Religion and Psychology [1 ed.] 9781608766895, 9781607410669

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Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

RELIGION AND PSYCHOLOGY

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RELIGION AND PSYCHOLOGY

MICHAEL T. EVANS AND

EMMA D. WALKER

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

EDITORS

Nova Science Publishers, Inc. New York

Copyright © 2009 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works.

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Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Religion and psychology / [edited by] Michael T. Evans and Emma D. Walker. p. cm. Includes index. ISBN:  (eBook)

1. Religion and science. 2. Psychology, Religious. I. Evans, Michael T. II. Walker, Emma D. BL53.R4353 2009 201'.615--dc22 2009009168

Published by Nova Science Publishers, Inc.    New York

CONTENTS

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Preface

vii

Chapter 1

Critical Methodology in the History of Psychology and Religion Robert Kugelmann

1

Chapter 2

Holistic Healing in Religion, Medicine and Psychology Søren Ventegodt, Niels Jørgen Andersen Isack Kandel and Joav Merrick

7

Chapter 3

Being in the World of Peacekeeping: Living the Unpresentable Susan L. Ray

17

Chapter 4

The Spiritual Dimensions of Trauma Healing Abdul Basit and John Tuskan

63

Chapter 5

Is There a Place for Spirituality in the Care of Elderly Patients? Stéfanie Monod, Etienne Rochat, Theologian and Christophe Büla

77

Chapter 6

Unforgiveness and Lifetime Prevalence of Psychopathology: Findings from an Epidemiological Study of United States Adults Loren Toussaint and Alyssa C.D. Cheadle

Chapter 7

Chapter 8

Chapter 9

Unforgiveness and the Broken Heart: Unforgiving Tendencies, Problems Due to Unforgiveness, and 12-Month Prevalence of Cardiovascular Health Conditions Loren Toussaint and Alyssa C.D. Cheadle Discovering a Stronger Sense of Self: The Influence of Religion and Spirituality on Emotional Well-Being of Infertile Women Robab Latifnejad Roudsari, Helen T. Allan and Pam A. Smith Navigating the Spiritual Journey of Infertility: Muslim and Christian Infertile Women’s Experiences Robab Latifnejad Roudsari, Helen T. Allan and Pam A. Smith

97

135

171

207

vi

Contents

Chapter 10

Discourse on Volunteering: The Benefits and Barriers Karen S. Dunn

Chapter 11

Representations of God Uncovered in a Spirituality Group of Borderline Inpatients Geoff Goodman

255

Two Studies Test the Effects of Religious Hallucinations on Perceptions of Insanity Monica K. Miller and Sabrina Dolson

267

Adaptive and Maladaptive Associations of Varieties of Religiousness and Belief Gerard Saucier

281

Chapter 12

Chapter 13

243

Short Commentary 1

What the Spiritual and Religious Traditions Offer Psychologists Thomas G. Plante

2

Resident Physicians’ Thoughts Regarding Compassion and Spirituality in the Doctor-Patient Relationship: A Brief Report Gowri Anandarajah and Marcia Smith

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Index

299

307 317

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PREFACE There has been a remarkable amount of popular and professional interest in the relationship between spirituality, religion, psychology, and health in recent years. This book begins with the importance of a critical methodology when studying the relationship between religion and psychology. Among the many topics presented is a study on the experience of contemporary peacekeepers faced with existential questions about life, death, being and the searching for meaning. Other chapters explore the relationship of holistic healing and personal development, recovery from trauma and spirituality, spirituality and a woman’s ability to deal with infertility, and the relationship between a person’s health and the ability to forgive. Chapter 1 - The study of the relationships between psychology and religion demands a critical methodology. The fundamental reason for a critical methodology lies in the need to avoid “essentialist” views of both psychology and religion. Essentialism, as the term is used, refers to the belief in a fixed essence or nature of something. So essentialism here would mean that the position is taken that there is one thing called “psychology” and another thing called “religion,” and that relationships between them can be examined. But neither psychology nor religion is such a fixed entity. What we psychology is the outgrowth of various scientific, social, and cultural developments over the past century and a half. While one can speak of something like a “cosmopolitan psychology” that is shared by people calling themselves psychologists in many lands, psychology is not a unified discipline. In its origins, it is multiple, often having distinct traditions of theory and praxis in various locales. In its current existence, it is a discipline lacking unity, lacking a “paradigm,” and maybe even a type of discipline that will not ever have a common paradigm, psychology not being like physics as a type of science. The author makes this claim in part by including not only diverse approaches in psychology, such as Lacanian psychoanalysis, transpersonal psychology, and cognitive psychology, but also by including the plethora of “pop” psychologies which, while not having a dignified place in academia, do constitute what many outside the ivory tower consider psychology, and often stake their lives upon it. Chapter 2 - The abstract aim of the human endeavors in the field of religion, medicine and psychology is basically the same: healing of human existence. Most interestingly, the process of holistic healing seems to be the same in all cultures, at all times and in all human endeavors. The authors try in this chapter to document the common nature of holistic healing and to describe how healing is related to personal development, especially development of the human consciousness enabling it to embrace and comprehend both the depth of self and the

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Michael T. Evans and Emma D. Walker

depth of the surrounding world. The authors argue that only by deepening the worldview, i.e., making our personal cosmology more complex, will we be able to reach the threshold for holistic healing. When we heal, not only are our spirit and heart healed, but also our body and mind, explaining why holistic healing has been such an important concept in all the religious and medical system of the worlds premodern cultures. Holistic healing thus seems to be the core concept of Hippocratic Greek medicine, the origin of modern medicine. The authors compare this to modern holistic healing in the holistic medical clinic that uses the concept of applied salutogenesis to induce healing not only of existential and sexual disorders, but also of serious illness, such as cancer and schizophrenia. They argue that only if the patient is willing to abandon his simplistic worldview can he have the fruit of holistic, existential healing and salutogenesis. In this chapter the religious experience is defined as the personal meeting with the totality of the universe; this can be a meeting with the universe as a person, i.e., God, or it can be the meeting with the fundamental source, the emptiness, sunya(ta) that creates the world, or it can be a unification with the universal energy lowing though everybody and everything. The universal quality of holistic healing is the development of sense of coherence (salutogenesis). Chapter 3 - This research study was a philosophical interpretive inquiry into the experience of contemporary peacekeepers. What is the experience of contemporary peacekeeping and how does it lead to trauma? This study reflected a commitment to understanding the nature of contemporary peacekeeping deployments. An interpretative phenomenological approach was appropriated from various texts to uncover the experience of contemporary peacekeepers who had received treatment a minimum of two years for psychological trauma resulting from recent deployments. Data was collected via one tape recorded interview, lasting between 1½ to 3 hours, with ten contemporary peacekeepers who had been deployed to Somalia, Rwanda, or the former Yugoslavia. The participants included six soldiers, two chaplains, one medic and one female nurse. Narratives from the transcribed interviews were reviewed with four of the participants and reflective journaling by the researcher provided further clarification of the data to understand the experience. Data analysis was undertaken throughout the research study by utilizing a thematic analysis of text in which themes emerged to document and understand the experience of contemporary peacekeeping. This chapter endeavors to reveal the situatedness of contemporary peacekeeping and contemporary peacekeepers being in the world. The peacekeepers’ descriptions of the situatedness of their bodies in time, space and relation provided a fresh way into understanding the experience of contemporary peacekeeping. Glimpses of the life world described by the peacekeepers reveal some of the ineffable unpresentable experiences of peacekeeping that lead to trauma. Like Alice falling Down the Rabbit Hole, contemporary peacekeepers are separated from their families and thrown suddenly down the rabbit hole of peacekeeping. They are taken on a journey of the unknown, with limited preparation for what they would experience and where they would live. They, like Alice, have to adapt to rapidly changing rules and situations. For peacekeepers there are changes from the known to the unknown and back to the known. Like Alice, contemporary peacekeepers tried to make sense out of the senselessness of the situations that they encountered. As well, their return home was also quick with limited transition. Deployments required many transitions in terms of time, space and relations. The peacekeepers revealed that the military became their family, with the bonds of brotherhood tightening over time. The profound losses of brother soldiers such as by suicide and the callous response by the military left many with a sense of betrayal

Preface

ix

of what’s right by the military leaders who held their trust. Their sense of betrayal was further deepened when the Band of Brothers that was the Airborne Regiment who served in Somalia were disbanded by their military family and the government. The rules of engagement restricted them from responding to human suffering all around them. The sheer stamina and self discipline of standing aside, in the face of the brutalities and cruelties inflicted upon their fellow human beings, makes one wonder how this erodes at the peacekeepers. Being in the world of peacekeeping left many of the peacekeepers with existential questions about life, death, being and the searching for meaning.

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“The rabbit hole went straight on like a tunnel for some way, and then dipped suddenly down, so suddenly that Alice had not a moment to think about stopping herself before she found herself falling down what seemed to be a very deep well.” —Carroll, 1865/1992, p3

Chapter 4 - Despite the amazing progress in understanding and treatment of mental disorders, psychiatry was severely constrained by two self-imposed limitations: (1) it was dominated by intellectuals who considered faith and spirituality to be vestiges of a prescientific era and (2) the Cartesian mind-body split long taken for granted in western medicine, prevented us from focusing on the mind’s crucial role in pain, anxiety, and depression. But during the past three decades, a growing body of evidence has suggested that spiritual and religious involvement is positively correlated to physical and mental health, and that faith protects people from anxiety and depression, especially when related to tragedy and trauma. This chapter explains the spiritual dimensions of trauma healing and delineates how faith and trust in a Supreme Power provides a steady anchor that can cure a person’s insecurity by quieting distress and generating hope and positive expectancy. Chapter 5 - The relationship between spirituality and medicine is a field of growing interest. Spirituality is a much broader concept than religiosity, and includes notions as diverse as the purpose and meaning of one’s life, the feeling of internal peace and harmony. Over the last 15 years, a large number of studies coming from different fields of research (medicine, nursing, sociology, psychology, and theology) investigated the association between spirituality (including religiosity) and health. Among those, several longitudinal epidemiological studies focusing on religiosity in elderly persons found an association between religiosity and lower mortality, better functional as well as cognitive status. Other studies, mostly cross-sectional, also found significant associations between the broader concept of spirituality and mental, physical, as well as functional health status. These empirical evidences are however limited and the nature of the association between spirituality and health remains unclear. Nevertheless, these observations suggest that spirituality could be a factor that influences health at an individual level. Spirituality is often closely associated with patients’ decisions regarding medical or treatment choices, and, traditionally, it has been considered as positive resource for coping with illness, especially when suffering or dying. However, spirituality might also influence negatively health outcomes. For instance, spiritual distress and religious struggle have been associated with higher mortality rate, more severe depression, hopelessness and desire of hastened death. Spiritual distress and religious struggle might have a clinical impact and potentially worsen patients comfort and quality of life. Overall, these observations suggest that spirituality is an important dimension to consider in clinical care. These observations

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Michael T. Evans and Emma D. Walker

therefore support the growing interest toward improving spirituality assessment in elderly patients, even though it remains to be determined whether interventions to improve spiritual distress and religious struggle would be both feasible and effective. In addition, ethical issues remain about the appropriateness to inquire about this dimension in frail older persons. In particular, the potential to be too intrusive into patients’ privacy and the risk to harm through inappropriate interventions must be fully considered and prevented. At a minimum, introducing the spiritual dimension into usual geriatric care should be based on a structured approach that is fully integrated into a comprehensive multidimensional assessment. In conclusion, several observations suggest that spirituality is an important dimension to consider in elderly patients to enhance a patient-centered care. Whether interventions aiming at improvement of spiritual distress will significantly contribute to improve health outcomes must still be determined. Chapter 6 - Interest in religiousness and its association with mental health has a long history. Interestingly, a neglected topic within this area of interest has to do with connections between forgiveness, unforgiveness, and psychopathology. The present chapter examines unforgiving tendencies and problems due to unforgiveness as they relate to a broad spectrum of diagnosed psychopathologies. Data for this project come from the National Epidemiological Assessment of Alcohol and Related Conditions (NESARC). Participants in this study were a nationally representative sample of 43,093 United States adults. Participants completed measures of unforgiving tendencies, problems due to unforgiveness, sociodemographics, and the Alcohol Use Disorder and Associated Disabilities Interview ScheduleDSM-IV Version. Results showed that unforgiving motives and problems due to unforgiveness were associated with increased odds of experiencing psychopathology in one’s lifetime. Social interruptions and problems due to unforgiveness were more potent risk factors for psychopathology, as compared to other types of unforgiving characteristics. Further, anger mediated associations between unforgiveness and psychopathology. Implications of these findings for the growing literature on forgiveness, unforgiveness, and mental health are discussed. Chapter 7 - The purpose of the current study was to examine associations between unforgiving tendencies, problems due to unforgiveness, and 12-month prevalence of cardiovascular health conditions. It was expected that unforgiveness would increase the risk of 12-month prevalence of cardiovascular problems. Participants for this study were a nationally representative sample of 43,093 United States adults. In addition to a battery of other assessments, participants completed measures of unforgiveness, anger, depression, and cardiovascular problems. Logistic regression analyses showed that unforgiving tendencies and problems due to unforgiveness were associated with elevated risks of cardiovascular problems in the past year. Numerous mechanisms explaining this association are possible namely biological, psychological, social, and behavioral. These mechanisms are discussed as they pertain to the current findings, and the implications of the present chapter’s findings for the growing literature on unforgiveness, forgiveness, and health are discussed. Chapter 8 - Background and Aim: An increased interest towards the effects of religion and spirituality on physical as well as mental health is apparent in the psychological and medical literature. Nevertheless, there is a dearth of study on the link between religion/spirituality and psychological adjustment in infertile women. This study explored how infertile women using religious/ spiritual meaning-making framework endeavored to maintain their emotional strength in dealing with infertility distress.

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Preface

xi

Methods: In a feminist grounded theory study 30 infertile women affiliated to different denominations of Christianity (Protestantism, Catholicism, Orthodoxy) and Islam (Shi’a and Sunni) were interviewed. Volunteer participants were purposively recruited in one Iranian and two UK fertility clinics and the sample size was determined by theoretical sampling and data saturation. Data were collected through semi structured in-depth interviews and analyzed using Strauss and Corbin’s mode of grounded theory. Results: The emergent categories included religious/ spiritual reappraisal of the meaning and causation of infertility, demonstrating faith-based positive emotions and adopting religious/ spiritual coping strategies which were encompassed in the core category of relying on a higher being. Religious infertile women presented a positive and beneficent image of God and viewed infertility as a God-granted phenomenon, God’s plan, God’s gift and God’s test. As a consequence, they believed in the spiritual or spiritual-medical causation of infertility. They represented positive emotions like optimism, feeling of peace and selfconfidence which helped them to handle the emotional burden of infertility peacefully. They mainly adopted religious/ spiritual coping strategies, which arose from their religious teachings and divine outlook to life. These strategies consisted of a combination of positive and negative religious coping strategies, although positive strategies were used with more variety and frequency. In addition, they used some non-religious coping strategies as well to be able to maintain and promote their emotional competence and as a result cope with their stressful situation using multiple coping strategies. Conclusion: Religious participants held a particular worldview, giving sacred meaning to life and talking about an internal knowing, certainty and assurance that they would be blessed by God, either through being granted a child or in other ways. This worldview resulted in optimism and positive thinking which consequently helped them to get the psychological fitness that gave them a sense of empowerment as an integral part of their recovery, i.e., the process of adaptation, transformation and self-discovery including changes in attitudes and values towards infertility. Chapter 9 - Background and Objectives: Little attention has been given to the religious dimensions of the experience of infertility in the literature and there are innumerable inquiries awaiting research in this arena. This study examined how Muslim and Christian women experienced infertility in a religious and spiritual context and how their beliefs affected the attempts they made to deal with different aspects of infertility. Methods: In this study, which was underpinned by the theoretical framework of feminist grounded theory, 30 infertile women affiliated to different denominations of Christianity (Protestantism, Catholicism, Orthodoxy) and Islam (Shiite and Sunni) were interviewed. Volunteer women were recruited in one Iranian and two UK fertility clinics using theoretical sampling. Data were collected through semi structured in-depth interviews and analyzed using grounded theory. Findings: Infertile women encountering infertility showed attributes like disbelief, uncertainty, and questioning as their first reactions. However, they gradually tried to preserve themselves from emotional collapse through using a religious/spiritual meaning-making framework. They viewed infertility as God’s will and believed that nothing can happen without God’s contribution and He has absolute control over people’s lives. As a result, they acknowledged their new identity as infertile and tried to cope with the situation adopting religious coping strategies. Their trust and reliance on God and their benevolent reappraisal helped them to be optimistic, hopeful and confident, as they believed in God’s wisdom,

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Michael T. Evans and Emma D. Walker

beneficence and power. Consequently, they became capable to disclose their situation to others and then started to find a solution on their own or through seeking help from their husbands/partners or close relatives and friends. They tried through establishing supportive marital relationships and offering spiritual sympathy to maintain a family cohesion. Their religious views on socialization as a religious value motivated them to search reassurance through the love and care of religious congregation as well as offering support to others to gain intimacy. They also tried to get help from their religious beliefs like believing in Godgiven cure, healing power of prayer and miracles while they were struggling to find a solution. They employed assisted reproductive technologies as long as they were compatible with religious authorizations. At the same time, they had a transcendental hope that they would be blessed one day and this divine hope motivated them to go ahead with their treatment procedures. Conclusion: Religious infertile women after experiencing ups and downs in their longterm spiritual journey were convinced that they could have a fruitful and dynamic life even without child. They believed that the whole process of struggling with different dimensions of infertility could not threaten their belief in God. Hence, it seems that their spirituality as far as they came to terms developed and they achieved a kind of spiritual strengthening embedded in religious hope in a great being. This spiritual strength gave them a sense of empowerment to handle infertility more peacefully. Chapter 10 - Older adults who are actively involved in formal volunteering have been found to report more positive moods; perceived increases in friends, productivity, well-being, and opportunities to learn and do more activities; better psychological well-being; greater life satisfaction; and lower mortality rates. One in three volunteers have reported that a religious organization sponsored their formal volunteering, accounting for the largest number of volunteers. Therefore, religious organizations provide many opportunities for older adults to volunteer, which may explain a possible link between religion and improved health outcomes. The purpose of this qualitative, focus group study was to explore the phenomenon of volunteerism to achieve a greater understanding of the reasons older adults volunteer and the perceived barriers for not volunteering. Three separate focus group sessions were conducted. Nineteen participants were interviewed. Majority were African-American, women, widowed, Protestant, and had achieved a high school or greater educational level. Intrinsic and extrinsic reasons for and against volunteering were revealed. Intrinsic reasons included positive biological, psychological, social, and spiritual health outcomes. Extrinsic reasons included priceless rewards, tangible rewards, values acquisition, and needs identification. Intrinsic perceived barriers were related to health, lack of knowledge, lack of motivation, personality issues, negative experiences, and pride. Extrinsic barriers included lack of resources and safety. Findings from this study will be used as a basis for developing a community-based intervention study to increase volunteerism among inner city older adults. Chapter 11 - Nine psychiatric inpatients diagnosed with borderline personality disorder participated in a psychodynamically oriented, exploratory spirituality group. Through drawings and group process, the patients uncovered and elaborated on their representations of God. Two patterns of representations were identified: 1) representations of a punitive, judgmental, rigid God that seemed to reflect directly and correspond with parental representations and 2) representations of a depersonified, inanimate, abstract God entailing aspects of idealization that seemed to compensate for parental representations. Interestingly, the second pattern was associated with comorbid narcissistic features in the patients. Those

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Preface

xiii

patients who presented punitive God representations were able to begin the process of recreating these representations toward more benign or benevolent images in the context of this group, while those participants who presented depersonified God representations seemed unable to do so. The author suggests that a spirituality group can facilitate the re-creation of representations of both God and self among spiritually curious borderline patients. Chapter 12 - In recent years, social scientists have paid an increasing amount of attention to the interaction between religion, psychology, and the legal system. Social scientists have studied the ways in which individuals’ religious characteristics and religious attitudes affect opinions toward punishment and juror verdicts. Other research has focused on how religious evidence offered at trial (e.g., the religiosity of the defendant) affects jurors’ verdicts. Yet other research has focused on how the death qualification process eliminates certain individuals affiliated with particular religious groups from the jury pool. This current research extends this emerging field of study by investigating whether the type of hallucinations (religious or non-religious) a defendant experiences affects perceptions of insanity and reasonableness. Chapter 13 - Tradition-oriented Religiousness (TR) and Subjective Spirituality (SS) define two independent dimensions, which have previously been shown to be relatively stable across time and to have very different correlates. Utilizing data from a large American community sample, this study extends previous work to examine how these two dimensions and other dimensions relevant to religiousness and belief predict adaptive and maladaptive tendencies. Criterion variables include internalizing and externalizing aspects of psychopathology, attachment, altruism, and group attitudes, as well as mature values as delineated by Rollo May. TR was associated primarily with maladaptive tendencies, the effects being primarily due to descriptive schemas; a conventional measure of religious involvement and commitment did not show as many maladaptive associations. SS was associated with a mixture of adaptive and maladaptive tendencies. Additional belief dimensions had more unambiguous associations: Unmitigated self-interest was associated with numerous maladaptive tendencies, and adherence to civic ideals (civil religion) was associated primarily with adaptive tendencies. These two additional dimensions, as well as the mature values index, showed some ability to predict change over time in altruism and in disorder-tendencies. Studies of belief vis-à-vis adaptiveness would be mistaken to concentrate solely on conventional religiousness, because other aspects of belief may have adaptive or maladaptive associations that are more powerful. Short Commentary 1 - There has been a remarkable amount of popular and professional interest in the relationship between spirituality, religion, psychology, and health in recent years. Contemporary interest in spirituality and religion is popular among not only the general population but also among many psychology professionals as well. While most people believe in God and consider themselves to be spiritual, religious, or both, most psychologists do not and have no training in religion and spirituality. Psychologists can learn much from the spiritual and religious traditions that offer principles and tools that are productive to use even if one does not share the same religious or spiritual beliefs or interests. The purpose of this brief commentary is to offer 13 spiritual and religious tools common among all of the major religious and spiritual traditions that can be utilized by contemporary professional psychologists in clinical practice and elsewhere in their professional work to enhance their already high quality professional services that they provide. In addition to the 13 tools, relevant ethical issues are briefly discussed.

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Short Commentary 2 – Background: The role of spirituality in health care is gaining increasing recognition. Compassion is an aspect of spirituality that has received little attention in the medical literature, yet is the foundation of the healing doctor-patient relationship. Although compassion fatigue in physicians is a commonly articulated concern, there is very little research regarding how physicians view this concept. Methods: Thirty-four family medicine resident physicians were interviewed regarding their views on spirituality, compassion and healing in medicine. These semi-structured individual interviews were transcribed verbatim and coded for ease of data management. The authors performed a qualitative analysis on all coded data that pertained to compassion, using the immersion/crystallization method. IRB approval was obtained. Results: Responses fell into four broad categories: definitions of compassion, its role in the doctor-patient relationship, barriers and facilitators. For many residents, compassion was seen as integral to healing and was closely linked to personal spirituality for many. Compassion was seen as having a dynamic role in the doctor-patient relationship, particularly at the end-of-life. Appreciation of the patient’s perspective was central. The most significant barrier was lack of time, both in patient encounters and time to attend to personal needs. Reflection and group process were important facilitators. Conclusion: Residents described compassion as an essential element of healing, and described conditions which can either promote or diminish its presence in patient care. These results can be used to make curricula changes that can foster the development and maintenance of compassion in the doctor-patient relationship.

In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Chapter 1

CRITICAL METHODOLOGY IN THE HISTORY OF PSYCHOLOGY AND RELIGION Robert Kugelmann

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University of Dallas, Irving, Texas, USA

The study of the relationships between psychology and religion demands a critical methodology. The fundamental reason for a critical methodology lies in the need to avoid “essentialist” views of both psychology and religion. Essentialism, as the term is used, refers to the belief in a fixed essence or nature of something. So essentialism here would mean that the position is taken that there is one thing called “psychology” and another thing called “religion,” and that relationships between them can be examined. But neither psychology nor religion is such a fixed entity. What we call psychology is the outgrowth of various scientific, social, and cultural developments over the past century and a half. While one can speak of something like a “cosmopolitan psychology” that is shared by people calling themselves psychologists in many lands, psychology is not a unified discipline. In its origins, it is multiple, often having distinct traditions of theory and praxis in various locales (see Danziger, 1996, 1997; Smith, 1997). In its current existence, it is a discipline lacking unity, lacking a “paradigm,” and maybe even a type of discipline that will not ever have a common paradigm, psychology not being like physics as a type of science (Van Hoorn, 1972). I make this claim in part by including not only diverse approaches in psychology, such as Lacanian psychoanalysis, transpersonal psychology, and cognitive psychology, but also including the plethora of “pop” psychologies which, while not having a dignified place in academia, do constitute what many outside the ivory tower consider psychology, and often stake their lives upon it. So too with religion. Ever since William James' The Varieties of Religious Experience, it has been recognized that religions come in an astonishing number of types, some requiring no church, no dogma, no deity. Others do, of course. Even James' broad treatment of the topic of religion was itself narrowly conceived, reflecting developments in what “religion” had come to mean in the modern world (Taylor, 2002). In earlier times, religion meant something other than a set of beliefs. In the thirteenth century, for example, Thomas Aquinas defined religion as a type of virtue, one in which a person relates to God. There is much more to say on this

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2

Robert Kugelmann

topic, but in the interest of brevity, let me simply say that religion, like psychology, is a historical object with changes and mutations over time and place, even if, as I have done here, one can identify some type of “family resemblance” among the diverse forms. Discerning a family resemblance does not compact them into a unity. These considerations are the basis for a need for a critical methodology in the study of the history of psychology (which has been undertaken, for example—among many possibilities, the work of Buchanan, 2002; Danziger, 1997; Dehue, 1995; Smith, 1997; Teo, 2001). By a “critical methodology” I mean an approach that seeks to discern the conditions of possibility for the object under investigation. In this case, it means a study of the historical conditions under which psychology, its concepts, theories, and practices, have come to take on the forms that they do. Good examples of the use of a critical methodology are found in Danziger’s (1997) study of the social and cultural conditions of possibility for such topics in psychology as “intelligence” and “personality.” These objects of psychological study are human kinds, not natural kinds (Hacking, 1995), meaning that they are not simply part of the natural world lying there to be discovered, but are historical and social categories shaped by particular human interests and responding to particular cultural contexts. Such an approach is especially needed in the areas where “psychology” and “religion” touch on the same areas of life, especially when one considers applied areas of psychology and such topics as pastoral counseling and the cura animarum, the care of souls, that have been important in the Christian traditions. Because in these areas, ground that once was largely and sometimes solely occupied by religious concepts and practices, is now also the purview of the psychologies. Since this contribution is a short communication, I will argue the point by way of illustration. In a Lenten sermon at St. Patrick's Cathedral in New York City, March 9, 1947, Msgr. Fulton J. Sheen initiated a debate over psychoanalysis. Sheen claimed, according to the New York Times, that Freudianism was an “escapism,” when what really is needed to make men whole is the sacrament of confession, and that it was based on “materialism, hedonism, infantilism and eroticism” ("Sheen denounces psychoanalysis," 1947). At this time, psychoanalysis was flourishing, in part because of the flight of German psychoanalysts to the United States during the Nazi regime, in part because of the contributions of analysts to the war effort, and in part because of the boom in clinical psychology and psychiatry after the war. Sheen, a philosophy professor at the Catholic University of America, was well known for his radio program, “The Catholic Hour,” of which he had been the host since 1930, with a wide and ecumenical audience.1 His sermon thus fell on fertile ground, because his “golden voice” (paraphrasing Time magazine from 1946)2 spoke with the authority of the church in the ears of many. The situation was confused, with charges and counter-charges, mainly based on the report in the Times, as well as upon general lack of distinction among “psychiatry,” “psychoanalysis,” and “Freudianism” in the Catholic community, in part because at the time, psychoanalysts of an orthodox Freudian orientation dominated New York psychiatry (see Hale, 1995, p. 277). Hence, the confusion was justified to a degree. The confusion stemmed from knowing exactly what Sheen condemned: Was it psychiatry? 1

His television program, “Life is Worth Living,” which began in 1952, would bring him even greater fame. He was a pioneer in the new medium and understood it well. 2 Time: “Golden-voiced Msgr. Fulton J. Sheen, U.S. Catholicism's famed proselyter, pulls 3,000 to 6,000 letters a Sunday but is on the air only four months of the year.” (Radio religion, 1946, January 21).

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Psychoanalysis? Or a variant of psychoanalysis, “Freudianism”? Sheen's vagueness mirrored public perception, and given the social reality of mid-century psychiatry, was justified. Protests from leading Catholic psychiatrists and from other psychoanalysts, such as A. A. Brill, received at first no reply from Sheen. In July, the controversy flared again, when four leading Catholic psychiatrists denounced Sheen's charge “that the practice of psychiatry is irreligious” ("Msgr. Sheen's attack hit by psychiatrists," 1947). The four were Edward A. Strecker (1886-1959), Leo Bartemeier (1895-1982), Frank J. Curran (1904-1989), and Francis J. Gerty (1892-1994). The initial Times article never said that Sheen said that “psychiatry was irreligious.” His remarks implied that, at least according to Curran, who resigned in protest from his position as head of the Psychiatry Department at St. Vincent's Hospital, a Catholic hospital in New York City, and from his archdiocesan duties as psychiatric expert to the matrimonial court and as a psychiatric consultant ("Psychiatrist quits in Catholic clash," 1947). He protested the fact that neither Sheen nor the archdiocese had clarified or corrected what to Curran were intemperate remarks. Curran wrote to St. Vincent's: “as a result of the newspaper publicity given to Msgr. Sheen's speech, private patients of mine as well as hospital patients of St. Vincent's stated that they could no longer come for psychiatric treatment or even consult a psychiatrist because they would be committing a sin if they did” ("Psychiatrist quits in Catholic clash," 1947). So even if Sheen had not equated psychoanalysis or even Freudianism with psychiatry, that's how it was taken, by eminent psychiatrists and by ordinary Catholics. The archdiocese stood by Sheen. He delivered another series of Lenten sermons from St. Patrick's cathedral the following year. The controversy crossed the Hudson River and into the rest of the nation. Harry McNeill (1947), a Catholic psychoanalyst, criticized Sheen in the July 25th issue of Commonweal, a leading Catholic magazine, objecting to the “pot shots” taken by Catholics at Freud. McNeill sought an even-tempered position, stating that of course there were tensions between psychoanalysis and Catholicism, because they both plowed the same field, character formation. Freudians, he said, had a lot to learn from Catholics, and then, speaking as an analyst, said that Catholics had things to learn from Freud. He proposed, among other things, that Catholics could learn about the developmental approach, because “our traditional psychology is largely philosophical and based upon an analysis of traits common to adults” (p. 352). McNeill’s position, shared by other psychologists (Burke, 1953), expressed dissatisfaction with the overly rationalistic approach of Neoscholastic philosophical anthropology, which contributed to Catholic animosity toward psychoanalysis and which was the dominant philosophical psychology among Catholics at the time. McNeill's article was summarized in Time magazine on August 4 (Freud and the Catholic church, 1947, August 4), giving the conflict national coverage, largely, no doubt, because of Sheen's celebrity. McNeill was taken, implicitly, as the synthesis of the divergent views of Sheen on the one hand, and the psychiatrists, such as Curran, on the other. Throughout the next decade, defenses of psychoanalysis and more nuanced critiques of it appeared in Catholic circles. The controversy subsided in Catholic circles when, in two addresses, Pope Pius XII affirmed the benefits of psychiatry, while admitting the dangers of erroneous views of the human person. This is the illustration. Here we have a conflict between psychology and religion. The religion was mid-twentieth century American Catholicism, which was militantly anticommunist and anti-modernist (Sheen paired Marx and Freud many a time). In addition, on the religious side, it was a condemnation made, not by the official church, but by a religious celebrity, who had the ear of the nation. On the other side, the psychology was

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Robert Kugelmann

psychoanalysis, which at the time was the dominant form of psychiatric theory, especially in New York City, a center of psychoanalytic power in the United States. The conflict of confession versus analysis was constructed within this historical context. A final note: Sheen’s argument was also directed against an alternative theology. Sheen's animus against Freud had another source, in addition to his legitimate criticism of some of the philosophical bases of analysis. When in 1947, before an audience of rabbis, Brill, objecting to Sheen's depiction of analysis, observed that “this 'unreasonable attack on Freud had something to do with the successful run of Dr. Joshua Loth Liebman's book, “Peace of Mind”'” ("Dr. Brill replies to Msgr. Sheen," 1947). Rabbi Liebman, like Sheen, was a successful radio religious personality, with appeal to Christians as well as Jews (Heinze, 2004, p. 205). While Liebman “befriended Christianity” (Heinze, 2004, p. 223), his bestseller, Peace of Mind, aimed its criticism against “irrational guilt—and Christianity's alleged encouragement of it” (Heinze, 2004, p. 222). His gentle version of psychoanalysis encouraged proposed a “theology of self-acceptance” (Heinze, 2004, p.223) in place of selfcondemnation. Liebman did not shrink from taking aim at the confessional, and he argued for the superiority of the analytic couch over the confessional booth: Rather than encouraging guilt and the seeking of atonement, psychological help “does not require that you feel sorry for your sins as long as you outgrow them” (Liebman, 1946, p. 30). Sheen's Lenten remarks, just months after Liebman's book appeared, seem a direct response to the theology of selfacceptance advocated by Liebman. Sheen stated: “There is no morbidity in confession. You don't look so much on your sins as you look upon your Saviour, who restores you to relationship with the Heavenly Father” ("Sheen denounces psychoanalysis," 1947). It was a battle of media titans; both Liebman and Sheen were charismatic orators with large ecumenical audiences. Sheen expanded upon his contrast between psychoanalysis and confession, clarifying them to some extent, in Peace of Soul, the title an allusion to Liebman's book. In conclusion then, the conditions of possibility for this conflicted relationship between a psychology and a religion (and between one religious view and another) were multiple: the defensive position of American Catholicism in the decades before the Second Vatican Council, especially in its strong condemnation of modernism; the ascendancy of psychoanalysis and a cultural tendency to see it as a substitute for religion; and perhaps especially, the role of the electronic media in propelling Sheen and Liebman to the status of celebrities.

REFERENCES Buchanan, R. D. (2002). On not "giving psychology away": The MMPI and public controversy over testing in the 1960s. History of Psychology, 5, 284-309. Burke, H. R. (1953, March). [Review of the book General Psychology]. American Catholic Psychological Association Newsletter, 3, 5-6. Danziger, K. (1996). The practice of psychological discourse. In C. F. Graumann & K. J. Gergen (Eds.), Historical dimensions of psychological discourse (pp. 17-35). Cambridge: Cambridge University Press. Danziger, K. (1997). Naming the mind: How psychology found its language. London: Sage.

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Dehue, T. (1995). Changing the rules: Psychology in the Netherlands, 1900-1985. Cambridge: Cambridge University Press. Dr. Brill replies to Msgr. Sheen. (1947, July 6). New York Times, pp. 42. Freud and the Catholic church. (1947, August 4). Available: http://www.time.com/time/magazine/article/0,9171,855857,00.html [2008, 21 July]. Hacking, I. (1995). Rewriting the soul: Multiple personality and the sciences of memory. Princeton: Princeton University Press. Hale, N. G., Jr. (1995). The rise and crisis of psychoanalysis in the United States: Freud and the Americans, 1917-1985. New York: Oxford University Press. Heinze, A. R. (2004). Jews and the American soul. Princeton: Princeton University Press. Liebman, J. L. (1946). Peace of mind. New York: Simon & Schuster. McNeill, H. (1947, July 25). Freudians and Catholics. Commonweal, 47, 350-353. Msgr. Sheen's attack hit by psychiatrists. (1947, July 2). New York Times, pp. 17. Psychiatrist quits in Catholic clash. (1947, July 20). New York Times, pp. 5. Radio religion. (1946, January 21). Available: http://www.time.com/time/magazine/article/0,9171,934406,00.html [2008, 23 July]. Sheen denounces psychoanalysis. (1947, March 10). New York Times, 18. Smith, R. (1997). The Norton history of the human sciences. New York: Norton. Taylor, C. (2002). Varieties of religion today. Cambridge: Harvard University Press. Teo, T. (2001). Karl Marx and Wilhelm Dilthey on the socio-historical conceptualization of the mind. In C. D. Green & M. Shore & T. Teo (Eds.), The transformation of psychology: Influences of 19th-century philosophy, technology, and natural science (pp. 195-218). Washington, DC: American Psychological Association. Van Hoorn, W. (1972). As images unwind: Ancient and modern theories of visual perception. Amsterdam: University Press Amsterdam.

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In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Chapter 2

HOLISTIC HEALING IN RELIGION, MEDICINE AND PSYCHOLOGY Søren Ventegodt1,2,3,4,5*, Niels Jørgen Andersen4,6, Isack Kandel7,8, and Joav Merrick5,8,9,10† 1The Quality of Life Research Center, Copenhagen, Denmark 2Research Clinic for Holistic Medicine, Copenhagen, Denmark 3Nordic School of Holistic Medicine, Copenhagen, Denmark 4Scandinavian Foundation for Holistic Medicine, Sandvika, Norway 5Interuniversity College, Graz, Austria 6

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8

National Institute of Child Health and Human Development, Jerusalem, Israel 9

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Norwegian School of Management, Sandvika, Norway Faculty of Social Sciences, Department of Behavioral Sciences, Ariel University Center of Samaria, Ariel, Israel

Office of the Medical Director, Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel

Kentucky Children’s Hospital, University of Kentucky, Lexington, United States

SUMMARY The abstract aim of the human endeavors in the field of religion, medicine and psychology is basically the same: healing of human existence. Most interestingly, the process of holistic healing seems to be the same in all cultures, at all times and in all human endeavors. We try in this chapter to document the common nature of holistic *

Correspondence: Søren Ventegodt, MD, MMedSci, MSc, Director, Quality of Life Research Center, Classensgade 11C, 1 sal, DK-2100 Copenhagen O, Denmark; Tel: +45-33-141113; Fax: +45-33-141123; E-mail: [email protected] † Professor Joav Merrick, MD, MMedSci, DMSc, Medical Director, Division for Mental Retardation, Ministry of Social Affairs, POBox 1260, IL-91012 Jerusalem, Israel; Tel: 972-2-6708122; Fax: 972-2-6703657; Mobile: 972-50-6223832; E-mail: [email protected]

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Søren Ventegodt, Niels Jørgen Andersen, Isack Kandel et al. healing and to describe how healing is related to personal development, especially development of the human consciousness enabling it to embrace and comprehend both the depth of self and the depth of the surrounding world. We argue that only by deepening the worldview, i.e., making our personal cosmology more complex, will we be able to reach the threshold for holistic healing. When we heal, not only are our spirit and heart healed, but also our body and mind, explaining why holistic healing has been such an important concept in all the religious and medical system of the worlds premodern cultures. Holistic healing thus seems to be the core concept of Hippocratic Greek medicine, the origin of modern medicine. We compare this to modern holistic healing in the holistic medical clinic that uses the concept of applied salutogenesis to induce healing not only of existential and sexual disorders, but also of serious illness, such as cancer and schizophrenia. We argue that only if the patient is willing to abandon his simplistic worldview can he have the fruit of holistic, existential healing and salutogenesis. In this chapter the religious experience is defined as the personal meeting with the totality of the universe; this can be a meeting with the universe as a person, i.e., God, or it can be the meeting with the fundamental source, the emptiness, sunya(ta) that creates the world, or it can be a unification with the universal energy lowing though everybody and everything. The universal quality of holistic healing is the development of sense of coherence (salutogenesis).

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INTRODUCTION Holistic healing is about the human healing his totality, i.e. healing of existence, or healing on an existential level [1,2]. In all religions the purpose is the direct experience of the universe in its totality; in some religions like Judaism, Christianity, and Islam, the universe appears, according to the famous Jewish philosopher Martin Buber (1878-1965) [3] to be a person, a You, a God; in other religions like Hinduism, Buddhism, Islamic, Jewish and Christian mystic, and the native American, African and Australian cultures, the universe appears as the void, sunya(ta), the great emptiness, the common, creative source of everything, the universal energy penetrating everything. Independent of the universe being a person or not, the goal of the religion is to help the person back to the experience of being a part of the universe, a person welcome in the world, a person in the deepest harmony with the universe. Most interestingly this striving for sense of coherence in religion seems to be identical with the striving for existential healing in the many different medical systems of the worlds premodern cultures: The ancient Greek Hippocratic character medicine [4], the medicine wheel and peyote medicine of the native Americans [5], the tradition of the about one million African Sangomas, the medical tradition of the Australian aboriginals [6], the tradition of the shaman healers of Northern Europe’s (i.e. the Sames), the tradition of druids and witches using the power of nature for healing. In modern holistic sexology we find the same intend of transcending the ego, to allow the patient to get full orgasm using the tool of surrendering to love, oneness, and sense of coherence [7-16]. The striving for sense of coherence, and the merging of own consciousness with the collective conscious is also quite remarkably the goal of depth psychology as it started with Carl Gustav Jung (1875-1961) and of one of the more recent trends in psychology called “positive psychology”. Several philosophers and researchers have reflected on the fact that holistic, existential healing, sense of coherence, and oneness with the world seems to be a

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fundamental objective of all human endeavor. This has lead to the successful concepts of perennial philosophy [18] and, as mentioned above, salutogenesis [1,2]. Taken to one single, abstract concept, all human striving seems to be about love – about loving and about being loved. Thus love being the essence of our human nature, the purpose of life [19-25] and the must fundamental motivation of our soul. Freud and the school of psychodynamic psychotherapy follow the fundamental motivations of man back to sexuality. In sexuality there is also this peculiar striving for unification, for the experience of oneness and transcendence; the full orgasm has been known to transcend ego and mind and everything else (comp. the French calling orgasm “le petit mort”, i.e. the small death) and modern sexologists like Reich and Osho (Bhagwan Shree Rajneesh) believed that only the full orgasm had the power to heal man in his present, highly neurotic condition [27,28]. So it seems that holistic healing, in the most abstract sense of helping man back to being a perfect and happy, healthy, meaningful, coherent part of the universe, is the basic goal of religion, medicine and psychology. If we look at religion, medicine and psychology most of the practices have though history been holistic practices and the intent seem to always be the same: healing of human existence, holistic healing or in other words salutogenesis.

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THE NATURE OF HOLISTIC HEALING The different cultures are primarily characterized by their world-view [29]. To understand the structure and nature of the world-view one must go to cosmology. Most interestingly, the depth of its cosmology determines the complexity of the culture including its religion, medicine and psychology. The more complex the cosmology, the more spiritually conscious, deeper reflected philosophically, and mystical is the culture. The cosmology thus seems to determine the quality of the culture and its religion and science. The complexity of the cosmology can be analyzed in a simple way using the concept of rays; the more rays or constitutional aspects a cosmology has, the more complex is it [25,26,28]. Interestingly the number of rays determines, if a culture is very spiritual or very materialistic; in a cosmology with only one ray everything is the same, and often this is taken to be matter. Modern biomedicine is thus based on the basic idea that the world is only chemistry and atoms, i.e. matter, allowing for a most practical and operational experience of the world, inviting the use of drugs and surgery for treatment. Jewish mysticism (the Kabbalah and Tarot build on this) is a cosmology seemingly with about 10 rays, or fundamental aspects of existence, allowing for a deep mystical experience of the world, deep existential reflection and healing, and even the personal meeting with God. Most psychological systems are in between, based on dualism with mind and matter allowing for some psychological and existential depth in the analyses without going all the way to mysticism. Using the concept of poly-ray cosmology as a fundamental frame for interpretation, it seems that the condition for holistic healing is high cosmological complexity. In Hippocratic medicine the ray-number were four corresponding to the four elements [4]; in Chinese medicine the ray number was five corresponding to five Chinese elements; in Hinduism the ray number was often seven, and in native American cosmology (the medicine wheel) the ray number was often eight (the eight directions of the wheel) [28]. Mystics like George Ivanovitch Gurdjieff (1877–1949) made highly ingenious analysis of the structure of the

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Søren Ventegodt, Niels Jørgen Andersen, Isack Kandel et al.

human soul, which is still very popular with business leaders worldwide [29]. This becomes quite practical in the end, allowing us to conclude that to meet God and heal existentially you need to develop your consciousness into a more complex understanding of self and the world. The concept of personal development [30-37] has been crystallized out of this cultural striving for a deeper understanding. Tools for personal development can be found in religion (prayer, meditation), medicine (healing, development of character, consciousness and self-insight into the purpose of life and talents) and psychology (psychotherapy, exercises).

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DISCUSSION Holistic healing thus basically is about the person developing a consciousness of sufficient depth and complexity to truly grasp both the world and the self, and in this understanding integrating the two into one, or creating the bridge from existence to the world. The religious experience is often that you become one with everything, that God is within you and outside you; that you are just one string of energy arising out of the subtle, divine energies of the universe, materializing a being that again a just a dancing particle in the divine unity of everything. It has been described many times in medicine and psychology that patients even with metastatic cancer and other mortal diseases have become completely happy [38] and even spontaneously well again [39]. Of course we all know stories of religious miracles, a little harder to believe for the skeptically, scientifically oriented mind. But basically, the message is the same: When you become once again one with the universe, improve your quality of life, and experience the magical sense of coherence, you will heal, not only your spirit, but also you mind and your body[40,41]. The healing of the heart have often been an issue, as has sexual healing, reviving the person from the most fundamental and basic level of existence. We have analyzed the nature of holistic healing from an existence-philosophical perspective, and found that we are born with a purpose of life, a gift of love to the world, and early in life we are forced to abandon this gift, and thus abandon the most valuable and divine aspect of our human nature. Holistic healing is basically about allowing ourselves to rediscover this hidden gem and become a unique and valuable person, not only to ourselves, but also to the surrounding world. We have used this theory of a personal life-mission [18-25] to help patients heal, when biomedicine could not help them and have found that holistic medicine in this way could heal every second patient with physical illnesses and chronic pains, mental illnesses, existential and sexual problems [9,15,42-46]. We have also found the effect of holistic healing to be lasting [47]. In practice, clinical holistic medicine has used the tools of conversational therapy, bodywork, and philosophical exercises to obtain the holistic healing and during the past 10 years cures have been developed for a number of illnesses and diseases [48-69]. Very often the patients have had religious experiences and deep, spontaneous insights in self in relation to healing [7,70-72]. Several patients even with mental illness, even schizophrenia and severe physical illness like cancer can seemingly be healed or helped this way [73-79].

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CONCLUSION So holistic healing, as we know it from religion, medicine and (depth) psychology, might have substantial values to offer modern man. A solution for many physical, mental, existential and sexual problems of modern man comes from the holistic healing that happens, when we develop our consciousness from being one-rayed – having a simple, materialistic worldview into a much more complex, loving and appreciative understanding of both our inner and our outer world. The abstract aim of the human endeavors in the field of religion, medicine and psychology is basically the same: healing of human existence. Most interestingly, the process of holistic healing seems to be the same in all cultures and we have tried in this chapter to document the common nature of holistic healing and to describe how healing is related to personal development, especially development of the human consciousness making it able to embrace and comprehend both the depth of self and the depth of the surrounding world. We argue that only by deepening the worldview, i.e., making our personal cosmology more complex, will we able to reach the threshold for holistic healing. When we heal, we heal our spirit, heart, body and mind, which explain why holistic healing has been such an important concept in premodern cultures. Holistic healing thus seems to be the core concept of the Hippocratic Greek medicine, the origin of modern medicine. We compared this to modern holistic healing in the holistic medical clinic using the concept of applied salutogenesis to induce healing not only of existential and sexual disorders, but also of serious illness like cancer and schizophrenia. We argue that only if the patient is willing to abandon his simplistic worldview, he can have the fruit of holistic, existential healing and salutogenesis. In this chapter the religious experience is defined as the personal meeting with the totality of the universe; this can be a meeting with the universe as a person, i.e. God, or it can be the meeting with the fundamental source, the emptiness, sunya(ta) that creates the world, or it can be a unification with the universal energy lowing though everybody and everything. The universal quality of holistic healing is the development of sense of coherence (salutogenesis) [80-82]. Only by looking for what is common in man’s fundamental endeavors of religion, medicine and psychology, can we find the abstract core of the meaning of life, and only by finding this meaning can we live a happy, healthy, able life, which we were meant to live. Development and perfection of experience seems to be the fundamental intent of the universe. Only when we surrender and start experiencing this directly can we understand existence and truly be.

