107 Blieszner, R., 4, 31, 122 Bonner, K., 8, 189 Braam, A.W., 156, 167 Bradburn Affect Balance Scale, 214 Brennan, M., 1, 3, 11, 225, 226-227, 228-229, 231 Brenner, Y.H., 73-74 Brokaw, T., 133 Bronfenbrenner, U., 142 Brown, S.L., 184 Bryk, A.S., 19 Buddhists, 89 Burris, C.T., 122, 124, 126 California Psychological Inventory (CPI), 108 Calvinists, 156 Cantor, N., 108 CAQ Generativity Scale, 108 Caregiver(s), to spouse with dementia, religious coping by, 171, 174-188. See also Dementia, caregivers to spouses with, religious coping by Caregiving Hassles Scale (CHS), 177

399

Carroll, M.M., 88, 93-94 Catholic(s), 89 Catholic Church, 78 Catholic Workers movement, 77 Catholicism, 74, 80, 82 Cavanaugh, J.C., 8, 171 Center for Epidemiologic Studies of Depression Index (CES-D), 155, 160-161, 160t, 162t, 179, 196 CES-D. See Center for Epidemiologic Studies of Depression Index (CES-D) CFI. See Comparative Fit Index (CFI) Chatters, L.M., 5, 6, 8, 139, 140, 231 Choice, spirituality as, 94t, 95-96 Christian(s), 157 Christian church, 77 Christianity, 87 CHS. See Caregiving Hassles Scale (CHS) Church of Scotland denomination, 59 Clarke, S.M., 8-9, 207 Clausen, J., 105 Clinchy, B.M., 133 Cohen, J., 161

400

Cohen, P., 161 Collaborative coping, 174, 175 Communist Jewish youth, 75 Communist Party, 76 Community, American Jewish, 77 Comparative Fit Index (CFI), 163 “Confidence with spiritual issues in health and social care,” 54-55 Confirmatory Fit Index (CFI), 16 Coping collaborative, 174, 175 emotion-focused, 173, 174 general, 178 by caregivers to spouses with dementia, 171, 172-173. See also Dementia, caregivers to spouses with, religious coping by problem-focused, 173, 174 religious, by caregivers to spouses with dementia, 171, 174-188 self-directing, 174, 175 Coping Inventory, 214 Council of Jewish Federations, 77 Counseling, for bereaved persons, 221-222

401

Covariance structure modeling, 14-19, 15f. See also Structural equation modeling (SEM) CPI. See California Psychological Inventory (CPI) CPI’s Self-Realization scale, 108 CR. See Critical ratio (CR) Critical ratio (CR), 163 Cromwell, R.E., 195 Cruzen, D., 186 Cumming, E., 62 Czar, G.C., 194 Darley, J., 193 Death, cause of bereavement and, 217-219 religiosity and, 217-219 Deferring, 174, 175 DeLongis, A., 172-173 Dementia, caregivers to spouses with general coping by, 172-173 religious coping by, 171, 174-188 future research related to, 185-186 study of, 176-185, 181t-183t 402

dependent variable measures in, 179 discussion of, 181, 183-185 independent variable measures in, 177-179 limitations of, 185 method of, 176-179 participants in, 176-177 results of, 180-181, 181t-183t Depressive symptoms religiosity and spirituality effects on, 189-205 study of, 194-203, 198t-200t discussion of, 200-203 measures in, 195-196 methods of, 194-197 participants in, 195 preliminary analyses of, 197-198, 198f procedures in, 194-195 recruitment in, 194-195 regression analyses of, 198-200, 199t, 200t results of, 197-200, 198t-200t Developmental life stages, challenges to programmes for, 61-63 Dillon, M., 105