ACKNOWLEDGMENTS The Danish Quality of Life Survey and the Quality of Life Research Center was 19912005 supported by grants from the 1991 Pharmacy Foundation, the Goodwill-fonden, the JLFoundation, E. Danielsen and Wife's Foundation, Emmerick Meyer's Trust, the FrimodtHeineken Foundation, the Hede Nielsen Family Foundation, Petrus Andersens Fond, Wholesaler C.P. Frederiksens Study Trust, Else & Mogens Wedell-Wedellsborg's Foundation and IMK Almene Fond. The research was approved by the Copenhagen Scientific Ethical Committee under number (KF)V.100.2123/91 and further correspondence.

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REFERENCES [1] [2] [3] [4] [5] [6] [7]

[8]

[9]

[10] [11]

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[12] [13]

[14]

[15]

[16] [17] [18] [19] [20]

Antonovsky A. Health, stress and coping. London: Jossey-Bass, 1985. Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Franscisco: Jossey-Bass, 1987. Buber M. I and thou. New York: Charles Scribner, 1970. Jones WHS. Hippocrates. Vol. I–IV. London: William Heinemann, 1923-1931. Anderson EF. Peyote. The divine cactus. Tucson, AZ: Univ Arizona Press, 1996. Morgan M. Mutant message from forever: A novel of Aboriginal wisdom. London: Harper Collins, 1990. Ventegodt S, Clausen B, and Merrick J. Clinical holistic medicine: the case story of Anna. III. Rehabilitation of philosophy of life during holistic existential therapy for childhood sexual abuse. Scientific World Journal, 2006;6:2080-91. Ventegodt S, Kandel I, Scientific World Journal,Merrick J. Clinical holistic medicine: how to recover memory without “implanting” memories in your patient. Scientific World Journal,. 2007;7:1579-89. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, and Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced impaired sexual functioning. Scientific World Journal, 2007;7:324-9. Ventegodt S, Kandel I, Neikrug S, and Merric J. Clinical holistic medicine: holistic treatment of rape and incest trauma. Scientific World Journal, 2005;5:288-97. Ventegodt S, Morad M, Hyam E, and Merrick J. Clinical holistic medicine: holistic sexology and treatment of vulvodynia through existential therapy and acceptance through touch. Scientific World Journal,. 2004;4:571-80. Ventegodt S, Morad M, Kandel I, and Merrick J. Clinical holistic medicine: problems in sex and living together. Scientific World Journal, 2004;4:562-70. Ventegodt S, Morad M, and Merrick J. Clinical holistic medicine: holistic pelvic examination and holistic treatment of infertility. Scientific World Journal, 2004;4:14858. Ventegodt S, Clausen B, Omar HA, and Merrick J. Clinical holistic medicine: holistic sexology and acupressure through the vagina (Hippocratic pelvic massage). Scientific World Journal, 2006;6:2066-79. Ventegodt S, Clausen B, Scientific World Journal,Merrick J. Clinical holistic medicine: pilot study on the effect of vaginal acupressure (Hippocratic pelvic massage). Scientific World Journal, 2006;6:2100-16. Ventegodt S, Andersen NJ, Kandel I, and Merrick J. Five tools for manual sexological examination and treatment. MedSciMonit, submitted 2008. Huxley A. The perennial philosophy. New York: Harper Collins, 1972. Ventegodt S, Andersen NJ, and Merrick J. Editorial: Five theories of human existence. Scientific World Journal, 2003;3:1272-6. Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health, 2003;15(1):89-91. Ventegodt S, Andersen NJ, and Merrick J. The life mission theory II. The structure of the life purpose and the ego. Scientific World Journal, 2003;3:1277-85.

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[21] Ventegodt S, Andersen NJ, and Merrick J. The life mission theory III. Theory of talent. Scientific World Journal, 2003;3:1286-93. [22] Ventegodt S, Andersen NJ, and Merrick J. The life mission theory IV. Theory on child development. Scientific World Journal, 2003;3:1294-1301. [23] Ventegodt S, Andersen NJ, and Merrick J. The life mission theory V. Theory of the anti-self (the shadow) or the evil side of man. Scientific World Journal, 2003;3:130213. [24] Ventegodt S, Kromann M, Andersen NJ, and Merrick J. The life mission theory VI. A theory for the human character: Healing with holistic medicine through recovery of character and purpose of life. Scientific World Journal, 2004;4:859-80. [25] Ventegodt S, Flensborg-Madsen T, Andersen NJ, and Merrick J. The life mission theory VII. Theory of existential (Antonovsky) coherence: A theory of quality of life, health and ability for use in holistic medicine. Scientific World Journal, 2005;5:377-89. [26] Reich W. [Die Function des Orgasmus]. Köln: Kiepenheuer Witsch, 1969. [German] [27] Osho B. Tao.The pathless path. New York: Renaissance Books, 2002. [28] Ventegodt S, Thegler S, Andreasen T, Struve F, Jacobsen S, Torp M, Aegedius H, Enevoldsen L, and Merrick J. A review and integrative analysis of ancient holistic character medicine systems. Scientific World Journal, 2007;12;7:1821-31. [29] Maitri S. The spiritual dimension of the enneagram. New York: Penguin Putnam, 2001. [30] Ventegodt S, Andersen NJ, and Merrick J. Quality of life philosophy: when life sparkles or can we make wisdom a science? Scientific World Journal, 2003;3:1160-3. [31] Ventegodt S, Andersen NJ, and Merrick J. Quality of life philosophy I. Quality of life, happiness and meaning in life. Scientific World Journal, 2003;3:1164-75. [32] Ventegodt S, Andersen NJ, and Merrick J. Quality of life philosophy II. What is a human being ? Scientific World Journal, 2003;3:1176-85. [33] Ventegodt S, Andersen NJ, and Merrick J. Quality of life philosophy III. Towards a new biology: Understanding the biological connection between quality of life, disease and healing. Scientific World Journal, 2003;3:1186-98. [34] Ventegodt S, Andersen NJ, and Merrick J. Quality of life philosophy IV. The brain and consciousness. Scientific World Journal, 2003;3:1199-1209. [35] Ventegodt S, Andersen NJ, and Merrick J. Quality of life philosophy V. Seizing the meaning of life and becoming well again. Scientific World Journal, 2003;3:1210-29. [36] Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy VI. The concepts. Scientific World Journal, 2003;3:1230-40. [37] Ventegodt S, and Merrick J. Philosophy of science: How to identify the potential research for the day after tomorrow? Scientific World Journal, 2004;4:483-9. [38] Grof S. LSD psychotherapy: Exploring the frontiers of the hidden mind. Alameda, CA: Hunter House, 1980. [39] Dige U. Cancer miracles. Copenhagen: Hovedland, 2000. (Danish) [40] Spiegel D, Bloom JR, Kraemer HC, and Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 1989;2(8668):888-91. [41] Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, et al. Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet, 1990;336(8708):129-33.

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[42] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, and Merrick J. Self-reported low self-esteem. Intervention and follow-up in a clinical setting. Scientific World Journal, 2007;7:299-305. [43] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, and Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced mental illness. Scientific World Journal, 2007;7:306-9. [44] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, and Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced physical illness and chronic pain. Scientific World Journal, 2007;7:310-16. [45] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, and Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) improves quality of life, health and ability by induction of Antonovsky-Salutogenesis. Scientific World Journal, 2007;7:317-23. [46] Ventegodt S, Kandel I, and Merrick J. A short history of clinical holistic medicine. Scientific World Journal, 2007;7:1622-30. [47] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, and Merrick J. Clinical holistic medicine: Psychodynamic short-time therapy complemented with bodywork. A clinical follow-up study of 109 patients. Scientific World Journal, 2006;6:2220-38. [48] Ventegodt S, and Merrick J. Clinical holistic medicine: Applied consciousness-based medicine. Scientific World Journal, 2004;4:96-9. [49] Ventegodt S, Morad M, and Merrick J. Clinical holistic medicine: Classic art of healing or the therapeutic touch. Scientific World Journal, 2004;4:134-47. [50] Ventegodt S, Morad M, and Merrick J. Clinical holistic medicine: The “new medicine”. The multiparadigmatic physician and the medical record. Scientific World Journal, 2004;4:273-85. [51] Ventegodt S, Morad M, Hyam E, and Merrick J. Clinical holistic medicine: Use and limitations of the biomedical paradigm. Scientific World Journal, 2004;4:295-306. [52] Ventegodt S, Morad M, Kandel I, and Merrick J. Clinical holistic medicine: Social problems disguised as illness. Scientific World Journal, 2004;4:286-94. [53] Ventegodt S, Morad M, Andersen NJ, and Merrick J. Clinical holistic medicine: Tools for a medical science based on consciousness. Scientific World Journal, 2004;4:347-61. [54] Ventegodt S, Morad M, Hyam E, and Merrick J. Clinical holistic medicine: When biomedicine is inadequate. Scientific World Journal, 2004;4:333-46. [55] Ventegodt S, Morad M, and Merrick J. Clinical holistic medicine: Prevention through healthy lifestyle and quality of life. Oral Health Prev Dent. 2004;2(Suppl 1):239-45. [56] Ventegodt S, Morad M, Vardi G, and Merrick J. Clinical holistic medicine: Holistic treatment of children. Scientific World Journal, 2004;4:581-8. [57] Ventegodt S, Morad M, Kandel I, and Merrick J. Clinical holistic medicine: A psychological theory of dependency to improve quality of life. Scientific World Journal, 2004;4:638-48.

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[58] Ventegodt S, Morad, M, Kandel I, Merrick J. Clinical holistic medicine: Treatment of physical health problems without a known cause, examplified by hypertention and tinnitus. Scientific World Journal, 2004;4:716-24. [59] Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Developing from asthma, allergy and eczema. ScientificWorld Journal 2004;4:936-42. [60] Ventegodt S, Merrick J. Clinical holistic medicine: Chronic infections and autoimmune diseases. Scientific World Journal 2005;5:155-64. [61] Ventegodt S, Flensborg-Madsen T, Andersen NJ, Morad M, Merrick J. Clinical holistic medicine: A pilot study on HIV and quality of life and a suggested cure for HIV and AIDS. Scientific World Journal 2004;4:264-72. [62] Ventegodt S, Merrick J. Clinical holistic medicine: Chronic pain in the locomotor system. Scientific World Journal 2005;5:165-72. [63] Ventegodt S, Gringols M, Merrick J. Clinical holistic medicine: Whiplash, fibromyalgia and chronic fatigue. Scientific World Journal 2005;5:340-54. [64] Ventegodt S, Merrick J. Clinical holistic medicine: Chronic pain in internal organs. Scientific World Journal 2005;5:205-10. [65] Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: The existential crisis – life crisis, stress and burnout. ScientificWorldJournal 2005;5:300-12. [66] Ventegodt S, Gringols M, Merrick J. Clinical holistic medicine: Holistic rehabilitation. Scientific World Journal 2005;5:280-7. [67] Ventegodt S, Morad M, Press J, Merrick J, Shek DTL. Clinical holistic medicine: Holistic adolescent medicine. Scientific World Journal 2004;4:551-61. [68] Ventegodt S, Merrick J. Clinical holistic medicine: The patient with multiple diseases. Scientific World Journal 2005;5:324-39. [69] Ventegodt S, Clausen B, Nielsen ML, Merrick J. Clinical holistic medicine: Advanced tools for holistic medicine. ScientificWorldJournal 2006;6:2048-65. [70] Ventegodt S, Clausen B, Merrick J. Clinical holistic medicine: The case story of Anna. I. Long-term effect of childhood sexual abuse and incest with a treatment approach. Scientific World Journal 2006;6:1965-76. [71] Ventegodt S, Clausen B, Merrick J. Clinical holistic medicine: The case story of Anna. II. Patient diary as a tool in treatment. Scientific World Journal 2006;6:2006-34. [72] Clinical holistic medicine: factors influencing the therapeutic decision-making. From academic knowledge to emotional intelligence and spiritual "crazy" wisdom. Scientific World Journal 2007;7:1932-49. [73] First do no harm: an analysis of the risk aspects and side effects of clinical holistic medicine compared with standard psychiatric biomedical treatment. Scientific World Journal 2007;7:1810-20. [74] Biomedicine or holistic medicine for treating mentally ill patients? A philosophical and economical analysis. Scientific World Journal 2007;7:1978-86. [75] Ventegodt S, Andersen NJ, Neikrug S, Kandel I, Merrick J. Clinical holistic medicine: Mental disorders in a holistic perspective. Scientific World Journal 2005;5:313-23. [76] Ventegodt S, Andersen NJ, Neikrug S, Kandel I, Merrick J. Clinical holistic medicine: Holistic treatment of mental disorders. Scientific World Journal 2005;5:427-45. [77] Clinical holistic medicine (mindful short-term psychodynamic psychotherapy complimented with bodywork) in the treatment of schizophrenia (ICD10-F20/DSM-IV

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[78]

[79]

[80]

[81]

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Søren Ventegodt, Niels Jørgen Andersen, Isack Kandel et al. Code 295) and other psychotic mental diseases. Scientific World Journal 2007;7:19872008. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Induction of spontaneous remission of cancer by recovery of the human character and the purpose of life (the life mission). Scientific World Journal 2004;4:362-77. Ventegodt S, Solheim E, Saunte ME, Morad M, Kandel I, and Merrick J. Clinic holistic medicine: Metastatic cancer. Scientific World Journal 2004;4:913-35. Sense of coherence and physical health. Testing Antonovsky's theory. Scientific World Journal, 2006;6:2212-9. Flensborg-Madsen T, Ventegodt S, Merrick J. Sense of coherence and physical health. A cross-sectional study using a new scale (SOC II). Scientific World Journal, 2006;6:2200-11. Flensborg-Madsen T, Ventegodt S, and Merrick J. Sense of coherence and physical health. The emotional sense of coherence (SOC-E) was found to be the best-known predictor of physical health. ScientificWorldJournal, 2006;6:2147-57. Flensborg-Madsen T, Ventegodt S, and Merrick J. Sense of coherence and health. The construction of an amendment to Antonovsky's sense of coherence scale (SOC II). Scientific World Journal, 2006;6:2133-9.

In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Chapter 3

BEING IN THE WORLD OF PEACEKEEPING: LIVING THE UNPRESENTABLE Susan L. Ray* The University of Western Ontario, London, Ontario, Canada

ABSTRACT

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This research study was a philosophical interpretive inquiry into the experience of contemporary peacekeepers. What is the experience of contemporary peacekeeping and how does it lead to trauma? This study reflected a commitment to understanding the nature of contemporary peacekeeping deployments. An interpretative phenomenological approach was appropriated from various texts to uncover the experience of contemporary peacekeepers who had received treatment a minimum of two years for psychological trauma resulting from recent deployments. Data was collected via one tape recorded interview, lasting between 1½ to 3 hours, with ten contemporary peacekeepers who had been deployed to Somalia, Rwanda, or the former Yugoslavia. The participants included six soldiers, two chaplains, one medic and one female nurse. Narratives from the transcribed interviews were reviewed with four of the participants and reflective journaling by the researcher provided further clarification of the data to understand the experience. Data analysis was undertaken throughout the research study by utilizing a thematic analysis of text in which themes emerged to document and understand the experience of contemporary peacekeeping. This chapter endeavors to reveal the situatedness of contemporary peacekeeping and contemporary peacekeepers being in the world. The peacekeepers’ descriptions of the situatedness of their bodies in time, space and relation provided a fresh way into understanding the experience of contemporary peacekeeping. Glimpses of the life world described by the peacekeepers reveal some of the ineffable unpresentable experiences of peacekeeping that lead to trauma. Like Alice falling Down the Rabbit Hole, contemporary peacekeepers are separated from their families and thrown suddenly down the rabbit hole of peacekeeping. They are taken on a journey of the unknown, with limited preparation for what they would experience and where they would live. They, like Alice, have to adapt to rapidly changing rules and *

Corresponding Address: The University of Western Ontario, Faculty of Health Sciences, HSA #32, London, Ontario. Canada. N6A 5C1; Business Phone # (519) 661-2111 Ext. 86576; E-mail: [email protected]; Fax: (519) 661-3929

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Susan L. Ray situations. For peacekeepers there are changes from the known to the unknown and back to the known. Like Alice, contemporary peacekeepers tried to make sense out of the senselessness of the situations that they encountered. As well, their return home was also quick with limited transition. Deployments required many transitions in terms of time, space and relations. The peacekeepers revealed that the military became their family, with the bonds of brotherhood tightening over time. The profound losses of brother soldiers such as by suicide and the callous response by the military left many with a sense of betrayal of what’s right by the military leaders who held their trust. Their sense of betrayal was further deepened when the Band of Brothers that was the Airborne Regiment who served in Somalia were disbanded by their military family and the government. The rules of engagement restricted them from responding to human suffering all around them. The sheer stamina and self discipline of standing aside, in the face of the brutalities and cruelties inflicted upon their fellow human beings, makes one wonder how this erodes at the peacekeepers. Being in the world of peacekeeping left many of the peacekeepers with existential questions about life, death, being and the searching for meaning. “The rabbit hole went straight on like a tunnel for some way, and then dipped suddenly down, so suddenly that Alice had not a moment to think about stopping herself before she found herself falling down what seemed to be a very deep well.” —Carroll, 1865/1992, p3

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INTRODUCTION Peacekeepers are soldiers trained for war as generations of soldiers before them were trained. War and peacekeeping are interconnected and intertwined through the experiences of these soldiers. This research study was a philosophical interpretive inquiry into the experience of contemporary peacekeepers. What is the experience of contemporary peacekeeping and how does it lead to trauma? This study reflected a commitment to understanding the nature of contemporary peacekeeping deployments. An interpretative phenomenological approach was appropriated from various texts to uncover the experience of contemporary peacekeepers who had received treatment a minimum of two years for psychological trauma resulting from recent deployments. Data was collected via one tape recorded interview, lasting between 1 ½ to three hours, with 10 contemporary peacekeepers who had been deployed to Somalia, Rwanda, or the former Yugoslavia.

THE PEACEKEEPERS The ten participants included six soldiers (Luke, Simon, Peter, James, John and Tim), two chaplains (Thomas and Matt), one medical assistant (Paul) and one female nurse (Mary). Their names were changed to pseudonyms for the purpose of anonymity. Five of the participants (Luke, James, Matt, Paul and Mary) have been released from the Canadian Forces (CF) and Peter is awaiting his release. Two (Simon and Thomas) are still serving in the (CF) and two (John and Tim) are trying to prevent their release from the (CF).

Being in the World of Peacekeeping: Living the Unpresentable

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Luke

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Luke is a 44 year old married man currently in an amicable separation, with two children. He grew up in a small South Western Ontario town and attended school with a friend in the cadet movement. Once Luke joined the cadets it became a lifelong thing for him and his friend. They were attracted to the type of life style and military mind set. It was a natural progression for both of them to join the reserves. Luke was a young carpenter’s apprentice and stayed with the local reserve unit for a little over 10 years. He became a licensed carpenter by trade and then, he decided to sell his business in order to join the regular force. In 1987, he joined the regular forces in the armored corps of the Royal Canadian Regiment (RCR). Luke was posted to Petawawa and was part of the reconnaissance squadron attached to an infantry battle group, third battalion of the RCR. While preparing to go to Bosnia, he was involved in a road accident on the base in Petawawa in a six wheel Cougar, which is an armored vehicle with a turret on the top. Luke sustained physical injuries such as whiplash and blinding headaches. Despite his injuries, in 1998, he served overseas in Bosnia as a troop sergeant. While overseas, Luke was involved in a similar road accident. He related the story of the accident to the sergeant major, the squadron commander and the doctor. Luke knew that his deployment was finished. He told them that it was probably better for all parties that he go back home and shortly after, he was repatriated back to Canada. Luke taught on a gunnery course, on the cougar platform in the classroom called the indoor miniature range, as the regimental gunnery sergeant. He wasn’t physically getting any better and was offered a medical release. Luke thought about it and accepted the medical discharge. He spent 13 years in the regular army and had a 23 year military career. In 1999, Luke was released from the military. Ten days after he was officially released from the forces, Luke was hired as the Chief Building Official in a civilian building department in southern Ontario. After two years, he went on short term disability and presently he is on long term disability. Luke sees a nurse therapist on a regular basis for PTSD.

James James is a 40 year old divorced male, with one daughter, who spent 20 years in the military. He is third generation military, serving in the same regiment, same unit and the same trade. James joined the military because he thought it was his destiny. As soon as he finished high school he went into the military at age 17. He was posted to Alberta, with the Strathconas, for three years. Then he went to the training base in New Brunswick for a year, to Germany for another five years, and then to Calgary again. In 1994, he was deployed to Bosnia for six months. On his return, he spent about a year and a half back in Edmonton, and then Medicine Hat, South Field for four years. In 2000, he was posted back to the unit in Edmonton and worked in a Warrant Officer’s position as a Master Corporal for about six months. James met with a major trigger that caused him to go on sick leave for three years. In 2004, he was sent to his last posting at a base in Ontario. Six months later in January 2005, he was officially released from the military. James sees a psychologist and a psychiatrist on a regular basis for depression and PTSD.

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Matt Matt is a 43-year-old single male from a small South Western Ontario town with eight years of post-secondary education. He obtained a bachelor’s degree in philosophy and history and a master’s degree in divinity. He joined the reserve army at 16 years of age because he didn’t want to work at the Ford plant. The military looked like a place where he could earn a couple of bucks, and go someplace. He had thought about being a priest as he had two very good role model priests in his home town. Matt was accepted to the Royal Military College. While he was attending a seminary at a university, the military employed Matt as a student chaplain. After eight years of study, he was ordained and spent a few years as a civilian priest. Four years later, Matt was sent to the regular forces. Matt was posted to Petawawa, and spent about a year and a half there. In 1993, he was deployed to Somalia for a six month tour. In 1994, six months from his return from Somalia he was standing in Yugoslavia. After six months, he returned to Canada. In 1999, after 21 years of military service, Matt was released from the military. He sees a psychiatrist on a regular basis for PTSD and attends an Operational Stress Injury Social Support (OSISS) group.

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Paul Paul is a 40 year old married man with three children. He grew up in Montreal as a single child. In 1989, he joined the army because his parents sent him for the good security and good pay. Paul was a medical assistant for 12 years. Paul was deployed in 1993-94 to the former Yugoslavia which is now Croatia, as a medical assistant. His job over there, for six months, was to take care of a section of 30 soldiers, spread out in three different houses, and the houses were located close to the front line. They were bombed, shelled, and shot at every day for three months. Afterwards it settled down, but because they were on the line it was constant stress with shooting and shelling. The doctor was an hour and a half away, and the closest medic who was 30-40 minutes away. Paul returned to Canada in April of 1994, and in June he was posted to Ottawa. He worked at the National Defense Medical Centre, which was the main hospital for the forces. As a medic in the hospital, he changed diapers and pumped feeding tubes. It was a big contrast from overseas where he had narcotics and some morphine in his pocket to working where he was not allowed to even give out Tylenol or talk about psychology to a client. In 2000, he was on the Disaster Assistance Response Team (DART) to go to Pakistan because of the big mud floods. Paul was unable to go because of his knees and back problems. He was released from the military in 2001 not for his PTSD but for his knees and back problems. Paul ‘came out of the closet’ with his diagnosis of PTSD in 2004. He waited ten years. After his release, he did a computer programmer course and then, lived on his pension for awhile. Presently, Paul works part time in his own life style coaching business. He sees a psychologist on a regular basis for depression and PTSD.

Being in the World of Peacekeeping: Living the Unpresentable

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Mary Mary is a 40 year old divorced woman who was born on Vancouver Island. She spent most of her life moving around because her father was a pilot in the military. After graduating high school, Mary attended a university in Ontario for a year. After one year, she left and worked overseas on one of the bases in the orderly room for two summers. Mary enrolled in nursing at a community college and then found a job at the Grenfell Mission in St. Anthony, Newfoundland for two years. She returned to Ontario and took an adult intensive care unit (ICU) nursing program at a university. Mary was trying to get into the military for pilot training while she was doing the ICU course but didn’t meet the criteria. Instead, they offered her enlistment as a nurse. She accepted and in early January of 1981 she went to basic training in Chilliwak for 13 weeks. Her first posting was to Halifax for two years and then to Vancouver Island and then, Ottawa for a year for the operating room (OR) course. She was posted to Halifax and worked in the OR there for 3 years and then posted to Edmonton. Mary decided to marry the fellow she had dated on and off for 4 ½ years, who lived in Nova Scotia. She left the military and spent 2 years working on her Bachelor of Business Administration at a nearby university. She was separated and divorced during that period. Mary went back to the military and was posted to Halifax, to the OR and attended university part time. Mary served in Bosnia in 1993-1994 while there was a full fledged civil war being waged. The mandate was to provide escort for humanitarian aid convoys and to assist in brokering the peace process. As a nurse, she was not directly involved in those activities, but rather filled a support role – primarily the care of the sick and injured. There were about 9 surgeries on her tour; a couple guys were hit by sniper fire and 2 guys died. Mary was in charge of the Operating Room (OR) the first 3 months of the tour, and then the OR, the Ward and the ICU for a month, and then just the Ward and ICU. It was stressful for Mary because she had not been near an ICU in 13 years, or a Ward for many years. She had a particular difficult case in the Unit near the end of the tour that “pretty much finished” her. In addition, while on her tour, she was assaulted by somebody who she had cared about which really affected her trust. In May 1994, she returned to Canada and was put on sick leave for about six months, before they put her on the medical list. She was shuttled back and forth between Ottawa and Halifax. Eventually, she was admitted to a psychiatric ward in an Ottawa hospital and attended a PTSD pilot program. Mary applied for the pension and was released from the military in 1996. This past year Mary went through the nursing refresher course and then, made the decision not to return to nursing. She started making jewelry and finger labyrinths. Mary is thinking about becoming a manicurist as well as establishing a nursing foot care business. She sees a psychiatrist on a regular basis for PTSD.

Peter Peter is a 42 year old married soldier who, I noticed, looked much older than that, as I sat talking with him for many hours in his home. He has grown children. Peter was born and raised in central Ontario. In 1985, Peter joined the military at 22 years of age because he was fairly young, needed a job and had a young family to support. He started his career on the combat side as a field engineer and did all of his training in Chilliwak. Peter was an older

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recruit. He had finished some college and was a new breed of soldier with a higher level of education. His first posting was Canadian Forces Base (CFB) Petawawa with a two combat engineer regiment and a lot of field time. Peter’s first tour was in 1989 to Cyprus. Upon his return, he spent about 4 years in Petawawa and was posted to a four command engineer regiment in Germany. In Germany, he took courses to become a search and rescue diver. In 1992, Peter went on his second tour on the initial rotation to Croatia under the UN Canadian commander, General McKenzie. In 1996, he served in Bosnia under NATO and was deployed to Kosovo from 1999 to 2000 under a joint NATO UN deployment. In 2000, he came back to Canada and was stationed in Petawawa and in Ottawa. Currently, he has been transferred to Eastern Ontario while he awaits his release from the military. Peter sees a psychologist on a regular basis for PTSD and attends an OSISS group.

Simon

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Simon is a 40 year old married French Canadian soldier with two teenagers. He had a normal childhood, good parents, and “didn’t get beaten up as a kid.” Simon doesn’t know why he joined the military. At 18 years of age, he joined the CF as an officer, went to a university in Ontario and became a communications specialist. He has served in the military for 22 years. In 1994, Simon did one full tour in Rwanda which was 10 months long. He became addicted to the adrenalin and was shipped off to Lebanon, Cambodia, the Persian Gulf twice and Kuwait. All these deployments occurred from 1994 to 1998. In 1998, he returned to Canada and worked for the Department of National Defense (DND). Currently, he is still serving in the CF. He sees a psychiatrist on a regular basis for PTSD.

Thomas Thomas is a 46 year old married chaplain with three children and almost 30 years of military service. He joined the primary reserve at 16 years of age for two reasons. First, there is a history of military service on both his mother and father’s side of the family and second, his father told him it was time to get a job. However, once he started serving he looked at it more as an obligation and duty of service to the Queen. He started off with the militia which is a land force reserve unit. Thomas spent about 2 years there applying for officer training. He failed the leadership performance objective and re-enrolled in the regular force as a radio technician. Thomas spent 10 years as a radio technician and obtained a Bachelor of Arts in Psychology and Sociology. He was posted in Kingston and enrolled in a chaplain training program for his Masters in Divinity. Thomas spent two years on leave without pay at a civilian parish, and then returned to full time service as a chaplain. Thomas has been posted to Petawawa, Calgary, Kingston, Halifax and Edmonton, where he was with a light infantry battalion. He was deployed to Haiti in 1995/96 over the Christmas period as a chaplain. He spent 6 weeks in Bosnia as a chaplain. Thomas was also involved in the Winnipeg flood and the ice storm in Montreal as well as a number of other minor operations.

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Thomas was almost released from the military while he was trying to get better. Instead, he took six months off and is back to work handling administrative duties. He is slowing working his way back to pastoral duties. Thomas sees a psychiatrist on a regular basis for depression, anxiety and PTSD and attends an OSISS group on base.

John

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John is a 40 year old married Francophone man who was born in New Brunswick. He went to school and grew up in various parts of Moncton. John is the oldest of six children. When he was 8 years old his family moved to the United States and then returned to an Anglo part of the province. John is fluent in both French and English. He had an extraordinarily good childhood; was heavily involved in sports and in his family. One of his school mates joined the military in Grade 12 and spoke about how much fun it was to be a sailor. John’s father lost his job so his plans to go to university were diminished. So, he went to the recruiting office with another friend and joined the military at 17 years of age. He selected communications as his trade. His first posting was in Alberta and he departed on his 18th birthday. In 1988, he joined the navy and was posted to Kingston. He was deployed to the Gulf War in 1991 for six months. Then he was deployed to the former Yugoslavia in 1992 for almost a year. In 1994, John was deployed to Rwanda for six months. He returned to Canada and was posted to Kingston. In 1999, he sought treatment and took a year off of work. John has not officially ‘come out of the closet’ (i.e. disclosing that he has PTSD) because he doesn’t want to be ‘red flagged’ and face release from the military. He has seen a psychologist and a psychiatrist for PTSD and attends an OSISS group.

Tim Tim is a 37 year old married soldier with five children in a blended family. At age 18, he joined the military because that’s what he always wanted to do. His grandfather was a pilot in World War II who instilled in him and his brother the idea of serving your country as “the patriotic thing to do”. Tim believed that everybody should serve their country. In 1987, he picked the infantry and was based in Cornwallis for basic training and then posted to Gage town, New Brunswick. Tim went on a jump course, a parachuting course and then, he was posted to the Airborne Regiment. He loved the Airborne because it was intensive training as well as challenging. In 1992, Tim was deployed to Somalia on his first tour for five and a half months. He came back to Canada in 1993. In 1994, Tim was deployed to Rwanda as part of the UN defense and security force for General Dallaire. In 1995, he came back to Canada for four years. In 1999, he was deployed to the former Yugoslavia under the North Atlantic Treaty Organization (NATO) for a seven month tour. In 2000, he was deployed to Ethiopia for six months. Tim is still serving in the CF on a base in Ontario. However, he has filed a grievance regarding his yearly performance as he feels the military is trying to write him off for things that stem from an incident that occurred a few years ago. He sees a psychologist on a regular basis for PTSD.

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THE SITUATEDNESS OF CONTEMPORARY PEACEKEEPING In order to gain a deeper understanding of contemporary peacekeeping and how the experience leads to trauma, it is important to first explore the situatedness of contemporary peacekeeping. Situatedness is important in understanding the experience of peacekeeping and peacekeepers being in the world. The relationship between man and the world is so close, says van den Berg (1987), that it is erroneous to separate them:

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Our world is not primarily a conglomeration of objects. …Our world is our home, a realization of subjectivity. If we want to understand man's existence, we must listen to the language of objects. If we are describing a subject, we must elaborate on the scene in which the subject reveals itself. (p. 39-40)

One of the peacekeepers described his forced release from the military as going “Down the Rabbit Hole” as in the book by Lewis Carroll (1865/1992) titled Alice’s Adventures in Wonderland. “Down the Rabbit Hole,” has become a popular term for a journey of adventure to the unknown. I think the metaphor of “Down the Rabbit Hole” can also help us understand elements of the experience of contemporary peacekeeping during their deployments to Somalia, Rwanda and the former Yugoslavia and their return to Canada. Alice’s journey to the unknown begins on the bank of a river with her older sister, feeling very bored. Suddenly a White Rabbit with pink eyes runs close by Alice proclaiming that it is very late, and pulls a pocket watch out of its waistcoat. Alice burning with curiosity follows the rabbit and hops right down a deep rabbit hole after him, giving no thought of how she plans to get out again. Thus begins her perilous journey of adventure to the unknown. She is separated from her family and has to adapt to strange rules and behaviors while finding her way back home. Like Alice, contemporary peacekeepers have to learn complex rules, reading not only situations but also people as they make their way through their deployments and back home to their families. Falling down the rabbit hole became a way to structure the findings to show the experience of contemporary peacekeeping. It also became a way for me as researcher to understand in greater depth why these peacekeepers were traumatized and why they were in such great need of healing. The following excerpts will help contextualize the situatedness of contemporary peacekeeping in their own words as much as possible in order to provide a basis from which to consider later on in the chapter how peacekeeping leads to trauma. I will endeavor to show the scenes and the experiences of the peacekeepers prior to, during and after their deployments.The headings within this chapter are themes that I felt were strongly present within the conversations with the peacekeepers and subsequent data analysis.

FALLING DOWN THE RABBIT HOLE: TRANSITIONS IN SITUATEDNESS In the following excerpts, contemporary peacekeepers take us “Down the Rabbit Hole” and offer a glimpse into their journey to the unknown. Peacekeepers described the sudden transitions in situatedness from Canada to their deployments overseas and then back home. They also described the space that they found themselves in overseas. Tim describes his transition in situatedness from Canada to his deployment to Somalia:

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My fiancé and I are driving back from my parent’s place to the base in Petawawa which is a 2 ½ hour drive in a snow storm. My family is waving. I’m leaving tomorrow. The next day we’re on a plane deployed to Africa. We hit the ground first in Mogadishu. As soon as we are off the plane; the place is unreal. The heat hits us like a ton of bricks. We go into the tent dripping wet. I think it is about an hour flight into Beledweyne. I remember flying in there and looking down at the city of Mogadishu. You could tell the utter chaos from the plane alone, just by looking at the city. It is a mess. I’m thinking, well what the heck are we going up to Beledweyne when there’s nothing but disaster down there. Where the hell are we going? We head out and we’re flying into Beledweyne. Now all of a sudden we’re on the ground. The ramp goes down. It’s just like out of a movie. I remember watching the movie Platoon. The ramp goes down and there is dust flying in and that’s what it is like. We’re all loaded up, we climb off the back of the plane and there’s nothing. It’s barren. You see two commandos. They’re all scattered amongst the airfield. We are there to secure this area so they can fly in supplies for the town, and other villages. We are given our areas of responsibility and basically we start digging in. That is our location where we work out of to do patrols into the town and perimeter security of the air field. That’s what we do there for approximately a month. Our first month and a half, we are on the air field living out of our little holes in the ground. You could be out in the middle of nowhere. You think you’re alone. You think there’s like nobody for miles. Five minutes later there’s a guy shows up with a camel. It’s unbelievable. All of a sudden you hear clip clop and where the hell are you coming from? It’s unreal. It’s hard to explain because they’re not quite a village and they’re not even a town. They have small groups of huts. They’re not nomadic. There are family plots or settings. They’re just spotted everywhere and to even parachute into something like that un-noticed it would be impossible.

Tim's sudden transition and contrast in climate from a snow storm in Canada to the dry, hot country of Somalia in Africa, seemed like a bizarre time out of time. He left peacefulness and familiarity for chaos both inside himself and without. It was hard to make sense of going from snow to dust and heat into a hole in the ground. The transitions in situatedness are also transitions for the body. There is a bizarreness about it that almost cut him in two; is he Tim here in Somalia or is he back in Petawawa. For Tim, landing in Somalia was unreal like the movie Platoon. Like Alice, he wonders where he is and literally finds himself living out of a hole in the ground. In contrast to the small holes in the ground, Tim finds that even though it seems to be out in the middle of nowhere from nowhere a man can appear with a camel much like the way the Cheshire cat appears to Alice. It takes time for Tim to adjust to the different landscapes from Canada to Somalia. So much is expected all at once of a peacekeeper to appear in a place in the middle of nowhere, with a camel coming from nowhere which shows his initial experience of dislocation and his immediate need to quickly adjust to his space. As he looks at the commandos, his knowledge of peacekeeping comes to the fore and he is able to put some logic on his placement. And yet, living out of a hole in the ground in order to secure the air field seems futile, Tim notes that in a place so open, it would be impossible to be unnoticed. The hole, rather than offering safety, opens up a whole multitude of complex worlds full of danger. One’s place or situatedness in the world is particularly important to soldiers as where they are located can mean life or death. In All Quiet on the Western Front, Remarque

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(1898/1962) describes the importance of place or lived space to the soldier. Paul the main character speaks: To no man does the earth mean so much as to the soldier. When he presses himself down upon her long and powerfully, when he buries his face and his limbs deep in her from the fear of death by shell-fire, then she is his only friend, his brother, his mother; he stifles his terror and his cries in her silence and security; she shelters him and gives him a new lease of ten seconds of life, receives him again and often forever. (p. 54)

Like Paul in All Quiet on the Western Front, in the next excerpt Tim describes the sense of importance that the environment represents to soldiers on his deployment to Rwanda. The safety and security of lying flat on the earth offers the chance of survival; of life rather than death and is preferable to falling down a hole like Alice or living out of a hole like the one in Somalia. We have all the security around the headquarters sorted out. The trip wires and all that are sorted, put up wire, wire obstacles and fencing and sand bagging and stuff like that, have all that sorted out, have the stadium reinforced, guns set up, fortification set up. So that is secure.

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In contrast to Somalia, Tim describes a sense of security in the closed space of a stadium that the military live in when deployed to Rwanda. The world of peacekeeping demands soldiers to contain their environment by closing off open spaces around them. For a soldier, whether on the front lines, living out of a hole or in a stadium, the sense of the earth as providing shelter as secure space represents safety in an unknown world out there in the middle of nowhere. Being shelled is the main work of the infantry soldier. Everyone has his own way of going about it. In general, it means lying down and contracting your body in as small a space as possible (Simpson, 1972, p.114).

Like Alice’s bodily transformations, soldiers contract their bodies into the lived space as much as possible, as this represents the chance of survival in a dangerous world. The particular place that soldiers find themselves on earth affords them varying degrees of safety and shelter in the unknown worlds that they find themselves confined to during their military service.

In the Rabbit Hole: An Oasis Four days notice and I went to the Gulf War. You don’t know if it’s going to be at a full out war. Is it going to be a peace keeping mission? Cypress is a staging area for all the international forces to go there and move on afterwards. Over the air they announce that the war started, even on the plane there is a mix of tears. We end up spending a couple of days in Cypress. We end up going to Kazar. I don’t know if it is an Arab country, an Afghan country, white or black or nothing. As we’re leaving the airport driving towards what is supposed to be our camp; you could smell the warm air. I don’t know if you’ve ever been down south, it’s

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just like that and it’s pretty peaceful. It just didn’t appear to be a war zone to me. I end up going to the Canadian camp. You can see it’s all bright, surrounded like a ship within an oasis. That’s how beautiful Kazar is.

John talks about the quick transition from Canada to Cypress and then the sudden transition to the Canadian camp in Kazar during the Gulf War. “I shall have to ask them what the name of the country is, you know. Please, Ma'am, is this New Zealand or Australia”? (Carroll, 1865/1992, p. 5). Like Alice, John does not know what type of mission, where he is going or what kind of country or people he will encounter. “She knelt down and looked along the passage into the loveliest garden you ever saw. How she longed to get out of that dark hall, and wander about among those beds of bright flowers and those cool fountains” (Carroll, 1865/1992, p.8). In the middle of the unknown, John, much like Alice, finds unexpected beauty and peace which he describes as an oasis in the midst of war. As a location in space, an oasis is an isolated area of vegetation in a desert, typically surrounding a spring or similar water source. An oasis is also defined as a haven or a shelter serving as a place of safety or sanctuary (Merriam-Webster’s Collegiate Dictionary, 2003). The oasis as a safe place stands in juxtaposed to the war raging outside. The quick transitions to the Gulf War and finding safe places foreshadows what is to come for John on subsequent multiple deployments. After the Gulf War, John describes his sudden transition to the former Yugoslavia. In the following excerpt, he describes the rapid transitions to many different countries on multiple deployments with many different living spaces which are part of the expectation for peacekeeping soldiers.

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What Latitude or Longitude I've Got To? It is shortly when the Balkans had started to erupt, my unit is still in Kingston at the time. The unit had always been asked to be the first one to set up international communications back home and abroad. My boss approaches me with short notice and asks me if I want to go to Bosnia. I am thinking it couldn’t have been any worse than where I had already gone to. He said it would be a blue beret mission. I would get to meet my colleagues for the next six months. I never really knew where Bosnia was. Pre deployment is very limited, no cultural information, nothing. We go to the Toronto airport. We’re on route to Germany to pick up our equipment. You’re at the airport. There are lots of different languages being spoken. Then you see the odd blue beret and multinational forces. Where is Ploce? It is in Croatia. We’re looking at the map. I see it on the map. It’s a nice beach resort. It’s where the Canadian support group starts off their convoys. Our role there is to provide communications for them back to Canada. Their role is actually to deliver supplies to Sarajevo and the other Canadian contingents and the theatre. Ploce is in the southwest along the coast near Mostar. We are there for a couple of weeks. We’re living in a hotel. Although there’s no heat or electricity, we are not actually roughing it. It is pretty good. Three months into my first task, I am asked to take over a communications position in Visoko. You can hear 50 caliber machine guns firing. I work 18 hours a day. You either pass out or you drink to take the edge off. Where I work is probably about the size of this office. Where we, the 6-7 guys rest, there are probably 20, 20x20 room with a TV. That’s where you could sit and watch movies and stuff, eating whenever we go to the mess hall. It could involve walking outside. So we didn’t eat that well either. It is confined space. But it feels safe.

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Once again, John is rapidly thrust down the rabbit hole into another unknown land with an unknown culture. John resorts to a map much like Alice who wonders what “Latitude or Longitude I've got to? (p. 5). John locates his situatedness on the map realizing that he is in a beach resort town. Is Ploce another oasis amidst the world of peacekeeping? Here he finds himself living in a sea side resort hotel with his fellow peacekeepers in sharp contrast to the violent world outside. Peacekeepers find themselves living in very austere conditions from a hole in the ground to a sea side resort hotel with no heat or electricity to a small confined office in a place called Visoko. No matter where they land, peacekeepers are trained to seek out safe places in their new environment. The small confined space of the office is John’s oasis where he feels safe from the world outside where machine guns are firing.

Jumping into the Hell Hole

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I am at a meeting with a deputy chief of defense. He says there is a flight leaving Friday from Trenton, get yourself on the plane over there and help Romeo Dallaire out. Between Wednesday and Friday nobody takes me aside and says listen, you’re about to jump into a hell hole there. Are you sure you’re up to this? Nobody tells. I am totally oblivious. So I go. Now with hind sight, I remember all these moments thinking that wasn’t good, that’s bad, that’s really bad, that’s not so bad, that’s worse. If only we had been educated. If only we had known a little bit. We probably would have processed the information differently, processed the experience differently, talked about it there as opposed to pretending nothing happened. It is kind of a culture shock for me to be told on a Wednesday to go to Rwanda. I leave on a Friday. I arrive there on a Sunday and within three days I’m sleeping in a refugee camp where people are dying. There’s shit everywhere. I’m thinking, what the hell! So there are dead rats everywhere. I’m thinking, I’m used to austere conditions but this is pretty awful.

Simon describes his quick transition from a meeting in Canada to a refugee camp in Rwanda. His deployment to Rwanda is similar to Tim and Johns’ deployments as there was little time or preparation to adjust to this unknown country and culture. Lived space is always a combination of external space and inner mental space, actuality and mental projection. In experiencing lived space, memory and dream, fear and desire, value and meaning, fuse with the actual perception (Pallasmaa, 2000). Simon’s inner mental space contains memories of bad and worse moments. For Simon, the external space of going down the rabbit hole which is Rwanda is like jumping into a ‘hell hole’. What is a hell hole? To Simon, it is a place he had never experienced before in his life as a peacekeeper. Like Alice, the dimensions and conditions of the space were to him unthinkable prior to his arrival in Rwanda. Would some preparation or education about Rwanda have helped him to perceive the experience differently? Lived space is space that is inseparably integrated with the person’s concurrent life situation (Pallasmaa, 2000). An expectation of peacekeeping is living in spaces with austere conditions. However, the transition from the drastically different current life situation of Canada to the conditions of a refugee camp in Rwanda is a culture shock that is ‘awful’ even for a soldier.

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Going to the Hobbit House

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There are people living at the top of this mountain in mud huts with straw thatched roofs! It looked like Lord of the Rings. We are going to the hobbit’s house. That’s exactly what it looked like. I thought oh my God, where the hell are we! This mountain road all the way up into this little village is a goat trail. No railing and there’s a sheer drop. It plummets down. Transport trucks are down there that had gone over the edge. You could see them. I can’t even believe they tried to get through here. I’m in the passenger seat. My view is straight down. I’ve pictures of when we finally got to the end of this mountain. You could see down from this bridge that we had to go across. You were like a kilometer up in the air. It’s like you were in an airplane taking a picture. Getting into the camp, I realize we’re going to live in this big warehouse for six months. We sleep on cots with no mattresses which are very uncomfortable. I wake up each morning with severe pain in my back. We live in a 4 x 6 probably 4 x 8 area of a tent. We are allowed to put up partitions. So we have some privacy. This is our spot for six months.

James speaks about the transition from his life style in Canada to the austere living conditions in the former Yugoslavia. Like Alice, James has to adapt to a very different environment than his own. He is dislocated by the situatedness of people who live in mud huts with thatched roofs. James can only make sense of his location by equating his situatedness with the hobbit’s house in the movie Lord of the Rings. Etymologically, the word “hobbitt” is referred to as the “kuduk” which is a worn –down form of “k^ud-d^ukan” (“holedweller”) by the folk of the Shire and Bree (Skeat, 1983, p. 284). Although the hobbit house is from a movie based on a fictional series of books, James connects himself to the very real danger of a mountain road with no railings where trucks can been seen that have fallen over the edge. His hobbit house is the small confined space in a ware house of the military camp in this unknown world. James describes how his body felt living in this small confined space. Lived space is not uniform, valueless space. These images of places are not detached pictorial images; they are experiences of embodied and lived space (Pallasmaa, 2000). Lived space is felt space. These places carry significant meanings for the peacekeepers which stay with them upon their return home. Much like Alice’s bodily transformations, peacekeepers have to transform themselves to fit the lived spaces of their deployments.

The Caucus Race We have about two weeks to go from peacekeeping to peacemaking. You have an Airborne Regiment that’s trained for months and months and months to do a very specific job in a specific way. Our equipment is packed and already at sea. We’re ready to go. The minister announces literally, and this is a professional army, we are told by message to all meet in this room in Petawawa. A big screen TV is set up. We are learning at the same time as our government what the new orders are. They announce that Canada is sending like 820 men as part of the American coalition. That’s where we learn what we are going to do. There is no recognizance. We have never been to where we are going to go. No maps, nothing. It means no blue beret, no handing out candy to little kids, no peacekeeping; this is peacemaking which is a huge difference. Literally you left Petawawa one morning, two days later you’re walking this line in Bosnia or Somalia.