403

Disengagement, successful, challenges to programmes for, 61-63 Durkheim, 33, 72, 81 Edmondson, R., 8-9, 207 Eisinga, R., 193-194, 201 Elderly Jewish, 77-78 religiousness in, 69-83. See also Religiousness, in the elderly Spirited Scotland’s challenges to programmes for, 61-63 Ellison, C.G., 140, 141, 154-155, 167 EM algorithm. See Expectation-maximization algorithm, 22-23 Emotional well-being, religious beliefs effects on, 153-170 described, 156-158 study of, 157-167, 159f, 160t, 162t, 163t, 165t analytical strategy in, 160t, 161 described, 157-158, 159f discussion of, 164-167 exploratory analyses of, 164 mean age differences in, 162, 163t 404

measures in, 159-161 method of, 158-161, 159f, 160t participants in, 159, 160t preliminary analyses of, 161, 162t procedure in, 158 relations among variables in, 162-164, 165t results of, 161-164, 162t, 163t Emotion-focused coping, 173, 174 Episcopal Mission, 113 Erikson, E.H., 63, 108 European American elders interpretation of religion and spirituality by, 85-99 study of discussion of, 96-97 implications of, 97 limitations of, 96-97 method of, 88-90 participants in, 88-89 procedures in, 89-90 results of, 90-96, 91t, 94t self-descriptors in, 90, 91t

405

study of, self-descriptors in, 90, 91t Expectation-maximization (EM) algorithm, 22-23 Falwell, J., 77 Feminist qualitative methods, 31-49. See also Spiritual resiliency, revealing of, feminist qualitative methods in Feminist theories, 35 Ferraro, K.F., 125, 227 Fetzer Institute/NIA, 140, 150 Fetzer Multidimensional Measure, 193, 195-196 Flaherty, R.W., 124 Flavell, J.H., 229-230 Folkman, S., 8, 172-173, 185 Fowler, R., 112 Frankl, V., 43, 64 Frantz, T.T., 122 Freud, S., 72, 81 Friedel, L.A., 175 Fromm, E., 64, 103, 104, 114 Galbraith, M.E., 186 Geertz, C., 43 Generalized Least Squares (GLSs), 16 George, L.K., 191

406

Gerontological Society of America (GSA), 1 GFI. See Goodness of Fit Index (GFI) Gilligan, C., 42 Glaser, B.G., 90 Glicksman, A., 4, 69 GLSs. See Generalized Least Squares (GLSs) Goldberger, N.R., 133 Goodness of Fit Index (GFI), 16 Gorsuch, R.L., 175 Gould, S.J., 79 Growth curves, latent SEM with, 14-19, 15f Gruen, R.J., 172-173 GSA. See Gerontological Society of America (GSA) Guarino, A.B., 6, 119 Guarnaccia, C.A., 9, 207 Haley, W.E., 184 Harlow, R., 108 Harrington, M., 77 Havighurst, R.J., 109 Hayslip, B., Jr., 8-9, 207, 214 HBCUs. See Historically Universities (HBCUs)

407

Black

Colleges

and

Health Boards, 65 Health care, spiritual issues in, 51-68. See also Spirited Scotland; Spiritual issues, in health and social care Health Care Trusts, 63, 65 Heenan, E.F., 154 Henry, W.E., 62 Historically Black Colleges and Universities (HBCUs), 143 HLM, 19 Hoelter’s Critical N, 163, 164 Hopkins Symptom Checklist, 214 Hypothesis of fit, religious coping and, 175 Identity, widowhood effects on, 121-125 IGC model, 13 IHD. See Institute of Human Development (IHD) Indian Ashram, 113 Individual growth curve (IGC) model, 13 Individual growth curve (IGC) modeling, 19-22 hypothetical example of, 20-22, 21f Inner process, in religion, 91-92, 91t Institute of Human Development (IHD) longitudinal study of men and women, 101-117 dwelling and seeking in individual lives, 110-114 408

influence on psychosocial adulthood, 107-109

functioning

in

late

measures of religiousness and spirituality in, 105-106 quantitative findings in, 106-109 religiousness as buffer against adversity, 109 results of, 106-114 Ishler, K.J., 8, 171 Jackson, L.M., 124 Jew(s), American, elderly, 77-78 Johll, M.P., 122 Judaism, 74, 82, 87 Jung, C., 114 Jungian psychology, 113 Kaiser, D.L., 175 Kelley-Moore, J.A., 125 Kenney, B.P., 195 Kinney, J.M., 8, 153, 171, 184 Koch, J.R., 227 Koenig, H.G., 89, 191, 202 Komsomol, 76 Koven, L.P., 8, 189 Krause, N., 156-157, 167, 192