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Susan L. Ray I remember lying on the ground in Somalia hearing shots going over my head. I thought where am I? Like its December and I just left Petawawa. Now it’s 120 degrees and I’m lying on the tarmac. I had gone through all the briefings. I remember I was only six months from my return from Somalia to my standing in Yugoslavia.

Matt talks about the quick transition from a peacekeeping to a peacemaking mission in Somalia. Much like Alice’s bodily transformations, peacekeepers have to quickly transform themselves from a peacekeeping force to a peacemaking force in order to adapt to the political situation of their government. The Caucus Race in Alice parodies political process: the participants run around in confused circles, never accomplishing anything (Carroll, 1865/2000). If we can take Alice as a symbol for the average citizen, we see that the Race does very little to benefit her. Likewise, the political process in Canada regarding peacekeeping missions did little to benefit the soldiers as last minute plans are made by the government as to where they are going and as to what type of mission they are assigned. Consequently, Matt describes his dislocation from peacekeeper to peacemaker with no map to situate either his new role or his new location. Emerging from his situatedness is the common peacekeeping expression of where am I? Peacekeepers describe constantly being on call. When the world situation changes, the government responds and the peacekeepers must be ready.

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The Rabbit Hole: Sights, Sounds and Smells There’s preparation prior to the deployment. However, there is nothing to really prepare you for what you are going to see. It is getting the mine field drills down, because that is our primary role, de-mining and bomb disposal. There is a lot of concentrated training in those aspects. You are not really prepared or you are sort of semi-prepared for the culture. However, for the most part nothing to really prepare you for those sounds those smells and that type of situation. You are usually two vehicles out in the middle of nowhere on the frontier where all the fighting is. There are a lot of mines. There is a lot of stuff going on.

Peter describes the transition from Canada to the former Yugoslavia. For Peter, the preparation overseas is limited to their soldiering duties of mine field drills, de-mining and bomb disposal. There is limited preparation about the culture with no preparation for what they are going to see, hear or smell. Peter describes his location as being out in the middle of nowhere; where there is a sense of danger. The frontier is open and dangerous for peacekeepers. There is no small safe confined space here. We can see that these lived spaces of peacekeeping have their specific temperature and odor. We can sense the texture and echo of these places that continue to haunt the peacekeepers long after they return home.

Debriefing the Rabbit Hole: The Pits Pre-deployment is the “pits”. Just prior to coming back to Canada, a couple of social workers come over and give us a “debriefing” of about 1 ½ hours. That is it. I fly back to Halifax.

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Mary describes her pre-deployment transition from Canada to the former Yugoslavia and her transition back to Canada. In Alice’s Adventures in Wonderland, Alice suddenly wakes up from her dream and finds herself lying on the bank with her head in the lap of her sister. Like Alice, Mary’s transition home is quick and sudden with little time to “debrief” what she has experienced overseas. Her traumatic experiences overseas are given no more than one and a half hours for expression which in turn gives new meaning to the word “debrief” or be brief? What about the other soldiers’ transition of coming home from their peacekeeping deployments?

Debriefing the Rabbit Hole: The Old Vets

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You have a debriefing package handed to you on an airplane. Here’s what the country is saying about you. I remember you get out, cleared customs, get on a bus, home. One of the other officers on the camp had bought me a six pack of beer, a quart of milk and a loaf of bread, and that is in my fridge. We do it too quickly. Traditional warfare only puts soldiers in harm’s way once in a while. Old vets will say we were called to the front line, like particularly the World War II and Korea; we spent 2-3 weeks of action, where we knew the enemy was there and then we came back in a safe place. Now there are no safe places. Coming back means coming home to Canada. It was a global war. I talk to old vets. I like military history. You may have left Canada in 1940; you didn’t get overseas, like into France until 1944 for three years. The coming home; there’s great stories written about demobilization of troops. They had to go by train from Europe to England. The old boys, the troop ships home, that’s where they settled all their scores. Like all the little petty arguments got solved on the ships. It was a spiritual journey, a psychological journey, an emotional journey.

Matt’s transition home is much like the transition from Canada to his deployments overseas. In both cases, Matt describes these transitions as too quick occurring in days and sometimes in hours. He contrasts his going overseas and coming home with the experiences of the veterans from World War II and Korea. The old veterans’ transition to the front lines in France occurred after four years of training in England. Matt emphasizes the importance of a safe place which the old veterans had overseas after serving on the front lines for two to three weeks at a time. This is in sharp contrast to the experiences of the peacekeepers that have no real sense of a safe place behind the front lines. There are no front lines as peacekeepers are always in the middle of the action while serving on their deployments overseas. For peacekeepers a safe place only really occurs upon their return to Canada. Or does it? Peacekeepers have no time to discuss their traumatic experiences with each other while journeying back home. Consequently, they carry their experiences with them even after their return to Canadian soil. For the old veterans like Alice down the rabbit hole, their deployment overseas and back home is seen as a spiritual, psychological and emotional journey as they have time to work through their experiences with each other. The importance of transition from place to place for soldiers and in particular from a war zone to home has been expressed by Shay (1994):

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Susan L. Ray Soldiers in World War II spent weeks or months with their units after fighting ended and universally returned by boat. The ‘long trip home’ is generally credited as an opportunity for mutual support and communal reworking of combat trauma. (p.61)

The long journey home is a time of transition whereby the old veterans can begin to work through the emotional and psychological turmoil of combat trauma. In modern times, the journey home is cut short making it more difficult for peacekeepers to adjust to coming back and being back at home. We can hear Matt’s longing to have this type of spiritual, psychological and emotional journey home.

Too Radical Extremes

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We laughed at the Americans coming home from Viet Nam. They would bring 2-3 people home at a time, piece meal, and big problems. A young reservist is sent back from Bosnia where he finishes his tour. So what does he do? He is home a week. He puts a rifle in his mouth and he pulls the trigger. No one understood what he had been through. He had no one to talk to. He went from like I’m in my unit in this country at war, and now I’m in Prince Albert, Saskatchewan. It is too radical extremes.

Matt foreshadows one of the consequences of a quick transition home from the war zone of Bosnia by discussing the transition home of Viet Nam veterans who were quietly and quickly brought back from overseas two to three soldiers at a time. Big problems occurred with Viet Nam veterans which Matt does not elaborate upon. Instead he describes the suicide of a young reservist brought home too quickly with no time to discuss what he went through in the war zone of Bosnia. For one young reservist, it is an extreme radical transition from Bosnia to his post in Prince Albert, Saskatchewan. Suicide is only one of the many consequences of the extreme radical transition from a peacekeeping deployment to a military base back in Canada. There are many suicides of fellow peacekeeping soldiers that took place both overseas and upon their return home. We will return to the discussion of suicide later on in this chapter.

THE MILITARY FAMILY It’s made to be your family. For instance, when you join the army you join a regimental family. The commanding officer is very much seen as the father figure. Your status with the family is very keenly determined in a very closely watched hierarchal structure. The benefit of being supportive of the structure is pretty obvious. You are promoted. You get good courses. The determinant of course of not following the hierarchal structure means you’re disciplined socially. It is very much like a family. I think for the A type personalities that join, I mean they feed on the positive and the negative reinforcement, that it can give and that they can give.

Matt reveals to us that being in the world of peacekeeping requires the soldier to become part of the military family. In the beginning, the social horizon of the soldier encompasses not only his/her family and other civilian ties, but also all those military formations such as the

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regiment to which he/she belong (Shay, 1994). However, to become a soldier means to become a loyal family member supportive of a hierarchal structure with father figures in command and discipline based on positive rewards or negative reinforcement. The danger of these types of deployments commands this type of loyalty that resembles family loyalty. Over time loyalty to the military family deepens and ties to a soldier’s family of origin lessen as shown by the following excerpts.

The Strings to Your Family Are Undone When you grow up you have attachments and strings to your parents and strings to your siblings and strings to your friends at school, etc. When you get into the military those strings are all undone or detached. The military wants you to sever all those strings and be part of the military family. They in essence become your pseudo-family. In essence the military is your family.

Peter describes the severing of attachments and strings to his non military family of parents, siblings and friends. The military family demands a type of loyalty that requires soldiers to detach from their families and friends at home. Over time, some peacekeeping soldiers lose responsiveness to the claims of any bonds, ideals, or loyalties outside a tiny circle of immediate comrades (Shay, 1994). This detachment from family and families can cause many problems for returning peacekeepers. Over time, a soldiers’ loyalty to their military family and to each other deepens even more as shown by the following excerpt.

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Tightening of the Military Family Bond We were pretty tight in Rwanda. On both those tours because in Rwanda in those platoons a lot of the guys that I went with in Rwanda were also the same guys that I went with in Somalia. Some of the guys were new. We all still bonded like a really tight family. The guys would do anything for each other.

Tim describes the tightening of his social horizon to a bond that resembles a really tight family that develops among peacekeeping soldiers that serve together on many deployments. Once overseas, the bond tightens to a tiny circle of immediate comrades who serve together in dangerous and unknown places as revealed in the previous excerpts on situatedness. The deep bond that develops over time is described as the Band of Brothers by the peacekeepers themselves and throughout history in literary sources as shown in the following excerpts. To deepen our understanding of the Band of Brothers, we will turn now to explore how soldiers in the military family bond together like brothers and how the military family grieves the loss of their brothers.

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THE CENTRALITY OF BROTHERHOOD AND GRIEVING LOSS IN THE MILITARY FAMILY It’s that band of brothers’ kind of closeness. You have to realize what the environment is like. It’s like being incarcerated; having not committed a crime. Your whole squadron lives in a carpet factory with rows of tents. You live, breath, eat and sleep army guy stuff, 24 hours a day, in a very close environment.

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Being in the world of peacekeeping, involves a bonding together that Luke describes as a Band of Brothers. In particular, he relates the connectedness to the closely lived shared space of the environment where soldiers find themselves together around the clock on deployments overseas. Much like an incarcerated prisoner, there is a commitment to this closely lived space of contemporary peacekeeping that does not end until their time has been served. The closely lived space of peacekeeping provides varying degrees of safety as well as the felt space of closeness to each other. The expression Band of Brothers has transcended time and thus, is a common term expressed throughout history by soldiers serving together. Where does the expression the Band of Brothers come from? Turning to the literature will bring us closer to understanding the expression the Band of Brothers. The expression Band of Brothers comes from a speech delivered by Henry V of England before the Battle of Agincourt between England and France fought on the feast of Saint Crispin in Henry V; Act IV, Scene 3, lines 57- 67, p.532 by Shakespeare (1623/1973): And Crispin Crispian shall ne’er go by, From this day to the ending of the world, But we in it shall be remember’d; We few, we happy few, we band of brothers; For he to-day that sheds his blood with me Shall be my brother; be he ne’er so vile, This day shall gentle his condition: And gentlemen in England now a-bed Shall think themselves accursed they were not here, And hold their manhood’s cheap whiles any speaks That fought with us upon St. Crispin’s day.

Confronted with the shedding of their blood, injury and death, soldiers are banded together like brothers in a way that ordinary civilians sleeping in their beds will never experience. Tim below takes us closer for a deeper understanding of the Band of Brothers felt by soldiers serving together in Somalia.

My Brothers: Closer than My Own Brother When we left Canada, we were tight on those operations. Those guys are my brothers now. We stay in touch. We’re so dispersed and scattered throughout the country. When I bump into these guys, I say they’re my brothers. We hug each other, go out for a beer, eat and go to my house. We’re brothers, when you share experiences like that. These guys would die

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for me. I’d die for them. We know it’s so true. I’m closer to these guys than I am my own brother because you’ve shared life and death with these guys. One particular day, we went out to investigate roadblocks and this brotherhood thing became so true. It really hit me. I would die for any guy in my platoon. I’d risk my life for them. My vehicle had been put in reserve over in this area. The other three vehicles came under fire. There was an immediate order to dismount and to move up as soon as these guys came under fire. We didn’t think twice. You would think that holy shit we’re going to get killed. There was none of that. The guys are getting shot at. Let’s go. All I wanted to do was get out of the vehicle and get up there. I mean that feeling; our brothers could be getting killed up there. We didn’t even know where the platoon was, and since we were in reserve, we were trying to push ourselves up high enough to find the platoon. We finally linked up with them and found out everybody was okay. You guys are all right. It’s all I could think about; I was just looking to my left and right making sure that we’re still alive. I didn’t care about myself. Is everybody okay? Every soldier wants to know how he’s going to react under fire. Now I know. That’s a big thing for every soldier. No matter what happens, I’m not going to worry about myself. I’m worried about that guy left and right of me. I know they’re going to do the same for me. Because the whole time, the guys left and right of me were making sure I was okay. That’s the person you are and they definitely don’t teach that. We’re all back together and it’s like, good work guys, good work.

Tim describes the kind of brotherhood that is experienced by soldiers that serve together. It is a Band of Brothers that tightens over time especially when they confront life and death together overseas. Tim describes one experience where the Band of Brothers comes alive and holds to be true. Once they face possible death, the soldiers’ band together to risk their own lives for each other. They would die for each other without hesitation. The self sacrifice of soldiers is part of their intrinsic nature that is greater than any training that their military family could ever provide. This type of bond is particular to soldiers who live closely together and face life and death situations on a daily basis. It is a bond that is closer than the bond or brotherhood between blood brothers and a bond that remains even after their return home. In the book All Quiet on the Western Front by Erich Maria Remarque (1898/1962), Paul the main character has a panic attack hiding in a shell hole. He should be moving forward, but he is too fearful. Then he hears the voices of his friends moving along the trench. This restores his courage. His thoughts at that point sum up the Band of Brothers felt by soldiers serving together. At once a new warmth flows through me. These voices, these few quiet words, these footsteps in the trench behind me recall me at a bound from the terrible loneliness and fear of death by which I had been almost destroyed. They are more to me than life, these voices, they are more than motherliness and more than fear; they are the strongest, most comforting thing there is anywhere: they are the voices of my comrades. (p. 216)

Like Tim, Paul’s comrades in All Quiet on the Western Front mean more to him at this moment than life, motherliness and fear. Their voices, words and footsteps are the most comforting because they are his comrades. Combat whether in war or on peacekeeping deployments calls forth “a passion of care among the men who fight beside each other that is comparable to the earliest and most deeply felt family relationships” (Shay, 1994, p.39). This type of brotherhood propels the soldier forward into possible death. Further moments of peacekeeping are explored to deepen our understanding of the Band of Brothers.

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That Was a Pretty Glorious Moment

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On another convoy, this is an ironic one, but one of our flatbed trucks broke down. I was on top of the trailer helping guys that trained. There was a British soldier who said to me in his British accent, do I know you? I don’t think so. He said I know you. We met in Ottawa. It was an actual fact. I had met this guy two years ago. We were here together. That was a pretty glorious moment. We were just shooting the shit. Then we heard pa-ting. I said what the hell was that? There was another ping, ting, and ting. It was a sniper shooting at him and me. We jumped about 20 feet to the ground and huddled up in the corner. The British soldiers went out and actually counter attacked his point. So here we were lying on the ground and almost ignoring the fact that somebody just tried to kill us, laughing about what was going on. I remember this Spanish UN tank came to our rescue. This big bearded Spaniard reaches down and gives me his hand. Are you okay? In this big deep voice, he goes don’t worry about it; we’ll take care of you from here on. My friend and I had gone all through this together; a bond like brothers. We got to the airport and that was the last time I saw him. He just disappeared off the face of the earth. I often wonder how he’s doing.

John describes three separate incidences of the kind of bond that develops between soldiers deployed overseas. In the first two incidences, there is the recognition of each other as fellow soldiers that transcends their countries of origins even when situated together in dangerous conditions. How bizarre that they laugh together in the face of possible death. This seems incongruent to us, yet not to fellow soldiers. These soldiers from different places in the world bond together and risk their lives for one another. Ironically, despite the bond like brothers, many do not meet each other often and once their service is over many never see each other again. However, there is a continuation of the bond among soldiers as they wonder often how their brothers are doing long after their military service is over. In All Quiet on the Western Front, Remarque (1898/1962) portrays the intense bonds of loyalty and friendship that spring up among the living soldiers, as a result of the shared experience of war. According to Remarque (1898/1962), these feelings towards each other are virtually the only emotions that preserve the soldiers’ fundamental humanity. We are soldiers. It is a great brotherhood, which adds something of the good-fellowship of the folk-song, of the feeling of solidarity of convicts, and of the desperate loyalty to one another of men condemned to death, to a condition of life arising out of the midst of danger, out of the tension and forlornness of death. (p.191)

The Band of Brothers emerges from a life that is lived together under the constant tension and possibility of death created by war and peacekeeping conflicts. Combat and peacekeeping deployments bond men together in a passion of care that the word brother only partly captures (Shay, 1994). It is a bond that transcends time across the generations of soldiers. The following excerpt will deepen our understanding of the Band of Brothers that transcends time across the generations of soldiers.

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It is All So Connected, the Old Vets, the Old War and the More Recent Ones I’m going to stand in the ranks with the other vets at the cenotaph. Well they’re older than you. It doesn’t matter. You know that line, age will not weary them. So I said no. I’m going to stand with the other veterans. They had their service at like 11:30 because they wanted to watch the one on TV from Ottawa. The woman on TV is a silver cross mother that I had anointed her son when he was dying. I’ve never seen his mother before. I thought that’s what she looks like. She could be my mother. At that moment that I saw her it struck me that it’s all so connected. It is all so connected and all interwoven, the old vets, the old war and the more recent ones and all just as stupid.

Back in Canada, Matt, a Catholic priest, is asked to perform a Remembrance Day service at the village cenotaph. The Band of Brothers is a connectedness to each other that transcends from one generation to another generation of soldiers and from war to peacekeeping deployments. Therefore, Matt is compelled to stand with the older veterans from the past wars. On TV, Matt realizes that the silver cross mother is the mother of a soldier that he had given last rites to overseas. He wrote her a letter upon the return of her son’s body. The mother sent him a lovely letter but he had never seen her. Seeing her face, reminds Matt of the bond among mothers across the generations who have lost their children to war and peacekeeping missions. She could have been any one of these mothers even his own. For Matt, the Band of Brothers connects the mothers, the old veterans, the old war and the more recent ones. Is their bond to each other so profound because of the experiences they have endured and have been unable to express to others? What happens when a brother soldier dies? What is the experience of losing one of the Band of Brothers?

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Suicide of a Brother in the Military Family All of a sudden we heard this shot. When I got there, he was sliding off the wall. The first thing I said was holy shit, this guy’s had it. I didn’t know who it was. He was in civvies at the time. So we couldn’t identify him. A medic on duty said to give us a hand. The other guy gave me a couple of field bandages. I started wrapping them around his head. All you heard was his body going through its reactions and stuff. I’m constantly checking the time and then trying to hold him. I still didn’t recognize him. My mind was playing tricks on me because I’m actually seeing things. I recognized his Airborne tattoos, Rolex watch and his actual shirt. I didn’t put it all together. His body was still. He put a bullet through his head. It’s 5:04 in the morning. We got to make a call here. He’s lying on a piece of concrete that had nothing but blood. It was probably 2 liters of blood draining out of his body. The ambulance backs up and a stretcher comes out. Half his head is gone. Somebody mentions that it is____. I said it wasn’t. I went to his bed. His weapon was gone. I ran down to the med station. I just realized holy shit that was him. The watch and the tattoo and all that started to come back. I asked if I could get in the ambulance and say a few words or whatever to him. I barely recognized him. He was totally white. I guess about an hour later I called my mom. I told her that one of my best friends died. I was a basket case that day. To this day I wonder if maybe I had had a couple beers with him maybe I could have prevented him from or at least maybe suspended it for a little while. We really didn’t get a chance to say goodbye. When we loaded him on the plane we gave him an honor guard in that way we did.

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Tim describes the traumatizing experience of the suicide of one of his brother soldiers who shoots himself on Christmas Eve during his deployment to Rwanda. His friend asks Tim to go to the bleachers have a few drinks and talk. Instead Tim decides to go for a drink with female soldiers next door. To this day, Tim questions whether or not he could have prevented or suspended for awhile his friend’s suicide if he had gone to the bleachers with him. The responsibility of looking out for each other in times of danger extends into looking out for each other at all times. The consequences of such responsibility can be a heavy burden for the soldier left standing long after the death of one of his brothers. The loss of a comrade, a brother has a profound effect on their fellow soldiers. Shay explains: “the particularity of the person, the specialness of the special comrade, who has died, comes not from objectively unique traits but from the movement of the soul that we properly call love” (1994, p.44). It is difficult for ordinary civilians to understand this type of special relationship among soldiers. The Band of Brothers bonds soldiers together as they face possible injury and death during peacekeeping deployments. Thus, the death of a brother soldier either by his/her own hands or by someone else can be as traumatizing as witnessing death by genocide, ethnic cleansing or famine. How does the military family respond to the suicide of one of their brother soldiers?

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Suicide in the Family: The Military Response One of our fellows killed himself on his third tour. He put a grenade down his flack vest and laid on it. He had 3.5 seconds to figure out what you’re going to do for the rest of your life. It was very effective. He killed himself in the front of the building. The rest of his section was on top of a building, a bunker, looking over no-man’s land, over the zone. They heard the explosion. They realized something was wrong when they saw the back panel of his flack vest with his spine and rib cage intact on the roof with them. I was asked to go give last rites and then to do grieve counseling with the troops. In charge of our contingent was a Canadian General who said this guy gets no funeral like other soldiers because he lacked moral fiber. If the unit wanted to do something they could, so of course we did. As a General, he was given the meritorious service cross for his service. Then promoted and sent back to Canada. People like that don’t deserve the dignity of a salute. They don’t deserve the respect of their peers. There’s no integrity. There are things that people do in their life that they’re not very proud of and that’s part of the human condition. We have a dark side and a light side. The man, who holds himself up saying, no, when he could have said nothing, had his own personal beliefs about why someone took their life. All he had to do was shut up for two more days and that’s a Canadian. Oh yes, this is 50 years after the end of World War II.This is in 1994.

Matt describes the traumatizing experience of the suicide of one of his brother soldiers serving in the former Yugoslavia. The loyalty of soldiers towards their military family is not returned when one of their brothers commits suicide. Instead, the brother soldier is not given a military funeral which would have been “what’s right” in the eyes of his brother soldiers. The ancient Greek word of “what’s right” called themis means moral order, convention, normative expectations, ethics, and commonly understood social values (Shay, 1994). Themis or “what’s right” captures the scope of the betrayal felt by many contemporary peacekeepers in many different situations. In this situation, there is a betrayal of the soldiers’ expectation of

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the moral and ethical duty to provide a military funeral to honor their brother. This expectation is denied by their General who is one of the holders in the military hierarchy of responsibility and trust. To add insult to injury, the General is promoted and given an award for his service. His lack of understanding of suicide which he equates to a lack of moral fiber only enhances a sense of betrayal and subsequent anger that emerges towards him. The refusal of the military family to honor the death of brother soldiers who committed suicide and the treatment by the military family towards the Airborne Regiment and those traumatized soldiers who survived their deployments inflicted manifold injuries upon them. We will turn now to the experience of those peacekeepers who served together as brother soldiers in the Airborne Regiment to deepen our understanding of their sense of betrayal.

The Airborne Disbanded: They Ripped Your Family Away

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When the Airborne disbanded, that was a rough, tough time. That was a big traumatic experience. It is a family. They ripped your family away from you. A lot of guys feel that way. We had something that we worked for our whole lives and we were totally proud of and we would have died for. Every one of us would have given our lives for it. Then the government just says F you, thanks, but no thanks. I can tell you that sticks with a lot of guys. A lot of them never let go of it. It’s been very difficult. I can tell you that much.

Tim describes the disbanding of the AirBorne Regiment by the government upon their return to Canada from their deployment overseas in Somalia. It was a family within a military family that was suddenly ripped away from these soldiers. The Airborne Regiment requires special training and dedication on the part of their soldiers. The disbandment of the Airborne Regiment was a difficult traumatic experience and a great loss for the members of this particular regiment of the military family. It is another type of death and betrayal or an injustice for the soldiers who served in the elite Airborne Regiment. Many of the peacekeepers have difficulty accepting and resolving this decision by the government because of their pride and willingness to die for their Regiment. In my practice, I have witnessed both the sense of pride shared by all of the soldiers trained to serve in this elite force as well as the sense of betrayal from both their military family and the government for disbanding the Airborne Regiment for the behaviour of two soldiers.

The Airborne Is Bad: That’s Your Family We came home on a jet and had a debriefing in Ottawa. It was all timed as we landed in Ottawa after that evening’s paper had been published. You cleared customs in Ottawa and then got on school buses and drove to Petawawa. There was a Canadian general that met us there. He said well for the most part you did a good job; keep a low profile, stay out of the lime light and this will all blow over. There could not have been a more humiliating experience. The media said the Regiment was not focused, useless, a failure, no good and bad. That’s your family. It’s not like you joined the army. You joined the airborne. You had to volunteer twice and go through all this special training. And good troops, good soldiers! And then you come home and oh you’re a

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Matt describes his return home to Canada from Somalia as a member of the Airborne Regiment. Their return is shrouded in secrecy and shame which is reinforced by one of their leaders in the military hierarchy. Instead of taking pride in this special Regiment within the military family, the military leader reinforces the negative press about the Airborne by informing the soldiers to stay hidden. Instead of pride, we can sense Matt’s humiliation and rage towards another leader in the military family who has betrayed the Regiment. Also, there is a sense of betrayal by the Canadian media. The negative portrayal by the media is especially difficult because the Airborne is his family, and in reality these are good soldiers that volunteer twice and go through special training. The harsh treatment of disbanding the Airborne Regiment for the actions of two soldiers is an injustice felt by Matt and the others soldiers who opened schools, and built bridges and roads that weren’t even part of their mandate. The Americans sent their military personnel there to observe how the Regiment was so successful in providing these humanitarian efforts. Why was this never portrayed in the media? The military justice system was never allowed to work in regards to the murder of a Somali prisoner. Why? Instead, the government set up the Somalia Inquiry.

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The Somalia Inquiry: They Disbanded the Airborne I spent a big chunk of my time at the Somalia inquiry that ended when they found out that it wasn’t so much the unit that was to blame, but the government who didn’t do things like orders and counsel and debates by parliament. All the checks and controls that parliament is supposed to make sure these things never happen didn’t happen. Surprisingly they disbanded the airborne rather than fix the problem of the chain of command and why parliament didn’t do their job.

Matt describes the Somalia Inquiry, which ended when it was realized that the chain of command and the government were to blame for not providing the checks and balances, rather than the Airborne Regiment. These processes insure that decisions made by the government and the chain of command, such as turning a peacemaking force like the elite Airborne Regiment into a peacekeeping mission, do not happen. The failure to fix both the chain of command and the government for not doing their job is not addressed. There is another betrayal of themis or “what’s right” as instead of blaming the chain of command and the government, the Airborne Regiment is made to play the scapegoat by the powers in both the military and the government hierarchy. In the following excerpt, Matt describes another situation in regards to the Airborne Regiment which only heightens his anger and sense of betrayal.

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Adding Insult to Injury The Somalis were fueling it too. We’re walking towards the Chateau Laurier past the National War Monument. It is crowded with Somalis. They are climbing all over it with big signs that say stop the war criminals, Canadians hate us. All the places you can protest in the world and I’m the first one to say that freedom of speech is something that I may not like what people say, but you can say it, but not on this place. It adds insult to injury. You can pick a thousand other pieces of real estate in Ottawa, but not the National War Memorial. The front lawn of parliament hill! Lobby the Canadian Broadcasting Corporation. Front door of the governor general’s house, the lawn of the Prime Minister’s house.

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Matt describes his deepening anger when there is an added insult to the injury inflicted when the government disbanded the Airborne Regiment. Although, he values freedom of speech, Matt would prefer that the Somalis protest anywhere else such as in places of government or the media. Much competes in this situation in terms of betrayal of themis or doing “what’s right”. The Somalis are situated at a sacred place, where Canadians come to honor their soldiers who died while serving in the wars overseas. Such dishonor towards his fallen dead brother soldiers adds further insult to his already injured sense of justice. Further insult and betrayal is fueled by the Somalis who dishonor the Airborne Regiment by calling them war criminals, when in actuality the vast majority of soldiers assisted them in providing humanitarian efforts to improve the conditions of their country. The war criminals, or those who should take responsibility, reside in the places of government and the media. These places would be more fitting for the Somalis to protest and lay blame. By blaming the Airborne Regiment, the chain of command and the government have left the Airborne Regiment alone to face a very humiliating public display by the Somalis. This sense of betrayal upon betrayal, humiliation and shame only heightens the anger and eventually, the trauma of Matt and the soldiers from the former Airborne Regiment who are sent to other units and redeployed overseas.

Shunned: Another Stigma Attached There was a big chunk of the guys on my tour in Yugoslavia; all of us had come from Somalia. On the uniform you wear the badge that you wore in the Airborne Regiment, your wings. You’d see it on parade. We’d all know one another. You look at the badge and the guy would look at your badge and go oh, you were in Somalia. Oh, like shunned. There’s another stigma attached.

Matt describes what happens to former Airborne Regiment soldiers who are re-deployed overseas. Once disbanded, the Airborne Regiment soldiers are dispersed among other regiments. Many are sent overseas to the tour in Yugoslavia. They are still recognizable as a former Airborne Regiment member as they proudly wear the wings on their uniforms. When other soldiers who did not serve in the Airborne Regiment recognize a former Airborne Regiment member, they shun them. Another sense of betrayal and isolation is added from within their own military family by their own brother soldiers. This sense of betrayal adds another layer of stigma that had already been dealt to them by their military leaders, the Canadian government, the media and the Somalis. In the following excerpt, Peter describes

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his anger, sense of betrayal and subsequent mistrust of the government on deployments following the disbandment of the Airborne Regiment.

The Government Has Washed Their Hands of Me

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I mean look at the Somalia affair. The government ran down the Airborne Regiment. A lot of people hung for that but nobody in the government. The bottom line is who actually made the decision to send the Airborne in? It was the government. What was the Airborne Regiment actually going to do? They were designed to be inserted behind enemy lines and cause as much damage and as much chaos as humanly possible. These guys are motivated, self sufficient, trained killing machines. All of a sudden you say take off your maroon beret, put on a blue beret and do a peacekeeping mission. It was the wrong unit, it was the wrong situation, and the government didn’t take any hits for that. They were the ones that actually put the rubber stamp on sending them in there. When I step off the plane and on to the tarmac of where ever I am, I know, my government has basically washed their hands of me.

Peter describes his reaction to the disbanding of the Airborne Regiment by the Canadian government. He is trying to understand and review what happened to the Airborne Regiment. Once again, the political process, much like the Caucus Race in Alice, did little to benefit the soldiers. The last minute plans by the government to send the Airborne Regiment into Somalia and to change their mission from peacemaking to peacekeeping has a profound and deadly impact on this elite unit. This experience has left Peter with the belief that no matter where or when soldiers are sent on deployments, the government will not support them or take any responsibility for their service. Soldiers are at the mercy of government decisions which then can lead to traumatization by their military family. A profound sense of betrayal and anger towards the government emerges from these loyal soldiers who are so willing to risk their lives for their country. At the end of the Caucus Race, Alice is forced to give everyone a prize. Eventually, the government is embarrassed and forced into giving the disbanded Airborne Regiment soldiers a medal in recognition of their service in Somalia. How do the former members of the Airborne Regiment respond to the recognition by their government for their service in Somalia?

The Government Is Embarrassed into Giving a Medal: Recognized, Not Recognized Canada issues medals every time it sends troops over seas. For Somalia it didn’t happen. The military is arguing look, you sent an expeditionary force overseas like we did in World War I, World War II and Korea. This is the same thing. Our practice is that we give a medal. We’re disbanding the unit and we’re supposed to give them all a medal? Wouldn’t that look stupid? The soldiers started to publish here’s what happened, it wasn’t the soldiers, our government has a chain of command from the Governor General to the Prime Minister, all the way down that says no one cabinet minister can send the military overseas. And this time it didn’t. The government is embarrassed into giving you medals. It’s the first time Canada has ever issued a medal for a campaign that there was a means test. Somalia is the only one that

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puts the word honorable service. For Somalia, they make a point of saying this is the only medal we ever minted that has the word honorable. It’s a medal, an original award that comes from the Queen in recognition of your service in the name of your country. You don’t know who got it until you’re in your dress uniform and you see other guys. Oh, you were in Somalia too! So there’s this thing that it was really horrible service and it was recognized, but not recognized.

Matt describes how the government was embarrassed into giving the disbanded Airborne Regiment soldiers a metal for serving in Somalia. It is the only medal minted that has the word honorable. The government disbanded the Airborne so it is ironic that they had the medal minted with the word honorable. What is the point being made by the government? Was this in some way an apology for disbanding and blaming the Airborne for their error? Matt goes on to describe a “magic” parade where 100 handpicked Airborne Regiment soldiers receive their medals first in Ottawa. He explains that this is done “symbolically” as a way to show that the great Canadian virtue of doing the right thing eventually came to the fore. However, the majority are handed their medals individually in private where no one can see behind closed doors “in the dark” with no parade and no photographers. Matt describes the ambiguity of being recognized but not recognized when the medals are handed out in secrecy which leads to anger, shame, stigma and embarrassment about their service in Somalia. They don’t know who received the medal until they are in their dress uniform with other soldiers. The underlying message is still that it was a horrible service that the government was forced to recognize because of the embarrassment generated from former Airborne Regiment soldiers and their military family that they should be treated like all the other soldiers who served on overseas missions. The disbandment of the Airborne Regiment was a traumatic experience for those soldiers who served together in this special military family. As well the secrecy of receiving the medal, leads to further trauma inflicted upon them by their own military family for Matt and the other former members of the Airborne Regiment. The peacekeepers descriptions of the situatedness of their bodies in time, space and relation provided a fresh way into understanding the experience of being in the world of contemporary peacekeeping. The following excerpts turn to living the unpresentable experiences of the world of peacekeeping as described by the peacekeepers on their deployments.

THE POOL OF TEARS: LIVING THE UNPRESENTABLE Alice shed gallons of tears, until there was a pool of tears all around her. She swam about trying to find her way out and back to the garden. The pool became quite crowded with birds and animals that had fallen into it and eventually, the whole party swam to the shore (Carroll, 1865/1992). Like Alice, peacekeepers try to find their way out of their experiences and to metaphorically swim ashore or find their way back home. In particular, they try to escape from the traumatic events that they witness. Peacekeepers, like previous generations of soldiers, experience traumatic events that hold the unpresentable. Dallaire (2003) brought forth in words the unpresentable destruction of human life that took place during the genocide of Rwanda. How do we express in words the tragedy of human suffering witnessed and

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sustained by contemporary peacekeepers who served overseas on recent deployments? There is a need to explore further glimpses of the life world described by the peacekeepers to reveal some of the ineffable unpresentable experiences of peacekeeping that lead to trauma. In the following excerpts, we hear the peacekeepers trying to express their experiences through words which are hard for us to hear. The ineffable is always rooted in an experience, an entity that manifests itself in life….Often the unpresentable, is an excluded or an ineffable thing, something difficult to bring to words (Cameron, 2006, p. 24).

The unpresentable is excluded from discourse and in turn, the public and others are not made aware of its presence. In the following excerpts, the peacekeepers bring to words the unpresentable rooted in the ineffable experience of the trauma of peacekeeping. These soldiers stand in the presence of the unpresentable in a way that Levinas (1947/1987) describes as ‘an absence of all refuge’ (p.69). The survivor of trauma is a “disturber of the peace…a runner of the blockade men erect against knowledge of ‘unspeakable’ things” (Tal, 1991, p. 231). They do not let us look away, for we have much to understand about peacekeeping and trauma. Their stories have words rooted in an experience that bring us back to the famine in Somalia, the genocide of Rwanda and the ethnic cleansing in the former Yugoslavia.

Rules of Engagement: The Things That Restrict You

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‘I don't think they play at all fairly,’ Alice began, in rather a complaining tone,' and they all quarrel so dreadfully one can't hear oneself speak—and they don't seem to have any rules in particular(Carroll, 1865/1992, p124).

Alice is subjected to the Queen’s Croquet Ground where the game is not played fairly and everyone quarrels. No one is waiting their turn, and the Queen is soon in a fury. Much like peacekeeping, Alice finds that there doesn’t seem to be any particular rules to follow and she is worried that eventually, the Queen’s fury will be turned against her. Peacekeeping is a very hard thing. Somalia was probably the easiest mission I’d done, in some ways, but yet in other ways it was the hardest thing because our rules of engagement were so ambiguous. They were changing on a daily basis. Every day you didn’t know what the color of the day was or the flavor of the day. It’s okay, we can’t kill the guy today, but tomorrow we’re going to change, if you can turn on your radio, you can change it or you can shoot him. Then the next day, if he’s carrying a weapon you can shoot him, but today you can’t. It was utterly ridiculous.

Tim describes the role of peacekeeping as hard because it is so ambiguous due to the ever changing rules of engagement. Like Alice, peacekeepers must adapt to rules that at times seem utterly ridiculous, nonsensical and could ultimately be turned against them. The ever changing rules of engagement make it very difficult for peacekeepers to know how to act in what can be life and death situations. The following is an excerpt from Tim’s experience with the rules of engagement while peacekeeping in Somalia.

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We were under strict orders that we weren’t allowed to give up our own water. I had to tell him no. I told him sorry, and he understood and smiled. He kept reminding me so much of my grandfather except that he was dark. It sticks with me to this day. He was so proud looking. He put his hand on my shoulder. That’s all right, son. It really hit me. I watched him walk away. I kept turning around. I was wondering; where was he going with this big mush bucket of beans? Did he have a family? Was he looking after the grandchildren? Where was he going? I kept looking back to see. It really made me feel so mad that I couldn’t give, I wanted to, but I couldn’t. That was the first real thing that really disappointed me; the fact that I was there to help these people. I actually had to say no, I can’t help you. It really affected me. It was the disappointment that those rules prevented you from giving your water. You were bound to follow those rules. I mean it’s not a big trauma. It’s the small things that people have to deal with. I mean those are the things that bothered me the most about all these tours is the children and the people that you can’t help. It’s those rules that restrict you.

It is not blood, guts and bullets that traumatizes Tim. One of the expectations of a soldier is the willingness to risk their lives and to expect blood, guts and bullets. Tim is on a convoy escort with trucks loaded with grain being shipped out that day from the airfield. The soldier peacekeepers are on the lookout for bandits. They are dripping wet not because of the heat but because of bandits waiting to shoot at them. Like Paul in All Quiet on the Western Front, Tim stretches out on the earth waiting to be shot at by bandits. He describes this situation as a ‘normal’ thing for a soldier. What traumatizes Tim is his inability to help an older Somali man. Tim describes meeting an old 6’5” tall Somali man in his late 50s, early 60s. He is massive about 200 to 230 lbs. with big hands, which is not typical as Somalis are thin or skinny. The Somali man wears a big white robe and carries a silver colored bucket with some lima beans mush inside. He stops Tim and motions to his water bottle asking for some water. The rules of engagement have been decided and situated elsewhere back home. Although Tim connects the Somalia man with someone in his personal life (his grandfather), the rules of engagement require him to turn away from normal reactions in life. In life, one would normally assist someone asking for some water. The situatedness of the peacekeepers demands that they are bound to those rules even when the rules restrict them from responding as a human being to the other. There are consequences to not following the rules of engagement. Tim describes another situation where he finds himself struggling with the rules of engagement in Somalia. I ended up shooting him in the leg because; well this is where the rules of engagement came in. I’m thinking I can’t shoot him there because I’ll go to jail. If I shoot him here I’ll go to jail. I can’t shoot him in the thigh or I’ll go to jail. I just worked my way all the way down. So I ended up shooting him basically in the ankle. He still didn’t drop it. I think the pain finally kicked in. It was about another minute and a half. I put three rounds in his foot. He was still hopping around! I talked to doctors about that. I think about it a lot. I wonder if he died from infection. I ended up in the hospital about a week later with some type of virus that knocked me out. They ended up bringing him into the hospital too. That was traumatizing more than anything. They actually kept us separate. They brought him in because I guess he was getting an infection. They didn’t want him dying. So they treated him; dressed his wound and sent him home or where ever he lived. Sometimes I wonder if I was in the right or not. I think I

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was. I could have killed the guy. I still would have been right. Inevitably, I think he would have released the machete. Sometimes I deal with it and wonder if he’s alive.

Tim describes his struggle with the ambiguity of the rules of engagement and the consequences of not following the rules. A man comes to the front gate hollering, screaming and swinging a machete while hacking away at the gate. Terrified people are running around. The soldier peacekeepers are telling him to drop the machete with their weapons up. Another told him to put the machete down while firing some warning shots. Tim explains that the soldier peacekeeper with a big machine gun is ready to fire it and fill him up. The man is ready to throw the machete at them. The ambiguity of the rules delays Tim’s decision for a minute and a half which could have cost Tim or the other soldiers a deadly injury or their lives. It is more important to decide which part of the man’s body to shoot at rather than react quickly in order to protect his or his brother soldiers’ bodies. To stop the man from throwing the machete, Tim decides to shoot him in the ankle and the foot as this is least likely to result in serving time in jail. Tim can face charges including time in jail if he unknowingly breaches the rules of engagement. Ironically, the military didn’t want the man to die so he ends up being treated in the same hospital as Tim. That was the most traumatizing part of the experience as he is afraid that the man will try to attack him in the hospital. If this were to happen, Tim would have to struggle again with the rules of engagement as to what is the right decision to make. The ambiguities of the rules of engagement make Tim question his decision to shot the man to this day. He wonders if he did the right thing and if the man is still alive. The central theme of Alice's Adventures in Wonderland is Alice's struggle to adapt to the nonsensical rules of this new world; metaphorically, it is Alice's struggle to adapt to the strange rules and behaviors of adults (Carroll, 1865/2000). Carroll is constantly reminding us of the consequences of not knowing the rules. Childhood is partially a state of peril, and Carroll names a few of those perils directly: “poison bottles that the child cannot read, falls, burns, wounds from blades that the child is too young to handle” (p.18). Much like peacekeeping, not knowing the rules or knowing them, however foolish, nonsensical or arbitrary those rules may be, is a source of great uncertainty and peril. The ambiguity of the rules of engagement leaves a mark on the peacekeepers long after their return home.

Cambodia: Why Doesn’t It Matter? When I started therapy I remember bringing up Cambodia. The therapist would say well that doesn’t matter, let’s talk about Rwanda. I’m thinking why doesn’t it matter? I went there injured. I was screwed up when I went there. So maybe my perspective was already different. We would drive places in Cambodia. I remember one day coming across this woman on the side of the road. She was begging for transport to go to a hospital because she had just lost a limb on a mine. Her husband has two artificial limbs because in the last three years he lost two of his limbs. These are farmers trying to make a living. These poor people are bleeding like a stuck pig on the side of the road. They were just left there to die. So of course that in itself is traumatic. To me it was really heart wrenching because I was already screwed up. I didn’t know what to do with the information.

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Although the interviews focused on the deployments to Somalia, Rwanda and the former Yugoslavia, Simon describes a traumatizing event that occurred while on deployment to Cambodia. He posed the question: Why doesn’t it matter? For Simon, witnessing human suffering mattered irregardless of where the deployment took place. In the telling of his story, it was important for Simon to convey that traumatic events witnessed by contemporary peacekeepers are not limited to Somalia, Rwanda and the former Yugoslavia. Peacekeepers have been witnesses to human suffering on multiple deployments to countries from around the world. Have we become so focused on the genocide in Rwanda and the ethnic cleansing in the former Yugoslavia, that other atrocities in the world are overlooked? Why doesn’t it matter? Contemporary peacekeepers bear the stories of suffering and trauma from multiple deployments. They remind us of those that are forgotten and left bleeding at the side of the road from around the world.

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Haiti: The Have Nots Where my PTSD comes out is Haiti. I was personally involved in the humanitarian operations and initiated some of the projects which were designed to work with the “have nots”. Organizations were not as above board as what we thought. One was a medical clinic in one of the poorer parts of town. I spent a lot of time with members of the helicopter squadron, refurbishing and cleaning it up. It was run by a missionary from Quebec. We were trying to get medical supplies and medical equipment. They were dealing with the HIV rate in Haiti. It runs about 25% or more. We found out afterwards that they may have been selling off some of the drugs and things like that. It was the same with the orphanages. Our engineers did a lot of work to rebuild the orphanage, their water supply and their living conditions. Mattresses and clothes were donated. We started looking at a plan to have Christmas parties at some of the orphanages. Many donations came in to provide traditional North American meals, turkeys, and everything else like that. We were given sort of a rough idea of numbers and a lot more showed up. Then we noticed a lot of the stuff that we had given them was starting to show up in the local community. So whether the sister who was an order of one was forced to give it out or if she was corrupt, we don’t know. We thought pouring our time and effort and energy in trying to do the best we could would make a difference. Then we had the rug pulled out from underneath us.

Like Simon, Thomas expresses the importance of understanding that the deployments to Somalia, Rwanda and the former Yugoslavia do not cover the broad spectrum of that time period. Other deployments such as Haiti have a capacity to traumatize although the nature of the trauma is different. Thomas describes the humanitarian operations in Haiti assisting the poorest of the poor. That degree of poverty so close to North America especially, the United States is a great contradiction of terms for Thomas. It is a challenge that confronts a lot of his world views. He questions his worldview of how the world should be fair and equal for all. When trying to do good deeds in a medical clinic and an orphanage is undermined by the very people they are trying to help, Thomas questions the purpose of being there. His trauma starts in Haiti because of the extreme poverty and the inability to make a lasting difference.

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Reconciling Good and Evil One of the things I really struggled with and I thought I had it down midway through the tour was reconciling good and evil. It’s all a crisis of the spirit. It’s called a spiritual dimension. How we relate to the rest of the world. Our constructs of how the world should be. Traumatic stress shatters those notions. So in that case everything is a spiritual crisis.

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Thomas describes his attempt to reconcile good and evil. For Thomas, who is a chaplain, the constructs and the shattering of these notions of how we relate to the rest of the world involve a spiritual crisis. The essence of psychological trauma is “the shattering of one’s experiential world- in particular, of those “absolutisms” that allow one to experience one’s world as stable, predictable, and safe, and oneself as inviolable” (Schwartz & Stolorow, 2001, p. 381). All traumatic events undermine the victim’s belief and trust in social order: “Every instance of severe traumatic psychological injury is a standing challenge to the rightness of the social order” (Shay, 1994, p.3). The word evil however inadequate has been used to present these ineffable and unpresentable atrocities. “Evil” describes something that is morally bad or wrong, and the world of morals is the world of people, their conduct and character (Janoff-Bulman, 1992). Human-induced victimizations make one directly aware of utter immorality in a way that “acts of God” cannot. They involve understanding, at a deep experiential level, that terror and pain to others was intentionally caused by another human being. Does the complexity of contemporary peacekeeping deployments make it difficult to understand in terms of good and evil? Is evil the best word to describe the absence of morality witnessed by contemporary peacekeepers on these deployments? We turn to the other peacekeepers to deepen our understanding of evilness in the contemporary world of peacekeeping.

What’s Fair, What’s Just, What’s the Right Thing to Do? What’s fair, what’s just, what’s the right thing to do? When you do the right thing and it ends up that someone dies. Or you do a simple act of charity and someone is killed because of it. Spirituality is one way. We all live in a bowl. We’re given all our beliefs and disbeliefs. Our belief system is given to us whether actively or passively. It’s the bowl that we’re put in at birth. It sort of involved all the triggers. All the buttons are put in place, mostly unconsciously I think. Most people learn like sense of fair play. If you have 6 of something and Susie next door has none, well then it’s fair that you give her some. Is it written down that way? Not really. We know that when someone is hurt and crying it’s natural to go over and lend support. Even just to ask what’s going on? There’s another part of the world which I think in spiritual theological reflection, that it experiences raw and unfiltered evil.

Matt questions his sense of what’s fair, what’s just and what is the right thing to do. How does one reconcile that doing the right thing, such as an act of charity, could result in the death of a human being? For Matt, who is a chaplain like Thomas, such experiences involve a spiritual theological reflection. Like Thomas, Matt tries to understand such experiences in terms of right from wrong and good and evil. Here we find Matt questioning, theorizing in

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order to try to understand some of the results of trauma. Facing raw unfiltered evil where these constructs have no meaning traumatizes Matt as his belief systems are shattered. No matter who commits the trauma, Matt believes that it breaks the person’s worldview of what they assume is right from wrong and good from evil. He searches for some way to understand what is happening. As he examines morality, he tries to find an explanation. But it seems his explanation fails. That is one of the things that makes Matt realize that something is wrong with him. After multiple deployments, he didn’t believe in anything anymore. It was getting worse not better. Peacekeepers confront raw unfiltered evil on multiple deployments where there is no sense of fair play, justice or certainty about the right thing to do. Do the dualities of right from wrong and good and evil offer any comfort or explanation?

Evil Is Inhuman Machines?

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I sometimes let myself think about the evil that men such as Bagosora wrought- the Hutu extremists, the young man of the interahamwe, even ordinary mothers with babies on their backs had become so drunk with the sight and smell of blood and the hysteria that they could murder their neighbors. What did they think as they were fleeing the RPF and stepping through blood-soaked killing fields and over corpses rotting into heaps of rags and bone? I rejected the picture of the genocidaires as ordinary human beings who had performed evil acts. To my mind, their crimes had made them inhuman, turned them into machines made of flesh that imitated the motions of being a human. The perpetrators on both sides had their “justifications”. For the Hutus, insecurity and racism had been artfully engineered into hate and violent reaction. In the RPF’s case, it was willing to fight to win a homeland at all costs, and its soldiers’ rage against the genocide transformed them into machines. (p.456)

In the excerpt from Shake Hands With The Devil: The failure of humanity in Rwanda, Romeo Dallaire (2003) writes that for him, it was incomprehensible to believe that the horrific atrocities committed in Rwanda were carried out by human beings. Evil was seen as the Devil that had transformed human beings into inhuman machines made of flesh. Does the duality of good and evil offer some comfort for Dallaire? Did transforming human beings into machines help Dallaire make sense out of such senseless killings?

There Is No God. There Is No Devil We were heading out of downtown Kigali. I was in the passenger seat on the right. The Senegalese guy was on the left driving. We got stopped at the barricade. Our Canadian flag is on the left shoulder. This guy comes inside the truck. He’s got his head right in front of it. I remember the eyes, red, red, red, eyes and drunk with banana beer. He’s waving this machete at the driver and me. He knows the Senegalese guy is not from Belgium because he’s black. He’s telling me I’m from Belgium. He wants me to step out of the vehicle. I’m thinking, he doesn’t know his countries. When I was at headquarters; they were giving big Canadian flags for both shoulders for the peacekeepers in Bosnia. When I went to Rwanda I wanted those big flags and they said no, those are only issued for Bosnia. So I’m in the jeep now. This guy thinks I’m from Belgium. I am thinking, no, no, Canada. Look and he is waving this machete. I don’t know if it was rusty or if it was bloody. I’m hoping it was rust. Then the Senegalese just hit the gas

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Simon disagrees with Dallaire that there must be a God because he saw the Devil over there in Rwanda. Simon explains that Dallaire is from another generation than him. For Simon, he shook hands with the Devil too. He knows the people, not the machines that Dallaire writes about in his book. Simon recalls an incident that happened after the Belgians got killed. For Simon, who served with Dallaire in Rwanda, the duality of good and evil and humans as killing machines offers no comfort or explanation. Where is God? For Simon, there is no God and no Devil. Such duality does not help him make sense out of such sense less killings. He could have lost his life because of mistaken identity on the part of a flesh and blood human being, not a machine. Such hatred towards another human being is hard to comprehend. Simon is confronted with human beings committing unthinkable acts. He remembers the eyes of a flesh and blood human being bent on killing him because he is mistaken for a Belgium. Simon’s internal dialogue remembers and questions if only he had a larger Canadian flag on both shoulders. Would it have made any difference? Why were the larger flags only issued for those serving in Bosnia? What makes peacekeepers ponder good and evil? Does this help them cope? How do we make sense out of such hatred?

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What’s Happened? It’s Hatred To see the number of people who are displaced in Bosnia. They were displaced just because they were neighbors and then because of religion. The fervor that was stirred up by Milosevic and Sarajevo or how one group was oppressed and the others weren’t going to take it anymore. All of a sudden neighbor against neighbor, come on what’s happened? All of a sudden this person is now dehumanized to the point where somebody feels it’s okay to kill them en masse. There was a whole plot of graves with green markers. A whole cemetery of Muslims killed for no other reason than they were Muslims. Just because one group said we’re better than the other. It’s hatred.

Thomas describes that being in the world of contemporary peacekeeping involves witnessing hatred on a scale never witnessed before by peacekeepers. People are killed en masse and whole cemeteries are filled for no other reason than religion. Peacekeepers are in situations that are difficult to reconcile as they are often at the extremes of life. Thomas questions how a neighbor can become a non human because of their religion. Does it make it easier to kill a human being who has been dehumanized? Will cemeteries forever hold the unpresentable for contemporary peacekeepers? How do contemporary peacekeepers heal from this kind of hatred on a broad scale?

Hatred That’s Difficult to Comprehend We were sitting in downtown Sarajevo. There was a mother with a baby and two small boys crossing the street. The next thing you heard was gun fire from off in the distance around

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her. She was pinned up in the street. I was the section commander. I ordered the carrier out and in front of her. We took six rounds in the side of the carrier. Just basically crept down the road beside her until she got to where she was going into the building. Here’s the mentality. I’m going to shoot this lady and the three kids because those children are going to grow up to kill my children. That’s the thinking. North Americans we don’t think that way. We don’t think that way, but that’s the way that they think! It’s very difficult for us to comprehend that type of hatred.

Peter describes the kind of mentality whereby someone would kill a woman and her three children in order to prevent the possibility that these three children will grow up and kill their children. How can North Americans, like contemporary peacekeepers, comprehend the type of hatred that extends across generations? How do peacekeepers heal from this kind of mentality of generational hatred? How do they make sense of such hatred?

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The Church: How Does That Make Sense? The next site was at a church. These people were all shot. Women, children, men, there were people killed in separate rooms. People were trying to hide their children, in their hiding spots. There was a priest killed right inside the church. I actually spent a great deal of time in the church alone. An altar boy was inside. He was bent almost in half it seems. They were all shot. There was actually a location where they had set up a gun, because there were spent casings piled up in one area. There was this one location in the courtyard where the bodies had just been piled in. I think it was three tiers or stacked up and you couldn’t walk by it without almost barfing. These people praised God. I mean these people among everybody; they built churches out in the middle of nowhere. They were killed! You know, praising God. How does that make sense? Basically in all the places these people were killed, were in church. This church was on top of a hill in the middle of nowhere. The most beautiful church I think I ever saw. It was a Catholic Church. It was an incredible massive site. I walked up to the altar. There was a can. I remember this can on the floor. This oil can, and right across the oil can it was from Canada. I kept looking at that can. It was a flower can. I thought Canada.

Tim describes one of the many atrocities that took place in the churches of Rwanda. He finds himself in the most beautiful church he ever saw in the middle of nowhere. Here in the world of peacekeeping, we find juxtaposed the most beautiful church with the dead bodies of men, women, children and babies. Etymologically, the word church comes from the old Anglo-French sentuarie, from the old French sainctuarie and from the old Latin language sanctuarium “a sacred place, holy shrine”. By medieval Church law, fugitives or debtors enjoyed immunity from arrest in churches, hence the term sense of “immunity from punishment” or sense of “place of refuge or protection” (Skeat, 1983, p. 465). Here in Rwanda, even in churches, there is no immunity or protection from the genocide. Where is God? In the midst of this senseless scene, Tim finds a flower can that came from Canada. Tim keeps looking at the flower can and thinks about Canada. In Canada, the church as a sanctuary is respected. Does Canada represent the only safe place for these contemporary peacekeepers? Or is the flower can that represents Canada the only thing that makes sense in this scene of senselessness? Does Tim cling to this symbol of Canada to take him away from

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the desecration of this holy place and perhaps to a saner world than he currently finds himself?

The School: How Could You Call Yourself a Person?

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We hear screaming atrocities, atrocities. He says that the school was full of dead people. All these people, children, and babies were dead for no reason. How could anybody bash a baby in the head? How could you do it! It’s cold. How could you call yourself a person? I can’t put a word on it. I just can’t understand it. Does that make somebody feel powerful? What kind of statement? There’s no statement being made there. There was so much going through my head when I was there. Maybe that’s why I spent so much time in the rooms. The room just the older kids there and I remember going in. They’re very Catholic in Rwanda. They had made the spiritual cross at the door. I had wondered what must have been going through these kids’ heads. How long had they been in this room waiting to die? Or had they waited at all? I remember having to go to my room waiting to get a spanking when I was a kid. I mean these kids were in this room waiting to get killed.

Tim describes the scene of an atrocity that took place in a school in Rwanda. We can see Tim’s thoughts and reactions as he tells us about this scene. Three rooms and one of the rooms are full of women and young children. One’s full of men. There’s another room with a few older children beaten to death and clubbed. He describes the sweet pungent smell of the early stages of decay. He remembers in one of the rooms, a beautiful woman holding her toddler in her arms. This sticks to him to this day. While recalling this woman, Tim remembers in a momentary flashback; a beautiful woman standing by the road who was killed. He has a visceral reaction thinking that he is going to pass out recalling this incident. Although he is a soldier, Tim could not prevent the slaughter of men, women, children and babies. One can feel his rage and sense of helplessness at his inability to do anything to prevent this atrocity. In this scene of mass murder, there is beauty and a reminder of another death. One atrocity reminds him of another atrocity. He asks himself a lot of questions: What leads people to do something so utterly disgraceful? Why? He remembers being angry. He remembers thinking, here we are soldiers and we can’t really do anything about this. At this point, all Tim wants to do is to go on a killing spree. There was nothing they could do about it. He feels so bad. Tim can’t understand and can’t put a word on how someone could kill innocent men, women, children and babies. Tim struggles with how someone could call themselves a person and yet kill innocent helpless human beings. There are no statements being made in these rooms of death. Tim stays here in the midst of these scenes and disfigurement that for us who are not peacekeepers is unpresentable and outside of our known discourse. Tim identifies with the kids who were killed with his own life as a child. The only thing that he can compare their experience to is what it felt like waiting in his room to be spanked. He tries to understand what was going through the heads of the older children as they waited to die. It is difficult to understand waiting to die when the only the comparison is waiting for a spanking. How long had they been in this room waiting to die? Or had they waited at all?

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How Do You Make Sense? You Don’t Make Sense of It

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This woman heaved over the razor wire of the camp, this bundle of rags. It was a baby dying of tuberculosis. The sores had come through the body. I thought oh my God! It looked like the baby had been eaten by something. It was all these open sores. We don’t have a way to treat babies. We have basic medical. We have surgeons. The baby died within a day. The soldier that picked the baby up had to be treated for tuberculosis and then the medical staff. What are you supposed to do with the life? The mother threw it away. I mean so what brings a mother to make that decision? A couple of days later a Somali white pickup truck full of people racing down the road, it tips over, bodies fall out, people are crushed, limbs removed. We went out with two ambulances and start to do first aid. The people that weren’t killed in the accident turned around and looted our ambulances. It would have been different if they looted and then came back and said we’re here to help. No, they looted and then kept going. You’re trying to say how to make sense out of it. How do you make sense? And you don’t make sense of it. You don’t. I remember we got a lecture that they were Somali or Muslim. I can see we made all kinds of big mistakes at the time; women and children get treated first. That’s what we do. So what did they do? They took the kids aside and beat them so hard that the kids didn’t come back to us anymore. So then the medics are saying what are we doing here? What?

Matt describes the inability to make sense out of several incidences in Somalia. In each incident there is a disregard for human life. Or was there? The mother knew her baby was dying. There was no hope in her world situation. She did a mother’s act to give the baby to someone in a situation where there was a hope for care. In the end, the mother was right. The baby died. What can the peacekeepers do? They can bear witness to this act. For Matt, the devaluing of life as in the situations with the people looting the ambulances and the Somalis beating their children profoundly affect him. The devaluing of human life is contrary to Matt’s beliefs. Matt goes on to describe the camp as a Wal-mart store. The Somalis would come to loot their garbage and other things. Because there is no police force, the peacekeepers have to shoot at the Somalis for stealing their empty plastic water bottles. There’s no other way to bring law and order. Matt questions; what the hell are we suppose to do? Peacekeeping soldiers are not policemen or social workers. He states that if they need social workers; send in social workers not soldiers. One of the underlying paradoxes of contemporary peacekeeping is despite trying to do good often the situation worsens for those around them. Matt wonders – would it have been better if they had not shown up? They were there and kids were beaten. The soldier peacekeepers brought food, which was not the type of food eaten by the Somalis. Matt remembers the violence of the Somalis against themselves and violence against one another. The soldiers would support one faction unknowingly to give a guy a contract to drive a truck. Another faction was not supported which caused the factions to be at one another’s throats. How do you make sense that if they had not been there it would have been better for the people they were trying to help? How do you make sense of the disregard and the throwing away of human lives? You don’t make sense of it. You don’t.

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This Is Senseless: It’s Chaos I’m thinking, one of these Serbs is drunk, or they’re all drunk, and maybe they’ll fire a few rounds into the air. It was like surreal. I think what am I here for? It doesn’t matter. I used to think well if you die while you’re saving some kid from a river or rescuing a mother from a burning house then there’s some value. But this? For what? This is senseless. Senseless killing which is what evil is. It makes no sense. It’s chaos. Goodness has a sense of order to it like the change of seasons, life and death. I mean that’s part of the progress. If I’m going to celebrate when someone has a baby being born, then in my faith and understanding, I can also celebrate a family that’s had a death. In the medical community you heal people and you help people die. It’s not success and failure, it’s the continuum, it’s life. But chaos it has no sense to it. It just destroys. Consumes. No rhythm, other than non-rhythm. You’re sitting there in the midst of it thinking well at home this would be. Well I’m not at home any more. I’m here.

Matt goes on to describe how senseless it was serving in the former Yugoslavia. He is deeply thinking about the senselessness of being killed at any moment by drunken Serbs for no reason. As in Somalia, human lives in the former Yugoslavia had no value. He shows us how these situations lead him to this kind of thinking. Chaos has no sense to it which is evil. Evil is chaos that consumes and has no rhythm. For him, natural rhythms such as cognitive structures and bodily life at home have been stripped away here. However, he is not home but overseas in the midst of chaos. Matt struggles with this way of being in the midst of chaos, where life is meaningless. How do contemporary peacekeepers make sense out of senselessness on these deployments overseas?

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It Makes No Sense We have footage of this hospital. It was the day after the militia stormed the hospitals and killed patients on the operating tables. These were people who had been injured during the fighting. The militia came in and doctors are suturing people in the operating room. These savages come in and hack people on the operating tables. We’re at the hospital and the doctors are freaked right out, talk about PTSD. It’s crazy. I can see killing somebody to defend yourself but to storm a hospital and kill patients. I don’t know. It’s a little warped. It was like a feeding frenzy, a bunch of rabid dogs. What killed any shred of belief I had that there was a purpose to your life, my purpose is very grounded. Its now, people today, tomorrow, but the purpose of life as a whole I don’t believe in that. After staring at so many dead people for so long, ten months, walking over corpses laid all over, raped women. I don’t believe in the purpose after looking at all these people, raped women, kids with their heads chopped off. I’m thinking all these people were just left there, rotting. So what’s the purpose of that? Weed and feed. I don’t know. Top soil? It makes no sense.

Simon describes the senselessness of atrocities that took place in a hospital and elsewhere in Rwanda. For Simon, the horrific atrocities that he witnesses are senseless acts committed by savages. Such senseless killings, of innocent and defenseless human beings in turn, kill his belief that there is a purpose to life. His purpose becomes grounded in today and tomorrow rather than the purpose of his life as a whole. It is a life lived in moments, the day and the

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next day not in the future. These atrocities have changed Simon’s belief of a future with a purpose forever. It makes no sense that innocent men, women and children were slaughtered. What’s the purpose of that? It makes no sense.

All of a Sudden the World Opens Up

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People are being slaughtered everywhere. Now there are 20 trucks from the UN saying you’re going, you’re not going and you’re going. It was a huge mess. People were yelling, screaming and fighting. As we’re triaging all of these people the Hutu rebels who were doing most of the killings show up in their pickup truck. They threaten the UN; threaten us, that what we’re doing is useless. We’ll never get to the airport today, because they won’t let the convoy go by. We did the normal thing of not being intimidated and say well, we’re carrying on with our orders and so loaded the trucks. As we’re loading the trucks we can see more and more Hutu coming into the hotel. The Hutu left the parking lot after threatening us, went to get reinforcements, came back up the hill, and set up an ambush. All of a sudden the world opens up. They opened up with machine guns and start firing on the side of the hotel because they wanted to intimidate us. They fired a bit in the trucks, but they were too far. I think my first experience with trauma was then. I had been there for about a week now. Although I had seen dead bodies and it’s discomforting, it’s not trauma, to me seeing a dead body is not trauma. The bullets are ricocheting. At one point this young boy that was about the age of my son at the time, got hit in the leg by a bullet. If I want to I can still see him. I can still see him flip inside out and fall on the ground yelling. I was about three feet from him. We brought him into the hotel. His family or friends gave him first aid. We had our job to do. So we kept doing our job. I always wondered about this; did he survive. Why him? Why not me? Why not that guy over there? I guess to me it was really hard to swallow because he was the same age as my son. He was about 10. The height, the build, of course he was black, my son is white, but it doesn’t matter. There was an association.

Simon describes an incident in Kigali that happened during the war in Rwanda at a hotel owned by a Belgian airline company. The hotel had become a refuge and a triage center. A lot of countries were accepting ex-patriots or refugees that had family in another country. The peacekeepers role was to figure out who gets to go, who doesn’t get to go, check identities and make sure they’re the right families. If they are not then they’ll end up in limbo or in an airport and they’ll be shipped back to Rwanda. It is ‘normal’ for the soldiers not to be intimidated by the Hutu rebels who were threatening them. Instead, they carry on with their orders while the Hutu rebels set up an ambush. Simon went on to describe in detail the situated ness of this world of peacekeeping. He is very aware of his location and the vulnerability of the space of a long laneway coming into the parking lot in front of the hotel with an embankment full of bushes and trees. This is an expectation of peacekeeping soldiers. Not only to be aware of the environment around them but to provide protection in the case of danger. After only a week in Rwanda, Simon does not find it traumatic to see dead bodies. Have the massive number of dead bodies left Simon with the inability to react to such atrocities committed on such a wide scale? For Simon, it is traumatic when the world suddenly opens up and the Hutu rebels start firing randomly into the bodies; the flesh of living human beings. For soldiers, the opening up of the world is the opening up of the flesh of the world. He can still see the wounded and open living human body of a 10 year old boy

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flip inside out and fall on the ground. As with the other peacekeepers, the situatedness binds Simon to the rules to keep doing his job. To this day, he wonders why him? Why not me? There is an association as the boy reminds Simon of his son who is the same age. Is Simon trying to make sense out of senselessness by making this connection to his personal life back home?

What the Hell Is Going On Here: This Is Not a War!

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The other connection I remember vividly. It really gave me a hard time when I came back home. It’s this man. I don’t know if it was the father or grandfather. He’s on his back, spread eagle; wearing a suit. He was dead of course. I’ve seen enough to know that he was dead probably for a day. The flies were just starting to kind of gather there, but beside him was a little girl. This nice little girl was my daughter’s age at the time. She was lying down on her side with a smile on her pretty face. Her skull had been cracked open like an egg by a machete. This is pretty fresh because the corpses bloated a bit. I remember looking at her and saying, this is not a war! Nobody admitted there was genocide at the time. I remember being fixated on this and saying, what the hell is going on here! That’s something that gave me a hard time coming back. I couldn’t watch my daughter sleep. You know kids sleep like that, at that age. This is a little girl about 6 years old. It’s the first sign that I think I was ill was probably this one night when I came back from Rwanda the first time. I went into the bedroom to kiss my daughter good night. I just froze when I saw her in that position. I think I was transported back. I didn’t have a good reaction at all with that. I just wrote it off as well of course you’re going to have bad feelings about this shit. You’ll get over it. I avoided going to kiss my daughter ever since in bed. Now she’s 15 years old, but if she’s sleeping, I don’t want to go there. I don’t want to find her dead.

Simon describes another incident that took place on a trail in Rwanda. His training as a soldier peacekeeper comes to the fore again when he recalls in vivid detail the environment around him. So many years later there is such vividness of detail. Is this part of the peacekeeper's knowledge and experience base or is it part of the traumatization? Or is it both? Simon describes a very narrow jeep and a half wide trail. On the way back down this trail, the peacekeepers come across a clearing on the side of the road among the trees that was not noticed on the way to a rebel camp. Another opening up of the world and opening up of the flesh of human beings. At first, the peacekeepers don’t recognize what lies in front of them. What the hell is that? The recognition of a dead man and a little girl murdered by the side of a trail brings home the reality of the situation. What the hell is going on here! This is not a war. This is genocide. It is traumatic to see innocent and defenseless human beings slaughtered particularly, when one of them reminds Simon of his little girl back home. When Simon sees the face of the little girl laying exactly the way his daughter sleeps, the face of the other, he is reminded of his daughter. Is Simon trying to make sense of the atrocities by making a connection to his personal life? To this day, the connectedness to his daughter to the little girl makes Simon unable to go to his daughter’s bedroom because of his fear of finding her dead.

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Soldiers Should Be Revered There’s a sense of pride, of putting on the uniform, and a sense of pride of defending my country and defending the beliefs that we believe in. Just the way that they treated each other. When we went in to Sarajevo, we saw bloated bodies floating in the river every day. It was like right over the bank of where we were working. For me, a soldier is something that should be revered because he made the sacrifice. If you make a sacrifice you should be revered. How much dignity is there laying face first in the mud with your pants pulled down around your ankles, bloated, and rotting? These guys that were floating in the river were nothing more than unfortunate soldiers that made the mistake of dying on the wrong side of the line. What you didn’t see was the scene, the old ladies, and the ladies in black kicking the eyes out of dead soldiers lying in the street, stomping on their heads, tying them up to the back of the truck, dragging them through the street down to the river, you didn’t see that.

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Peter describes a scene in Sarajevo in the former Yugoslavia. Through Peter’s account, we are able to see other sides of the complicated and complex world of contemporary peacekeeping. There are a couple of very famous pictures in Time Magazine of downtown Sarajevo with the pictures of the women in black crying over their dead son or their dead children. Peter explains that the public find it very heart wrenching and say oh my God! He brings us to the lived experience rather than pictures in a magazine and in so doing reveals more about the experience of contemporary peacekeeping. This is a traumatizing experience for Peter as he identifies with the unfortunate brother soldiers who made the mistake of dying in enemy territory. For Peter, it is important to revere soldiers as they make the supreme sacrifice for their country. Instead, he is confronted with the desecration of dead soldiers’ bodies by old women who we have only seen in pictures weeping over their dead family. Scarry (1985) wrote: When the Irishman’s chest is shattered, when the Armenian boy is shot through the legs and groin, when a Russian woman dies in a burning village, when an American medic is blown apart on the field, their wounds are not Irish, Armenian, Russian, or American precisely, because it is the unmaking of an Irishman, the unmaking of an Armenian boy, the unmaking of a Russian woman, the unmaking of an American soldier that has just occurred, as well as in each case the unmaking of the civilization as it resides in each of those bodies. (p.122)

Perhaps, the unmaking of nationalities occurs when one is faced with man’s inhumanity to man whether it is by man- made violence or by the indifference towards a famine stricken population. To these peacekeepers, their nationality became insignificant and it was their humanity and, in particular, their relationship to fellow soldiers that mattered. Who weeps for the soldiers? Is it Peter and the other peacekeepers? Do they bear witness so that we don’t forget the soldiers?

The Other Side of Insanity One day I’m with these civilians escorting them to a particular mass grave site. We came to a halt. If there was no shooting or anything I would just let myself roll to a stop. I would put myself in 1st get out and do what I have to do. That day of course there was no shooting. The

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war was over. I shut my engine off. I’m rolling. As we’re coming to a stop we hear something. So we step out of the vehicle. One of the women that were with us says oh my God! You just went over somebody’s pelvis or something. The bones crushed. This had been three months after the war ended so they were nice and dry. I remember saying to her, you should hear it when you roll over a skull because it really pops. The woman looked at me with this look of disgust like what the hell are you talking about? I remember that night laying in bed and saying are you going insane? That was something stupid to say. Why did you say that? I was starting to question. I guess. Not feeling comfortable with who I was becoming at the time. Now of course I wasn’t like that all the time. That was probably the first moment where I remember vividly being there in my cot staring at the bug net thinking, if I continue to change like this how am I going to be a father? I had seen the other side of insanity; or over the line of insanity, I had been right to the edge where insanity is. I’m thinking I don’t want to go there!

Simon describes an incident in Rwanda that made him question his sanity and what he might become. Simon went on to explain that he had a habit during the war. He had some kind of jeep that was diesel and really noisy. Simon couldn’t hear what was going on outside with the engine clacking. He would put his jeep in neutral and turn the engine off and roll to hear if there was firing or shooting or mortars or anything happening. If there was something happening Simon would start up in neutral again, put it in 3rd gear and take off. During the war, this habit could have saved his life. Peacekeepers are trained to remember habits that can save their live and the lives of others. This habit stayed with him even after the war ended. He made a callous remark about the sound of bones being crushed under his jeep. This made Simon question his sanity. To witness atrocities or the other side of insanity made Simon question whether he would go there too. Marlow in Joseph Conrad’s novel Heart of Darkness (1903/1999) recognizes the kinship between the civilized, rational and the primitive, instinctual nature of man. War and intrastate conflicts reveal the power of man’s primitive and instinctual nature to dominate his civilized and rational one. While witnessing the madness that lies just over the edge of restraint, Marlow also comes to understand the powerful temptation that exists to cross that line: Well, you know, that was the worst of it- this suspicion of their not being inhuman …what thrilled you was just the thought of their humanity- like you- the thought of your remote kinship with this wild and passionate uproar. Ugly. Yes, it was ugly enough; but if you were man enough you would admit to yourself that there was in you just the faintest trace of response to the terrible frankness of that noise, a dim suspicion of there being a meaning in it which you- you so remote from the night of first ages-could comprehend. And why not? The mind of man is capable of anything-because everything is in it, all the past as well as all the future. What was there after all? Joy, fear, sorrow, devotion, valor, rage-who can tell? - But truth- truth stripped of its cloak of time. Let the fool gape and shudder-the man knows, and can look on without a blink. (p. 59-60)

Conrad defined all humans as having an "inner evil" or Heart of Darkness which is an inner struggle between good and evil. Humans struggle with their own morals and their own battle with their hidden evil. Is this a conflict that exists in everyone? Is this a universal truth of the human condition? In Rwanda, Simon had been to the edge of insanity and he didn’t want to go there. What happens when one crosses over the line of insanity?

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Turning into Them All of a sudden I heard the shot gun go off. I looked at my boss. I said listen, if he shot that dog I’m going to kill him. He didn’t say anything. He just looked at me. Then I see these two guys walking by with a garbage bag that’s got something in it. You guys are no better than the assholes that are here. You guys are looking for an excuse to kill. I thought I saw my comrades turning into these animals who lived in this war zone. It really disturbed me. I thought it was my responsibility to let these guys know that they were turning into them.

James describes an incident in Bosnia where peacekeepers crossed over the line of insanity. He recalls a little German shepherd puppy. Roving camp guards with a shot gun asked James to give them the dog. James told them he will keep the dog if they were planning to kill it. The guards told him they would let it go outside of the camp. As he was leaving the camp, the guards shot the dog. James believes that they were looking for any excuse to kill. He feels that he had a responsibility to let them know what they were turning into. The senseless killing of an innocent dog was turning them into the animals called human that lived in the war zone, randomly killing human beings and animals. War and intrastate conflicts reveal the frailty of goodness, the social order and the underling chaos that can erupt at any time. Where does it start and when does it end?

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Chaos: From Spitting Out Your Gum to Genocide One night it was three years ago, we happened to arrive home at the same time. I’m pulling in the driveway. He’s getting off the bus. He was going through a bad time, the teenage thing. He spits his gum on the porch. So inside I don’t know what to do. I’m losing it inside because to me chaos starts with spitting your gum on the porch. Then it’s genocide. There’s no in between. There’s no stopping it. Where are we going to end up? So I talked myself down. This is all in 3-5 seconds. I talked myself down, calmed myself. I think every parent has gone through that rebellious stage. For me there was no escalation. It went from pitching your gum to genocide. Where are we going to end up here? For me it was total panic.

Simon describes an incident that occurred back in Canada with his son who was fifteen at the time. Back home, there is potential for chaos in every situation. For Simon, chaos, such as genocide, starts with spitting out your gum, with no in between. There is no stopping it. Where are we going to end up here? He starts to lose it inside and feels total panic. No control over the genocide in Rwanda means no control over any situation. A benign occurrence such as the spitting out of gum represents the beginning of the chaos of genocide. Where are we going to end up here? Where do contemporary peacekeepers end up?

CONCLUSION This chapter endeavored to reveal the situatedness of the experience of peacekeeping and peacekeepers being in the world and living the unpresentable. The experience of contemporary peacekeeping is like falling down a rabbit hole. Turning to Alice’s Adventures in Wonderland:

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Down, down, down When suddenly thump! Thump! Down she came upon a heap of sticks and dry leaves, and the fall was over (p.6). Like Alice falling Down the Rabbit Hole, contemporary peacekeepers are separated from their families and thrown suddenly down the rabbit hole of peacekeeping. They are taken on a journey of the unknown, with limited preparation for what they would experience and where they would live. They, like Alice, have to adapt to rapidly changing rules and situations. As well, their return home was also quick with limited transition. For Alice, there are bodily transformations and a change from the known to the unknown and back to the known, from childhood to adulthood and from innocence to wisdom (Carroll, 1865/2000). For peacekeepers there are changes from the known to the unknown and back to the known. Like Alice, contemporary peacekeepers tried to make sense out of the senselessness of the situations that they encountered. Deployments required many transitions in terms of time, space and relations. The peacekeepers revealed that the military became their family, with the bonds of brotherhood tightening over time. The profound losses of brother soldiers such as by suicide and the callous response by the military left many with a sense of betrayal of “what’s right” by the military leaders who held their trust. Their sense of betrayal was further deepened when the Band of Brothers that was the Airborne Regiment who served in Somalia were disbanded by their military family and the government. Glimpses of the life world described by the peacekeepers reveal some of the ineffable unpresentable experiences of peacekeeping. The rules of engagement restricted them from responding to human suffering all around them. The sheer stamina and self discipline of standing aside, in the face of the brutalities and cruelties inflicted upon their fellow human beings, makes one wonder how this erodes at the peacekeepers. Being in the world of peacekeeping left many of the peacekeepers with existential questions about “life”, “death”, “being” and the searching for “meaning”. Some of the unanswered questions for the peacekeepers were: What brings a mother to make that decision? (i.e. throwing away her baby). You’re trying to make sense out of it. How do you make sense? What leads people to do something so utterly disgraceful? Why? Does that make somebody feel powerful? What kind of statement? There’s no statement being made there. I’m thinking all these people were just left there, rotting. So what’s the purpose of that? Where are we going to end up here? Being in the world of peacekeeping left many of the peacekeepers with unanswered existential questions about life, death, being and the searching for meaning that without treatment will stay with them for the rest of their lives.

REFERENCES Cameron, B. (2006). Towards understanding the unpresentable in nursing: Some nursing philosophical considerations. Nursing Philosophy, 7(1), 23-35. Carroll, L. (1865/1992). Alice’s adventures in Wonderland and through the looking glass. New York, NY: Bantam Doubleday Dell.

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Carroll, L. (1865/2000). Annotated Alice: The definitive edition. Introduction and notes by Martin Gardner. New York, NY: Norton. Conrad, J. (1903/1999). Heart of darkness. Peterborough, Ont.: Broadview Press. Dallaire, R. (2003). Shake hands with the Devil: The failure of humanity in Rwanda. Canada: Random House. Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York, NY: Free Press. Levinas, E. (1947/1987). Time and the other. R. A. Cohen (Trans.) Pittsburg, PA: Duquesne University. Merriam-Webster’s collegiate dictionary (11th ed.).(2003).Springfield, MA: MerriamWebster. Pallasmaa, J. (2000).The Architecture of image: Existential space in cinema. Helsinki: Rakennustieto. Remarque, E.M. (1962). All Quiet on the Western Front. Greenwich, Conn: Fawcett Publications. Scarry, E. (1985). The body in pain: The making and unmaking of the world. New York, NY: Oxford University Press. Schwartz, J. M. & Stolorow, R. D. (2001). Trauma in a presymbolic world. Psychoanalytic Psychology, 18, 380-387. Shakespeare, W. (1623/1973). The complete works of William Shakespeare. W. J. Craig (Ed.).London, England: Henry Pordes. Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. New York, NY: Maxwell McMillan International. Simpson, L. (1972). Air with armed men. London: London Magazine Editions. Skeat, W. W. (1983). A concise etymological dictionary of the English language. Oxford: At the Clarendon Press. Tal, K. (1991). Speaking the language of pain: The Vietnam War literature in the context of the nature of trauma. In P. K. Jason (Ed.). Fourteen landing zones: Approaches for Vietnam War literature. (pp. 217-50). Iowa City: University of Iowa. Van den Berg, J.H. (1987). A different existence: Principles of phenomenological psychopathology. Pittsburgh: Duquesne University Press.

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In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Chapter 4

THE SPIRITUAL DIMENSIONS OF TRAUMA HEALING Abdul Basit* and John Tuskan†

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ABSTRACT Despite the amazing progress in understanding and treatment of mental disorders, psychiatry was severely constrained by two self-imposed limitations: (1) it was dominated by intellectuals who considered faith and spirituality to be vestiges of a prescientific era and (2) the Cartesian mind-body split long taken for granted in western medicine, prevented us from focusing on the mind’s crucial role in pain, anxiety, and depression. But during the past three decades, a growing body of evidence has suggested that spiritual and religious involvement is positively correlated to physical and mental health, and that faith protects people from anxiety and depression, especially when related to tragedy and trauma. This paper explains the spiritual dimensions of trauma healing and delineates how faith and trust in a Supreme Power provides a steady anchor that can cure a person’s insecurity by quieting distress and generating hope and positive expectancy.

The issue of Posttraumatic Stress Disorder [PTSD] has become a topic of growing interest and concern in the mental health field, and many new approaches have been developed to help victims. Of course, people in every age have had to deal with traumatic events or cope with catastrophe. As early as 524 BCE Prince Siddhartha, who would become the Buddha, became so absorbed by the intolerable problems of suffering he saw among his people that he left his father’s palace and spent many years searching for a solution. All great prophets and mystics have been deeply concerned with the uncertainty and suffering that attends mortal existence. The approaches of the monotheistic religions, namely Judaism, Christianity, and Islam, to trauma are fundamentally similar, for these religions are offshoots of the Abrahamic faith. It is worth special mention, however, that modern western therapy is not always synonymous with a Judeo-Christian approach. *

Abdul Basit is a former assistant professor of psychiatry at Northwestern University, Chicago.

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In this chapter we will review the efficacy of traditional treatment offered to clients suffering from Posttraumatic Stress Disorder. We will critically evaluate some research studies that have cast serious doubts upon the usefulness of modern treatment, and have even indicated that it might adversely affect the client’s psychological health. We will further demonstrate the spiritual dimensions of trauma healing and delineate how, in times of crisis, faith works like an anchor point. But before we discuss these issues, it is important to define PTSD, discuss its etiology, and critically evaluate modern therapeutic approaches.

DEFINING PTSD In DSM-IV, PTSD is defined as an Anxiety Disorder that occurs after and as a result of a major, disturbing, out of the ordinary event in a person’s life, such as war or rape. It may have a delayed onset.[1] In other words, it is a severe and long-standing emotional disorder that can occur after a variety of traumatic events, such as war, physical assault (rape), car accidents, life-threatening disasters (9/11), natural catastrophes (tsunamis), or a shattering personal loss. Major symptoms of PTSD are feelings of fear and helplessness; sudden flashbacks (the victims reliving the event); re-experiencing the events through nightmares; the numbing of emotional response and disturbing interpersonal relationships; hyper-vigilance; an exaggerated startled response; and irritability and occasional outbursts of anger.

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THE ETIOLOGY OF PTSD The findings of research in this area are inconclusive. One can simply state that the etiology is clear: someone personally experiences a trauma and therefore develops a disorder. But studies have shown that only one out of four people, who have suffered trauma actually develop a full-blown Posttraumatic Stress Disorder (Green et al., 1990)[2]. Actually PTSD is a surprisingly complex issue that involves biological, psychological, and social factors. As with other mental disorders, our biological and psychological vulnerabilities play an important role. Breslau, David, and Andreski (1995)[3] studied a random sample of 1,200 individuals and identified that certain characteristics, such as a tendency to be anxious due to early experiences and other factors (e.g. minimal education) could be considered predictors of increased risk for PTSD. Other studies, especially those done by King et al. (1996)[4] indicated that psychological factors, especially early anxiety-provoking experiences that were unpredictable and uncontrollable would make individuals more vulnerable to PTSD. Vernberg et al. (1996)[5] studied 568 elementary school children and concluded that social support from parents, close friends, class mates, and teachers are important protective factors. It is not difficult to understand why social support is crucial. After all, human beings are social animals, and a loving, caring group of people around them helps to combat emotional and psychological stresses effectively. †

John Tuskan is the director, Refugee Mental Health Services and Faith-Based Community Initiatives Coordinator at the Center for Mental Health Services, Rockville, Maryland.

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TRADITIONAL TREATMENT Although at present there is no single drug especially designed to reduce PTSD’s symptoms, clients often respond positively to antidepressants and antiadrenergics (Friedman & Southwick, 1995).[6] In a recently published article on this subject, Davidson (2006)[7] recommended Selective serotonin reuptake inhibitors (SSRIs) as the first-line of therapy for PTSD. If PTSD clients exhibit a high level of anxiety and depression, they should be seriously considered for drug therapy. There is, however, a divergence of opinion when it comes to psychotherapy. Some of the most commonly used therapeutic approaches are: (1) Cognitive therapy, (2) CognitiveBehavioral therapy, (3) Dialectical Behavior therapy, (4) Acceptance and Commitment therapy, and (5) Functional Analytical therapy. However, it is not yet clear how best to evaluate these different approaches, all of which have claimed positive outcomes to a limited degree. It is very difficult to determine which type of therapy is more effective for psychotherapy is an “art,” not a science. Since the process of psychotherapy cannot be quantified, it cannot be objectively measured. Even when two therapists strictly follow Cognitive therapy, their personalities, styles, and ways of approaching issues may not be the same. Meichenbaum (1994)[8] acknowledged that there was not sufficient evidence to suggest the superiority of one form of treatment over another. Unfortunately, the modern therapists place more emphasis on method and technique and tend to ignore the fact that a positive outcome largely depends upon the quality of the clienttherapist relationship. No matter what kind of therapy is used, the outcome will not be positive, if the therapist cannot gain the client’s trust and confidence. A warm, positive, accepting, and non-judgmental therapist, who shows genuine concern for the client’s problems, can be highly effective (Rogers, 1962).[9] But in psychotherapy research, the therapist has been a neglected variable. Garfield (1997)[10] also pointed out that most of our research on psychotherapy has focused on comparing different forms of psychotherapy and that the importance of the therapists’ contribution to the outcome has received inadequate attention.

RESEARCH ON THE OUTCOME OF PSYCHOTHERAPY Before we critically evaluate the therapeutic techniques used for PTSD clients, it may be necessary to briefly discuss the research on the outcome of psychotherapy. When the famous British psychologist Eysenck (1952)[11] seriously questioned the effectiveness of psychotherapy, it sparked an intense debate among clinicians in the United States. A series of research studies were undertaken (Bergin, 1971;[12] Bergin & Lambert, 1978;[13] Kazdin & Wilson, 1978;[14] Rachman & Wilson, 1980[15]) that consistently indicated its effectiveness in helping people. But skepticism persisted due to “allegiance effect.” This shadow of doubt was finally removed when the ‘Consumer Reports’ study (Seligman, 1995)[16] gave unbiased and reliable evidence that psychotherapy is effective and it helps people. Its results were taken seriously by the clinicians for two reasons: (1) there was no allegiance effect, and (2) it was the largest study sample ever gathered.

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However, these same results were startling, especially in two areas. The study revealed that: (1) the type of psychotherapy clients receive makes little difference to the treatment’s overall effectiveness and (2) the therapists’ experience and training do not affect the success of therapy as most clients assume. Of all these research findings the most disturbing one was the evidence that the outcome of psychotherapy is not improved by clinical experience or professional training. Jacobson (1997)[17] who has studied therapy outcome for decades, stated, “The question of whether experience or training enhances outcome has been studied extensively, reviewed exhaustively, and meta-analyzed to death. Skeptics have looked at the data in all sorts of ways to find a way to challenge the devastating conclusions…no one has been able to find that either the amount of clinical experience or the degree of professional training enhances outcome.”

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IS THE TRADITIONAL PTSD TREATMENT EFFECTIVE? In almost all traditional types of therapy used to treat PTSD, clinicians tend to agree that victims should discuss the original trauma with the therapist in order to overcome the debilitating effects of the disorder. However, we must not forget that remembering is a reconstructive process, not just a straightforward retrieval of past experiences. The trick, of course, is to re-arrange the exposure so that it will be therapeutic rather than traumatic. It is worth noting that no research data exist to date to show that re-living traumatic experiences, which may have been automatically repressed with the passage of time, can help clients cope effectively with their symptoms. On the contrary, research studies have shown that asking clients to relive the traumatic experiences during individual or group therapy sessions may adversely affect their psychological health. A review of these studies which appeared in the Harvard Mental Health Letter (1997;[18] 2003[19]) indicated that the traditional treatment may make trauma victims hypersensitive to their symptoms, and further suggested that concentrating too much on psychological wounds may be non-therapeutic. Similar concerns have been raised by others (Rose, Bison, & Wessely, 2003)[20] who stated that providing mental health services and other associated activities have the potential for worsening the outcome of some PTSD survivors because the clinicians may be increasing their expectancies and their awareness of developing psychological symptoms. In her book - The Woman Who Can’t Forget - Price (2008)[21] has clearly demonstrated that a healthy person possesses a harmonious balance between memory and forgetfulness and that sometimes the inability to forget is not a gift, but a curse. It fact, the ability to forget has its own place because it helps people put things behind them and move on. The ability to forgive and forget ultimately allows people to come to terms with difficult and painful losses. Time becomes a trustworthy and reliable antidote for emotional pain – an essential feature of PTSD. Some skeptics have carried this point to the extreme. For example, Brewin (2003)[22] claims that a PTSD diagnosis is a sociopolitical invention of western society, and that normal human reactions to stressful events becomes pathological only when diagnoses are applied to them.

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THE THERAPEUTIC ROLE OF FAITH AND SPIRITUALITY Since the hypothesis here is that tragedies and traumas belong to the spiritual realms, it makes sense to explain whether we are using religion and spirituality interchangeably and, if not, what the difference is between them. The word “religion” comes from the Latin root “religio” which refers to a bond between humanity and some greater than human-power (Wulff, 1997).[23] And, by spirituality we mean those experiences, beliefs, and phenomena that pertain to the transcendent relationship between the person and a Higher Being that provides answers about the purpose and meaning of life, suffering, sorrow, and death (Bergin, 1997).[24] The founders of all world religions were involved in an intellectual and spiritual endeavor to gain insight into the ultimate issues of human existence. After gaining the enlightenment or receiving revelation, they explained how to spiritually connect with the Divine Power that is present in the universe. It is, therefore, obvious that spirituality is embedded within all religions. However, over the course of time these spiritual leaders’ teachings were gradually transformed into organized religions, a development that tends to foster a prescribed set of beliefs and rituals, that very often take the form of legality. Organized religions also have an underlying assumption that only their beliefs are correct and that the followers of other religions will be punished for their wrong or mistaken beliefs. A famous Sufi (Muslim mystic) Rumi, who strongly opposed this prejudice and insularity, stated: “[I am] Not Christian or Jew or Muslim, not Hindu, Buddhist, Sufi, or Zen. Not any religion or cultural system. I am not from the East or the West.”[25] If this “holier than thou” attitude is removed from organized religions, and focus is placed only on the process of inner transformation connecting people with the Divine Power that encompasses the universe, then an approximate definition of spirituality is provided: spirituality is a positive and loftier side of the individual’s experience that is identified with personal transcendence and supraconsciousness, both of which create a deeper bond with the Supreme Being. Therefore, the answer to the question raised in the beginning is that religion and spirituality are sometimes used interchangeably. For this reason researchers have differentiated between extrinsic and intrinsic religiousness (Larson et al., 1998).[26] Extrinsic religiousness is defined as using religion for one’s own needs, such as gaining social status or worldly goods and riches, while intrinsic religiousness is defined as using religion as a guiding point to purify one’s soul, transcend the illusion of everyday awareness, comprehend a greater sense of meaning and purpose in life, and keep one’s spiritual connection with the Supreme Power.

THE SURGE OF INTEREST IN SPIRITUALITY’S THERAPEUTIC ROLE The question now is why a spiritual approach maybe more effective in trauma healing. This is the crux of our hypothesis. Before getting into this, however, it is necessary to lay the groundwork for the above-mentioned proposition. During the past three decades, a growing body of evidence has suggested that spiritual and religious involvement is positively related to physical and mental health and that faith protects one from anxiety and depression, especially in the case of personal tragedy and trauma. This has resulted in a surge of interest

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in the therapeutic role of faith and spirituality. The following factors have contributed to this radical change in thinking.

A. The Disillusionment with Science Science was once viewed as humanity’s new hope, and many predicted that religion’s influence would continue to decline, even to the point of extinction. There is today, however, a renewed interest in religion and spirituality the world over. Science is no longer considered a panacea for humanity’s problems. The two world wars, the Nazi holocaust, widespread violence, soaring crime rates, high rates of suicide, family disintegration, social upheavals, and terrorism have challenged people to find meaning in the world today. As Armstrong (2000)[27] remarked: “Rational thought, that achieved astonishing success in the practical sphere, could not assuage our sorrow.” Also, science could not answer questions about the ultimate meaning and value of human life. The renowned psychiatrist Frankl (1959),[28] who survived years of torture in Nazi death camps, believed that only when one has been able to find a deeper meaning and purpose of life, can one withstand trauma and tragedy. Even Freud (1930)[29] acknowledged that “…only religion can answer the question of the purpose of life. One can hardly be wrong in concluding that the idea of life having a purpose stands and falls with the religious system”

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B. The Impact of Modern Physics Unfortunately, biomedical science is still following the Cartesian mind-body split, and thus relies heavily upon a reductionist and materialistic approach that claims to be based on the truths of physics. But the irony here is that it is actually clinging to the outdated ideas of the twentieth- century physics. Modern physics has completely revolutionized our concept of the universe. Einstein’s theory of relativity, Max Plank’s quantum theory, Heisenberg’s uncertainty principle, and other scientific theories have deconstructed the mechanistic and reductionist assumptions of the mainstream science (Susskind, 2006).[30] Incredible as it may sound, Einstein stated that the distinction between past, present, and future is only an illusion.[31] Also, after probing into the underlying assumptions of physics and quantum theory, the renowned scientist Bohm rejected the idea that the processes in the molecular domain are governed by chance. In The Undivided Universe which he coauthored with Hiley (1993),[32] an alternative interpretation of quantum physics was offered: the prevailing view of a universe fragmented into objects separated by space and time is false. Therefore, the separateness of individual objects in space and time is apparently an illusion. This would mean that we live in a nonlocal universe. The famous physician Larry Dossey, who is the author of five books, including “Space, Time, and Medicine”(1982)[33] and “Beyond Illness” (1984)[34] and other books, carried this assumption one step further and stated that if our mind is nonlocal in space and time, then the universe becomes a place of interaction and connection. And, if the nonlocal mind is a reality, then psychic abilities, intuitive connections between parents and children, as well as between twins, maybe empirical and not supernatural (Levin, 2001).[35]

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C. Mind/Body Medicine This field has revolutionized the concept of healing. Recent research studies (Goleman, D., & Gurin, J., (1993)[36]; Benson, (1996)[37]; Levin & Larson, 1997[38]; Bergin, 1997[39]) suggest a strong link between the immune system and the central nervous system and highlight the mind’s crucial role in pain, hypertension, depression and anxiety. Due to the fast-expanding field of psychoneuroimmunology (Goleman, 1993),[40] evidence is mounting that the immune system becomes less effective under protracted stress, and that emotions deeply affect a person’s physical well-being. It has also become evident that the mind, the most powerful weapon in the battle for health, can have both a positive and negative effect. Benson (1996)[41] has pointed out faith’s therapeutic touch. When research on brain science (Newberg et al., 2001)[42] uncovered the possible neurological underpinnings of spiritual experiences, it revealed that the spiritual impulse is rooted in the biology of the brain. In other words, their research confirmed Benson’s views.