409

Labouvie-Vief, G., 2 Lazarus, R.S., 8, 172-173, 174, 175 Levin, J.S., 12, 26, 140, 141, 154-155, 167, 192 Levine, E.G., 184 Life Satisfaction Index (LSI), 89, 109 Lincoln, C.E., 143, 144 Lincoln, K.D., 140 LISREL, 14 Listening, as central research activity, 45-46 Little, T.D., 22 Lopata, H.Z., 120 Loyola Generativity Scale, 108 LSI. See Life Satisfaction Index (LSI) MacKinlay, E., 64 Mamiya, L., 143, 144 Marx, K., 72 Maton, K.I., 208 Maximum-likelihood estimates (MLEs), 163 Maximum-likelihood (ML) estimation algorithms, 23-24 Maximum-likelihood (ML) method, 16, 19-20 McCracken, G., 38 McFadden, S.H., 1, 122, 225, 226, 228, 230 410

Menard, S., 25 Meyers, L.S., 194 Miller, P.H., 229-230 Miller, S.A., 229-230 Miller, T.C., 87 ML. See Maximum-Likelihood (ML) ML estimation algorithms, 23-24 MLEs. See Maximum-likelihood estimates (MLEs) Moberg, D., 61 Moral code, in religion, 91t, 92 Mormon Church, 110, 111 Mowat, H., 4, 51, 56 Mroczek, D.K., 3, 11 “Multidimensional Measurement of Religiousness/ Spirituality for Use in Health Research,” 70, 150 Muntaner, C., 155 National Health Service (NHS), 55, 56, 58, 59, 65 National Survey of Black Americans, 143-144, 192 Nazis, 75 Nelson-Becker, H.B., 5, 85 Neugarten, B.L., 109, 226 NHS. See National Health Service (NHS)

411

NHS Trusts, 65 Noone, M.E., 6, 119 OLSs method, 19 Ordinary least squares (OLSs) method. 19 Organizational religiosity, 160, 160t Pargament, K.I., 8, 88, 171, 174, 175, 183 Park, J.H., 194 Patrick, A., 104 Patrick, J.H., 1, 8, 153, 189, 225, 227-228, 229-230, 231 Payne, B.P., 122, 154 Personal deity, spirituality as relationship with, 94-95, 94t Peterson, B.L., 191 Philadelphia Geriatric Center (PGC) Morale Scale, 191 Philadelphia Geriatric Center (PGC) Positive and Negative Affect Scale, 161 Polling, J.N., 87 Positive affect, 161 Presbyterian(s), 75, 77 Presbyterianism, 71 Private religiosity, 195 Problem-focused coping, 173, 174

412

Prosocial behaviors, religiosity and spirituality effects on, 189-205 study of, 194-203, 198t-200t analytic approach to, 196-197 discussion of, 200-203 measures in, 195-196 methods of, 194-197 participants in, 195 preliminary analyses of, 197-198, 198f procedures in, 194-195 recruitment in, 194-195 regression analyses of, 198-200, 199t, 200t results of, 197-200, 198t-200t Protestant churches, 113 Quest religiosity, 123-124 and bereavement, 124-125 Quest Scale, 126, 129 Ramsey, J.L., 4, 31, 122 Ranger, L.M., 210 Raudenbush, S.W., 19 Ray, R., 3 Reformed Judaism, 71