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D. Research on Religion and Health An extensive research study conducted by Miller (1999)[43] clearly demonstrated that spiritual and religious involvement is positively related to health and inversely related to disorders. With surprising consistency these findings hold across physical, mental, and substance abuse disorders. The comprehensive study of religion and health conducted by Koenig, McCullough, and Larson (2001)[44] also indicated a positive association between spirituality and greater hope and optimism as well as a statistically significant correlation between religious involvement and a greater sense of purpose and meaning in life. The research work done by Yates et al., (1981);[45] Miller, (1999?)[46]; Larson, et al., (1998)[47], Koenig et al., (2001)[48] , and Levin (2001)[49] further indicated that: (1) the rates of depression and anxiety related illness among religiously committed people are much lower; (2)the suicide rate is four times higher among non-religious people than religious people; (3) that church-goers have lower blood pressure than non-churchgoers even when adjusted to account for smoking and other risk factors; (4) those who are religiously committed have half the risk of dying from coronary-artery disease as those who have no faith; and (5) among the 232 heart-surgery patients, one of the predictors of survival was the strength and comfort they drew from religion. A preponderance of evidence suggests the therapeutic role of spirituality. These research findings reveal that spirituality and faith protect people from various forms of anxiety, especially those related to tragedy, trauma, and end-of-life issues. Perhaps in times of crisis spirituality and faith can help cushion the emotional blow, thus facilitating the grieving and adaptation process.

FAITH AS AN ANCHOR POINT To endure and survive tragedy and trauma, we need an anchor point. Research studies (Cohen & Wills1985;[50] Keane et al., 1985[51]) have consistently identified that the larger the network of friends and relatives upon which one can call in a time of crisis, the better the

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one’s ability to cope with catastrophe. Consequently, tragedy and trauma are less likely to have a harmful effect on people who enjoy high levels of family, social, and community support. So far no one has objected to or taken any issue with these findings. In the same vein, we could add one more coping mechanism: a transcendental relationship to a Higher Being that gives meaning and purpose to life. According to the monotheistic religions (Judaism, Christianity, and Islam), dealing successfully with sorrow and pain as well as trauma and tragedy people need a steady anchor, a Higher Being who cures their insecurity by bringing them into communion or spiritual contact with the Supreme Being. As Benson (1996)[52] stated that if faith in the medical treatment is proven to be wonderfully therapeutic, then one’s belief in the invincible and infallible force would carry more healing power. Benson (1996)[53] also believes that human beings might be wired for God because such a belief soothes and calms those individuals faced with the burden of mortality and human fraility. Spirituality seems to be especially valuable in dealing with crises that may challenge the fundamental premises of existence, because at such times people cannot find any immediate explanation that can comfort them. During these critical moments strong religious beliefs may fill this void, thus helping people to stabilize their troubled emotions and nerves and preventing further distress. It is no wonder that people have an innate tendency to return to faith and to seek spiritual strength, especially when tragedy strikes. Not surprisingly, in the aftermath of 9/11, many stories emerged affirming the role of faith and spirituality in comforting the traumatized. For example, the Wall Street Journal published an article on September 11, 2001: “After the Terror, God Reappears in Public Life.” Similarly, the Washington Post published an article on September 17, 2001: “First Source of Comfort: When Events Overwhelm, Clergy, Not Doctors, Are on the Front Line.”

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THE SPIRITUAL PERSPECTIVE The Buddha clearly stated that nobody is immune to pain and suffering and further indicated that all living beings go through suffering during this earthly existence. However, according to him, the suffering can be significantly reduced by controlling one’s greed, anger, and insatiable thirst for worldly goods and riches. He further emphasized that during this earthly existence nothing endures because everything is continually in a state of flux (Armstrong, 2001).[54] The patience and fortitude of Job and Jonah is a glorious testimony to unwavering faith in God and remaining steadfast in the face of adversity. The Qur’an consistently affirms that God is the only Protector and the Everlasting Refuge (112:2).[55] During a period of trauma and tragedy, the Qur’an advises the believers to have patience and complete trust in God and to show firm resolution just as the Prophet and other Biblical messengers did (Qur’an 46:35).[56] Its teachings emphasize that in times of crisis, believers should seek assistance through patience and prayer: “O you, who believe, seek assistance through patience and prayer; surely God is with those who are patient” (2:153).[57] Faith in God offers comfort and solace: “And if anyone puts his trust in God, sufficient is God for him…He will bring ease after hardship.”(65:3-7).[58] Based on these Quranic teachings, the Sufis (Muslim mystics) developed a conceptual framework that explains one’s experience of

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tragedy and trauma as a period of test and trial that affirms one’s faith, makes one humble, and purifies one’s soul. The unsurpassed self-sacrificing spirit of Jesus is one of the best examples of how faith and spirituality can be the best shield when facing tragedy and trauma. Jesus gives the example of a person who, “built a house and dug deep, and laid the foundation on a rock; when the flood arose, the storm beat vehemently upon the house and could not shake it for it was founded upon a rock”( Luke 6:48).[59] Similarly faith and trust in a Supreme Power is like a foundation on a rock. When we have this anchor point, the storms and stresses of everyday life, do not make us falter. Nor do we become unsteady, vacillate, or fall victim to malignant doubts and fears. Without this faith, without this anchor point in life, one drifts relentlessly into a vast ocean of fear, doubt, and uncertainty. This anchor point gives one hope in the face of despair, shows light at a time of darkness, lifts one up when burdens are heavy, makes death bearable, and fills one with the spirit to strive against evil. Few can deny the religion’s consoling power, healing strength, and comforting balm. In fact, faith and spirituality help people discover how to reconcile themselves to the formidable facts of life and death.

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THE SPIRITUAL PERSPECTIVE IN PSYCHOTHERAPY Strange as it may sound, in fact, spirituality and psychiatry have a lot in common, for both of them (1) seek to fix the broken spirit or broken psyche; (2) work to untie the psychic knots (or unseal the soul); (3) help people change (for the better); (4) use the value system to determine whether behavior is good or bad, healthy or sick, and (5) use counseling as a technique to bring about change in the individual. Further, the interface of spirituality in psychotherapy is unavoidable, simply because a majority of the world’s people (85%) profess a belief in God or a Higher Power. The U.S. population is also highly religious and spiritual; nearly 96% believe in God or a Universal Spirit (Shafranske, 1996b).[60] The spiritual approach in therapy has many points in common with modern psychotherapy; however, a few points are basically different. The points that characterize the spiritual approach are as follows: 1. Modern psychotherapy places a greater emphasis on the cognitive aspects: knowledge, understanding, and gaining insight. In other words “knowledge is tantamount to cure.” But in spiritual therapy, any knowledge that cannot be translated into action is of little worth. Unless there is a change of mind and heart (unsealing the soul) or seeing problems with the eyes of the heart [ayn al-qalb], no real change can be expected in the client. 2. Sacrifice, virtue, gratitude, trustworthiness, and forgiveness have become oldfashioned terms, and thus are not used or even mentioned in modern psychotherapy. But now a growing body of evidence (Benson, 1996;[61] Taylor, 1997;[62] Lieberman & Eisenberger, 2005[63]) shows that just as highly negative emotions are linked to the risk of illness, such positive emotional traits as optimism, hope, gratitude, and forgiveness are linked to good health.

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Abdul Basit and John Tuskan 3. The glorification of individual rights at the expense of family and community has become the hallmark of our modern society. The language of obligation and commitment is totally absent. Therapeutic language cannot really make any sense of community. The spiritual approach greatly emphasizes the important role of family and community, given that all monotheistic religions are community-based. 4. The blame game, which has become very popular in modern therapy, is not only counterproductive and non-therapeutic, but is also a purely non-spiritual approach. Many therapists have begun to lead their clients to find their parents responsible for most, if not all, of their problems. Thus, relationships become a battle grounds. The act of blaming ignites a negative impulse and sets the ball rolling in a mutually destructive direction. Instead of reopening an old wound, we should put some balm on it by practicing the best therapy: leading the client toward compassion and forgiveness. 5. The spiritual approach tends to encourage the clients to engage in meditation or contemplation, which usually are integral parts of all prayers. Almost all prayers require a calm and quite place where one can concentrate and direct his/her attention to the Ultimate Power. There are three other essential elements in these prayers: (1) one is secluded in a quiet place and tries to forget the mundane thoughts of daily life (2) one directs his/her attention to the Higher Power and attempts to gradually descend into a state of meditation or contemplation and (3) one keeps repeating certain prayers, in coordination with certain muscular activities. This comes very close to what Benson (1996)[64] has described as the basic steps to evoke a “relaxation response.” And, it is known that such a response tends to decrease one’s blood pressure, heart rate, muscle tension, and breathing rate. 6. Since modern psychotherapy is rooted in agnosticism, the client has no anchor point but can only rely upon new coping techniques. The spiritual approach, however, encourages a strong faith and trust in God as the main anchor point. Benson (1996)[65] is more emphatic about the therapeutic touch of faith: “I have found that faith quiets the mind like no other form of belief, short-circuiting the non-productive reasoning that so often consumes our thoughts … faith seems to transcend experience and base reality, it is supremely good at quieting distress and generating hope and expectancy.”

SUMMARY It has been emphasized that while the events that precipitate PTSD may be the same, not everyone exposed to them develops PTSD symptoms. Even when we take into consideration the relevant genetic factors, the disorder cannot be fully explained without considering the cognitive factors that play a crucial role in perpetuating these symptoms. Further, modern research in the fields of mind/body medicine, religion, and health has demonstrated that spirituality and faith are positively related to physical and mental health. The spiritual dimensions of trauma healing, long neglected in psychiatry, have been discussed in the light of modern research. While acknowledging that, in general, the spiritual dimensions of trauma healing is the same in different religions, an attempt has been made to highlight those points

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that characterize the approaches of the three monotheistic religions: Judaism, Christianity, and Islam.

ABOUT THE AUTHORS Abdul Basit, PhD, is a former assistant professor of psychiatry at the Feinberg Medical School, Northwestern University in Chicago, Illinois. He has served as the director of the Multicultural Mental Health Services at the University of Chicago; as superintendent of a psychiatric hospital in Illinois; and as a member of the US National Mental Health Advisory Council for four years. He was acknowledged by the U.S. government as a “Nationally Recognized Leader in the Field of Mental Health.” A former Fulbright scholar, Dr. Basit has written extensively and has authored a book and two book chapters. He was also editor-inchief of the Journal of Muslim Mental Health for four years. E-mail:[email protected]. John J. Tuskan, Jr., RN, MSN, is a US Public Health Officer who is currently assigned to the Substance Abuse and Mental health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), Rockville, Maryland. He is the director of the Refugee Mental Health Program, which works with the Federal Office of Refugee Resettlement to provide technical assistance, consultation and training on the health, welfare and social integration as well as torture survivors and victims of international human trafficking. He has concurrently served as SAMHSA’s Faith-Based and Community Initiatives Coordinator and CMHS’s International Initiative Officer. E-mail: [email protected].

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REFERENCES [1] [2]

[3]

[4]

[5]

[6]

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, (4th Edition). Washington, DC. Green, B., Grace, M., Lindy, J., Glaser, G., & Leonard, A.C. (1990). Risk factors for PTSD and other diagnoses in a general sample of Vietnam Veterans. American Journal of Psychiatry, 147, 729-733. Breslau, N., Davis G. C., and Andreski, M.A., (1995). Risk Factors for PTSD-related traumatic events: A prospective analysis. American Journal of Psychiatry, 152, 529535. King, D. W., King L. A., Foy, D. W., & Gudanowski, D.M. (1996). Prewar factors in combat related posttraumatic stress disorder: Structural equation modeling with a national sample of female and male Vietnam veterans. Journal of Consulting and Clinical Psychology, 64, 520-531. Vernberg, E.M., LaGreca, A.M., Silverman, W.K., & Prinstein, M. J. (1996). Prediction of pos-traumatic stress symptoms in children after Hurricane Andrew, Journal of Abnormal Psychology, 105, 237-248. Friedman, M.J., AND Southwick, S.M. (1995). Towards pharmacotherapy for posttraumatic stress disorder. In M. J. Friedman, D.S. Charney, and A.Y. Deutch (Ed.),

74

[7] [8]

[9] [10] [11] [12]

[13]

[14] [15] [16]

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[17] [18] [19] [20]

[21] [22] [23] [24] [25] [26]

Abdul Basit and John Tuskan Neurobiological and clinical consequences of stress: From normal adaptation to PTSD (pp. 461-481) Philadelphia:Lippincott-Raven. Davidson, J., (2006). Pharmacological treatment of acute and chronic stress following trauma, Journal of Clinical Psychiatry, 67, Suppl 2:34-9. Meichenbaum, D. (1994). A clinical handbook/practical therapist manual: For assessing and treating adults with Post-Traumatic Stress Disorder (PTSD). Waterloo, Ontario: Institute Press. Rogers, C. R.. (1962). The Interpersonal Relationship: The Core Guidance, Harvard Educational Review, 32, No. 4 Fall, 416-529. Garfield, S.L.((1997) The Therapist as a Neglected Variable in Psychotherapy Research, Clin Psychol Sci Prac 4:40-43. Eysenck, H.J. (1952). The Effects of Psychotherapy: an evaluation. The Journal of Consulting Clinical Psychology, 16:319-24. Bergin, A.E., (1971) The evaluation of therapeutic outcomes. In A.E. Bergin & S.L. Garfield (Eds.), Handbook of Psychotherapy and behavior change: An empirical analysis (pp.217—270). New York: John Wiley & Sons. Bergin, A.E. & Lambert, M.J.(1978). The evaluation of therapeutic outcomes. In S.L. Garfield & A.E. Bergins (Eds.) Handbook of Psychotherapy and behavior change: An empirical analysis (2nd ed., pp.139-190) New York: John Wiley & Sons. Kazdin, A.E. & Wilson, G.T. (1978). Evaluation of behavior therapy: Issues, evidence and research strategies. Cambridge, MA: Ballinger. Rachman, S.J., & Wilson, J.T. (1980). The effects of psychological therapy. Oxford: Pergamon Press. Seligman, M.E.P., (1995).The Effectiveness of Psychotherapy: The Consumer Reports Study, American Psychologist, Vol. 50, No. 12 (pp. 965-974). Jacobson, N., (1997) The Overselling of Therapy. In K. F. Bernheim (Ed.) Abnormal Behavior (p.325) Baltimore: Lanahan Publishers. The Harvard Mental Health Letter, March (1997). Post-traumatic Treatment Failure (p. 7). The Harvard Mental Health Letter, November (2003). What does not help and what may. (pp. 4-5). Rose, S., Bisson. J., & Wessely. S., (2003). A Systematic review of single psychological interventions (debriefing) following trauma: Updating the Cochrane review and implications for good practice. In R. Orner & U. Schnyder (Eds.), Reconstructing early intervention after trauma: Innovations in the care of survivors (pp.228-235). Oxford, UK: Oxford University Press. Price, J., & Davis, B. (2008). The Woman Who Can’t Forget, New York: Free Press. Brewin, C.R.(2003). Pos-traumatic stress disorder: Malady or Myth? New Haven, CT: Yale University Press. Wulff, D.M.(1997). Psychology of Religion: Classic and Contemporary (2nd ed.). New York: Wiley & Sons. Bergin, R. (1997). A Spiritual Strategy, Washington, DC, APA. Barks, Coleman (1998). The Essential Rumi, English translation by Barks, New York: Quality Paperback Book Club (p. 32). Larson, D.B., Swyers, J.P., & McCullough, M.E. (1998) Scientific Research on Spirituality and Health, Rockville,MD: NIH for Health Care Research.

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[27] Armstrong, K. (2000). The Battle for God, New York: Alfred A. Knopf. (p. 13). [28] Frankl, V.E.(1959). Man’s Search for Meaning, Boston, MA, Beacon Press. [29] Freud, S. ([930]- 1962]. Civilization and Its Discontent, In J. Starchy (ed. and trans.). Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hograth Press (p.25). [30] Susskind, L. (2006). The Cosmic Landscape: String Theory and the Illusion of Intelligent Design, New York: Little Brown & Company. [31] Hawking Stephen(2007). A Stubbornly Persistent Illusion: The Essential Scientific Works of Albert Einstein, Philadelphia: Running Press. [32] Bohm, D.and Hiley, B. (1993). The Undivided Universe, London: Routledge Publisher. [33] 33 Dossey, L.(1982). Space, Time, & Medicine, Boulder: Shambhala [New York] Random House [34] Dossey, L. (1984). Beyond Illness,Boulder: Shambala [New York]New Science Library. [35] Levin, J., (2001). God, Faith and Health: Exploring the Spirituality-Healing Connection, New York: John Wiley & Sons (p.196). [36] Goleman, D., & Gurin, J.(1993). Mind Body Medicine: How to Use Your Mind for Better Health, New York: Consumer Reports Books. [37] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster. [38] Levin, J.S. Larson, D.B. Puchalski, C.M. (1997). Religion and Spirituality in Medicine: Research and Education, Journal of American Medical Association, 178, 792-793. [39] Bergin, R. (1997). A spiritual Strategy, Washington DC, APA. [40] Goleman, D., & Gurin, J.(1993). Mind Body Medicine: How to Use Your Mind for Better Health, New York: Consumer Reports Books, (pp. 3-38). [41] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster. [42] Newberg, A., D’Aquilli, E., Rause, V., (2001) Why God Won’t Go Away, New York: Ballantine Books. [43] Miller, W.R., (1999). Integrating Spirituality Into Treatment ,NIH Report, Published by the U.S. Department of Health & Human Services. [44] Koenig, H.G., McCullough, M.E., Handbook of Religion and Health. [45] Yates, J.W., Chalmer, B.J., James, P.(1981). Religions in Patients with advanced cancer, Medical and Pediatric Oncology 9: (2) 121-8. [46] Miller, W.R., (1999). Integrating Spirituality Into Treatment ,NIH Report, Published by the U.S. Department of Health & Human Services. [47] Larson, D.B., Swyers, J.P., & McCullough, M.E. (1998) Scientific Research on Spirituality and Health, The John Templeton Foundation. [48] Koenig, H.G., McCullough, M.E., Handbook of Religion and Health. [49] Levin, J., (2001). God, Faith and Health: Exploring the Spirituality-Healing Connection, New York: John Wiley & Sons. [50] Cohen, S., and Willis, A.T., (1985) Stress, Social Support, and the buffering hypothesis, Psychological Bulletin, 98, 310-357. [51] Kean, T.M., Zimering, R.T., & Caddell, J. (1985). A Behavioral formulation of posttraumatic stress disorder in Vietnam veterans. The Behavior Therapist, 8, 9-12.

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[52] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster. [53] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster (pp.196-199). [54] Armstrong, K. (2001). Buddha, New York: Penguin Putnam Inc. [55] Qur’an, Chapter 112, Verse 2. [56] Qur’an, Chapter 46, Verse 35. [57] Qur’an, Chapter 2, Verse 153 [58] Qur’an, Chapter 65, Verse 3-7. [59] Luke’s Gospel, Chapter 6, Verse 48. [60] Shafranske, E.P., (1996). Religion and the Clinical Practice of Psychology, Washington, DC: American Psychological. [61] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster. [62] Taylor, E., (1997). A Psychology of Spiritual Healing, West Chester, PA: Chrysalis Books. [63] Liberman, M.D., and Eisenberg, N., Eds. (2005). Social Neuroscience:People Thinking about People, Boston: MIT Press. [64] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster, (pp. 134-136). [65] Benson, H. (1996). Timeless Healing: The Power and Biology of Belief, New York: Simon & Schuster (p.203).

In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Chapter 5

IS THERE A PLACE FOR SPIRITUALITY IN THE CARE OF ELDERLY PATIENTS? Stéfanie Monod*, Etienne Rochat, Theologian and Christophe Büla Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Medical Center Lausanne, Switzerland

ABSTRACT

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The relationship between spirituality and medicine is a field of growing interest. Spirituality is a much broader concept than religiosity, and includes notions as diverse as the purpose and meaning of one’s life, the feeling of internal peace and harmony. Over the last 15 years, a large number of studies coming from different fields of research (medicine, nursing, sociology, psychology, and theology) investigated the association between spirituality (including religiosity) and health. Among those, several longitudinal epidemiological studies focusing on religiosity in elderly persons found an association between religiosity and lower mortality, better functional as well as cognitive status. Other studies, mostly cross-sectional, also found significant associations between the broader concept of spirituality and mental, physical, as well as functional health status. These empirical evidences are however limited and the nature of the association between spirituality and health remains unclear. Nevertheless, these observations suggest that spirituality could be a factor that influences health at an individual level. Spirituality is often closely associated with patients’ decisions regarding medical or treatment choices, and, traditionally, it has been considered as positive resource for coping with illness, especially when suffering or dying. However, spirituality might also influence negatively health outcomes. For instance, spiritual distress and religious struggle have been associated with higher mortality rate, more severe depression, hopelessness and desire of hastened death. Spiritual distress and religious struggle might have a clinical impact and potentially worsen patients comfort and quality of life. *

Author address: Dr St. Monod, Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Centre (CHUV), CUTR Sylvana, Ch. De Sylvana #10, CH-1066 Epalinges, Switzerland; Tél.: +41-21-314-3811; Fax: +41-21-314-3858; E-mail: [email protected]

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Stéfanie Monod, Etienne Rochat and Christophe Büla Overall, these observations suggest that spirituality is an important dimension to consider in clinical care. These observations therefore support the growing interest toward improving spirituality assessment in elderly patients, even though it remains to be determined whether interventions to improve spiritual distress and religious struggle would be both feasible and effective. In addition, ethical issues remain about the appropriateness to inquire about this dimension in frail older persons. In particular, the potential to be too intrusive into patients’ privacy and the risk to harm through inappropriate interventions must be fully considered and prevented. At a minimum, introducing the spiritual dimension into usual geriatric care should be based on a structured approach that is fully integrated into a comprehensive multidimensional assessment. In conclusion, several observations suggest that spirituality is an important dimension to consider in elderly patients to enhance a patient-centered care. Whether interventions aiming at improvement of spiritual distress will significantly contribute to improve health outcomes must still be determined.

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INTRODUCTION The relationship between spirituality, religiosity, religion, and health is a field of growing interest. Most researchers have initially investigated the association between religiosity or religion, and health. The profound modification of the relationship to religion in developed societies, the relative decline of the Judaeo-Christian religions, and the increasing attraction for alternative forms of spirituality, led researchers to focus their investigations on the broader concept of spirituality rather than solely on religion. At the present time, in western countries, a great number of individuals will not qualify themselves as “religious”, but they will consider themselves “spiritual” (Koenig, McCullough & Larson, 2001). The concept of spirituality has been moving from a religious institutional field, with organized religions, toward a more complex, universal field. At the same time, religion and spirituality have been increasingly considered as a person’s private matter. Thus, religion has been loosing progressively its significance for a growing number of individuals. This situation leads to the necessity to clearly define the terms of spirituality, religion, and religiosity, especially within the field of clinical research. While some may consider religion and spirituality as indistinguishable, others believe that spirituality is a much broader dimension that can include or not religiosity aspects. There is no consensual definition of spirituality, but attempts have been made to define spirituality within health research, as proposed by Larson in 1997 (Larson, Swyers.J.P. & McCullough, 1997). He defined spirituality as “the quest for understanding life’s ultimate questions and the meaning and purpose of living, which often leads to the development of rituals and a shared religious community, but not necessarily”. Thus, according to this definition, spirituality might include notions as diverse as the purpose and meaning of one’s life, but also the feeling of internal peace and harmony. Beside this definition of spirituality, religion can be defined as an organized system of beliefs, practices, and symbols designed to facilitate closeness to a higher power. Religion also includes the understanding of one’s relationship with and responsibility to others. Finally, religiosity (or religiousness) is usually considered to include three major dimensions: organizational religious activities (e.g., church attendance), non organizational religious activities (e.g., private and personal religious

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behaviours), and subjective or intrinsic religiosity, that reflect the extent to which religion is the primary motivating factor in people’s lives, drives behaviour, and influences decisionmaking. In this review, we will consider spirituality as a much broader concept than religion or religiosity, although these last two dimensions are included within the spirituality concept, as shown in Figure 1. Nevertheless, these terms are not always clearly distinguished in the literature, and, as a result, the terms of spirituality or religiosity are sometimes used as synonyms and sometimes not. Whenever possible, we attempted in this review to specify the concept referred to behind the terms used.

Spirituality

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Religiosity

Figure 1. Spirituality concept that may or may not include religiosity aspects.

Over the last twenty years, numerous studies investigated the links between spirituality (including religiosity) and health in older persons. Most results suggested that spirituality is an important dimension to consider in the care of elderly persons. Nevertheless, the exact place that spirituality should take in the care of patients remains unclear. In addition, benefits of taking into account patient’s spirituality are not well identified. This review highlights the current knowledge about the relationship between spirituality and health, and discusses some ethical issues raised by spirituality assessment, especially in elderly persons. Finally, we propose different models designed to support the inclusion of the spiritual dimension into the care of older patients.

EPIDEMIOLOGICAL EVIDENCES OF AN ASSOCIATION BETWEEN SPIRITUALITY AND HEALTH Over the last 15 years, a large number of studies coming from different fields of research (medicine, nursing, sociology, psychology, and theology) investigated the association

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between spirituality (including religiosity) and health. Two systematic reviews identified more than 850 studies that documented the association between religiosity and mental health (Koenig & Larson, 2001)(Hackney & Sanders, 2003). In these reviews, religiosity was found to be mainly associated with lower prevalence of depression, less anxiety, and lower suicide rates. Another systematic review also explored the links between religiosity and physical health (Koenig et al., 2001) and identified about 350 studies. These studies showed that religious beliefs and activities were associated with better immune function, fewer heart diseases, improved cardiac outcomes, lower blood pressure, and improved health behaviours. Although much more difficult to measure, spirituality, in a broader concept, has also been associated with better mental and physical health, health-related quality of life and other health outcomes (Mueller, Plevak & Rummans, 2001). These results highlight an association between spirituality and health, but the direction, as well as the strength of this association remains blurred, because most of these studies were cross-sectional, and most did not control for potential confounders. As a consequence, no definitive conclusion could be made about a potential causal link. Beside these results, some longitudinal studies of good methodological quality have been conducted. Among them, several longitudinal studies found an association between religiosity and lower mortality, better functional, as well as cognitive status. These results are detailed below.

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Religiosity and Mortality A meta-analysis of data from 42 studies examined the association between religiosity and all-causes of mortality (McCullough, Hoyt, Larson, Koenig & Thoresen, 2000). In these included studies, religious involvement was measured, most of the time, either by public religious involvement (e.g., frequency of religious services attendance), or by subjective religiousness. Results of this meta-analysis showed that religious involvement was significantly associated to an increased probability of being alive at follow-up (OR: 1.29, 95% CI:1.20-1.39). Several cohort studies in elderly people also found an association between religiosity and lower mortality. For instance, analyses from the EPESE cohort, which included community-dwelling elderly persons aged 64 years and over, showed that the frequency of religious attendance was associated with a decreased risk of death in the entire cohort (RR for death: 0.78, 95% CI:0.70-0.88). However, analyses stratified by study sites showed that this association remained significant in only 2 of the 4 sites (Bagiella, Hong & Sloan, 2005). In one EPESE site (North Carolina) where public religiosity was shown to be significantly associated with longer survival (Koenig, Hays, Larson, George, Cohen, McCullough et al. 1999), private religious activities (i.e. prayer, bible lecture, meditation) were also associated with lower mortality in functionally unimpaired older adults (Helm, Hays, Flint, Koenig & Blazer, 2000). Specifically, subjects reporting that they rarely or never participated in private religious activities had an increased probability of dying (adj HR: 1.47, 95%CI: 1.07-2.03) compared to those who reported more frequent participation to private religious activities, even after adjustment for multiple confounders, including health practices, depression, social support, and other religious practices. These results support the hypothesis that non-organizational religious activity could have a protective effect on mortality, beyond the one generally attributed to involvement in social activities or larger social networks. As an

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explanatory factor, some have suggested that repetitive ritual of prayer or meditation would provide health benefits through various mechanisms such as blood pressure reduction or improved psycho-neuroendocrine function (Levin, 1996).

Religiosity and Functional Status

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Although data are more limited, epidemiological studies also found an association between religiosity and better functional, as well as cognitive status in older persons. In the EPESE cohort, frequency of religious services attendance was a strong predictor of better functioning at the end of the follow-up (12 years). In this study, Idler and al. found that social ties, health practices, and indicators of well-being, did reduce but did not eliminate these effects (Idler & Kasl, 1997), suggesting an independent effect of attendance to religious services. Inversely, incident disability had minimal effects on subsequent services attendance in this cohort of elderly persons. Attendance patterns following disability occurrence were primarily explained by previous attendance patterns and subjective religiousness. Finally, in this same cohort, frequency of religious services attendance was also associated to a lower prevalence of cognitive impairment after 3 years of follow-up (OR: 0.64, 95%CI: 0.49-0.85), even after adjustment for sociodemographics, health practices, and biomedical covariates (Van Ness & Kasl, 2003). Overall, these results add to previous data from cross-sectional studies supporting the hypothesis of an independent link between spirituality and health. However, even though they are more convincing, these empirical evidences remain limited. Furthermore, the nature of the association between spirituality and health remains unclear. Numerous hypotheses have been proposed to explain this association and are discussed in the next paragraph.

Summary of Hypotheses Explaining the Association between Spirituality and Health Numerous hypotheses have been proposed to explain the observed association between spirituality and health outcomes (Levin, 1994; Levin, 1996). These hypotheses can be viewed from two complementary perspectives, individual and psychosocial. At an individual level, religiosity has been associated with healthier behaviours and better treatment adherence, especially in some religious group. In addition, as previously mentioned, spiritual practice, such as prayer and meditation, have also been associated with improved psychological outcomes. At a psychosocial level, frequent religious involvement and greater intensity of religious experience may be associated with better health due to religion’s promotion of social support, sense of belonging, and convivial fellowship. Frequent services attendance could also encourage a physical, as well as cognitive activity, especially in older persons. In conclusion, some epidemiological evidences suggest an independent association between spirituality and health, but factors underlying this relationship remain hypothetical. Most likely, these factors are complex and are operating through multiple pathways. Overall, epidemiological evidences alone would not be sufficient to support the indication to

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“prescribe religious activities” as Sloan wrote in an article (Sloan, Bagiella, VandeCreek, Hover, Casalone, Jinpu et al. 2000). Nevertheless, these observations strongly suggest that spirituality could be a factor that influences health at an individual level. This influence will be further developed in the next chapter.

CLINICAL INFLUENCE OF SPIRITUALITY IN THE CARE OF ELDERLY PATIENTS Spirituality has been shown to be associated with better health outcomes in several epidemiological studies that were previously mentioned, but the influence of spirituality on health could also be negative. In addition, spirituality might also influence health status because it could often be closely associated with patients’ decisions regarding treatment choices. These aspects are developed below.

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Positive Aspects of Spirituality on Clinical Care Spirituality has been frequently considered exclusively as a positive resource for patients to cope with their illness, especially when suffering or dying. Patients challenged by illness or functional decline, may turn to spiritual values to find comfort, answers, and support to better cope with their illness. Numerous studies have been published to illustrate these positive aspects of spirituality. In a review of studies that examined the relationship between religious involvement, coping with illness, and health outcomes, religious involvement appeared to help patient to cope better and experience psychological growth from their negative health experiences, rather than be defeated or overcome by them (Koenig, Larson & Larson, 2001). This positive effect was particularly apparent in those with serious and disabling medical illnesses. In a longitudinal study in medically ill hospitalized elderly patients, positive methods of religious coping (i.e., seeking spiritual support) were associated with improvements in depression and quality of life at 2 years follow-up (Pargament, Koenig, Tarakeshwar & Hahn, 2004). Moreover, religiousness, firmness, and consistency of beliefs and practices, appeared also to buffer against the fear of death and dying in old age (Wink & Scott, 2005). Spirituality and religion seem therefore to play a significant role in the lives of older adults and in their ability to cope with various hardships that accompany the aging process, especially chronic illnesses, and grief (MacKinlay, 2001) (Nelson-Becker, Nakashima & Canda, 2007) (Crowther, Parker, Achenbaum, Larimore & Koenig, 2002). Unfortunately, spirituality might also influence negatively health outcomes, especially when patients are suffering from negative religious coping or spiritual distress.

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Negative Aspects of Spirituality on Clinical Care Patient’s health might be indeed negatively influenced by two entities: religious struggle and spiritual distress. Religious struggle, less common than positive religious expression, can be manifested by negative feelings toward God, including reports of anger at God, feeling punished by God, or believing that the devil was at work in the illness. These negative forms of religious coping have been associated with poorer physical health outcomes, greater depression, and lower quality of life in medically ill hospitalized elderly patients (Koenig, Pargament & Nielsen, 1998). Moreover, religious struggle has also been associated with increased mortality in medically ill elderly patients (Pargament, Koenig, Tarakeshwar & Hahn, 2001). The authors found that subjects experiencing religious struggle at baseline had a slightly increased risk of mortality after 2 years of follow-up (RR: 1.06, 95%CI:1.01-1.11), even after adjustment for sociodemographic, mental, and physical health status. Beside religious struggle, spiritual distress has also been studied, though less frequently and mostly in the context of end-of-life care. Spiritual distress might be defined either by the presence of unmet spiritual needs (as the need to find meaning or to have a relationship with its own transcendence), or by a low spiritual well-being. When suffering, patients frequently struggle with questions about meaning and purpose in life. In post-acute geriatric rehabilitation care, spiritual distress seems highly prevalent (about 60% of patients at admission), and was associated with several patient’s characteristics (Monod, Rochat, Martin & Bula, 2007). Compared to the others, in multivariate analysis, patients with spiritual distress were younger (81.6 ± 8.6 vs 83.9 ± 7.6 years; P .05). The third set of questions asked participants to imagine that the person was told to vandalize a church. The same three hallucinations were used (i.e., God, President, dog). In this case, all three groups differed significantly from each other. Hallucinations from a dog (M = 1.60) were more likely to indicate insanity than a hallucination from the President (M = 2.33), and both of those were more likely to indicate insanity than a hallucination from God (M = 2.73; all ps < .05). Mean Differences by Hallucination Entity Three more analyses were conducted to determine whether there were differences among the different types of crimes, for each of the three different hallucination entities (i.e., God, President, dog). When God was the hallucination entity, participants perceived the person committing the killing spree (M = 2.36) as more insane than the person committing the bank robbery (M = 2.57) or the person who vandalized the church (M = 2.7). However, this effect was only marginally significant (p = .057), and none of these groups differed from each other. The same pattern emerged when the dog was the hallucination entity. Participants saw the killer as more insane (M = 1.32) than the bank robber (M = 1.54) or the church vandal (M = 1.59; p = .010). While the overall effect was significant, none of the three group means were significantly different from the others. When the President was the hallucination entity, there was no significant difference overall or between groups. Study One Discussion Overall, scores on the sanity/insanity measure indicated that participants thought all of the individuals in the scenarios were quite likely to be insane, regardless of their type of crime

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or the hallucination entity they experienced. This suggests, not surprisingly, that hallucinations triggered participants’ insanity schemas. In addition, hallucinations about God were less likely to indicate insanity as compared to the other hallucination entities. This effect, however, was slightly different depending on the crime that was committed. When the person was instructed to go on a killing spree or rob a bank, he was most likely to be considered insane if he had hallucinated about a dog than either God or the President (which did not differ from each other). However, when the crime was related to religion (vandalizing a church), he was seen as the least likely to be insane when he had received instructions from God as compared to either of the other hallucination entities. The results also indicated that individuals experiencing God hallucinations were seen as most insane when they went on killing sprees, and least insane when they vandalized churches. The same pattern was found for hallucinations of a dog. Although this study did not investigate reasons for participants’ answers, it is possible to infer a few possibilities. In all three crime scenarios, having a hallucination of a talking dog led to the greatest perceptions that the person was insane. Possibly, hearing an animal talk is consistent with participants’ insanity schemas (e.g., distorted thinking). Simply put, sane people might believe that God or the President is talking to them, as these are entities that have the ability to speak (assuming that one believes God can and does speak to individuals). On the other hand, no sane person would believe that a dog was talking. Although this study cannot confirm participants’ reasoning, this is one possible explanation for the findings. In addition, for hallucinations containing instructions from God or a dog, individuals who killed were seen as more insane than those who robbed banks or vandalized churches. Possibly, the severity of the crime influenced responses. Committing a severe crime may be part of participants’ insanity schemas. Simply put, committing severe crimes may indicate that one is insane. Perhaps severity maps on to other aspects of individuals’ insanity schemas, such as “evil intent” (Finkel, 2000). There may be a religious explanation for some of these results, as well. It is possible that at least some participants believed that God might talk to someone who is sane. The Bible claims that God talked to many individuals, including Moses and the apostle Paul. Some such Biblical individuals who heard God talking became major leaders and oft-discussed Biblical figures. These individuals were not considered to be ‘insane,’ and thus some participants might believe that God can talk to sane individuals. This might explain why hallucinations containing instructions from God led to perceptions that the individual was more likely to be sane, as compared to hallucinations containing instructions from a dog and, in the case of vandalizing a church, instructions from the President. It is also possible that participants might believe that God would instruct someone to vandalize a church that He does not approve of; this could explain why the person who hallucinated that God instructed them to vandalize a church was seen as more sane as compared to people who robbed a bank or committed murder. In contrast, participants might believe that God would never command someone to kill other people or rob a bank as these are more serious and violent crimes. Because vandalizing a church is not as serious or violent, perhaps it is more believable that God would command this act. Of course, the scenarios did not say as much, and it is not possible to know what participants were thinking. Nevertheless, this research suggests that both the type of crime and the identity of the hallucination entity affect perceptions of sanity. Future studies are needed to fully investigate these issues.

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Study One did not measure whether participants felt that the criminal in the scenario met the requirements of legal insanity; it only measured their own perceptions of insanity. It also did not measure whether individuals felt the person was reasonable to follow the instructions given by the hallucination entity. Study Two expanded on the results of Study One by investigating participants’ perceptions within a legal setting.

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Study Two The second study was an experiment designed to investigate whether different types of hallucination entities affected judgments of sanity and reasonableness in a mock trial situation. Specifically, the research question was: Does a hallucination containing instructions from God produce different perceptions of legal insanity and reasonableness than does a hallucination containing instructions from a dog? Thirty-one college student mock jurors (55% female) read one of two trial summaries involving a female defendant who killed her child. Half of the participants read that the defendant had hallucinations that God told her to kill her child, while the other half read that she had hallucinations that a dog told her to kill her child. The trial summaries were approximately 370 words long and included a legal definition of insanity based on the Durham test (described previously). Participants indicated whether they believed the defendant was legally insane or sane and their certainty in their sanity decision. Thirteen mock jurors believed the defendant was legally sane, while 18 believed the defendant was legally insane. The insanity decision was then multiplied by the participant’s certainty answer, creating an “insanity certainty” scale from –5 (very certain in a sanity decision) to 5 (very certain in an insanity decision). A t-test revealed no statistical differences in the insanity certainty variable (t = .1, p > .05), although the God hallucination group was somewhat more certain in a sanity decision (M = .6) than was the dog hallucination group (M = .72). Participants next indicated, on a scale from 1 (not reasonable) to 5 (very reasonable), whether they thought it was reasonable for the defendant to believe her hallucinations were real. There was a significant difference in perceptions about reasonableness (t = 2.5, p < .05). Jurors who read about a God hallucination (M = 3.4) believed it was more reasonable for her to believe that the hallucination was real, as compared to jurors who read about a dog hallucination (M = 2.5).

Discussion of Study Two This second study indicated that mock jurors were sharply divided as to whether the defendant was insane, regardless of the entity in the hallucination. This may indicate that jurors are considering factors other than mental illness in their decisions. Specifically, a mental illness (and hallucinations) is not enough to automatically find the defendant to be insane. These results could also indicate jurors’ skepticism of defendants who are claiming insanity. Perhaps some participants doubted whether the defendant had actually experienced a hallucination, reasoning that it might just be an excuse to try to “get away with” murder. Such reasoning would comport with findings of Ogloff (1991), which indicated that individuals considered whether the individual claiming insanity was truly insane or just pretending. Results also indicated that mock juror participants who were given a legal definition of insanity did not differentiate between hallucinations that contained instructions from God and

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hallucinations that contained instructions from a dog. However, the hallucination entity did affect perceptions of reasonableness. Specifically, participants felt that it was more reasonable for the woman to believe that the God hallucinations were real as compared to the dog hallucinations. The mean responses indicate that mock jurors, especially those in the God hallucination group, believed it was somewhat reasonable to believe the hallucinations. Perhaps the mock jurors were taking the defendant’s mental illness into account; that is, they felt that-- given her mental illness-- it was reasonable for her to believe the hallucination was real. As with Study One, this study did not ask participants to give reasons for their decisions, so these conclusions are merely speculation based on the statistical results.

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GENERAL DISCUSSION AND CONCLUSION As expected, participants in Study One largely believed that individuals who experienced hallucinations were insane. Participants used a 9 point scale (1 = very likely insane to 9 = not at all likely to be insane) to rate the individual in the scenario who had experienced a hallucination. Depending on the condition, insanity ratings ranged from 1.32 to 2.73—clearly indicating that the individual was perceived to be insane. In contrast, only 58% of participants in Study Two thought the defendant was legally insane. Their “insanity certainty” scores also indicated their uncertainty as to whether the defendant was insane. The means for each group (i.e., the God hallucination and the dog hallucination) were near 0, which was the mid point on the scale. This indicates that mock jurors were uncertain and sharply divided as to whether the defendant was insane. The differences in insanity beliefs between the studies could be a result of different stimuli, or it could be a difference between perceptions of “general insanity” (study 1) and “legal insanity” (study 2), with the latter being a more stringent standard. Study One findings are in accord with previous research which found that participants’ schemas of insanity include factors such as lack of intent to harm (Ogloff, 1991), distorted thinking and incapacity (Finkel, 2000). The more a hallucination indicates lack of intent to harm (e.g., following God’s orders under the assumption that God would not direct one to do harm), distorted thinking (e.g., believing that God, the President or a dog is talking to you), and incapacity (e.g., inability to resist following instructions from this entity), the more it fits within the insanity schemas investigated by Ogloff and Finkel. Study One investigated participants’ personal schemas of insanity, while Study Two investigated mock jurors’ perceptions of legal insanity. When asked to determine whether someone was sane (without any legal definition of insanity), participants indicated that people who committed crimes due to hallucinations containing instructions from God were less likely to be considered insane. Similarly, Study Two found that mock jurors felt that it was more reasonable to believe a hallucination was real when the hallucination entity was God, as compared to a dog. Thus, when the hallucination entity is God, individuals may be perceived as more sane and reasonable. However, when mock jurors in Study Two were given instructions regarding the legal definition of insanity, the hallucination entity did not affect verdicts. Taken together, the studies indicate that personal schemas of insanity and personal beliefs about reasonableness of behavior are somewhat different from legal standards of insanity. This comports with previous studies (e.g., Finkel, 2000) indicating that jurors have

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notions of insanity that are not necessarily the same as those expressed in the legal standard. As such, the current research suggests that the Study One participants could have been using different criteria as Study Two participants. This could indicate that participants use different criteria when asked to give a personal decision as opposed to when they give a decision as a mock juror. This does not necessarily mean that jurors are unable to follow the legal instructions (although Finkel, 2000 and Ogloff, 1991 suggest that jurors have difficulty doing so), it merely suggests that the decision-making process is different depending on whether someone is making the decision as a “regular” person or as a juror. Research specifically testing this notion is needed. It is important to note some limitations of the current studies. First, participants in Study Two read a brief written trial summary. This experience is quite different from that of real jurors, who will see and hear days or weeks worth of testimony. The lack of verisimilitude may have affected participants’ responses. Mock jurors also did not deliberate, as would real jurors. Group dynamics can influence individuals’ decisions. Similarly, knowing that their verdicts had no real-life implications might affect mock jurors’ decisions. It is hoped that real jurors would take more time to decide the fate of a real defendant than the mock jurors took in deciding the fate of the defendant in this mock trial. In addition, these studies only investigated a limited number of crimes and types of hallucinations; as a result, broad generalizations are not possible. Finally, the discussion above makes some assumptions about what participants were thinking when they were making their decisions about insanity. The current research did not assess participants’ reasons for their decisions. More research is needed to determine what specific factors jurors rely on when making their insanity decisions. Despite these limitations, the current studies provide the first insight into participants’ schemas of, and legal decisions about religious hallucinations. As a whole, these studies indicate that participants may believe that hallucinations involving God could be real (i.e., that the person is not insane), or at least that it is reasonable to believe that God could speak to someone. Their personal perceptions of insanity lead them to find people to be more reasonable and less likely to be insane when they had a hallucination of God as compared to other hallucination entities (e.g., a dog or the President). Although these two studies indicate that different types of hallucinations do affect participants’ decision-making in different ways, more research is necessary to fully understand this phenomenon.

REFERENCES American Law Institute (1962). Model Penal Code. Washington, DC: Author. American Psychiatric Association (2000): Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. Batson v. Kentucky, 476 U.S. 79 (1986). Bornstein, B. H. & Miller, M. K. (2009). God in the Courtroom: Religion’s Role at Trial. New York: Oxford. Finkel, N.J. (1991). The Insanity Defense: A Comparison of Verdict Schemas. Law and Human Behavior, 15, 533-555.

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J.E.B. v. Alabama, 511 U.S. 127 (Ala. 1994). Johnson, S. D. (1985). Religion as a defense in a mock-jury trial. Journal of Social Psychology, 125, 213–220. Kerr, N. L., Hymes, R. W., Anderson, A. B., & Weathers, J. E. (1995) Defendant-juror similarity and mock juror judgments. Law and Human Behavior, 19, 545-567. Miller, M. K. (2006). Religion in Criminal Justice, New York: LFB Scholarly Publishing, LLC. Miller, M. K., & Bornstein, B. H. (2006). The use of religion in death penalty sentencing trials. Law and Human Behavior, 30, 675–684. Miller, M. K. & Hayward, R. D. (2008). Religious Characteristics and the Death Penalty. Law and Human Behavior, 32, 113-123. NBC11.com (2007, January 10). Jury Reaches Verdict in LaShuan Harris Trial. NBC11.com Retrieved September 5, 2008, from http://www.nbc11.com/print/10706388/detail.html NYtimes.com (2007, January 18). California: Woman Ruled Insane in Children’s Deaths. NYtimes.com Retrieved September 5, 2008, from http://www.nytimes.com/2007/01/18/ us/18brfs-INSANE.html?_r=1&scp=2&sq=LaShuan%20Harris&st=cse&oref=slogin NYtimes.com (2008, February 20). Father Tells of Slaying Suspect’s Long Ordeal. NYtimes.com Retrieved September 5, 2008, from http://www.nytimes.com/2008/02/20/ nyregion/20commit.html?scp=2&sq=David%20Tarloff&st=cse NYtimes.com (2008, April 16). In Murder of Manhattan Therapist, Lawyer Plans Insanity Plea. NYtimes.com Retrieved September 5, 2008, from http://www.nytimes.com/ 2008/04/16/nyregion/16tarloff.html?scp=13&sq=David%20Tarloff&st=cse NYtimes.com (2008, May 21). Suspect’s Delusions Described to Judge. NYtimes.com Retrieved September 5, 2008, from http://www.nytimes.com/2008/05/21/nyregion/ 21tarloff.html?scp=11&sq=David%20Tarloff&st=cse Ogloff, J. (1991). A Comparison of Insanity Defnese Standards on Juror Decision Making. Law and Human Behavior. 15, 509-531. Regina v. M’Naghten, 10 Cl. And F. 200, 8 Eng.Rep.718 (1843). Seattletimes.nwsource.com (2008, June 5). Judge Declares Mistrial in Haq Case; Jewish Federation Jury Couldn’t Agree. Seattletimes.com Retrieved September 5, 2008, from http://seattletimes.nwsource.com/html/localnews/2004458503_haq05m.html Summers, A., Hayward, R. D., & Miller, M. K. (in press). How death qualification systematically excludes jurors based on religious characteristics, justice philosophy, cognitive processing, and demographics. Journal of Applied Social Psychology. Van Voorhis, P., Braswell, M., & Lester, D. (2007). Correctional Counseling & Rehabilitation. Cincinnati, OH: Anderson Publishing. Wade, C., & Tavris, C. (2008). Invitation to Psychology. Upper Saddle River, NJ: Pearson. Wainwright v. Witt, 469 U.S. 412 (1985).

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In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Chapter 13

ADAPTIVE AND MALADAPTIVE ASSOCIATIONS OF VARIETIES OF RELIGIOUSNESS AND BELIEF Gerard Saucier* University of Oregon, Eugene, Oregon, USA

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ABSTRACT Tradition-oriented Religiousness (TR) and Subjective Spirituality (SS) define two independent dimensions, which have previously been shown to be relatively stable across time and to have very different correlates. Utilizing data from a large American community sample, this study extends previous work to examine how these two dimensions and other dimensions relevant to religiousness and belief predict adaptive and maladaptive tendencies. Criterion variables include internalizing and externalizing aspects of psychopathology, attachment, altruism, and group attitudes, as well as mature values as delineated by Rollo May. TR was associated primarily with maladaptive tendencies, the effects being primarily due to descriptive schemas; a conventional measure of religious involvement and commitment did not show as many maladaptive associations. SS was associated with a mixture of adaptive and maladaptive tendencies. Additional belief dimensions had more unambiguous associations: Unmitigated selfinterest was associated with numerous maladaptive tendencies, and adherence to civic ideals (civil religion) was associated primarily with adaptive tendencies. These two additional dimensions, as well as the mature values index, showed some ability to predict change over time in altruism and in disorder-tendencies. Studies of belief vis-à-vis adaptiveness would be mistaken to concentrate solely on conventional religiousness, because other aspects of belief may have adaptive or maladaptive associations that are more powerful.

In recent years, results of numerous studies have been interpreted as demonstrating the healthy and adaptive effects of religiousness on human functioning. One limitation is that these studies have typically relied on fairly narrow ways of defining religiousness, and *

Correspondence should be addressed to: Gerard Saucier, Department of Psychology, 1227 University of Oregon, Eugene OR 97403-1227 USA; e-mail: [email protected]; tel.: 541-346-4927; fax: 541-346-4911

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another is that many studies have used neither large samples nor a wide diversity of criterion variables. Here I examine results from a large community sample with relevant criterion variables related to not only prototypical religiousness, but some non-prototypical forms. As will be seen, these results raise questions about the replicability of some previous findings and the generality of previous conceptions, and suggest some intriguing new directions for research on the adapative and maladaptive associations of belief. Religiousness appears to have some positive effects on health and longevity (Kozielecki, 1991; Powell, Shahabi, & Thoresen, 2003). These include protective effects with respect to alcohol/drug abuse (Miller, 1998). Nonetheless, there may be negative effects as well as positive effects (Koenig, 1997).

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TRADITIONAL RELIGIOUSNESS AND OTHER VARIANTS OF BELIEF Psychologists outside the specialized discipline of the “psychology of religion” often treat religious/spiritual beliefs as a unitary aspect of individual differences. But laypersons seem able to recognize distinct vectors in such beliefs (Zinnbauer et al., 1997). Multiple vectors are implied in the contemporary phrase “spiritual but not religious,” referring to contemporary metaphysical religion and “unchurched,” eclectic, and “psychological” spirituality (Fuller, 2001). One can find many definitions of “religiousness” in the psychological literature, including concrete, abstract, metaphysical, prescriptive, relationshiporiented, inner-motivation-oriented, and existential-quest-oriented definitions (Zinnbauer, Pargament, & Scott, 1999). The most prototypical definitions of religiousness focus on enactment in conjunction with belief. Argyle and Beit-Hallahmi (1975) defined religion as “a system of beliefs in a divine or superhuman power, and practices of worship or other rituals directed towards such a power” (p. 1). The emphasis on worship and rituals implies community activity that binds or ties people together. Indeed the word “religion” comes from Latin religio, derived from ligo meaning “to tie or bind” (etymologically related to the English word “ligament”). Definitions of “spirituality” usually put more emphasis on the individual and on subjective experience (Shafranske & Gorsuch, 1984; Vaughan, 1991), often closer in meaning to the natural-language term “mysticism.” Mysticism can be any doctrine that acknowledges or advocates that the highest truth occurs by some way other than the physical senses and usual cognitive processes (Reber, 1995; cf. Hood, 1975). That is, mystical knowledge is a direct personal knowledge of the divine, involving experiences having a strongly subjective character. Reflection on these key terms influenced Saucier and Skrzypińska (2006) to distinguish between tradition-oriented religiousness (TR) and subjective spirituality (SS). However, this distinction was implicit in prior scholarship and research. Zinnbauer, Pargament, and Scott (1999) made specific contrasts between (a) organized religion and personal spirituality, (b) substantive religion and functional spirituality, and (c) negative religiousness and positive spirituality. In each of these contrasts, the first term reflects TR and the second term SS. Emmons (1999) noted that spirituality can be strongly related to religiousness, though it is not always. Whereas spirituality has a strong subjective element and involves “a search for meaning, unity, connectedness to nature, humanity, and the transcendent” (Emmons, 1999, p.

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877), religion has a strong traditionalist element, providing a “faith community with teachings and narratives that enhance the search for the sacred and encourage morality” (Emmons, 1999, citing Dollahite, 1998, p. 877). Scholars describing diverse religions have noted a distinction between mystical and more orthodox trends (e.g., Sabatier, 1905; Schuon, 1953), fundamentalism being in many respects an attempt to reassert orthodoxy, whereas mystical trends are represented in Sufism, Kaballa, Zen, and so on. The terms esoteric and exoteric has been used to capture these distinctions (Schuon, 1953). Exoteric religion emphasizes form, and tends toward literalistic dogmas, with a claim to exclusive possession of the truth, sentimentality, and an emphasis on morality and personal salvation. Esoteric religion, in contrast, is more metaphysical, contemplative, oriented to knowledge, wisdom, and unification with divinity, and toward the spirit and not the letter of religious teachings. A similar distinction was made by Sabatier (1905) between authority- and spirit-focused approaches to religion. Empirical support for such a contrast was provided by a study of the content of isms terms in the English language. Saucier (2000), assuming that the most important worldviewbelief concepts tend to become represented in words ending in "-ism," extracted 266 such terms from an English-language dictionary and built items directly from their definitions. In a sample of 500 college students, the replicable item structures had no more than four factors. A parallel study of isms found in a Romanian-language dictionary, in Romania, replicated the four-factor structure (Krauss, 2006). Two of the four factors—Alpha and Delta—correspond to tradition-oriented religiousness and subjective spirituality. Concepts loading most highly on Alpha emphasize individual differences in adherence to traditional and religious sources of authority; this factor is correlated substantially with conservatism and authoritarianism. Concepts loading highly on Delta emphasize unorthodox spirituality. They involve individual differences in beliefs emphasizing intuition and spiritual experiences of a mystical nature, but including some currently fashionable superstitions. Alpha and Delta appear to encapsulate the distinction between tradition-oriented religiousness and subjective spirituality. Saucier and Skrzypińska (2006) showed that subjective spirituality (SS) and traditionoriented religiousness (TR) are empirically highly independent and have distinctly different correlates in the personality domain, suggesting that individuals with different dispositions tend toward differing styles of beliefs. For example, TR is associated with low openness to experience, as well as authoritarianism, traditionalism, and collectivism rather than individualism. SS is associated high openness to experience, as well as eccentricity, absorption, fantasy-proneness, dissociation, magical and superstitious beliefs. The previously observed pattern (e.g., Saroglou, 2002) of Big Five correlates of religiousness held for TR only, and then mainly when Agreeableness emphasizes altruism and Conscientiousness emphasizes ‘strictness.’ TR is identifiable with one of the isms factors, and SS with another; it is not clear whether the effects of religiousness on mental health are due to the TR or the SS component of spirituality, or some other component. What about the other two factors? They certainly are dimensions of belief and worldview, but might they be non-prototypical forms of religiousness? One factor (Beta) has been labeled “Unmitigated Self-Interest” (Saucier, 2000). The labeled pole of the dimension emphasizes materialism, hedonism, and solipsism, involves a prioritizing of gratification and exploitation. The other pole of the dimension prioritizes ethics and morality, and may be harmonious with at least mild expressions of asceticism, in which one renounces gratification, exploitation, and more generally the pursuit of power and pleasure in favor of ethical

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Gerard Saucier

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principles. This stripped-down moralism (i.e., the moralism often associated with religion but here not involving supernatural beliefs) might be considered a non-prototypical form of religiousness, one involving no particular supernatural entities but simply an emphasis on ethics, morality, and renouncing a pleasure-seeking, self-interest-seeking approach to life. Religious movements, perhaps especially at their inception, often contain such an emphasis at quite a strong dosage level. The other factor may be one more non-prototypical form of religiousness. This factor (Gamma) involves a combination of patriotism, rational humanism, and support for a constitutional civil government, that is, a set of civic ideals and norms for binding a community together. Rousseau (1762/1968) initiated the concept of “civil religion” (see also Bellah, 1967), which can be taken to refer quasi-religious manifestations associated with adherence to a political culture. Examples are veneration given to political documents (e.g., a constitution or a declaration of national independence), past political leaders (e.g., “founding fathers), veneration of casualties and veterans of a nation’s wars, civic shrines associated with founders, past leaders, veterans, and national heroes, recitation of national pledges and anthems, and various national myths. “Civic religion” has the same meaning as “civil religion” and is preferred here due to the lesser ambiguity of the term “civic.” This Gamma factor likely refers to manifestations of civic religion, though I label it more cautiously as Adherence to Civic Ideals. In summary, then, the four isms factors can be viewed as four varying forms of belief. One—Tradition-oriented Religiousness—is the most prototypical form of religiousness. A second—Subjective Spirituality—is a commonly arising alternative to the first. The other two are even less prototypical of, but still relevant to, religiousness. Each involves a constellation of beliefs that has some relevance to an understanding of religiousness.

USEFUL CRITERIA FROM DIVERSE DOMAINS FOR ADAPTIVE AND MALADAPTIVE FUNCTIONING Variables related to psychopathology are important criterion variables for a personality measure (cf., Roberts et al., 2007; Grucza & Goldberg, 2007), and more broadly for measures of belief. These variables are indicative of the quality of human functioning, but others are also relevant. One criterion for good functioning is healthy relationships, which should be reflected in healthy adult attachment patterns. It has long been proposed that religiousness should in theory be related to altruism. And since Allport (1959), there has been debate about whether and in what direction religion is associated with prejudice. In addition, this study uses a novel measure of adaptive versus maladaptive values. Values are a specific component of the domain of beliefs that involves judgments about what is good or preferable (cf., Rokeach, 1968). Schwartz has defined them as trans-situational goals that set out desirable end-states or behaviors, and guide how we choose and evaluate both behaviors and situations (Schwartz, 1992). A developmental conception of values was provided by Rollo May (1967). According to May, in the trajectory of healthy human development there is a shift in the nature of values that is subtle but potentially profound in its effects. May outlined a conception of “mature values,” whose presence should theoretically serve to diminish or prevent neurotic anxiety. Mature (or viable) values go beyond simple

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physical gratification and survival, beyond an exploitative attitude toward nature and toward other people, and beyond a desire for approval from others or to become like others. Mature values transcend the immediate situation and the immediate in-group. They involve empathy, generosity, ethics, and ultimately extend to humanity as a whole, while building on wisdom accumulated in humanity’s past. They are in continuous transformation (not hardening into dogma). Involving creativity and freedom, they are chosen by the person and not by others. Compared to immature values, mature values have a more highly symbolic character, involving a more abstract conception of the good; accordingly, the more mature their values, the less it matters to a person whether their “values are literally satisfied or not,” because “satisfaction and security lie in the holding of the values” (p. 82). This conception of mature values makes a clear distinction between (what are proposed to be) adaptive versus maladaptive values. Interestingly, it appears to combine two dimensions in the higher-level structure of goal contents found across 15 cultures by Grouzet et al. (2005); that is, mature values seem to involve both intrinsic goals and selftranscendence goals. However, the maturation may involve not only values and goals but also worldview beliefs—descriptive schemas about what the world is like. That is, maturation may move from a short-sighted, small-minded worldview (self as the only reality, personal pleasure as the highest attainable good, my own group as superior) that justifies unmitigated pursuit of self-interest, to a worldview that is more far-sighted and broad-minded. This maturation is not inevitable: Many individuals retain through middle and old age an ‘immature’ value system emphasizing gratification, exploitation, and the approval of others. This study included a measure of this intriguing construct—mature values—for a first look at how adaptive vs. maladaptive values might be related to various forms of religiousness and belief.

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METHOD Participants Participants were 703 members of the Eugene-Springfield community sample (58% female, mean age 51 in 1993; Grucza and Goldberg [2007] provide more details). Most measures of religious and other beliefs were administered in early 2001, and criterion measures were administered at various points between 1995 and 2008. Sample size was 703 for examining the intercorrelations of the belief scales. For the validity analyses, the largest possible subset of these 703 was used for the data from each year, that is, within data from each year there was listwise deletion of cases with missing data, so that sample sizes were 560 in 1995, 656 in 2000, 621 in 2001, and 550 in 2008. None of the criterion variables were administered at the same time as the belief-dimension variables; the 2001 criterion-variable data was collected in a separate questionnaire administered several months after the measures of religious and other beliefs.

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Gerard Saucier

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Measures of Religiousness and Belief Saucier (in press) developed short marker scales for the four factors first found in the study of isms (Saucier, 2000). Saucier (in press) demonstrated the stability and internal consistency of scales with a total of 28 items, six each for Tradition-Oriented Religiousness and Subjective Spirituality, eight each for Unmitigated Self-Interest and Adherence to Civic Ideals. Each scale is balanced with respect to keying and includes either six or eight items. The present analyses used a slightly improved version of one of these scales: The Adherence to Civic Ideals scale revised so that one previous item (“I don’t see much use in strictly and literally adhering to the law”) is removed, replaced by three items that provide a fuller representation of humanistic rationalism. This revision was effected so as to make the marker scales correspond more perfectly to the factor as found originally by Saucier (2000), a blend of patriotism, constitutionalism, and humanistic rationalism. Epstein (1998) has made a useful distinction between descriptive and motivational schemas; the first includes statements about what the world is like, the latter are statements about how things should be, what is good or bad, and what means should be used to achieve desired ends. The four belief dimensions each consist of a mixture of these two types of schemas. To enable further insights into the sources of any effects, prior to this study I divided the marker scales in such a way that each scale had one subset (roughly half) consisting of more descriptive-schema items, and another subset consisting of the remaining items which were more motivational, and ran some analyses using these subcomponent scales. Table 1 shows how the 30 items were divided into descriptive and motivational subsets. Religiousness can alternatively be measured with a single adjective item (as shown by Saucier & Skrzypińska, 2006), and that item was used here, administered in 1995. Saucier (in press) reported a 2-year retest stability of .80 for this single-item measure. As a measure of religious involvement and commitment (attendance and devotion) and of intrinsic religiosity I examined correlations of the belief dimensions with the Duke Religion Index (Koenig, Patterson, & Meador, 1997): This scale uses five items: how often one attends religious services, how often one spends time in private religious activities (e.g., prayer, meditation, scriptural study), and how true it is that (a) one experiences a divine presence, (b) one’s religious beliefs are fundamental to one’s life, and (c) one carries one’s religion over into other spheres of life. Internal consistency (coefficient Alpha) was .90 for this index. Table 1. Items for the 30-item Survey of Dictionary-based Isms (SDI-30), with Each Scale Divided into Descriptive (D) and Motivational (M) Subsets Scale Items Tradition-oriented Religiousness TR-D

I believe in predestination—that all things have been divinely determined beforehand. The world is ruled by the opposing forces of good and evil. (-) There is no God or gods.

TR-M

Religion should play the most important role in civil affairs.

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Table 1. (Continued) Scale

Items

Tradition-oriented Religiousness (-) I don't believe in a messiah who will come to save the world. (-) There's little value in strict adherence to religious scriptures. Subjective Spirituality SS-D

Natural objects (and even Nature itself) have conscious life. An individual soul can be mystically united with the single source from which all existence comes. (-) Animals don't have souls or spirits.

SS-M

Enlightenment can be gained through meditation, self-contemplation, and intuition. (-) Practices like meditation will not lead one to enlightenment. (-) No objects have magical or spiritual powers.

Unmitigated Self-Interest USI-D

The self is the only reality. I believe in the superiority of my own ethnic group. (-) My own race is not superior to any other race.

USI-M

People ought to be motivated by something beyond their own self-interest.

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Worldly possessions are the greatest good and highest value in life. The pleasures of the senses are the highest good. (-) There is a higher good than the pleasures of the senses. (-) Nonmaterial attributes are more important than outward beauty. Adherence to Civic Ideals Knowledge is the awareness of individual facts and an understanding of the logical ACI-D relations among these facts. (-) I believe that reason is not a good guide to knowledge and truth. (-) All forms of government are oppressive and undesirable and should be abolished ACI-M

I have profound respect for historical institutions, laws, and traditions. I emphasize reason, scientific inquiry, and human fulfillment in the natural world. I believe in the virtues of self-reliance and personal independence. I believe in government by law with the consent of those people governed.

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Gerard Saucier Table 1. (Continued)

Scale Items Tradition-oriented Religiousness I love and am devoted to my country (-) I dislike my country (-) I am opposed to constitutional forms of government

Criterion-Variable Measures

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Criterion (i.e., dependent) variables selected a priori for these analyses were the following. Most involves use of a multipoint rating scale, with the range of this scale described below. Year of administration is provided in parentheses for each measure.

Externalizing and Internalizing Disorder Tendencies Included were adjective measures developed by the author to capture broad-level tendencies toward disorders as defined by Krueger et al. (1998; cf. Achenbach & Edelbrock, 1984). Adjectives were rated on a 1-to-7 scale, and the adjectives were administered in 1995 and again in 2008. Externalizing adjectives werea alcoholic, careless, dishonest, inconsiderate, irresponsible, reckless, and violent. Internalizing adjectives were afraid, depressed, sad, tired, withdrawn, and worried. Externalizing-disorder tendencies should theoretically have similar correlates as the addictive-behavior and “acting out” indicators described above; internalizing-disorder tendencies should have similar correlates to the remaining psychopathology indicators described below. Internal consistency was reasonable: .70 for externalizing and .83 for internalizing (in 1995). The stability correlation across 13 years was .46 for externalizing and .55 for internalizing. Also included were four items measuring adult attachment styles (Bartholomew & Horowitz, 1991): one item each for secure, dismissive, preoccupied, and fearful attachment. Bartholomew has implied that these four styles might be reduced to two dimensions (secure vs. fearful, and preoccupied vs. dismissive), but so as to preserve all information, in this study each item was treated as a separate variable. A measure of altruism involved responses to five adjectives (Compassionate, Generous, Helpful vs. Greedy, Selfish) on a 1-to-7 response scale. Like the externalizing and internalizing adjective measures, this measure was administered on two occasions 13 years apart. Internal consistency was a reasonable .71 (in 1995). The stability correlation across 13 years was .49. As with the adjectival disorder-tendency scales, there was virtually no change in the mean score for altruism across the 13-year span. Group Attitudes As an indicator, at least indirect, of prejudice, I used items from a 2001 questionnaire. Respondents were given names of various groups and “sorts of people” and asked which deserve more influence, power, and respect, and which deserve less, responding on a fivepoint scale for each (Much more, slightly more, already have the right amount, slightly more,

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much more). Indexed were unfavorable attitudes toward groups against whom prejudice is now (a) relatively proscribed (members of minority groups, mixed-race couples; 2 items) or (b) relatively non-proscribed (feminists, gay and lesbian people; 2 items), and also a third group: (c) people in poverty (poor people, those living on welfare payments; 2 item). Internal consistency was .64, .73, and .65 for (a), (b), and (c) respectively.

Adaptive/Maladaptive Values Also based on 2001 data was a preliminary index of mature values. The author and a graduate assistant scrutinized May’s (1967) writings on mature values, and each rated the relative suitability of items used in the values surveys of either Schwartz (1992) or Rokeach (1973). A consensus selection of 17 items was made; mature values items included Freedom, Choosing own goals, Meaning in life, Creativity, A world of beauty, Wisdom, Honest, Helpful, Mature love, and Unity with nature; immature-values items (scored negatively) included Pleasure, A comfortable life, Wealth, Social power, Social recognition, Preserving my public image, and Obedient. As an indicator of divergent validity, in the EugeneSpringfield Community Sample (N=391), the aggregate mature values index correlated only modestly with scores on collectivist/allocentric and individualist/idiocentric values (.17), and Machiavellianism (-.15). The mature-values items were scored based on the usual response scale of Schwartz (1992) – a 9-point (-1 to +7) response scale with “opposed to my values” and “of supreme importance” anchoring the end-points. Internal consistency (coefficient Alpha) was .59 for this heterogeneous but theoretically meaningful composite.

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Analyses The prime analyses were partial correlations between the belief variables and the many criterion variables, with sex and age partialed out. To aid in interpretation of effects, the descriptive and motivational-schema subsets of these scales were examined post hoc. Based on prior research and theorizing, it was expected that Tradition-oriented Religiousness, the closest proxy to a standard measure of religiousness, would be associated with indicators of adaptive functioning and not with indicators of maladaptive functioning. Because previous research has tended to assume that religiousness is the main dimension of belief with adaptive consequences, it was expected that the other belief-dimension scales would show only chance-level effects.

RESULTS Table 2 shows the inter-scale correlations among the belief measures, which served as predictors in subsequent analyses. Correlations among the four scales for the belief dimensions were quite low — .14 and under in magnitude. As Table 2 shows, Traditionoriented Religiousness, the Duke Religion Index, and the single adjective “religious” are all intercorrelated approximately .70, indicating they do converge on a single underlying construct, even if each may contain a good deal of unique content.

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Gerard Saucier Table 2. Descriptive and Interscale Correlations for the Belief-Dimensions Statistic

TR

SS

USI

ACI

Mean Standard Deviation Skewness Kurtosis

2.94 0.90 -0.10 -0.81

2.94 0.81 -0.15 -0.41

1.72 0.50 0.77 1.35

4.20 0.42 -0.88 1.75

Coefficient Alpha

0.79

0.75

0.70

0.68

Correlation with: SS USI ACI Adjective “Religious” (N=568) Duke Religion Index (N=563)

0.06 -0.14 -0.13 0.71 0.68

0.07 -0.12 0.06 0.00

-0.05 -0.23 -0.35

-0.09 -0.13

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Note. N for the descriptive statistics on the belief dimensions was the full sample, N=703. The correlation between the adjective “Religious” and the Duke Religion Index was .72 (N=477). TR – Tradition-oriented Religiousness, SS – Subjective Spirituality, USI – Unmitigated Self-Interest, ACI – Adherence to Civic Ideals. TR, SS, USI, and ACI are all measured with items on a 1-to-5 scale of disagreement/agreement, and the mean provided here is the average item response across items, after reverse-keyed items are reflected.

Table 3 presents the partial correlation coefficients (controlling for sex and age) of belief variables with the adjectival externalizing and internalizing variables. Since these variables were administered on two occasions 13 years apart (either 6 years before or 7 years after the belief variables) it is instructive to examine which associations replicate best. Best replicating were: (a) the positive association of Unmitigated Self-Interest with externalizing tendencies and (b) the negative association of Adherence to Civic Ideals with both internalizing and externalizing tendencies. Table 3. Correlations of Relevant Religiousness and Belief Scales with Various Adaptive Functioning Criteria, Controlling for Sex and Age Adaptive Functioning Criterion 1. Externalizing-disorder tendencies Internalizing-disorder tendencies Externalizing-disorder tendencies Internalizing-disorder tendencies

Year

N

TR

SS

USI

ACI

1995

560

-0.04

.12*

.11**

-.21***

1995

560

.11*

.10*

0.01

-.21***

2008

550

-0.02

0.04

.22***

-.21***

2008

550

0.04

.09*

.16***

-.17***

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Varieties of Religiousness and Belief Table 3. (Continued) Adaptive Functioning Criterion

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2. AAS Dismissive attachment AAS Fearful attachment AAS Preoccupied attachment AAS Secure attachment 3. Altruism (adjectives) Altruism (adjectives) 4. Mature values 5. Unfavorable to minorities Unfavorable to gays and feminists Unfavorable to poor people Residuals indicating change: Externalizing tendencies 1995-2008 Internalizing tendencies 1995-2008 Altruism 1995-2008

Year

N

TR

SS

USI

ACI

2000 2000

656 656

-0.07 0.05

-0.03 0.03

.14*** 0.05

.09* -0.08

2000 2000

656 656

.10* 0.04

0.06 .11**

0.05 -0.01

-.12** 0.04

1995 2008

560 550

.10* 0

0.06 0.05

-.10* -.23***

.11** .19***

2001

621

-.14**

.24***

-.37**

-0.04

2001

621

.21***

-.09*

.26***

0.08

2001

621

.46***

-.30***

0.02

0.03

2001

621

.10*

-.14***

.20***

.13**

447

-0.02

-0.03

.12*

-.13**

447

-0.01

-0.01

.16**

-0.09

447

-0.05

0.02

-.14**

.18***

19952008 19952008 19952008

Note. * p < .05, ** p < .01, *** p < .001. Year – year that measure was administered. N – Sample size for analyses on given criterion variable. TR – Tradition-oriented Religiousness, SS – Subjective Spirituality, USI – Unmitigated Self-Interest, ACI – Adherence to Civic Ideals. “Residuals indicating change” are unstandardized residuals from linear regression using 1995 scores to predict 2008 scores, for each variable.

The second section of Table 3 presents relations of belief with attachment variables. Each belief-dimension was associated with one of the four attachment items: TR positively and ACI negatively with preoccupied attachment, USI positively with dismissive attachment, and SS positively with secure attachment. The next section of Table 3 presents correlations with the index of mature versus immature values. Mature values was positively associated with SS, but negatively with both TR and USI.

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Gerard Saucier

The final section of Table 3 presents correlations with the group-attitude variables. TR was vigorously associated with unfavorable views of feminist and gay and lesbian people, and to a lesser degree minorities and poor people. SS had an inverse pattern of associations. USI was associated with unfavorable views of minorities and poor people. The descriptive- and motivational-schema subsets of the belief-dimension marker scales usually generated highly similar correlations with criteria, indicating that both kinds of schemas generally contribute to the predictiveness of the scales. However, for USI the descriptive schemas were more highly correlated with the group-attitude variables, which is sensible given that both ethnocentrism items are among the USI-D items in Table 1. What if correlations for the adjective Religious, or for religious involvement and commitment (the Duke Religion Index; DRI) are substituted for those TR (in Table 3)? In either case, the maladaptive associations with internalizing tendencies (in 1995), immature values, and unfavorable attitudes toward minorities and poor people become smaller and nonsignificant. In either case, an adaptive-direction negative correlation with dismissive attachment becomes very slightly larger and significant. The adaptive-direction correlations with altruism (in 2008) and with secure attachment rise to .10 and are significant, but only for the DRI. The significant associations TR showed with altruism in 1995 and with unfavorable attitudes toward gays and feminists remain if either the DRI or the adjective are substituted. These results imply that the most adaptive aspects of religiousness are effects of involvement and commitment, and do not proceed from the descriptive beliefs found in a traditional religious worldview. The USI scale’s eight items include two items referencing ethnocentrism (the superiority of one’s own race or ethnic group). Except for the prejudice-related criteria, the associations of USI found in Table 3 were found to stem almost entirely from the non-ethnocentrism component of USI; when these two items were aggregated into a separate subscale they generated relatively few associations beyond the group-attitudes criteria. The bottom of Table 3 presents correlations between the belief-dimension scales and an index of change in the externalizing, internalizing, and altruism criterion variables. This index is the unstandardized residual from a linear regression in which the 1995 score for a criterion variable is used to predict the 2008 score on the same variable. The residual values indicate change in scores (whether positive or negative) between 1995 and 2008. Prior expectations would be that TR (or some other indicator of religiousness) would predict adaptive-direction changes in these scores, that is, lower disorder tendencies and higher altruism. But in fact the correlations were miniscule and non-significant, and the same was true if the adjective Religious or the Duke Religion Index was substituted for TR. SS also had miniscule, nonsignificant associations with change. In contrast, USI and ACI generated larger magnitudes of effect, with USI (in 2001) significantly predicting increases in both kinds of disorder tendencies and also decreases in altruism in the 1995-2008 time span, while ACI (in 2001) significantly predicted decreases in externalizing tendencies and increases in altruism in the same time span. Incidentally, if mature values (in 2001) were used as a predictor of change between 1995-2008 in these criterion variables, the correlation with change in altruism was positive (+.14) and significant (p < .01), indicating that mature values might also facilitate increases in altruism. There are some hazards in attempting an overall synopsis of how adaptive versus maladaptive these four belief dimensions are. There is first the issue of whether major criteria for adaptiveness are omitted in this study: No doubt many are. Secondly, there is the question

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of how to optimally weight one domain (e.g., disorder tendencies) against another (e.g., prejudice). But one summary might be a simple box score of associations that are significant (unlikely to have arisen by chance, i.e., the 95% confidence interval for the estimate of association not including .00) for each belief dimension, comparing how many involved criteria implying adaptiveness versus how many implied maladaptiveness. Across 14 criterion variables, one would expect perhaps one significant association due to chance, but all four belief dimensions had far more than one. Tradition-oriented Religiousness (TR) had seven significant associations, one in an adaptive and five in a maladaptive direction. If the adjective Religious were substituted for TR, this would be two adaptive and one maladaptive; if the Duke Religion Index were substituted, this would be four adaptive and one maladaptive. Subjective Spirituality (SS) had eight significant associations, five in an adaptive direction, three maladaptive. Unmitigated Self-Interest (USI) had nine significant associations, all in an unfavorable direction. Adherence to Civic Ideals (ACI) also had nine significant associations, all but two in a favorable direction. Another summary can be based on the average correlation, after all correlations in sections 1 through 5 of Table 3 are adjusted so that all criterion variables are scored in a favorable direction, thus a positive correlation indicates adaptiveness. The average adaptive r, across 14 criterion variables, for both TR was -.07 (standard deviation .14); this average changed to +.01 for the adjective Religious, and +.02 for the Duke Religion Index. The average adaptive r for SS was +.04 (standard deviation .13). The ACI average was +.07 (SD .12), and that for USI was -.14 (SD .11). Computations of the standard error of the mean indicated (by a one-sample t test) that only USI was significantly (p < .01) different from .00, and thus this is the finding to be taken most seriously. However, for ACI .06 was the p value (likelihood of a result this extreme if the true r were .00 was only six percent). The same pattern -- maladaptive associations for USI, adaptive associations for ACI, and mixed associations for TR and SS – held in the analyses using residuals representing change across a 13-year span (bottom of Table 3). Thus, overall it appears that unmitigated selfinterest and adherence to civic ideals are stronger predictors of adaptiveness-related criteria than are the more overtly spiritual/religious variables.

DISCUSSION It would be hazardous, based on these data, to attempt strong inferences about how relatively adaptive or maladaptive various forms of belief are; caution is needed because of a variety of limitations. It is not clear how the full domain of adaptive versus maladaptive tendencies should be represented and, although the selection of 14 criterion-variables used here is certainly diverse, it is unlikely to be an entirely fair sampling of that domain. The variables used here were not explicitly selected to represent such a domain. The criterionvariables here involved self-report, and so are liable to any distortions endemic to this type of data. Finally, this sample is representative of neither the U.S. nor the world population. It is relatively older on average than either of these populations, and more predominantly European in ancestry. Compared to the U.S. population, Oregon is among the most secular states in the nation, and it is possible that the adaptiveness of religious beliefs is higher in social contexts where religious beliefs are highly normative.

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These limitations aside, results do enable some intriguing inferences regarding the favorable and unfavorable aspects of religiousness and other forms of belief. One summary point would be that beliefs involving supernatural phenomena appear to have both good and bad associations. Thus, tradition-oriented religious beliefs seem to involve trade-offs vis-a-vis adaptiveness: They seem to go with somewhat higher altruism, but the values they promote appear to be immature by May’s theory, and perhaps associated with prejudice. More unorthodox subjective forms of spirituality lead to trade-offs as well, but to a very different set: They seem to go with mature values and with freedom from prejudice, but also with an increased risk of internalizing and externalizing disorders. Another summary point: A self-seeking worldview has mainly maladaptive associations, whereas adherence to a kind of “civic religion” has mainly adaptive associations. That is, the unmitigated pursuit of self-interest seems to be associated with increased tendencies toward psychopathology (cf., Lane, 2000), with higher proclivity to prejudice, and with immature values. On the other hand, agreement with aspects of the civic religion predominant in Western-style democracies – patriotism, constitutionalism, and humanistic rationalism – has mostly adaptive associations, including lowered tendencies toward both externalizing and internalizing disorders and higher altruism. Results give some validation support to the mature values index that was used. The moderate negative correlation (-.37 in Table 3) with Unmitigated Self-Interest is in accord with the definition of the mature values construct, which emphasizes that mature values involve moving away from a narrow, self-focused worldview. The demonstration that maturity of values, by this index, predicts changes over time in altruism gives some indication that the index may have power for forecasting outcomes in a way consistent with May’s values-maturation conception. The research design and analyses presented here are correlational in nature. It is not possible to infer cause and effect. However, a few variables were administered both well before and well after the belief-dimension measures, enabling some estimate as to whether significant associations are more likely to involve beliefs as antecedents or as consequents of other variables. Associations of Adherence to Civic Ideals with (high) altruism and with (low) externalizing and internalizing disorder tendencies were not similar whether these criteria were administered in the antecedent or consequent position. Altruism was associated with TR only prospectively, suggesting that altruism leads to TR more than the other way around, but any effect sizes appear small. The positive association of Unmitigated Self-Interest with both internalizing and externalizing disorder tendencies, however, was considerably higher when the criterion variable was administered after rather than before the belief variable, which suggests that USI may be a leading indicator of later disorder tendencies. The results for altruism suggest something similar: USI may be a leading indicator of declining altruism, and rejection of unmitigated self-interest may lead to increases in altruism. Mature values, which was moderately associated with USI (-.37), was also shown to predict increases in altruism across a 13-year time span. These estimates as to antecedent-consequent relations are provisional, of course, until tested within a longitudinal design in which all variables are administered at each of multiple occasions. This study’s findings have implications for a future theoretical framework. Values-andbelief constellations tend to reflect what could be called (based on Geertz, 1964; Swidler, 1986) a cultural model -- an organized system, explicit or implicit, regulating lower-level social/psychological processes. A cultural model implies membership in a moral community

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of some sort. When individuals align themselves with such a model, they may experience some combination of heightened life-purpose (e.g., existential meaning) and social support (e.g., through organized religion or community activities). Civic religion may be an especially potent vessel for these beneficial effects because its cultural model is widely shared. In contrast, in most Western societies at least, tradition-oriented religiousness defines only a powerful subculture, whereas other subcultures may not share these beliefs. In contrast to the shared cultural model of civic religion, a self-seeking or “instrumentalist” worldview seems to orient one toward purely economic sources of life-meaning, undercutting the possibilities for social support, a shared moral framework, or other benefits of a cultural model; tending to erode a sense of community, it leads to unfavorable effects. So the pattern of effects found in this study might largely be explained under a single proposition: Active participation in a shared moral community tends to be beneficial for human functioning, whereas the lifestyles associated with a gratification- and exploitation-based worldview limit such participation and tend to be detrimental to human functioning.

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CONCLUSION Scientists who are interested in associations between belief and adaptive functioning may be making a mistake if they concentrate entirely on conventional religious practices and beliefs. Evidence presented here suggests that this more conventional orientation is a mixed bag in terms of associations and possible effects. Recent research has identified a more unconventional religious orientation – here labeled subjective spirituality – that also appears to be a mixed bag. More fertile ground, from the standpoint of identifying a clear pattern of associations with adaptive functioning, may be found in dimensions of belief that are more peripherally associated with religiousness, dimensions that do not directly involve supernatural phenomena. It appears more beneficial to have an ethical/moral worldview than a self-seeking one, and more beneficial to adhere to the “civic religion” of one’s society than to reject that consensual set of beliefs. On the assumption that this pattern of effects can be widely replicated, understanding its basis will be consequential for both scientific theory and public policy.

AUTHOR NOTE Special thanks to Seraphine Shen Miller for assistance with work on values, to Robert F. Krueger for advice on construct of adjective-based indicators for externalizing and internalizing disorder tendencies, and to Lewis R. Goldberg for comments on an initial version of the manuscript. Correspondence may be addressed to Gerard Saucier, Department of Psychology, 1227 University of Oregon, Eugene, OR 97403, USA (E-mail: [email protected] ).

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REFERENCES Achenbach, T. M., & Edelbrock, C. S. (1984). Psychopathology of childhood. Annual Review of Psychology, 35, 227-256. Allport, G. W. (1959). Religion and prejudice. Crane Review, 2, 1-10. Argyle, M. & Beit Hallahmi, B. (1975). The social psychology of religion. London: Routledge. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226-244. Bellah, R. N. (1967). Civil religion in America. Journal of the American Academy of Arts and Sciences, 96 (1), 1-21. Dollahite, D. C. (1998). Fathering, faith, and spirituality. Journal of Men’s Studies, 7, 3-15. Emmons R.A. (1999). Religion in the psychology of personality: An introduction. Journal of Personality, 67, 6, 873-888. Epstein, S. (1998). Cognitive-experiential self theory. In D. Barone, M. Hersen, & V. B. VanHasselt (Eds.), Advanced personality (pp. 211-238). New York: Plenum. Fuller, R. C. (2001). Spiritual, but not religious: Understanding unchurched America. Oxford: Oxford University Press. Geertz, C. (1964). Ideology as a cultural system. In Apter, D. E. (Ed.), Ideology and discontent. New York: Free Press of Glencoe. Grouzet, F. M. E., Kasser, T., Ahuvia, A., Fernandez Dols, J. M., Kim, Y., Lau, S., Ryan, R. M., Saunders, S., Schmuck, P., & Sheldon, K. M. (2005). The structure of goal contents across 15 cultures. Journal of Personality and Social Psychology, 89, 800-816. Grucza, R. A., & Goldberg, L. R. (2007). The comparative validity of 11 modern personality inventories: Predictions of behavioral acts, informant reports, and clinical indicators. Journal of Personality Assessment, 89, 167-187. Hood, R. W. (1975). The construction and preliminary validation of a measure of reported mystical experience. Journal for the Scientific Study of Religion, 14, 29-41. Koenig, H. G. (1997). Is religion good for your health? The effects of religion on physical and mental health. New York: Haworth Pastoral Press. Koenig, H.G., Patterson, G. R., & Meador, K. G. (1997). Religion index for psychiatric research: A 5-item measure for use in health outcome studies. American Journal of Psychiatry, 154, 885. Kozielecki , J. (1991). Z Bogiem albo bez Boga (With God or without God). Warszawa: PWN. Krauss, S. (2006). Does ideology transcend culture? A preliminary examination in Romania. Journal of Personality, 74, 1219-1256. Krueger, R. F., Caspi, A., Moffitt, T. E., & Silva, P. A. (1998). The structure and stability of common mental disorders (DSM-III-R): A longitudinal-epidemiological study. Journal of Abnormal Psychology, 107, 216-227. Lane, R. E. (2000). The loss of happiness in market democracies. New Haven, CT: Yale University Press. May, R. (1967). Psychology and the human dilemma. Miller, W. R. (1998). Researching the spiritual dimensions of alcohol and other drug problems. Addiction, 93, 979-990.

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Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality: Linkages to physical health. American Psychologist, 58, 36-52. Reber, A. S. (Ed.) (1995). Penguin dictionary of psychology (2nd ed.). London: Penguin. Roberts, B. W., Kuncel, N. R., Shiner, R., Caspi, A., & Goldberg, L. R. (2007). The power of personality: The comparative validity of personality traits, socioeconomic status, and cognitive ability for predicting important life outcomes. Perspectives on Psychological Science, 2, 313-345. Rokeach, M. (1958). Beliefs, values, and attitudes. San Francisco, CA: Jossey-Bass. Rokeach, M. (1973). The nature of human values. New York: Free Press. Rousseau, J.-J. (1762/1968). The social contract (M. Cranston, Trans.). New York: Penguin. Sabatier, A. (1905). Religions of authority and the religion of the spirit (L. S. Houghton, Trans.). New York: McClure, Phillips, and Company. Saroglou, V. (2002). Religion and the five factors of personality: A meta-analytic review. Personality and Individual Differences, 32, 15-25. Saucier, G. (2000). Isms and the structure of social attitudes. Journal of Personality and Social Psychology, 78, 366-385. Saucier. G., (in press). Measures of the personality factors found recurrently in human lexicons. In G. J. Boyle, G. Matthews, and D. Saklofske (Eds.), Handbook of personality theory and testing: Vol. 2 – Personality measurement and assessment. London: Sage. Saucier, G., & Goldberg, L. R. (1998). What is beyond the Big Five? Journal of Personality, 66, 495-524. Saucier, G., & Skrzypińska, K. (2006). Spiritual but not religious? Evidence for two independent dispositions. Journal of Personality, 74, 1257-1292. Schuon, F. (1953). The transcendent unity of religions (P. Townsend, Trans.). New York: Pantheon. Schwartz, S. H. (1992). Universals in the content and structure of values: Theory and empirical tests in 20 countries. In M. Zanna (Ed.) Advances in experimental social psychology, (Vol. 25) (pp. 1-65). New York: Academic Press. Shafranske, E. P., & Gorsuch, R. L. (1984). Factors associated with the perception of spirituality in psychotherapy. Journal of Transpersonal Psychology, 16, 231-241. Swidler, A. (1986). Culture in action: Symbols and strategies. American Sociological Review, 51, 273-286. Vaughan, F. (1991). Spiritual issues in psychotherapy. Journal of Transpersonal Psychology, 23, 105-119. Zinnbauer, B. J., Pargament, K. I., Cole, B., Rye, M. S., Butter, E. M., Belavich, T. G., Hipp, K. M., Scott, A. B., & Kadar, J. L. (1997). Religion and spirituality: Unfuzzying the fuzzy. Journal for the Scientific Study of Religion, 36, 549-564. Zinnbauer, B. J., Pargament, K. I., & Scott, A. B. (1999). The emerging meanings of religiousness and spirituality: Problems and prospects. Journal of Personality, 67, 6, 889920.

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In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Short Commentary 1

WHAT THE SPIRITUAL AND RELIGIOUS TRADITIONS OFFER PSYCHOLOGISTS Thomas G. Plante Santa Clara University, Santa Clara, California, USA

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ABSTRACT There has been a remarkable amount of popular and professional interest in the relationship between spirituality, religion, psychology, and health in recent years. Contemporary interest in spirituality and religion is popular among not only the general population but also among many psychology professionals as well. While most people believe in God and consider themselves to be spiritual, religious, or both, most psychologists do not and have no training in religion and spirituality. Psychologists can learn much from the spiritual and religious traditions that offer principles and tools that are productive to use even if one does not share the same religious or spiritual beliefs or interests. The purpose of this brief commentary is to offer thirteen spiritual and religious tools common among all of the major religious and spiritual traditions that can be utilized by contemporary professional psychologists in clinical practice and elsewhere in their professional work to enhance their already high quality professional services that they provide. In addition to the thirteen tools, relevant ethical issues are briefly discussed as well.

Keywords: spirituality, religion, psychology, integration, psychotherapy

INTRODUCTION In recent years, the field of psychology has appeared to have rediscovered spirituality and religion. There has been an outpouring of psychology and religion integration books, articles, workshops, and conferences of late. For example, the American Psychological Association offered no published books on these topics only a decade ago and now have a dozen published books available with more forthcoming. This is contrasted by the many years of

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psychology and religion working in parallel universes that intersected only very infrequently. Gallup and other national polls and surveys suggest that approximately 95% of Americans believe in God, 40% attend religious services on a weekly basis or more, and more than 85% of the population is affiliated with some religious tradition and denomination (e.g., Gallup, 2002; Gallup & Lindsay, 1999). Thus, spirituality and religion appear to be an important and central part of life for many people in our society. However, most psychologists are not affiliated with a religious tradition and only a third report that religion or spirituality is important to them (Delaney, Miller, & Bisono, 2007). Furthermore, most have very little if any training on spirituality and religion and how they may impact their work as psychologists (Russell & Yarhouse, 2006). This is starting to change as it should. In my careful review of the spiritual and religious traditions, there appears to be many spiritual and religious tools that could be better understood and employed by psychologists in their professional work regardless of the particular faith tradition (or lack of faith tradition) of either their clients or themselves. The purpose of this commentary is to briefly introduce thirteen spiritual and religious tools that unfold from the commonalities of the major religious and spiritual traditions that can be incorporated into professional psychological services. More details regarding these tools are published elsewhere which the reader may wish to review (Plante, 2008; Plante, 2009). This brief chapter is primarily suited for psychologists and other mental and health care professionals who provide professional services to the general public in various treatment and consultation environments.

THIRTEEN SPIRITUAL AND RELIGIOUS TOOLS FOR PSYCHOLOGISTS

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Meditation Research has demonstrated that there are many mental and physical health benefits from regular meditative contemplative practices (Kabat-Zinn, 2003; Shapiro & Walsh, 2007). Mindfulness meditation is a good example of using a religiously based practice from the Buddhist tradition that can be adapted and secularized for contemporary psychotherapeutic environments. While mindfulness meditation has had the most acceptance among health care professionals relative to other meditative and contemplative techniques steeped in religious traditions, other meditative practices can be embraced and incorporated into our work with success and similar therapeutic results (Plante & Thoresen, 2007; Walsh, 1999). Benefits of regular meditative practice include stress reduction, acceptance of self and others, as well as improved coping and enhanced interpersonal relationships. Many physical benefits such as lower blood pressure and tempered stress reactivity are also probable for those who meditate in an ongoing manner (Kabit-Zinn, 2003; Shapiro & Walsh, 2007).

Prayer Research from a variety of quality studies suggests that there are both mental and physical health benefits of engaging in regular prayer activities. Prayer is defined in a variety of ways but is generally considered to be an ongoing communication with the divine or

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sacred. All of the religious faith traditions encourage and support prayer but they may differ greatly in style, technique, and practice. Some of the specific mental health benefits of prayer engagement have included enhanced psychological functioning, well-being and meaning, and stress reduction (Masters, 2007).

Vocation, Meaning, Purpose and Calling in Life Spirituality and religious engagement provide direction and opportunities to develop and nurture an enhanced sense of meaning, purpose, calling, and vocation in one’s life. All of the religious and spiritual traditions offer thoughtful guidelines to concerns about how someone should manage their life with often detailed directions and strategies for obtaining more meaning and purpose. Many people who seek professional psychological services are looking for more meaning, purpose, and calling in their lives. Often people are at a crossroad in life and are looking for direction which their spiritual and religious tradition might help provide.