413

Reformed Christians, 73 Religion belief in, 90-91, 91t causal models and pathways in, 148-149 defined, 5-7, 71-76, 87-88, 90-93, 91t inner processes in, 91-92, 91t interpretation of, by African American and European American elders, 85-99. See also African American elders, interpretation of religion and spirituality by; European American elders negative influences of, 91t, 92-93 psychosocial mechanisms in, 147-148 responsible action and moral code in, 91t, 92 science and, 78-80 self-descriptors about, 90, 91t social context in, 139-152 social location and, 146 world views of, 142-145 Religion and Problem-Solving Scales (RPS), 178-179 Religiosity adjustment in adulthood, 207-224 study of, 211-221 analysis of, 215 414

design of, 215 discussion of, 219-221 implications for counseling in, 221-222 measures in, 212, 214-215 method of, 211-215, 213t participants in, 211-212, 213t procedures in, 212 purpose of, 211 results of, 215-219, 216t, 217t age as factor in, 215-216, 216t, 217t cause of death and, 217-219 defined, 208 described, 191-192 effects on depressive symptoms and prosocial behaviors, 189-205. See also Depressive symptoms, religiosity and spirituality effects on; Prosocial behaviors measurement of, 208 organizational, 160, 160t private, 195 quest and bereavement, 124-125 in widows’ search for meaning, 123-124

415

separating constructs of, 192-193 well-being and, 155-156 Religious beliefs, emotional well-being effects on, 153-170. See also Emotional well-being, religious beliefs effects on Religious coping, 178-179 by caregivers to spouses with dementia, 171, 174-188. See also Dementia, caregivers to spouses with, religious coping by and hypothesis of fit, 175 Religious dwelling development over life course, 106-107 psychosocial implications of, 101-117 sample of, 105 religiousness in, measures of, 105-106 Religious life, fruits of, 7-9 Religiousness as buffer against adversity, 109 defined, 5-7, 105-106, 225-232 development over life course, 106-107 in the elderly, 69-83 American context of, 76-78

416

influence on psychosocial adulthood, 107-109

functioning

in

late

late life, 21st century studies of, 1-10 measures of, 105-106 study of, epistemological stirrings in, 3-5 Responsible action, in religion, 91t, 92 Rider, J., 214 RMSEA. See Root Mean Square Error Approximation (RMSEA) Robinson, P., 77 Rogosa, D.R., 19 Roman Catholics, 156 Roof, W.C., 103, 104, 105-106, 114 Root Mean Square Error Approximation (RMSEA), 163 RPS. See Religion and Problem-Solving Scales (RPS) Ryan, D., 4, 51, 56, 57, 58, 59 Saner, H., 19 Schaefer, C.A., 175 Schnabel, K.U., 22 Schoenrade, P.A., 127 Schwabkovsky, L., 186 Science, religiousness and, 78-80

417

“Science as a Vocation,” 78 Scottish Executive-Funded Action Research Project, 55-56 Scottish Parliament, 52 Second Vatican Council, 78 Self-directing coping, 174, 175 SEM. See Structural equation modeling (SEM) SEM-LGC model, 13 Serenity Prayer, 173 Shamanic journeys, 113 Shichman, S., 107 Smith, G.J., 62, 124 Smith, P.C., 210 Sobelew-Shubin, A., 186 Social care, spiritual issues in, 51-68. See also Spirited Scotland; Spiritual issues, in health and social care Social-Democratic youth, 75 “Socialism, My Temple,” 73-74 Spirited Scotland, 51-68 challenges to healthcare policy arising from, 60-61 challenges to programmes for older people from, 61-63 conferences related to, 57-58 418

courses for practitioners, 54-55 described, 54-59 healthcare chaplaincy of, 59 historical background of, 52-54 networks associated with, 58-59 newsletter of, 58-59 policy issues related to, 63-64 research related to, 56-57 Scottish Executive-Funded Action Research Project, 55-56 Spiritual experiences, of recent widows, 119-138. See also Widow(s), recent, spiritual experiences of Spiritual issues courses for practitioners, 54-55 in health and social care, 51-68 historical background of, 52-54 Spiritual resiliency, revealing of conceptual frameworks in, 34-36 cross-cultural perspective in, 35 denominational specificity in, 36 design implications in, 35-36 feminist qualitative methods in, 31-49 419