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Acceptance of Self and Others (Even with Faults) Religious and spiritual traditions provide wise counsel regarding the benefits of accepting ourselves and others even with faults and imperfections. The traditions offer various strategies for redemption, forgiveness, reconciliation, and acceptance from others and also from the divine. Certainly much of the work of psychologists in psychotherapy highlight the notion that it can be very useful to accept what we can’t change and change what we can to enhance the quality and well being of ourselves and others. The often quoted and well known “serenity prayer” well articulates what so much of psychotherapy tries to accomplish. It states: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” Applying this prayer and working towards acceptance of self and others is a frequent topic of conversation in psychological services and spiritual and religious traditions can offer much on this issue.

Ethical Values and Behaviors The religious and spiritual traditions have spent hundreds and even thousands of years fine tuning many time-tested guidelines and principles for ethical living. Living more ethically, even without religious or spiritual guidance, is likely to have psychological, relationship, community, and other benefits (Plante, 2004). Curiously, the primary ethical principles endorsed for psychologists that are articulated in the ethics code (American Psychological Association, 2002) overlap with many of the very same ethical guidelines offered and supported by the various religious and spiritual traditions. These include guiding principles and values such as respect, responsibility, integrity, competence, and concern for others (RRICC, Plante, 2004). For example, both the professional ethics codes and religious and spiritual traditions encourages people to be concerned about and help improve the welfare of others (and especially for those in greatest need), to be honest and maintain integrity in all that we do and say, and to be respectful to everyone and to life. How we apply these

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principles to our day-to-day decisions can be challenging and debatable but the principles themselves are embraced by the spiritual and religious traditions as well as the professional psychological associations and community. While ethical living does not need to be rooted in spiritual and religious traditions, these traditions offer many years of reflection on ethical topics that can be enlisted among those engaged or not engaged in these religious and spiritual communities.

Being Part of Something Larger and Greater than Oneself The religious and spiritual traditions contribute to a sense of being part of something larger than ourselves. Religion and spirituality offers a path to help place life and our many challenges in a better and bigger perspective. These traditions offer wisdom and advice on issues and concerns that happened long before us as well as those that might be important long after our passing. Additionally, being part of something bigger and perhaps more important than ourselves can greatly assist in better coping and managing the many stressful challenges and transitions in our lives.

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Forgiveness, Gratitude, Love, Kindness, and Compassion The religious and spiritual traditions, at their very best, encourage people to be forgiving, grateful, loving, kind, and compassionate. For example, many research studies have demonstrated the positive mental, physical, and community health benefits of forgiveness (Koenig et al., 2001). Forgiveness is a productive foil to anger, hostility, and bitterness. Studies have found that those who tend to be more grateful often sleep better, are more optimistic, more energetic, and maintain higher quality and more satisfying interpersonal relationships (e.g., Emmons & McCullough, 2003). Additionally, all of the major religious and spiritual traditions encourage and support love, kindness, and compassion (Armstrong, 2006) also having many mental, physical, community, and relational benefits (Snyder & Lopez, 2007). Treating others as you wish to be treated, popularly referred to as the “golden rule,” is supported and emphasized in all of the major religious and spiritual traditions (Armstrong, 2006).

Volunteerism and Charity The religious traditions universally encourage and support charitable works and volunteerism attempting to help those in great need and try to make the world a better place for everyone. Remarkably, research suggests that two-hours per week or more of volunteer activities is associated with mental and physical health benefits and actually reduces mortality risks over time as much as 40% (Oman & Thoresen, 2003). The religious traditions generally offer an effective organizational structure to nurture productive community engagement that most often emphasize helping those in greatest need such as the poor and marginalized of society. Furthermore, ongoing volunteerism usually provides the volunteer with an enhanced

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sense of meaning, purpose, and calling that can often help keep their own troubles and stressors in better perspective.

Ritual and Community Support Research over many years and in many ways has consistently found that mental and physical health benefits can be secured from social support. Religious and spiritual practices, services, rituals, and other activities provide ongoing community social networking opportunities shared with others who maintain similar values, beliefs, perspectives, and traditions. Regular religious service attendance, Bible or other scripture studies, and many holiday celebrations within family and faith communities all provide organized and ongoing opportunities for social connection, networking, and support. As our society has become more isolating and individualistic, the religious and spiritual communities are one of the few remaining places where ongoing social support and rituals can occur.

Social Justice

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The religious and spiritual wisdom traditions all support social justice ideas and activities to make the world a more humane and just place. Furthermore, social justice activities and engagement helps people to be less focused on themselves. It is often hard to feel overly stressed and caught up by our own daily hassles and challenges when confronted with the serious and often life threatening challenges of poverty, oppression, violence, and disease experienced by the majority of the world’s population.

Spiritual Models Religious and spiritual models provide followers with excellent exemplars to imitate (Oman & Thoresen, 2003, 2007). The recent highly popular question, “What would Jesus Do?” is a perfect example. Ancient religious models such as Jesus, Buddha, and Mohammad, as well as many of the more contemporary religious and spiritual models such as Gandhi, Mother Teresa, the Dali Lama, Martin Luther King, and even family and friends can act as a template or model for how to live and act in a better way. Research has indicated that observational learning is a very powerful method to acquire new skills and behaviors (Bandura, 1986). Having spiritual and religious role models can be a highly productive way to help motivate and inspire others to “go and do likewise” (Luke 10:37).

Bibliotherapy Psychologists and other health care professionals have used bibliotherapy to help others for decades. They have encouraged their clients to read various self-help and other books to augment their treatment and enhance their lives. Many of these materials are also used for

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psycho-educational purposes such as learning more about a particular diagnosis and treatment options. These books are also frequently used to increase client motivation or provide inspiration. The religious and spiritual traditions also usually encourage their members to read sacred scripture such as the Bible as well as other sacred readings and commentaries on sacred texts to improve their faith, spirituality, and lives in general.

Sacredness of Life The religious and spiritual traditions all nurture and support the notion that life is sacred and that the divine lives within all of us. This concept that we are all very important, sacred, and perhaps a “child of God” have many important implications and ramifications for how we perceive ourselves as well as interact with others. The religious faith communities and traditions instruct and underscore that if we are in fact sacred, then everyone must be treated with a great deal of respect, kindness, love, and compassion. Psychologists and other professionals can then use this perspective of sacredness in their psychotherapeutic work. They can encourage their clients to find more ways to enhance their self worth as well as their interpersonal relationships.

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ETHICAL ISSUES There are several very important ethical issues that should be outlined when considering the integration of spiritual and religious tools into psychological work. First, it is important for all psychologists and health care professionals to only practice within their area of professional competence. While a clinician who may be spiritual, religious or both might want to integrate these interests and their beliefs into their professional work, it would be inappropriate and unethical to practice outside of one’s area of training and expertise or to promote their particular spiritual and religious beliefs and traditions onto their clients. Second, professionals must avoid any potentially exploitive dual relationships most especially when their clients are members of their own religious congregations. Client referrals generally emerge from people that are known through similar activities and organizations including fellow congregants in faith communities. In these circumstances, potential dual relationships and conflicts of interest can quickly unfold. Finally, professionals must avoid any potential bias by supporting one faith tradition or belief system over another. Psychologists, like anyone else, perhaps maintain particular positive or negative impressions about various religious and spiritual traditions and communities. They must be aware and respectful of the diversity of beliefs and practices even within each religious and religious tradition. Psychologists must closely follow and adhere to their ethics code (American Psychological Association, 2002) and get appropriate ongoing consultation and training as needed. Of course, other health care professionals much adhere to their ethics codes as well as any legal limitations to their licensing credentials.

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CONCLUSION While psychology as an independent academic and professional discipline and profession has been conducting research, practice, consultation, and teaching for over 100 years, the great religious and spiritual communities and traditions have thoughtfully reflected upon and offered many helpful suggestions on life and living for thousands of years. Rather than ignore what these important traditions offer, professional psychology should embrace them in a manner that makes sense for high quality, contemporary, and ethical professional practice. In doing so, psychology may well benefit from the thirteen spiritual and religious tools common in all of the major spiritual and religious traditions that can be applied to their professional work regardless of the beliefs and practices of their clients or themselves. While recent years have seen an increase in the thoughtful integration of psychology and religion in both research and clinical practice, we have a long way to go to mutually benefit from what psychology and religion have to offer.

ABOUT THE AUTHOR

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Thomas G. Plante, Ph.D., ABPP is professor of psychology at Santa Clara University, adjunct clinical professor of psychiatry and behavioral sciences at Stanford University School of Medicine, and in private practice in Menlo Park, California. He has authored a dozen books including the most recent, Spiritual Practicies in Psychotherapy: Thirteen Tools for Enhancing Psychological Health (2009, American Psychological Association). Address correspondence to Thomas G. Plante, Psychology Department, Alumni Science Hall, Room 203, Santa Clara University, Santa Clara, CA. 95053-0333; Email: [email protected]; Telephone: 408-554-4471.

REFERENCES American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073. Armstrong, K. (2006). The great transformation: The beginning of our religious traditions. New York: Anchor Books. Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall. Delaney, H. D., Miller, W. R., & Bisono, A. M. (2007). Religiosity and spirituality among psychologists: A survey of clinicians members of the American Psychological Association. Professional Psychology: Research and Practice, 38, 538-546. Emmons, R.A., & McCullough, M.E. (2003). Counting blessings versus burdens: Experimental studies of gratitude and subjective well-being. Journal of Personality and Social Psychology, 84, 377-389. Gallup, G. H., Jr., (2002). The Gallup poll: Public opinion 2001. Wilmington, DE: Scholarly Resources.

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Gallup, G., Jr., & Lindsay, D.M. (1999). Surveying the religious landscape: Trends in U.S. beliefs. Harrisburg, PA: Morehouse. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Research and Practice, 10, 144-156. Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York: Oxford. Masters, K.S. (2007). Prayer and Health. In T. G. Plante & C. E. Thoresen (Eds), Spirit, Science and Health: How the Spiritual Mind Fuels the Body (pp. 11-24). Westport, CT: Praeger/ Greenwood. Oman, D. & Thoresen, C.E. (2003). Spiritual modeling: A key to spiritual and religious growth? The International Journal for the Psychology of Religion, 13, 149-165. Oman, D.& Thoresen, C.E. (2007). How does one learn to be spiritual? The neglected role of spiritual modeling in health. In T. G. Plante & C. E. Thoresen (Eds), Spirit, science and health: How the spiritual mind fuels physical wellness (pp. 39-56). Westport, CT: Praeger/Greenwood. Plante, T.G. (2004). Do the right thing: Living ethically in an unethical world. Oakland, CA: New Harbinger. Plante, T. G. (2008). What do the spiritual and religious traditions offer the practicing psychologist? Pastoral Psychology, 56, 429-444. Plante, T. G. (2009). Spiritual Practicies in Psychotherapy: Thirteen Tools for Enhancing Psychological Health. Washington, DC: American Psychological Association. Plante, T. G., & Thoresen, C. E. (Eds.) (2007). Spirit, science and health: How the spiritual mind fuels physical wellness. Westport, CT: Praeger/Greenwood. Russell, S. R., & Yarhouse, M. A. (2006). Religion/Spirituality within APA-accredited psychology predoctoral internships. Professional Psychology: Research and Practice, 37, 430-436. Shapiro, S.L., & Walsh, R. (2007). Meditation: Exploring the Farther Reaches. In T. G. Plante & C. E. Thoresen (Eds), Spirit, Science and Health: How the Spiritual Mind Fuels the Body (pp. 57-71). Westport, CT: Praeger/ Greenwood. Snyder, C.R., & Lopez, S.J. (2007). Positive psychology: The scientific and practical explorations of human strengths. Thousand Oaks, CA: Sage. Walsh, R. (1999). Essential spirituality: The seven central practices. New York: Wiley & Sons.

In: Religion and Psychology Editors: Michael T. Evans and Emma D. Walker

ISBN 978-1-60741-066-9 © 2009 Nova Science Publishers, Inc.

Short Commentary 2

RESIDENT PHYSICIANS’ THOUGHTS REGARDING COMPASSION AND SPIRITUALITY IN THE DOCTOR-PATIENT RELATIONSHIP: A BRIEF REPORT Gowri Anandarajah* and Marcia Smith 1

The Warren Alpert Medical School of Brown University, Pawtucket, Rhode Island 02860, USA

ABSTRACT

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Background The role of spirituality in health care is gaining increasing recognition. Compassion is an aspect of spirituality that has received little attention in the medical literature, yet is the foundation of the healing doctor-patient relationship. Although compassion fatigue in physicians is a commonly articulated concern, there is very little research regarding how physicians view this concept. Methods Thirty-four family medicine resident physicians were interviewed regarding their views on spirituality, compassion and healing in medicine. These semi-structured individual interviews were transcribed verbatim and coded for ease of data management. We performed a qualitative analysis on all coded data that pertained to compassion, using the immersion/crystallization method. IRB approval was obtained. Results Responses fell into four broad categories: definitions of compassion, its role in the doctor-patient relationship, barriers and facilitators. For many residents, compassion was seen as integral to healing and was closely linked to personal spirituality for many. Compassion was seen as having a dynamic role in the doctor-patient relationship, particularly at the end-of-life. Appreciation of the patient’s perspective was central. The most significant barrier was lack of time, both in patient encounters and time to attend to personal needs. Reflection and group process were important facilitators. *

Corresponding Author: Gowri Anandarajah MD, Department of Family Medicine, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860; Tel: 401-729-2236; Fax: 401-729-2923; e-mail: [email protected]

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Gowri Anandarajah and Marcia Smith Conclusion Residents described compassion as an essential element of healing, and described conditions which can either promote or diminish its presence in patient care. These results can be used to make curricula changes that can foster the development and maintenance of compassion in the doctor-patient relationship.

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INTRODUCTION In the last decade there has been increasing evidence for a positive association between spirituality, religion and health [1-9]. As a result, spirituality is being integrated into mainstream medicine in a number of meaningful ways [10-12]. Many medical schools, residency programs and fellowship programs are also including spirituality as part of their curricula [13-15]. Since spirituality is a complex construct [16-21], some aspects of spirituality have received more attention than others. Many studies have addressed patients’ religious and spiritual beliefs regarding medical care and how to address these issues in the current medical system [9,22-25]. However few have focused on the therapeutic role of compassion in the doctor-patient relationship. A recent paper presenting conceptual models of spirituality in the doctor patient relationship includes compassion as a subtle, yet powerful aspect of spiritual care and the healing therapeutic relationship [16]. Compassion is articulated by many religious traditions as fundamental to spirituality and is beginning to be recognized as an important area for research [26-27]. Unfortunately, today’s healthcare system, with its emphasis on technology and efficiency, has undervalued the role of compassion in medicine. As a result, many physicians, who originally entered the field of medicine with a desire to provide high quality compassionate care to their patients, struggle to maintain their ideals and suffer from compassion fatigue [28-30]. Residency education is a time when young physicians are most acutely faced with the struggle between their desire to provide compassionate patientcentered care and the demands of the medical system in which they practice. This is a critical time for the development of a physician’s professional identity and practice style. Therefore it is crucial to explore ways in which to preserve residents’ spiritual well-being and help them maintain their ability to provide compassionate care to their patients. We have found that the introduction of a spirituality and medicine curricula into residency program is one way to begin this process [31]. This brief report presents data specifically looking at the beliefs and needs of family medicine residents regarding the role of compassion in medical care and it’s relationship to spirituality. This study provides insights into approaches for fostering compassionate care in medicine.

METHODS This paper presents the analysis of a subset of qualitative interview data from a larger study in which family medicine residents were broadly interviewed regarding their views on spirituality and medicine. The study was reviewed and approved by the Institutional Review Board for the Protection of Human Subjects (IRB).

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The setting was a university affiliated family practice residency in the Northeast United States. All 38 family medicine residents who where enrolled in the residency program at the time were invited to participate in the study. Thirty-seven residents agreed to be interviewed for this study and 3 interviews were lost due to equipment failure. Therefore 34 interviews were ultimately analyzed. The group of residents in this study included 29 women and 9 men, all graduates of US medical schools. Interviews were semi-structured individual interviews 30-45 minutes long, which were audio-taped and transcribed verbatim. The original data set was coded to facilitate data management. For this study all text pertaining to compassion underwent detailed analysis using the immersion-crystallization method [32]. Two researchers (GA and MS) first analyzed transcripts independently and then in a series of meetings in order to reach agreement regarding the themes present in the data set. GA is a family physician and educator. MS is a psychologist and educator. Transcripts were first analyzed in groups by year in training, then as a whole.

RESULTS Two areas of questioning in the original interviews yielded the majority of the data. Residents were asked to reflect on how compassion relates to healing and spirituality and about their needs regarding the ability to maintain compassion. As with the larger data set, there were some differences between classes, although overall the themes appeared in all three years of training. Table 1 summaries the themes and subthemes found in this data set and provides representative quotations of the major themes.

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Defining Compassion The majority of resident physicians described compassion as integral to the profession of medicine, and related to healing. A variety of definitions were offered including providing comfort, being present with and/or alleviating suffering, and providing hope. Compassion was described as a felt sense of connection with patients and their stories. Some experienced a deep sense of satisfaction through connecting with patients on a human level. Compassion was seen as an internal quality of the physician “it has to be in you”, but also as something that occurs between doctors and their patients. Although intangible, it can be demonstrated with words and behavior.

Compassion and Spirituality A spiritual framework was seen as closely related to the ability to maintain compassion for many residents, but not absolutely essential. Many of these young physicians articulated a direct relationship between their choice of medicine as a career and their personal spiritual beliefs. Many stated that compassion was central to their spiritual beliefs and approach to life.

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Table 1. Themes and sub-themes in resident physicians’ views regarding compassion and spirituality in patient care Themes Definition of compassion

Sub-themes Integral to medicine and healing

Example quotations “The best practice of medicine there is a large element of compassion”.

Providing comfort, presence, hope

“Hopefully medical practice is not only dealing with the nuts and bolts of it but also providing them a place of refuge, and some sense of hope”.

Alleviating suffering Connection Internal quality

“Compassion means your ability to identify with people and actively help relieve their suffering”. “A compassionate doctor is one who takes the time and is able to connect on some level other than the medical level”. “Compassion comes from being a good person, and a person who is able to empathize with others because of their kindness”.

Compassion and spirituality

Closely related to spirituality

“My spirituality contributes to the way I am compassionate with patients or the way I take care of them”.

Spirituality not necessary for compassion

Compassion in the doctor-patient relationship

Personal spirituality enhances compassion

“A lot of doctors care very much and do an excellent job with their patients in addressing their needs without going into the spiritual”.

Addressing patients’ spiritual concerns are factors in compassionate care

“For a spiritual patient, part of being compassionate is acknowledging their spiritual beliefs”.

Understanding patients’ perspective

“What I am bringing is the capacity to understand. It makes me feel really good as a person, makes me feel fulfilled when I know that I have understood and I’ve made somebody feel understood.

Communicate understanding Relevance in end-of-life care Undervalued in healthcare system

“When I have had to go see a patient who died and I had to pronounce, at those times it seems to be very emotional and also very spiritual”.

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Compassion in the doctor-patient relationship (Continued) Facilitators to compassion

Reflection – personal and group process Role models

“The conflict is between my beliefs and the way we practice medicine”. The way we objectify people and the way we treat the body, the way we use our medical tools, the way we get excited about a case and what we value. We value answers, and I don’t think answers always exist”. “I think that you need a certain amount of time of remove from that. Time when I can do things that are spiritually and emotionally rejuvenating for me whether that is spending time outside, or spending time with friends and family, spending time alone.

Balance – personal and professional Basic needs met (eg. sleep, time) Appreciation

“Groups where we talk about difficult relationships and difficult physician/patient relationships I think that is really important”. “If there’s just a time when people could sit down and say “what do you need to become the physician you want to be?”. “The most helpful thing I’ve seen is role models. Having people who are open and honest about themselves and how they do it, how they get up and do it another day”. “To gain balance to the best of my ability, is to balance the work day so I’m not stressed out all the time. I think it will be putting a higher priority on my personal life and maintaining balance in that”. “I think the main thing is to step away and get the big picture”. “The most important things are the basic needs like sleeping, eating, having time away from work, and exercise is important for me”.

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Table 1. (Continued) Themes Barriers to compassion

Sub-themes Limited time for patients and self Offensive views of patients Disagreements regarding healthcare choices Lack of self-confidence

Example quotations “It feels very uncomfortable to me when the family for whatever reason wants to keep pushing and pushing and no matter how I try to explain it, they don’t seem to understand. And I just want to walk away from the whole situation, because I feel like I am doing harm and I’m not supposed to be doing harm”. “There have been patients who have said things they think about that were quite offensive to me and disturbing to me and I had to overcome that to continue to take care of them”. “My biggest barrier within me right now is my time constraints and just my feelings of the same thing, of being overwhelmed by having time constraints and burdens on my shoulders, that I feel sometimes I can’t take on or hear other people’s burdens as well”. “A certain amount of knowledge and competency. I mean, if you have no idea what you are doing, I gues you could still be compassionate, but I think it comes easier if you think you know what you doing is to say, okay”.

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However, most residents also acknowledged that compassion in medicine could exist without a specific spiritual framework. Many believed that compassion in the doctor-patient relationship could be enhanced by a spiritual framework and by spiritual practice. In addition, acknowledging patients’ spiritual beliefs and considering the spirit of patients were described as being factors in compassionate care.

Role of Compassion in the Doctor-Patient Relationship The dynamic and central role that compassion plays in the doctor-patient relationship was described in many ways. Patient stories reflected the direct experience of the profound effect of compassion, in which significant shifts in the doctor-patient relationship can occur when compassion is communicated. The ability to understand the perspective of the patient and/or the family plus to communicate this understanding to patients was described as fundamental to providing compassionate care. The critical role of comfort with emotional expression during this type of communication was also identified. Most residents saw compassion as particularly relevant in end of life care, during which time compassion may be the only truly healing intervention the physician can provide. Finally, several residents commented that, despite its role in patient care and healing, compassion is undervalued in the United States healthcare system. One resident described a case in which his/her compassion for a dying patient put him/her in conflict with other team members who favored intensive intervention.

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Factors That Facilitate Compassion Reflection was articulated as important in appreciating the patient’s perspective, maintaining the ability to be compassionate, and developing confidence as a provider. Although individual reflection was very important, a theme which emerged, particularly in the second and third year transcripts, was the important role of group process with other residents in developing and maintaining compassion. Residents appreciated peer support and the opportunity to reflect and realign with personal values, such as caring for underserved and vulnerable populations. A balance between work and personal time was repeatedly identified as an important condition for maintaining compassion. Basic needs included rest, sleep, connection with family and friends, and personal time for reflection, fun and time away from medicine. Residents also appreciated the presence of role models for how to provide compassionate care, and how to balance personal and professional life. Finally, a few young physicians acknowledged that although they believe that thanks should not be necessary, the occasional word of appreciation went a long way towards maintaining their ability to provide compassionate care to their patients.

Barriers to Compassion Residents discussed many barriers to providing compassionate care. Lack of time emerged as the most significant barrier to maintaining compassion. Time pressure was

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identified as a barrier to exploring the patient’s perspective and spiritual issues. Lack of time also interfered with reflection and self-care, which in turn affects ability to be compassionate. Residents also found it difficult to express compassion when patients expressed views that the resident found personally offensive or when healthcare decisions by the patient or by the healthcare team differed significantly from their own. This was particularly relevant in endof-life decision making. Finally, physicians in training described times when insecurity regarding their own medical decision making skills distracted them from being compassionate towards the patient. This was especially true of residents in their first year of postgraduate training.

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CONCLUSION This study elucidates the barriers and facilitators to providing compassionate care in the doctor-patient relationship from the perspective of family physicians in training. Since the questions regarding compassion in this study where asked in the context of a longer interview regarding spirituality in medical practice, themes that emerged must be viewed within this context. Although the relationship between compassion and spirituality has been studied in other disciplines and contexts [27], there are very few studies regarding physicians’ views on compassion and spirituality. Since compassion fatigue is a growing concern amongst practicing physicians [28-30], this study provides some useful insights into ways in which the sustained ability to provide compassionate care can be fostered in practicing physicians, and physicians in training. Key barriers to providing compassionate care to patients included factors intrinsic to the current health care system, including the rushed pace typical of patient encounters and the general lack of value placed on the provision of compassionate care in this system. In order to address these barriers, a larger look at the health system as a whole is necessary. Individual barriers and facilitators articulated by family medicine residents can help in the formation of educational and system changes within training programs that may help foster compassion in the doctor-patient relationship. These include such things as: time for reflection in groups [30] and individually; spirituality curricula to enhance communication around issues of ultimate concern to patients [29,33-34]; focus on care at the end-of-life [25,35]; encouragement of self-care and mindful practice [35]; and value placed on the therapeutic benefit of compassionate medical care [16]. Finally, it is essential that faculty and others recognize and appreciate the long hours and grueling work physicians endure on a daily basis during residency training [28]. In order to foster compassionate patient care in young physicians, we need to provide appreciation and compassionate care for them.

REFERENCES [1]

[2]

Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious Commitment and Health Status: A Review of the Research and Implications for Family Medicine. Arch Fam Med. 1998; 7: 118-124. Levin JS, Larson DB, Puchalski CM. Religion and Spirituality in Medicine: Research and Education. JAMA. 1997; 278(9):792-3.

Resident Physicians’ Thoughts Regarding Compassion and Spirituality… [3]

[4] [5] [6] [7]

[8] [9]

[10]

[11]

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[12]

[13] [14] [15]

[16] [17] [18] [19]

[20] [21]

315

Larimore WL, Parker M, and Crowther M. Should clinicians incorporate positive spirituality into their practices? What does the evidence say? Ann Behav Med. 2002;24(1):69-73. Mueller PS, Plevak DJ, and Rummans TA. Religious involvement, spirituality and medicine: Implications for clinical practice. Mayo Clin Proc. 2001;76:1225-1235. Koenig HG. Religion, spirituality and medicine: Implications for clinical practice. South Med J. 2004; 97:1194-1200. Powell LH, Shahabi L, and Thoresen CE. Religion and spirituality: Linkages to physical health. American Psychologist. 2003; 58(1):36-52. Seeman TE, Dublin LF, and Seeman M. Religion/Spirituality and health: A critical review of the evidence for biologic pathways. American Psychologist. 2003; 58(1):5363. Thoresen CE, and Harris AHS. Spiritulity and health: What’s the evidence and what’s needed? Ann Behav Med. 2002; 24(1):3-13 Ehman JW, Ott BB, Short TH, Ciampa RC, and Hansen-Flaschen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;156:1803-1806. Joint Commission on Accreditation of Healthcare Organizations. Spiritual assessment. Available at: http://www.jointcommission.org/AccreditationPrograms/Hospitals/Standards/FAQs/Pro vision+of+Care/Assessment/Spiritual_Assessment.htm AAMC Report 1998: Report I of the Medical School Objectives Project. Learning objectives for medical school education: Guidelines for medical schools. Acad Med. 1999;74:461-2. WHOQOL SRPB Group. A cross-cultural study of spirituality, religion and personal beliefs as components of quality of life. Soc Sci Med. 2006;62(6):1486-97. Epub 2005 Sept 13. Fortin AH, and Barnett KG. STUDENT JAMA. Medical school curricula in spirituality and medicine. JAMA, 2004; 291(23):2883. King DE, and Crisp J. Spirituality and health care education in family medicine residency programs. Fam Med. 2005; 37:399-403. ACGME. Hospice and palliative medicine core competencies. ACGME. Available at: http://www.acgme.org/acWebsite/downloads/RRC_progReq/540_hospice_and_palliati ve medicine_02122008.pdf. Accessed 3/24/2008. Anandarajah G. The 3H and BMSEST models for spirituality in multicultural whole person medicine. Ann Fam Med. 2008;6:448-458 McBrien B. A concept analysis of spirituality. Br. J. Nurs. 2006;15(1):42-5 Miller WR, and Thoresen CE. Spirituality, religion and health: An emerging research field. Am Psychologist. 2003; 58:24-35 Hill PC, and Pargament KI. Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. Am Psychologist. 2003; 58:64-74 Zinnbauer BJ, et al. Religion and spirituality: Unfuzzing the fuzzy. J Sci Stud Relig. 1997; 36(4):549-564 Shea J. Spirituality and Health Care: Reaching Towards a Holistic Future. Chicago: Park Ridge Center; 2000

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

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[22] McCord, et al. Discussing spirituality with patients: A rational and ethical approach. Ann Fam Med. 2004;2:356-61. [23] Oyama O, and Koenig HG. Religious beliefs and practices in family medicine. Arch Fam Med. 1998;7:431-435. [24] Anandarajah G, and Hight E. Spirituality and medical practice: The HOPE questions as a practical tool for spiritual assessment. Am Fam Phys. 2001;63:81-8. [25] Sulmasy, DP. A biopsychosocial-spiritual model for the care of patients at the end of life. The gerontologist. 2002;42:24-33. [26] Post SG, Underwood LG, Schloss JP, and Hurlbut WB (ed). Altruism and Altruistic Love: Science, Philosophy, and Religion in Dialogue. New York, NY: Oxford University Press; 2002. [27] Fehr B, Sprecher S, and Underwood LG, Science of Compassionate Love: Research, Theory, and Practice. Oxford, England, Malden Mass: Wiley-Blackwell. 2009. [28] Bellini LM, and Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005;80:164-7 [29] Elder N, Ricer R, and Tobias B. How respected family physicians manage difficult patient encounters. J Am Board Fam Med.. 2006;19:533-41 [30] Benson J, and Magraith K. Compassion fatigue and burnout: the role of Balint groups. Aust Fam Phys. 2005;34:497-8. [31] Anandarajah G, Long R, S and mith M. Integrating spirituality and medicine into the residency curriculum. Acad Med. 2001; 76(5):519-20 [32] Borkan J. Immersion/Crystallization In Crabtree BF and Miller WL. Doing Qualitative Research. Thousand Oaks, California: Sage Publications, Inc. 1999. [33] Anandarajah G, Mitchell M, S and tumpff J. Evaluation of a required spirituality and medicine teaching session in the family medicine clerkship. Fam Med. 2007; 39(5):31112 [34] Anandarajah G, and Mitchell M. A spirituality and medicine elective for senior medical students: 4 years’ experience, evaluation and expansion to the family medicine residency. Fam Med. 2007; 39(5):313-5 [35] Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC. Ann Fam Med 2008;6:406-411. [36] Epstein RM. Mindful Practice. JAMA. 1999;282:833-9.

INDEX # 9/11, 64, 70

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A AAS, 291 Aboriginal, 12 abortion, 101, 128, 222 absorption, 283 abusive, 261, 262 accountability, 193 accounting, xii, 243, 244 accuracy, 246 ACI, 287, 290, 291, 292, 293 acquisitions, 249, 251 acute, 74, 83, 94, 163, 208 adaptation, xi, 69, 74, 102, 172, 191, 196 adaptive functioning, 289, 295 adjustment, x, 80, 81, 83, 130, 132, 171, 177, 201, 204, 225, 231, 236, 240, 253 administration, 288 administrative, 23 administrators, 235 adolescence, 131, 256 adolescent adjustment, 128 adolescents, 127, 132 adult, 21, 103, 141, 231, 251, 252, 253, 284, 288 adult population, 103, 141, 251 adulthood, 60, 95, 131, 256 adults, x, xii, 3, 46, 74, 80, 82, 90, 93, 94, 95, 97, 98, 101, 102, 103, 104, 125, 127, 129, 132, 135, 136, 139, 140, 141, 166, 202, 237, 238, 243, 244, 245, 246, 247, 248, 249, 251, 252, 296 affective dimension, 91 affective experience, 164 Africa, 25, 100, 131, 177, 195, 211

African American, xii, 104, 111, 141, 144, 201, 203, 237, 239, 243, 247 African American women, 203, 239 African Americans, 201, 237 African continent, 195 afternoon, 246 age, 4, 19, 20, 21, 22, 23, 37, 55, 56, 63, 82, 102, 110, 111, 130, 144, 145, 178, 180, 190, 198, 202, 210, 215, 217, 229, 233, 238, 245, 247, 249, 250, 252, 258, 261, 263, 285, 289, 290, 297 aging, 82, 93, 94 aging process, 82 agoraphobia, 107, 108, 112, 114, 120 aid, 21, 39, 40, 53, 55, 91, 255, 261, 271, 289 AIDS, 15, 201, 237, 250 air, 2, 25, 26, 29, 54 Alabama, 269, 279 Alaska, 111, 144 Albert Einstein, 75 Alberta, 19, 23 alcohol, 128, 132, 167, 174, 203, 239, 282, 296 alcohol consumption, 128, 167 alcohol problems, 132 alcohol use, 128, 167, 174 ALI, 270, 272 alienation, 209, 212 ALL, 107 Allah, 186, 187, 188, 192, 226 allergy, 15 alternative, 4, 68, 78, 212, 270, 271, 284 altruism, xiii, 281, 283, 284, 288, 292, 294 altruistic behavior, 252 Alzheimer’s disease, 204, 240, 253 ambiguity, 43, 46, 185, 232, 284 ambulance, 37 ambulances, 53 American Heart Association, 136, 166 American Indian, 111, 144

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Index

American Psychiatric Association, 73, 257, 264, 271, 278 American Psychological Association, 5, 167, 168, 299, 301, 304, 305, 306 Amsterdam, 5 analysts, 2 anger, x, 39, 40, 41, 42, 43, 64, 70, 83, 97, 99, 110, 111, 112, 118, 120, 123, 126, 127, 128, 129, 131, 135, 136, 138, 139, 140, 141, 143, 145, 146, 154, 162, 163, 164, 165, 168, 172, 173, 175, 186, 188, 189, 195, 212, 231, 261, 262, 302 angina, 142, 145, 146, 154, 162 Angola, 100 animals, 43, 59, 64, 246, 247 Animals, 287 ankles, 57 anorexia, 262 antecedents, 166, 201, 237, 294 anthropology, 3 antidepressants, 65 antisocial personality, 110, 112 antisocial personality disorder, 110 ants, 184, 224, 225 anxiety, ix, 23, 63, 64, 65, 67, 69, 80, 98, 100, 101, 102, 105, 106, 107, 112, 117, 123, 130, 131, 141, 143, 164, 167, 173, 174, 175, 188, 189, 195, 197, 200, 236, 284 anxiety disorder, 105, 143 APA, 74, 75, 306 appetite, 105, 106, 143 application, 132, 169, 180, 216 applied research, 127, 253 appraisals, 203, 239 argument, 4, 270 Ariel, 7 Arizona, 12 Armed Forces, 104, 141 arousal, 164, 175 arrest, 51 arson, 78 ART, 194, 232 arteries, 142 arteriosclerosis, 142, 145, 146, 154 artery, 69, 137, 169 arthritis, 247 Asian, 111, 144, 179, 181, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 216, 217, 222, 225, 226, 227, 228, 232 assault, 64, 173, 271 assessment, x, 78, 79, 84, 85, 87, 88, 89, 90, 91, 92, 93, 94, 100, 165, 174, 180, 181, 210, 211, 218, 234, 264, 265, 297, 315, 316 assumptions, 61, 68, 233, 263, 278

asthma, 15 atherosclerosis, 167 Atlantic, 23 atoms, 9 atrocities, 47, 48, 49, 51, 52, 54, 55, 56, 58 attachment, xiii, 256, 257, 265, 281, 284, 288, 291, 292 attacks, 107, 108 attitudes, xi, xiii, 87, 172, 196, 203, 210, 239, 252, 267, 268, 270, 281, 289, 292, 297 attribution, 184, 209 Australia, 27, 95 Austria, 7, 101 authoritarianism, 283 authority, 2, 88, 108, 258, 261, 263, 273, 283, 297 autoimmune, 15, 250 autoimmune deficiency syndrome, 250 autoimmune disease, 15 autoimmune diseases, 15 autonomy, 88, 89, 257 avoidance, 104, 108, 130, 142, 258 avoidant, 256 awareness, 66, 67, 197, 199, 235, 257, 263, 267, 272, 287

B babies, 40, 49, 51, 52, 53, 191 baby boom, 253 baby boomers, 253 bachelor’s degree, 20 back, viii, 8, 9, 18, 19, 20, 21, 22, 23, 24, 25, 27, 29, 30, 31, 32, 35, 37, 38, 43, 44, 45, 50, 53, 55, 56, 57, 59, 60, 178, 183, 186, 192, 221 Balkans, 27 Bangladesh, 203, 213, 239 bankruptcy, 109 banks, 275 barrier, xiv, 250, 252, 307, 312, 313 barriers, xii, xiv, 243, 244, 251, 252, 307, 313, 314 basic needs, 311 battery, x, 101, 135 beating, 53 beer, 31, 34, 49 behavior, 71, 74, 106, 109, 126, 139, 167, 168, 252, 265, 270, 271, 273, 277, 288, 309 behavior therapy, 74 behavioral sciences, 305 behaviours, 79, 80, 81, 84, 172, 197, 212, 217 Belgium, 49, 50 belief systems, 49 beliefs, xi, xii, xiii, 1, 38, 48, 53, 57, 67, 70, 78, 80, 82, 84, 85, 86, 87, 88, 89, 91, 93, 95, 132, 175,

319

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Index 176, 185, 186, 187, 191, 195, 197, 198, 202, 203, 205, 207, 208, 210, 211, 212, 213, 218, 223, 224, 225, 227, 230, 231, 233, 238, 239, 241, 257, 260, 264, 265, 267, 268, 269, 271, 277, 282, 283, 284, 285, 286, 292, 293, 294, 295, 299, 303, 304, 305, 306, 308, 309, 310, 315, 316 beneficial effect, 140, 234, 254, 295 benefits, 3, 79, 81, 90, 91, 126, 136, 137, 140, 162, 163, 176, 180, 216, 248, 249, 250, 253, 256, 295, 300, 301, 302, 303 benign, xiii, 59, 255 bereavement, 105, 143, 174, 253 betrayal, viii, 18, 38, 39, 40, 41, 42, 60 bias, 304 Bible, 80, 186, 192, 193, 228, 229, 268, 269, 275, 303, 304 binding, 284 birds, 43 birth, 48, 265 births, 104, 141 Blacks, 104, 141 blame, 40, 41, 72, 213 blaming, 40, 41, 43, 72 bleeding, 46, 47 blocks, 193 blood, 34, 35, 37, 45, 49, 50, 69, 72, 80, 81, 83, 136, 138, 139, 140, 142, 163, 174, 204, 240, 300 blood glucose, 139 blood pressure, 69, 72, 80, 81, 136, 138, 139, 140, 163, 174, 204, 240, 300 blood pressure reduction, 81 blood transfusion, 83 blurring, 89 bomb, 30 bonding, 34 bonds, viii, 18, 33, 36, 38, 60 borderline, xii, 255, 257, 262, 263, 264, 265 borderline personality disorder, xii, 255, 257, 262, 264 Bosnia, 19, 21, 22, 27, 29, 32, 49, 50, 59 Boston, 75, 76, 177 boys, 31, 50, 272 brain, 13, 69, 249 breaches, 46 breakdown, 194, 230 breast cancer, 13 breathing, 72, 259 breathing rate, 72 Britain, 198 broad spectrum, x, 47, 97, 191, 195, 197 brothers, 33, 34, 35, 36, 38, 261 Buddha, 63, 70, 76, 303 Buddhism, 8

Buddhist, 67, 261, 300 buffer, 82, 95 buildings, 272 bulimia, 102 burn, 109, 173 burning, 24, 54, 57, 260 burnout, 15, 316 burns, 46 buses, 39 bushes, 55 buttons, 48

C caliber, 27 Cambodia, 22, 46, 47 Canada, 17, 19, 20, 21, 22, 23, 24, 25, 27, 28, 29, 30, 31, 32, 34, 37, 38, 39, 40, 42, 49, 51, 59, 61, 130 cancer, viii, 8, 10, 11, 16, 75, 83, 84, 86, 87, 90, 93, 94, 95, 167, 174, 192, 200, 204, 236, 240 cancer care, 83, 86, 95 cancer treatment, 84 capital punishment, 268 car accidents, 64 cardiovascular disease, 136, 141, 163, 166, 169 cardiovascular function, 138 cardiovascular risk, 139 cardiovascular system, 139, 140 caregivers, 83, 95 caregiving, 204, 240 carrier, 51 case study, 213 cast, 64 Cataracts, 247 catastrophes, 64 catatonic, 271 categorization, 246, 260 category a, 183, 221 category b, 219 category d, 220, 245 Catholic, 2, 3, 4, 5, 37, 51, 52, 169, 178, 179, 193, 194, 210, 212, 215, 216, 222, 226, 228, 232, 234, 260, 269 Catholic Church, 51, 210, 260 Catholics, 3, 5, 232, 260, 268 causal antecedent, 166 causal inference, 102 causal model, 102, 169 causation, xi, 172, 184, 194, 195, 213, 223 Census, 103, 104, 141 Census Bureau, 103, 141 central nervous system, 69 certificate, 246

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320

Index

chain of command, 40, 41, 42 chaos, 25, 42, 54, 59 chest, 57, 106, 107, 142 Chevron, 264, 265 child abuse, 270 child development, 13 childbearing, 173 childbirth, 173 childhood, 12, 15, 22, 23, 60, 131, 204, 240, 256, 262, 272, 296 childhood sexual abuse, 12, 15 childless, 173, 198, 209 children, 14, 19, 20, 21, 22, 23, 37, 45, 51, 52, 53, 55, 57, 64, 68, 73, 168, 181, 184, 187, 189, 190, 194, 212, 217, 222, 223, 224, 225, 229, 230, 231, 233, 241, 249, 263, 271 China, 100 Chinese medicine, 9 cholesterol, 139, 174, 247 Christianity, xi, 4, 8, 63, 70, 73, 129, 131, 132, 137, 169, 171, 195, 200, 207, 208, 210, 213, 215, 220, 236, 265, 270 Christians, 4, 102, 178, 187, 215, 226, 232, 233 Christmas, 22, 38, 47 chronic illness, 82, 174 chronic pain, 10, 14, 251, 252 chronic stress, 74, 164 CINAHL, 211 Cincinnati, 279 civil war, 21 civilian, 19, 20, 22, 32, 40, 104, 141 classes, 309 classification, 196, 197 classroom, 19 cleaning, 47 clients, 64, 65, 66, 72, 210, 269, 300, 303, 304, 305 clinical psychology, 2 clinical trial, 131 clinician, 304 clinics, xi, 171, 177, 198, 207, 214, 215, 225, 234 close relationships, 130, 168, 256 Cochrane, 74 codes, 183, 219, 220, 301, 304 coding, 182, 183, 219, 220, 221, 246 cognitive ability, 297 cognitive activity, 81 cognitive impairment, 81, 88, 246 cognitive process, 279, 282 cognitive processing, 279 cognitive psychology, vii, 1 coherence, viii, 8, 10, 11, 13, 16 cohesion, xii, 208 cohort, 80, 81, 244

Collaboration, 89, 92, 199 collectivism, 283 college students, 100, 101, 103, 138, 139, 140, 283 Columbia, 104, 141 communication, 2, 173, 226, 244, 300, 313, 314 communities, 86, 100, 136, 180, 302, 303, 304, 305 community, xii, xiii, 2, 21, 40, 47, 54, 70, 72, 78, 80, 85, 86, 98, 100, 101, 132, 139, 169, 193, 198, 212, 214, 226, 231, 233, 243, 244, 245, 249, 250, 251, 252, 253, 268, 281, 282, 283, 284, 285, 294, 301, 302, 303 community support, 70 compassion, xiv, 72, 174, 210, 261, 302, 304, 307, 308, 309, 310, 311, 312, 313, 314 compatibility, 181 compensation, 191, 194, 256, 257, 265 competence, xi, 172, 175, 176, 177, 194, 196, 301, 304 competency, 312 complex behaviors, 244 complexity, 9, 10, 48, 136, 179, 215, 264 compliance, 175, 224 components, 85, 95, 197, 203, 219, 231, 239, 315 comprehension, 177, 195 compulsive behavior, 139 computing, 111, 144 concentration, 172, 194 conception, 212, 284, 285, 294 conceptual model, 136, 308 conceptualization, 5, 98, 180, 199, 215, 220, 315 conceptualizations, 85 concrete, 37, 282 conduct disorder, 109 confession, 2, 4 confidence, 65, 192, 198, 223, 227, 230, 232, 293, 313 confidence interval, 293 confidentiality, 182, 218 conflict, 3, 58, 132, 231, 265, 310, 313 confounders, 80, 84 confrontation, 177, 184, 185, 222, 224 confusion, 2, 136, 194 Congress, iv conjecture, 126 consciousness, vii, 8, 10, 11, 12, 13, 14, 67, 191, 196, 198, 259 consensus, 85, 94, 289 consent, 88, 218, 246, 287 constraints, 312 construct validity, 166 construction, 16, 182, 219, 296 constructivist, 236 consulting, 186, 212

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Index consumption, 128, 167 continuity, 173 control, xi, 59, 80, 90, 107, 140, 141, 164, 166, 173, 176, 184, 185, 191, 196, 197, 199, 208, 214, 223, 225, 233, 235, 269, 270, 272 control condition, 270 control group, 90, 140 conversion, 256, 265 Copenhagen, 7, 11, 13 Coping, 87, 130, 176, 191, 194, 200, 201, 202, 204, 205, 236, 237, 238, 240, 241 coping model, 176, 195, 230 coping strategies, xi, 165, 172, 175, 176, 191, 193, 194, 195, 196, 197, 199, 200, 208, 218, 224, 230, 236 coping strategy, 133, 170, 186, 194 coronary artery disease, 136, 169 coronary heart disease, 13, 140, 167, 168 correlation, 69, 105, 142, 176, 288, 290, 292, 293, 294 correlation coefficient, 290 correlations, 286, 289, 291, 292, 293 costs, 49, 126 counsel, 40, 301 counseling, 2, 38, 71, 201, 234, 236 couples, 172, 173, 174, 188, 199, 201, 202, 203, 204, 208, 210, 225, 229, 231, 234, 236, 238, 239, 240, 289 courts, 40 creativity, 285 credentials, 304 credibility, 182, 219 crime, 34, 68, 269, 270, 271, 272, 273, 274, 275 crimes, 49, 267, 271, 273, 274, 275, 277, 278 criminals, 41 criticism, 4 Croatia, 20, 22, 27 cross-cultural, 95, 128, 131, 203, 239, 315 cross-sectional, ix, 16, 77, 80, 81, 100, 101, 102, 127, 166 cross-sectional study, 16 crying, 48, 57 crystallization, xiv, 307, 309 cultural beliefs, 211 cultural perspective, 131, 201, 237 cultural practices, 210 cultural stereotypes, 231 culture, 9, 28, 30, 130, 185, 210, 211, 213, 233, 234, 284, 296 curiosity, 24 curriculum, 316 Cyprus, 22 cystic fibrosis, 204, 240

D daily living, 83 Dallas, 1, 166 danger, 25, 29, 30, 33, 36, 38, 55, 107, 255, 257 DART, 20 data analysis, 24, 181, 182, 218, 219, 220, 233 data collection, 180, 182, 183, 216, 218, 219, 233 data generation, 215 data set, 175, 309 database, 182, 220 death, vii, ix, xiii, 9, 18, 25, 26, 34, 35, 36, 38, 39, 44, 48, 52, 54, 60, 66, 67, 68, 71, 77, 80, 82, 83, 90, 94, 95, 106, 143, 168, 225, 262, 265, 267, 268, 269, 270, 279 death penalty, 268, 269, 270, 279 deaths, 104, 141 debates, 40 debtors, 51 debts, 109 decay, 52 decision making, 84, 219, 227, 231, 271, 314 decision-making process, 278 decisions, ix, 40, 42, 77, 82, 83, 87, 95, 106, 143, 199, 204, 240, 252, 268, 270, 272, 276, 277, 278, 302, 314 defects, 140 defendants, 267, 269, 270, 271, 273, 276 defense, 23, 28, 269, 270, 271, 279 defenses, 3 definition, 67, 78, 87, 91, 98, 209, 268, 276, 277, 294 delusions, 271 demobilization, 31 demographic characteristics, 110, 144, 179, 216 demographic data, 180, 217, 245 demographic factors, 127, 141, 146, 154 demographics, x, 97, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 136, 144, 145, 146, 148, 149, 150, 151, 152, 153, 154, 156, 157, 158, 159, 160, 161, 279 denial, 172, 262 Denmark, 7 density, 220 deposition, 211 depressed, 104, 105, 106, 142, 143, 190, 288 depression, ix, x, 19, 20, 23, 63, 65, 67, 69, 77, 80, 82, 83, 88, 90, 98, 100, 101, 103, 106, 111, 128, 129, 130, 132, 135, 141, 145, 146, 152, 153, 160, 161, 162, 163, 164, 165, 167, 172, 173, 174, 175, 176, 188, 189, 190, 195, 197, 200, 201, 236, 251 depressive disorder, 130 depressive symptoms, 83, 90, 130, 173, 177, 196, 248