future research related to, 44-45 study of, 36-39 affect from, 40-42 community effects from, 39-40 complexity of results of, 47 contributions of, 45-47 data analysis in, 38-39 denominational specificity of, 46 discussion of, 39-44 exploratory status of current findings from, 44 findings of, 39-44 implications of, 39-44 listening in, 45-46 participants in, 36-37 procedures in, 37-38 questions of meaning from, 43-44 relationships effects from, 42-43 triangulation of methods in, 46-47 symbolic interactionism in, 34-35 Spiritual seeking psychosocial implications of, 101-117 sample of, 105 420

religiousness in, measures of, 105-106 Spirituality adjustment in adulthood, study of, 211-221 measures in, 212, 214-215 method of, 211-215, 213t participants in, 211-212, 213t procedures in, 212 purpose of, 211 as belief, 94t, 95 as choice, 94t, 95-96 defined, 5-7, 87-88, 93-96, 94t, 103, 106, 208 development over life course, 106-107 effects on depressive symptoms and prosocial behaviors, 189-205. See also Depressive symptoms, religiosity and spirituality effects on; Prosocial behaviors influence on psychosocial adulthood, 107-109

functioning

in

late

interpretation of, by African American and European American elders, 85-99. See also African American elders, interpretation of religion and spirituality by; European American elders late life, 21st century studies of, 1-10 measurement of, 208

421

measures of, 105-106 as relationship with nature and other people, 94t, 95 as relationship with personal deity, 94-95, 94t research on, 11-29 self-descriptors about, 90, 91t subjective, 195-196 Spirituality in Health and Social Care Newsletter, 59 “Spirituality in Health and Social Care Project,” 56 Stephens, K., 122 Stephens, M.A.P., 184 Strauss, A.L., 90 Stress Questionnaire, 178 Structural equation modeling (SEM), 12 with latent growth curves, 14-19, 15f analysis of, 15f, 17-18 limitations of, 18-19 overview of, 14-17, 15f Structural equation modeling (SEM)-latent growth curve (SEM-LGC) analysis, 15f, 17-18 limitations of, 18-19 Structural equation modeling (SEM)-latent growth curve analysis (SEM-LGC), 13

422

Subjective spirituality, 195-196 Symbolic interactionism, 34-35 Tarpley, W.R., 124 Tarule, J.M., 133 Taylor, R.J., 5, 6, 8, 139, 140, 231 Texas Revised Inventory of Grief (TRIG), 212-23 “The greatest generation,” 133 Theories, “conversation” about, 225-232 Thoits, P.A., 174 Thomas, N., 77 Thompson, E.H., Jr., 6, 119 Thompson, S.C., 186 TLI. See Tucker-Lewis Index (TLI) Tobin, S., 109 TRIG. See Texas Revised Inventory of Grief (TRIG) Trolley, B.C., 122 Tucker-Lewis Index (TLI), 163 Ulmer, A., 210 ULSs. See Unweighted Least Squares (ULSs) Unitarian church, 113 United Jewish Communities, 77 University of Dundee, 54 423

Unweighted Least Squares (ULSs), 16 Van Tran, T., 156, 192 Vaughan, C.E., 195 Vitaliano, P.P., 174 Weber, M., 4, 71-72, 73, 78, 81-82 Weiland, S., 226 Well-being emotional, religious beliefs effects on, 153-170. See also Emotional well-being, religious beliefs effects on religiosity and, 155-156 Whitboume, S.K., 124 Widow(s) recent, spiritual experiences of, 119-138 discussion of, 133-135 studies of, 125-133, 126f, 128t search for meaning by, quest religiosity in, 123-124 Widowhood described, 121-125 identity shift in, 121-125 Wilson, G., 61 Wink, P., 5-6, 101, 105 Wood, J.T., 42 424

Wuthnow, R., 103, 104, 105-106, 114 Zendo, 113 Zinnbauer, G.J., 87, 98, 104 Zionist-Socialist youth, 75

425