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322

Index

deprivation, 184, 195, 209, 223 desert, 27 destruction, 43 detachment, 33 devaluation, 262 deviation, 293 Diagnostic and Statistical Manual of Mental Disorders, 73, 278 diagnostic criteria, 257 diarrhea, 107 diastolic blood pressure, 139, 140 diesel, 58 dieting, 105, 143 diffusion, 85 dignity, 38, 57, 210 disabilities, 128, 167 disability, 19, 81, 93, 251 disabled, 93, 198 disappointment, 45 disaster, 25, 221 discipline, vii, ix, 1, 18, 33, 60, 175, 282, 305 disclosure, 224, 230 discomfort, 226, 258 discourse, 4, 44, 52, 223 discrimination, 249 discriminatory, 199 diseases, 10 dislocation, 25, 30 disorder, xiii, 64, 66, 72, 73, 74, 100, 105, 107, 108, 110, 112, 120, 125, 128, 130, 143, 167, 281, 288, 290, 292, 293, 294, 295 disposition, 128 dissatisfaction, 3, 193, 194 dissociation, 172, 283 distortions, 293 distraction, 190, 248 distress, ix, x, 63, 70, 72, 77, 78, 82, 83, 87, 88, 89, 90, 93, 94, 101, 102, 103, 171, 177, 190, 196, 201, 203, 237, 239 distribution, 179, 216 District of Columbia, 104, 141 divergence, 65 diversity, 85, 87, 101, 178, 198, 214, 215, 220, 233, 282, 304 divorce, 128, 131 doctor-patient, xiv, 307, 308, 310, 313, 314 doctors, 45, 54, 89, 192, 198, 213, 227, 228, 234, 272, 309, 310 dogmas, 283 dogs, 54, 273 donations, 47, 232 donor, 228 doors, 43

dosage, 284 dream, 28, 31 drinking, 104, 108, 142, 194, 213 driver’s license, 109 drug abuse, 282 drug dependence, 102 drug therapy, 65 drug use, 174 drugs, 9, 47, 104, 109, 142 DSM, x, 15, 64, 97, 102, 105, 107, 128, 143, 167, 296 DSM-II, 102, 296 DSM-III, 102, 296 DSM-IV, x, 15, 64, 97, 105, 107, 128, 143, 167 dualism, 9 duality, 49, 50 duration, 164, 178, 215 dust, 25 duties, 3, 23, 30 dysregulation, 169 dysthymia, 106, 112

E ears, 2 earth, 26, 36, 45, 188 eating, 27, 261, 311 ecological, 203, 239, 253 economic status, 210 ectopic pregnancy, 222 eczema, 15 Education, 75, 127, 167, 179, 199, 204, 205, 216, 235, 241, 245, 314 educational attainment, 110, 111, 144, 145 educational background, 180, 217 egg, 56, 228, 232 ego, 8, 9, 12, 262 Egypt, 195 ejaculation, 211 elaboration, 130, 168 elderly, ix, x, 77, 78, 79, 80, 81, 82, 83, 84, 87, 91, 94, 95, 101, 129, 140, 198, 202, 203, 238, 239, 253 elders, 203, 239, 253 electricity, 27, 28, 248 elementary school, 64 e-mail, 281, 307 embryo, 232 emigration, 104, 141 emotion, 128, 130, 133, 169, 170, 173, 208, 226 emotion regulation, 169 emotional, x, xi, 15, 16, 31, 32, 64, 66, 69, 71, 90, 99, 130, 133, 165, 170, 171, 172, 173, 176, 177,

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Index 178, 181, 185, 187, 188, 190, 194, 195, 199, 203, 205, 207, 208, 209, 213, 217, 223, 224, 225, 227, 230, 234, 239, 241, 263, 310, 313 emotional abuse, 130 emotional disorder, 64 emotional distress, 225 emotional health, 241 emotional intelligence, 15 emotional responses, 173, 209 emotional well-being, 227 emotions, xi, 36, 69, 70, 99, 163, 168, 172, 175, 181, 188, 190, 191, 195, 196, 217 empathy, 98, 138, 234, 285, 316 employers, 244 employment, 251 empowerment, xi, xii, 172, 188, 196, 198, 208, 231, 235 encouragement, 4, 175, 314 endocrine, 175 end-of-life care, 83, 84, 85, 310 energy, viii, 8, 10, 11, 47, 106, 175, 214, 248, 258, 261 engagement, ix, 18, 44, 45, 46, 60, 191, 196, 301, 302, 303 England, 31, 34, 61, 178, 186, 187, 189, 191, 192, 215, 222, 225, 226, 228, 229, 316 Enlightenment, 287 environment, 26, 28, 29, 34, 55, 56, 86, 178 epidemiology, 125, 127, 129 equating, 29 equilibrium, 172, 173 ethical issues, x, xiii, 78, 79, 88, 92, 299, 304 ethical principles, 284, 301 ethical questions, 88 ethics, 38, 93, 232, 283, 285, 301, 304 Ethiopia, 23 ethnic background, 178, 215 ethnic groups, 214 ethnicity, 180, 204, 217, 233, 240 ethnocentrism, 292 etiology, 64 Europe, 31 evening, 250, 259 evil, 13, 48, 49, 50, 54, 58, 71, 195, 212, 261, 262, 272, 273, 275, 286 excuse, 59, 276 exercise, 139, 248, 251, 252, 258, 311 expertise, 304 exploitation, 283, 285, 295 exposure, 66, 263 ex-spouse, 131 externalizing, xiii, 281, 288, 290, 292, 294, 295 externalizing disorders, 294

extinction, 68 extreme poverty, 47 extrinsic rewards, 249 eye, 269 eyes, 24, 38, 49, 50, 57, 71, 259

F fabric, 259 face validity, 165 facilitators, xiv, 307, 314 factor analysis, 167 failure, 39, 40, 49, 54, 61, 93, 131, 190, 208, 209, 309 faith, ix, xi, 54, 63, 64, 67, 69, 70, 71, 72, 83, 85, 86, 87, 95, 172, 174, 181, 187, 188, 191, 194, 197, 210, 212, 213, 226, 228, 229, 264, 268, 283, 296, 300, 301, 303, 304 familial, 177 family, viii, xii, xiv, 2, 18, 21, 22, 23, 24, 25, 32, 33, 35, 38, 39, 40, 41, 42, 43, 45, 54, 55, 57, 60, 68, 70, 72, 95, 104, 108, 109, 110, 125, 128, 142, 143, 167, 173, 208, 210, 212, 213, 222, 226, 241, 249, 257, 260, 303, 307, 308, 309, 311, 312, 313, 314, 315, 316 family history, 109, 128, 167 family medicine, xiv, 307, 308, 309, 314, 315, 316 family physician, 309, 314, 316 family relationships, 35, 173 family support, 257 famine, 38, 44, 57 farmers, 46 fatalism, 230 fatalistic, 187, 235 fatigue, xiv, 15, 172, 307, 308, 314, 316 faults, 301 fax, 281 fear, 26, 28, 35, 56, 58, 64, 71, 82, 95, 99, 108, 126, 173, 175, 209, 250 fears, 71, 209, 256 February, 218, 279 feedback, 182, 219 feeding, 20, 54 feelings, 36, 56, 64, 83, 107, 125, 169, 172, 173, 189, 190, 209, 218, 222, 252, 257, 260, 261, 262, 264, 312 feet, 36, 55, 188 females, 102, 129, 268 femininity, 223 feminist, xi, 171, 172, 204, 207, 208, 214, 218, 237, 238, 240, 292 fencing, 26

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324

Index

fertility, xi, 171, 173, 177, 178, 181, 185, 186, 188, 189, 190, 191, 193, 194, 196, 198, 202, 207, 210, 212, 213, 214, 215, 217, 221, 222, 225, 230, 234, 235, 238 fertility rate, 212 fertilization, 174, 201, 203, 212, 236, 239 fiber, 38, 39 fibromyalgia, 15 fibrosis, 204, 240 FICA, 85 fidelity, 231 financial resources, 214 fine tuning, 301 fire, 21, 26, 35, 46, 50, 54, 109, 258 first aid, 53, 55 first language, 233 First Nations, 40 fitness, xi, 172, 196 flashbacks, 64 flavor, 44 flexibility, 269 flight, 2, 25, 28 floating, 57 flood, 22, 71 flow, 181, 218, 261 focus group, xii, 243, 244, 245, 246, 247, 251, 252 focus groups, 244, 245, 247, 252 focusing, ix, 63, 77, 163, 234 food, 53 Ford, 20, 241 forecasting, 294 forgetfulness, 66 forgiveness, x, 71, 72, 86, 97, 98, 99, 100, 101, 102, 103, 104, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 135, 136, 137, 138, 139, 140, 142, 146, 162, 163, 165, 166, 167, 168, 169, 170, 175, 260, 261, 262, 301, 302 fortification, 26 fortitude, 70 Fox, 249 France, 31, 34, 100 freedom, 41, 176, 180, 197, 217, 285, 294 Freud, 3, 4, 5, 9, 68, 75 Friday, 28 friendship, 36, 173, 191 frustration, 190 fulfillment, 248, 287 functional approach, 253 functional aspects, 91

G Gallup, 300, 305, 306 Gallup poll, 305 gamete, 228, 232 gametes, 228 Gamma, 284 garbage, 53, 59 gas, 49, 248 gay men, 205, 241 gender, 103, 130, 198, 209, 210, 213, 226, 231, 253, 269 gender differences, 209 gene, 278 general practitioner, 178 general practitioners, 178 generalizability, 127, 136, 233 generalization, 233, 274 generalizations, 278 Generalized Anxiety Disorder, 117, 123 generation, 19, 37, 50, 214 genetic factors, 72 genocide, 38, 43, 44, 47, 49, 51, 56, 59 geriatric, x, 78, 83, 91, 92, 252 Germany, 19, 22, 27, 101 gift, xi, 10, 66, 172, 184, 195, 223, 230, 246 gifts, 184, 192, 210, 223, 230 glass, 60 glucose, 139 goal setting, 251 goals, 199, 284, 285, 289 government, iv, ix, 18, 29, 30, 39, 40, 41, 42, 43, 60, 73, 284, 287, 288 grades, 110, 144 grain, 45 grants, 11, 193 greed, 70 grief, 82, 199 grounding, 219 group therapy, 66, 263 grouping, 221 groups, xiii, 25, 83, 84, 90, 101, 102, 111, 140, 144, 163, 176, 178, 182, 205, 210, 214, 215, 220, 226, 233, 241, 244, 245, 247, 250, 252, 253, 265, 267, 269, 274, 288, 309, 314, 316 growth, 82, 98, 101, 176, 177, 197, 211, 224, 231, 306 guidance, 191, 230, 301 guidelines, 301 guiding principles, 301 guilt, 4, 173, 175, 176, 190, 226, 252, 268 guilty, 105, 143, 173, 258, 270, 271, 272 Gulf War, 23, 26, 27

Index guns, 26, 27, 28, 55

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H habitat, 249 hacking, 46 Haiti, 22, 47 hallucinations, xiii, 267, 270, 271, 272, 273, 274, 275, 276, 277, 278 handling, 23 hands, 38, 42, 45, 50, 61, 107, 184, 225, 259 hanging, 191, 194, 198 happiness, 13, 101, 102, 128, 186, 192, 198, 224, 225, 226, 296 harassment, 197 hardening, 142, 285 hardships, 82 harm, ix, x, 8, 15, 77, 78, 88, 267, 272, 273, 277, 312 harmony, ix, 8, 77, 78 Harvard, 5, 66, 74, 97, 135 hate, 41, 49 hazards, 212, 292 healing, vii, ix, xii, xiv, 7, 8, 9, 10, 11, 13, 14, 24, 63, 64, 67, 69, 70, 71, 72, 94, 174, 175, 202, 208, 210, 227, 228, 231, 237, 238, 307, 308, 309, 310, 313 health care, xiv, 85, 89, 92, 167, 195, 199, 200, 201, 204, 212, 235, 237, 239, 240, 241, 300, 303, 304, 307, 308, 310, 312, 313, 314, 315 health care professionals, 90, 300, 303, 304 health care system, 314 health effects, 164, 165 health problems, 141, 145, 146, 154, 162, 163, 165 health psychology, 136 health services, 66, 128, 204, 240 health status, ix, 77, 82, 83, 94, 137, 202, 238 hearing, 30, 273, 275 heart, v, viii, 8, 10, 11, 13, 46, 57, 58, 61, 69, 71, 72, 80, 106, 107, 135, 136, 138, 139, 140, 142, 164, 166, 167, 168, 175, 184, 201, 237, 247, 248 heart attack, 107, 142, 175 heart disease, 80, 140, 142 heart rate, 72, 138, 139, 164 heartbeat, 142 heat, 25, 27, 28, 45 hedonism, 2, 283 height, 55 helplessness, 52, 64, 172, 173 herbs, 227 heterogeneous, 289 high blood pressure, 142 high school, xii, 19, 21, 104, 110, 141, 144, 243, 247 higher quality, 302

325

hip, 175 Hippocrates, 12 Hispanic, 104, 110, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 141, 144, 145, 148, 149, 150, 151, 152, 153, 156, 157, 158, 159, 160, 161 Hispanic origin, 111, 144 Hispanics, 104, 141 HIV, 15, 47, 90, 95, 201, 205, 237, 241 HIV/AIDS, 90, 95 holistic, vii, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 90, 174, 198, 199, 201, 210, 234, 237, 248, 251 holistic approach, 199, 234 holistic care, 174, 198, 199, 201, 210, 234, 237 holistic medicine, 10, 12, 13, 14, 15, 16 hopelessness, ix, 77, 83, 103, 132, 167, 172 horizon, 32, 33 hospice, 86, 315 hospital, 3, 20, 21, 45, 46, 54, 73, 89, 90, 91, 257, 271 hospitalization, 261 hospitalized, 82, 83, 84, 88, 94 hospitals, 54, 91, 177, 214 host, 2, 94, 163 hostility, 99, 128, 130, 131, 136, 138, 141, 163, 168, 302 hotels, 104, 141 House, 13, 29, 61, 75, 165, 168, 253 household, 103, 104, 110, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 141, 144, 145, 148, 149, 150, 151, 152, 153, 156, 157, 158, 159, 160, 161, 261 household income, 110, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 144, 145, 148, 149, 150, 151, 152, 153, 156, 157, 158, 159, 160, 161 households, 104, 141 housing, 104, 141 HPA, 175 human, vii, ix, 2, 3, 5, 7, 8, 9, 10, 11, 12, 13, 16, 18, 38, 43, 45, 47, 48, 49, 50, 52, 53, 54, 55, 56, 58, 59, 60, 64, 66, 67, 68, 70, 73, 86, 177, 184, 185, 193, 195, 202, 210, 211, 213, 237, 273, 281, 284, 287, 295, 296, 297, 306, 309 human activity, 210 human condition, 38, 58, 202, 237 human development, 284 human dignity, 210 human nature, 9, 10 human reactions, 66 human sciences, 5 human values, 297 humane, 303

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Index

humanism, 284 humanitarian, 21, 40, 41, 47 humanitarian aid, 21 humanity, 36, 49, 57, 58, 61, 67, 249, 282, 285 humans, 50, 58 humiliation, 40, 41, 173 Hurricane Andrew, 73 husband, 46, 110, 194, 209, 224, 225, 261 hypersensitive, 66 hypertension, 69, 140, 142, 145, 146, 154, 162, 167, 169, 247 hypothalamic, 175 hypothalamic-pituitary-adrenal axis, 175 hypothesis, 67, 75, 80, 81, 125, 138, 256, 257 hysteria, 49

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I ice, 22 id, 30, 81, 107 idealization, xii, 255, 262 identification, xii, 243, 246, 249, 251 identity, xi, 50, 195, 208, 209, 214, 224, 230, 251, 261, 263, 275, 308 ideology, 296 Illinois, 73 illusion, 67, 68, 255 imagery, 138 images, xiii, 5, 29, 255, 257, 261, 263, 264 immediate situation, 285 immersion, xiv, 307, 309 immigration, 104, 141 immune function, 80, 174 immune system, 69, 175 immunity, 51 implementation, 95, 245 in situ, 24, 25, 50 in vitro, 201, 203, 212, 236, 239 in vitro fertilization, 201, 203, 212, 236, 239 in vivo, 183, 220 incest, 12, 15, 101, 128 incidence, 106, 167, 174 Incidents, 145 inclusion, 79, 123, 178 income, 110, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 139, 144, 145, 148, 149, 150, 151, 152, 153, 156, 157, 158, 159, 160, 161, 181, 217 incurable, 173 independence, 137, 284, 287 India, 100, 131 Indian, 111, 144 indication, 81, 268, 294

indicators, 81, 140, 163, 167, 198, 288, 289, 295, 296 indices, 137, 138, 174 indirect effect, 209 individual differences, 164, 167, 282, 283 individual rights, 72 individualism, 283 induction, 14 infants, 250 infarction, 146, 154 infection, 45 infections, 15 inferences, 293, 294 inferiority, 226 infertile, x, xi, xii, 171, 172, 173, 174, 177, 178, 180, 181, 184, 185, 188, 189, 190, 191, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 207, 208, 209, 210, 211, 212, 213, 214, 215, 217, 219, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 238, 239 infertility, vii, x, xi, xii, 12, 171, 172, 173, 177, 178, 180, 181, 184, 185, 187, 188, 189, 191, 192, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 207, 208, 209, 210, 211, 212, 213, 214, 215, 217, 219, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241 inhibition, 129, 175 inhibitors, 65 inhuman, 49, 58 injuries, 19, 39 injury, iv, 34, 38, 39, 41, 46, 48 injustice, 39, 40, 99 innocence, 60 insane, 58, 267, 268, 270, 271, 272, 273, 274, 275, 276, 277, 278 insecurity, ix, 49, 63, 70, 314 insemination, 228 insight, 10, 67, 71, 178, 197, 198, 214, 227, 231, 256, 278 inspiration, 304 instability, 174 institutions, 91, 287 instruments, 85, 86, 87 intangible, 309 integration, 73, 91, 92, 169, 183, 221, 256, 262, 299, 304, 305 integrity, 38, 173, 199, 301 intelligence, 2 intensive care unit (ICU), 21 interaction, xiii, 68, 91, 139, 183, 221, 236, 253, 267 interactions, 86, 183, 220, 231, 244 interdisciplinary, 90, 91, 92

327

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Index interface, 71 interference, 226 internal consistency, 165, 286 internalizing, xiii, 281, 288, 290, 292, 294, 295 international communication, 27 interpersonal conflict, 139, 168 interpersonal events, 130 interpersonal relations, 64, 300, 302, 304 interpersonal relationships, 64, 300, 302, 304 intervention, xii, 74, 87, 88, 90, 95, 99, 100, 128, 129, 140, 201, 202, 236, 238, 243, 244, 251, 252, 313 interview, viii, 17, 18, 84, 85, 88, 103, 105, 128, 139, 141, 143, 165, 167, 178, 180, 181, 182, 183, 204, 215, 217, 219, 220, 241, 246, 308, 314 interviews, viii, xi, xiv, 17, 47, 102, 103, 141, 171, 178, 180, 181, 182, 183, 200, 207, 215, 217, 218, 219, 220, 221, 229, 236, 246, 251, 307, 309 intimacy, xii, 89, 193, 208, 209, 226, 231, 257 intrastate, 58, 59 intrinsic, 35, 67, 79, 86, 176, 198, 235, 246, 248, 251, 252, 285, 286, 314 intuition, 283, 287 invasive, 226 inventories, 296 Investigations, 100 investigative, 173 investment, 231 Iran, 171, 199, 207, 214, 219, 235 irritability, 64 Islam, xi, 8, 63, 70, 73, 171, 186, 193, 195, 207, 208, 210, 213, 215, 220 Islamic, 8, 199, 235 isolation, 41, 125, 173, 209, 226, 231 Israel, 7, 212 IVF, 174, 202, 214, 228, 238 ivory, vii, 1

J JAMA, 314, 315, 316 Japan, 203, 239 Jerusalem, 7, 201, 237 jewelry, 21 Jews, 4, 5, 211 Jordan, 167, 168 Judaism, 8, 63, 70, 73, 211 judge, 260, 269, 271, 272 judgment, 219, 259, 261, 262 jumping, 28 Jung, 8 juries, 269 juror, xiii, 267, 269, 271, 273, 276, 278, 279

jurors, 267, 268, 269, 270, 271, 272, 273, 276, 277, 278, 279 jury, xiii, 267, 269, 270, 271, 279 jury trial, 279 justice, 40, 41, 49, 99, 138, 169, 279, 303 justification, 176

K keep a low profile, 39 Kentucky, 7, 269, 278 killing, 42, 49, 50, 52, 54, 59, 271, 273, 274, 275 King, 64, 73, 231, 303, 315 knees, 20, 248 knots, 71 Korea, 31, 42 Korean, 129 Kosovo, 22 Kuwait, 22

L labor, 244 lack of control, 190 land, 22, 28, 38 landscapes, 25 language, 4, 24, 51, 61, 72, 181, 182, 212, 219, 233, 282, 283 laptop, 103, 141 later life, 202, 238 Latino, 110, 144 laughing, 36 law, 51, 53, 211, 270, 286, 287 laws, 287 lawyers, 272 leadership, 22, 265 learning, 29, 173, 249, 250, 304 Lebanon, 22 leg, 45, 55 legality, 67 lens, 202, 238 licensing, 304 life course, 91 life experiences, 198 life satisfaction, xii, 86, 102, 243, 244, 251 life stressors, 203, 239 lifestyle, 13, 14, 19, 20, 29, 137, 165, 175, 191, 194, 210 lifestyle changes, 13 lifestyles, 295 life-threatening, 64, 89, 90, 94

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328

Index

lifetime, x, 97, 103, 106, 107, 108, 109, 110, 111, 112, 118, 125, 127, 129, 166 ligament, 282 likelihood, 249, 293 Likert scale, 180, 217 limitation, 166, 233, 281 limitations, ix, 14, 63, 127, 136, 165, 233, 252, 264, 278, 293, 294, 304 Lincoln, 182, 202, 219, 238 linear, 291, 292 linear regression, 291, 292 linguistic, 233 linkage, 138, 139 links, 79, 80, 130, 167, 174, 183, 221 lipid, 174 lipid profile, 174 lipids, 201, 237 lipoproteins, 201, 237 listening, 193, 227, 234, 272 living conditions, 29, 47 loading, 55, 283 local community, 47 location, 25, 27, 29, 30, 51, 55, 182 locus, 196 London, 4, 12, 17, 61, 75, 128, 177, 200, 202, 203, 204, 214, 236, 238, 239, 240, 296, 297 loneliness, 35, 125, 173, 226 long period, 125 longevity, 282 longitudinal studies, 80, 102, 128, 130 longitudinal study, 82, 95, 168, 203, 239 loss of control, 173, 214 losses, viii, 18, 60, 66, 214 love, xii, 8, 9, 10, 38, 87, 98, 101, 102, 127, 175, 186, 191, 193, 197, 208, 226, 231, 256, 258, 261, 288, 289, 302, 304 loyalty, 33, 36, 38 LSD, 13 lying, 2, 26, 30, 31, 36, 37, 56, 57, 258

M Machiavellianism, 289 machines, 42, 49, 50 magnetic, iv mainstream, 68, 136, 198, 308 maintenance, xiv, 308 major depression, 102, 103, 105, 143, 145 maladaptive, xiii, 165, 281, 282, 284, 285, 289, 292, 293, 294 malignant, 71 management, xiv, 174, 231, 251, 307, 309 Manhattan, 279

manic, 190 manifold, 39 man-made, 194 marital life, 225 marital status, 110, 111, 144, 145, 180, 217 market, 296 marriage, 194, 209, 210, 222 married women, 222 Marx, 3, 5 Maryland, 64, 73 materialism, 2, 283 maturation, 285, 294 meals, 47 mean arterial blood pressure, 140 meanings, 29, 297 measurement, 100, 101, 105, 129, 130, 139, 143, 166, 168, 297, 315 measures, x, 84, 85, 86, 87, 97, 101, 103, 104, 105, 135, 140, 142, 165, 175, 256, 284, 285, 288, 289, 294 media, 4, 39, 40, 41, 227, 231 mediation, 137 mediators, 130, 164, 168, 227 medical care, 84, 85, 308, 314 medical school, 308, 309, 315 medical student, 316 medicine, vii, ix, xiv, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 63, 72, 77, 79, 94, 185, 213, 307, 308, 309, 310, 313, 314, 315, 316 meditation, 10, 72, 80, 81, 175, 286, 287, 300 Medline, 211 membership, 111, 144, 294 memory, 5, 12, 28, 66, 172 men, 2, 29, 35, 36, 44, 49, 51, 52, 55, 61, 101, 103, 128, 167, 200, 205, 208, 209, 212, 213, 232, 236, 241, 309 mental disorder, ix, 15, 63, 64, 126, 129, 143, 264, 271, 272, 296 mental health, ix, x, 63, 66, 67, 72, 80, 90, 93, 94, 97, 98, 99, 100, 101, 102, 103, 125, 126, 127, 128, 129, 131, 132, 167, 171, 174, 175, 176, 177, 196, 198, 200, 201, 202, 236, 237, 238, 252, 283, 296, 301, 315 mental illness, 10, 14, 111, 205, 241, 270, 271, 272, 276, 277 mental representation, 263, 264 messengers, 70 meta-analysis, 80, 93, 127, 129, 131, 132, 167, 175, 196, 200, 236, 251, 254 metaphor, 24 metastatic, 10, 13 metastatic cancer, 10 Mexican, 129

329

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Index Mexican Americans, 129 midlife, 202, 238 midwives, 198, 210, 234 migrant, 205, 212, 241 military, viii, 18, 19, 20, 21, 22, 23, 24, 26, 29, 31, 32, 33, 35, 36, 38, 39, 40, 41, 42, 43, 46, 60, 104, 132, 141 milk, 31 mind-body, ix, 63, 68 mines, 30 mining, 30 minorities, 268, 291, 292 minority, 178, 228, 269, 289 minority groups, 289 missions, 30, 37, 43 MIT, 76 mobility, 251 modality, 253 modeling, 73, 101, 306 models, 79, 90, 91, 92, 102, 111, 118, 123, 127, 137, 145, 146, 154, 162, 163, 165, 231, 257, 303, 308, 311, 313, 315 modern society, 72 modernism, 4 modules, 129, 167 money, 109, 250 mood, 101, 105, 106, 131, 143, 188, 249 morale, 198 morality, 48, 49, 283 morals, 48, 58 morbidity, 4, 94 morning, 29, 37, 250, 252 morphine, 20 mortality, ix, xii, 70, 77, 80, 83, 94, 95, 136, 165, 167, 203, 239, 243, 244, 251, 253, 302 mortality rate, ix, xii, 77, 243, 244, 251 mortality risk, 302 mortgage, 109 MOS, 104, 142, 166 motels, 104, 141 motherhood, 223, 228 mothers, 37, 49, 241, 263 motivation, xii, 9, 243, 250, 252, 263, 282, 304 motives, x, 97, 100, 273 mouth, 32, 107 movement, 19, 38 Mozambique, 195 multicultural, 315 multidimensional, x, 78, 91, 136, 175, 208 multidisciplinary, 90, 95, 198, 234 multiple factors, 84 multivariate, 83, 84 murder, 40, 49, 52, 268, 271, 275, 276

muscle, 72 muscles, 106 Muslim, v, xi, 53, 67, 70, 73, 179, 181, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 207, 212, 213, 214, 216, 217, 222, 225, 226, 227, 228, 232, 233, 234 Muslims, 50, 178, 214, 215, 232, 233 mutations, 2 myocardial infarction, 142, 145, 146, 154, 162, 167

N naming, 246 narcissism, 262, 264, 265 narcissistic, xii, 255, 262, 263, 264, 265 narcotics, 20 narratives, 202, 229, 237, 283 nation, 3, 293 nationality, 57 Native Hawaiian, 111, 144 NATO, 22, 23 natural, 2, 5, 19, 48, 54, 64, 94, 181, 210, 211, 218, 282, 287 natural science, 5 Nebraska, 268 negative coping, 176, 196, 224 negative emotions, 71, 99, 163, 185, 195 negative experiences, xii, 99, 243 negative life events, 175 negative reinforcement, 32, 33 negative relation, 175 neglect, 209, 261 nerves, 70, 107 nervousness, 107, 189 Netherlands, 5, 100, 195, 197 network, 69, 271 networking, 303 neuroendocrine, 81 neurotic, 9, 284 neuroticism, 127, 166 Nevada, 267 New England, 168, 204, 240 New Science, 75 New York, iii, iv, 2, 3, 4, 5, 12, 13, 60, 61, 74, 75, 76, 93, 94, 100, 128, 132, 133, 167, 168, 169, 200, 202, 203, 236, 237, 238, 239, 253, 264, 265, 278, 279, 296, 297, 305, 306, 316 New York Times, 2, 5 New Zealand, 27, 128 Newton, 204, 240 NHS, 182, 201, 219, 237 nicotine, 102 Nielsen, 11, 15, 83, 94, 201, 202, 237, 238

330

Index

nightmares, 64 NIH, 74, 75 nodes, 220 noise, 58 non-institutionalized, 104, 141 nonverbal, 180, 217 normal, 22, 45, 55, 66, 74, 126, 173, 199, 222 norms, 284 North America, 47, 51, 213, 232 North Atlantic, 23 North Atlantic Treaty Organization, 23 North Carolina, 80 Northeast, 309 Norway, 7 nurse, viii, 17, 18, 19, 21, 210, 247 nurses, 89, 198, 202, 210, 218, 234, 238 nursing, ix, 21, 60, 77, 79, 87, 200, 204, 236, 241, 264 nuts, 310

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O obligation, 22, 72, 189 observational learning, 303 observations, ix, x, 77, 78, 82, 84, 89, 93, 138, 263 occupational, 105, 143 odds ratio, 112, 114, 120, 145, 146 oil, 51 old age, 82, 202, 229, 238, 285 older adults, xii, 80, 82, 93, 94, 129, 202, 237, 243, 244, 245, 247, 248, 249, 251, 252, 253 older people, 196, 202, 238 old-fashioned, 71 Oman, 244, 251, 253, 302, 303, 306 Oncology, 75, 89, 93, 95 open space, 26 open spaces, 26 openness, 257, 263, 283 openness to experience, 283 opposition, 232 oppression, 303 optimism, xi, 69, 71, 172, 174, 185, 186, 192, 194, 195, 196, 224, 225 Oregon, 281, 293, 295 orgasm, 8, 9 orientation, 2, 93, 176, 198, 200, 203, 235, 239, 256, 295 orthodox, 2, 85, 212, 232, 234, 283 outpatient, 180, 215 outpatients, 84, 100, 218

P Pacific, 111, 144 Pacific Islander, 111, 144 pain, ix, 14, 15, 29, 45, 48, 61, 63, 66, 69, 70, 107, 142, 173, 175, 247, 248, 251, 252, 261 pain management, 251 Pakistan, 20, 200, 236 Pakistani, 212, 232 palliative, 94, 315 palliative care, 94 panic attack, 35, 107, 108 panic disorder, 107, 108, 120 paradox, 263 parent-child, 132 parenthood, 208 parents, 20, 22, 33, 64, 68, 72, 109, 250, 256, 260, 261, 262, 263, 265 parole, 268 partnership, 189 passenger, 29, 49 password, 182 pastoral, 2, 23 pathology, 175 pathways, 81, 137, 163, 168, 175, 202, 238, 315 patient care, xiv, 91, 308, 310, 312, 313, 314 patient-centered, x, 78, 91, 92, 308 patients, ix, x, xii, 3, 10, 13, 14, 15, 54, 69, 77, 78, 79, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 93, 94, 95, 100, 138, 140, 167, 169, 173, 174, 175, 177, 192, 198, 199, 203, 204, 210, 211, 214, 234, 239, 240, 246, 252, 255, 261, 262, 263, 264, 265, 308, 309, 310, 312, 313, 314, 315, 316 patriotism, 284, 286, 294 pay off, 109 peace process, 21 Peacekeepers, 18, 24, 28, 30, 31, 43, 47, 49, 50, 58 peacekeeping, viii, 17, 18, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 40, 42, 43, 44, 46, 48, 50, 51, 53, 55, 57, 59, 60 peer, 251, 313 peer support, 313 peers, 38 pelvic, 12 pelvis, 58 penalty, 268, 269, 270, 279 pension, 20, 21 perceived control, 165 perception, 3, 5, 28, 84, 195, 198, 202, 212, 213, 238, 297 perceptions, xiii, 84, 93, 128, 180, 213, 217, 233, 267, 272, 273, 275, 276, 277, 278 perfusion, 140

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Index permit, 257, 263 perseverance, 186 Persian Gulf, 22 personal communication, 244 personal life, 10, 45, 56, 311 personal values, 88, 313 personality, xii, 2, 4, 5, 100, 109, 125, 127, 129, 166, 167, 168, 174, 186, 200, 225, 235, 243, 250, 253, 262, 263, 283, 284, 296, 297 personality disorder, 100, 109 personality factors, 297 personality inventories, 296 personality scales, 167 personality traits, 297 personhood, 261 pessimism, 195 pharmacotherapy, 73 Philadelphia, 74, 75, 132, 168 philosophers, 8 philosophical, viii, 3, 4, 10, 15, 17, 18, 60 philosophy, 2, 5, 9, 12, 13, 20, 279 phobia, 102, 120, 126 physical health, 15, 16, 80, 83, 99, 131, 132, 136, 137, 138, 140, 162, 163, 164, 165, 166, 167, 168, 174, 204, 240, 297, 300, 302, 303, 315 physical treatments, 213 physical well-being, 69 physical world, 228 physicians, xiv, 84, 85, 89, 90, 91, 93, 94, 95, 174, 204, 210, 234, 240, 307, 308, 309, 313, 314, 315, 316 physics, vii, 1, 68 physiological, 140, 163, 164, 168, 169, 175, 178, 195, 213, 218 physiological arousal, 163 physiology, 169 pig, 46 pilot study, 12, 15, 94, 95 pilot training, 21 pilots, 272 pituitary, 175 planning, 59, 89, 172 plants, 213 plaques, 249 plasma, 201, 237 plastic, 53 play, 40, 44, 48, 49, 64, 72, 82, 84, 140, 165, 177, 196, 198, 211, 272, 286 pleasure, 283, 285 poison, 46 Poland, 220 police, 53, 250 political leaders, 284

331

poor, 46, 47, 138, 176, 289, 291, 292, 302 poor health, 138 population, xiii, 57, 71, 98, 99, 102, 103, 104, 125, 127, 129, 136, 140, 141, 163, 166, 167, 233, 252, 269, 293, 299, 300, 303 Portugal, 100 positive correlation, 198, 293 positive emotions, xi, 172, 175, 185, 194, 195, 224 positive mood, xii, 243, 244 positive relation, 175, 176 positive relationship, 175, 176 posttraumatic stress, 73, 75, 100, 130 posttraumatic stress disorder, 73, 100, 130 post-traumatic stress disorder, 73, 75 potato, 248 poverty, 47, 289, 303 power, xii, 4, 8, 9, 58, 67, 70, 71, 78, 87, 175, 177, 184, 187, 192, 195, 197, 208, 211, 213, 223, 224, 227, 228, 229, 231, 232, 233, 249, 262, 282, 283, 288, 289, 294, 297 powers, 40, 287 praxis, vii, 1 prayer, xii, 10, 70, 80, 81, 86, 174, 175, 177, 192, 193, 201, 208, 213, 225, 232, 237, 253, 286, 300, 301 predictors, 64, 69, 95, 111, 118, 129, 137, 145, 203, 239, 289, 293 pre-existing, 195 preference, 202, 237, 268 pregnancy, 173, 174, 178, 211, 215, 222, 229, 232 pregnancy test, 178, 215 pregnant, 105, 143, 178, 189, 190, 212, 215, 222, 229 pregnant women, 190, 212 prejudice, 67, 93, 182, 218, 284, 288, 292, 293, 294, 296 preschool, 256 press, 40, 100, 132, 202, 222, 267, 268, 270, 279, 286, 297 pressure, 69, 72, 80, 81, 107, 136, 138, 139, 140, 142, 163, 173, 174, 176, 184, 204, 226, 240, 300, 313 prestige, 208 prevention, 129, 167 primary data, 244 prisoners, 40 privacy, x, 29, 78, 88, 89, 178, 214 private, 3, 43, 78, 80, 86, 93, 286, 305 private practice, 86, 305 proactive, 253 proactive interference, 253 probability, 80, 111, 128, 132, 136, 144, 182 probe, 181, 218

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332

Index

problem solving, 196, 197 problem-solving strategies, 196 procreation, 210 production, 211, 218 productivity, xii, 243, 244 program, 2, 21, 22, 109, 251, 308, 309 projective test, 256 property, iv, 109, 220 proposition, 67, 295 prosecutor, 269 prosperity, 194 protection, 51, 55, 182, 250 protective factors, 64, 166 Protestants, 211, 232 protocols, 138, 232 proxy, 163, 289 pseudo, 33 psyche, 71 psychiatric disorder, 103 psychiatric disorders, 103 psychiatrist, 3, 19, 20, 21, 22, 23, 68, 271 psychiatrists, 3, 5 psychoanalysis, vii, 1, 2, 3, 4, 5 psychological association, 302 psychological distress, 101, 102, 130, 131, 132 psychological health, 64, 66, 133, 177, 198, 211 psychological injury, 48 psychological processes, 126, 294 psychological states, 165 psychological stress, 64, 172, 174 psychological well-being, xii, 129, 132, 175, 176, 177, 196, 197, 198, 203, 239, 243, 244, 253 psychologist, 19, 20, 22, 23, 65, 188, 202, 238, 257, 271, 306, 309 psychology, vii, ix, xiii, 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 20, 61, 77, 79, 133, 135, 136, 167, 170, 201, 203, 211, 237, 239, 267, 282, 296, 297, 299, 305, 306 psychometric properties, 131 psychopathology, x, xiii, 61, 97, 103, 105, 111, 112, 114, 118, 120, 123, 125, 126, 127, 129, 131, 262, 281, 284, 288, 294 psychophysiology, 169 psychosis, 174 psychosocial support, 199 psychosocial variables, 103, 127, 137, 141 Psychosomatic, 167, 169, 205, 241 psychotherapeutic, 129, 234, 300, 304 psychotherapy, 9, 10, 12, 13, 14, 15, 65, 66, 71, 72, 200, 201, 236, 237, 263, 297, 301 psychotic, 16 PTSD, 19, 20, 21, 22, 23, 47, 54, 63, 64, 65, 66, 72, 73, 74, 131

public, 3, 4, 41, 44, 57, 80, 86, 108, 129, 200, 227, 230, 236, 289, 295, 300 public health, 200, 236 public policy, 295 punishment, xiii, 51, 177, 211, 260, 267 punitive, xii, 210, 255, 258, 261, 262, 264, 269, 270

Q Qualitative evaluation, 240 qualitative research, 181, 183, 204, 217, 220, 233, 236, 240, 241, 252, 253 quality assurance, 182 quality of life, ix, 10, 13, 14, 15, 77, 80, 82, 83, 86, 90, 94, 95, 98, 131, 175, 176, 197, 203, 205, 239, 241, 251, 315 quantum, 68 quantum theory, 68 Quebec, 47 query, 228 questioning, xi, 48, 207, 221, 222, 229, 309 questionnaire, 85, 180, 217, 285, 288 questionnaires, 85, 256, 268

R race, 110, 111, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 144, 145, 148, 149, 150, 151, 152, 153, 156, 157, 158, 159, 160, 161, 202, 210, 238, 269, 287, 289, 292 racial groups, 269 racism, 49 radiation, 90 radiation therapy, 90 radio, 2, 4, 22, 44 rail, 261 random, 64, 102 range, 19, 105, 127, 142, 164, 179, 215, 220, 255, 256, 288 rape, 12, 64 rating scale, 288 ratings, 277 rats, 28 reaction formation, 262 reactivity, 139, 163, 167, 168, 300 reading, 24, 183, 192 real estate, 41 reality, 3, 40, 56, 68, 72, 195, 197, 220, 229, 230, 255, 265, 271, 285, 287 reasoning, 72, 275, 276 rebel, 56 recall, 35, 139, 166

333

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Index recalling, 52, 139 recognition, xiv, 36, 42, 43, 56, 210, 249, 289, 307 reconcile, 48, 50, 71 reconciliation, 132, 169, 301 recovery, vii, xi, 13, 16, 139, 167, 172, 196, 205, 231, 241 recruiting, 23, 251 recurrence, 167 refining, 183, 221 reflection, 9, 48, 186, 214, 225, 302, 313, 314 refuge, 51, 55, 310 refugees, 55 Registry, 102 regression, x, 102, 111, 118, 123, 135, 145, 291, 292 regular, 19, 20, 21, 22, 23, 109, 278, 300 regulation, 164, 169, 265 regulations, 260, 263 rehabilitation, 15, 83, 94, 252 reinforcement, 32, 33 rejection, 294 relationship, vii, ix, xiii, xiv, 4, 24, 38, 57, 65, 67, 70, 77, 78, 79, 81, 82, 83, 84, 86, 89, 91, 99, 120, 126, 127, 129, 130, 131, 132, 138, 139, 146, 154, 162, 166, 167, 174, 175, 176, 181, 193, 196, 197, 203, 205, 212, 213, 225, 230, 234, 239, 241, 256, 258, 261, 272, 282, 299, 301, 307, 308, 309, 310, 313, 314 relationship quality, 127, 132 relationships, vii, xii, 1, 35, 64, 72, 86, 101, 103, 109, 125, 126, 128, 130, 136, 138, 140, 165, 168, 173, 174, 176, 183, 208, 209, 221, 224, 225, 230, 245, 256, 257, 262, 268, 284, 300, 302, 304, 311 relatives, xii, 69, 109, 173, 208, 222, 224, 226 relativity, 68 relaxation, 72, 175, 177, 191, 203, 240 relevance, 87, 284 reliability, 105, 127, 128, 142, 143, 167, 182, 220 religions, 1, 8, 63, 67, 70, 72, 78, 137, 175, 198, 210, 211, 215, 234, 235, 283, 297 religiosity, ix, xiii, 77, 78, 79, 80, 81, 84, 85, 86, 87, 89, 90, 102, 128, 129, 130, 132, 167, 175, 176, 177, 180, 181, 196, 198, 203, 211, 217, 218, 220, 225, 233, 239, 267, 269, 286 religious belief, xii, 70, 80, 84, 87, 93, 176, 177, 185, 186, 191, 208, 211, 218, 224, 225, 227, 230, 233, 265, 269, 286, 293, 294, 304, 315 religious beliefs, xii, 70, 80, 84, 87, 93, 176, 177, 185, 186, 191, 208, 211, 218, 224, 225, 230, 233, 265, 269, 286, 293, 294, 304, 315 religious groups, xiii, 83, 220, 267, 269 religious traditions, xiii, 299, 300, 301, 302, 305, 306, 308

religiousness, x, xiii, 67, 78, 80, 81, 82, 86, 95, 97, 98, 135, 136, 137, 162, 165, 174, 196, 198, 203, 239, 281, 282, 283, 284, 285, 289, 292, 294, 295, 297 remission, 16 Renaissance, 13 rent, 109 repair, 125, 199 replicability, 282 replication, 102, 129 representative samples, 98, 102, 166 representativeness, 219 reproduction, 210 research design, 294 reserves, 19 residuals, 291, 293 resilience, 133, 170, 238 resistance, 94 resolution, 70, 172, 173, 174, 175, 224, 230 resources, xii, 101, 173, 177, 191, 194, 198, 212, 214, 234, 243, 250, 252 responsibilities, 88 responsiveness, 33 restaurant, 190, 272 retention, 244 retirement, 252 rewards, xii, 33, 184, 243, 249, 251, 252 Rhode Island, 307 rhythm, 54 rhythms, 54 risk, x, 15, 35, 36, 42, 45, 64, 69, 71, 78, 80, 83, 88, 89, 97, 112, 114, 118, 125, 127, 135, 136, 141, 146, 162, 163, 165, 166, 167, 168, 175, 203, 240, 294 risk factors, x, 69, 97, 136, 141, 163, 168 risks, x, 99, 125, 127, 133, 135, 146, 154, 170, 249, 252, 302 roadblocks, 35 robbery, 274 rolling, 58, 72 Romania, 188, 283, 296 rubber, 42 rumination, 125, 128, 130, 131, 164, 165 Russian, 57 rust, 49 Rwanda, viii, 17, 18, 22, 23, 24, 26, 28, 33, 38, 43, 44, 46, 47, 49, 50, 51, 52, 54, 55, 56, 58, 59, 61

S sacred, xi, 41, 51, 172, 198, 212, 230, 283, 301, 304 sadness, 173, 262 safeguard, 194, 230

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334

Index

safety, xii, 25, 26, 27, 34, 243, 250, 252, 256, 257 sample, x, xi, xiii, 64, 65, 73, 84, 97, 102, 103, 104, 111, 112, 125, 127, 129, 132, 135, 136, 139, 141, 144, 145, 166, 167, 169, 171, 178, 179, 182, 214, 215, 219, 233, 234, 245, 246, 251, 252, 281, 282, 283, 285, 290, 293 sample design, 111, 144 sampling, xi, 103, 104, 141, 171, 178, 179, 182, 207, 215, 220, 221, 233, 252, 257, 293 sand, 26 Sarajevo, 27, 50, 57 satisfaction, xii, 84, 86, 93, 101, 102, 128, 131, 186, 197, 198, 225, 231, 234, 243, 244, 248, 251, 285, 309 saturation, xi, 171, 179, 215 scheduling, 252 schema, 271, 273, 286, 289, 292 schemas, xiii, 268, 272, 273, 275, 277, 278, 281, 285, 286, 292 schizophrenia, viii, 8, 10, 11, 15, 174, 267, 271, 272 scholarship, 282 school, xii, 9, 19, 21, 23, 33, 39, 40, 52, 64, 104, 107, 109, 110, 141, 142, 143, 144, 243, 247, 249, 250, 308, 309, 315 school work, 107 schooling, 110, 144 scientific theory, 295 scientific understanding, 199 scores, 31, 105, 111, 142, 145, 246, 251, 274, 277, 289, 291, 292 search, xii, 22, 173, 195, 208, 213, 231, 282 searches, 49 searching, vii, ix, 18, 60, 63, 197, 198 Seattle, 264, 271 secondary education, 20 secret, 173 secular, 137, 212, 293 security, 20, 23, 25, 26, 176, 209, 285 selecting, 104, 141, 179, 214, 219, 220, 233 Self, v, 14, 129, 146, 147, 148, 150, 152, 154, 155, 156, 158, 160, 171, 176, 197, 247, 283, 286, 287, 290, 291, 293, 294, 301 self worth, 304 self-care, 253, 314 self-concept, 209 self-confidence, xi, 172, 188, 194, 195, 224, 312 self-discovery, xi, 172, 196 self-efficacy, 165, 167, 209 self-empowerment, 199 self-esteem, 14, 165, 173, 174, 176, 192, 196, 199, 214 self-help, 303 self-interest, xiii, 281, 284, 285, 287, 293, 294

self-rated health, 102 self-regulation, 164 self-report, 142, 145, 146, 177, 233, 247, 251, 293 self-reports, 233 self-understanding, 256 self-worth, 248 semi-structured interviews, 180, 217 Senegal, 195 sensitivity, 233, 234 sentencing, 268, 269, 270, 271, 279 separateness, 68 separation, 19, 212 September 11, 70, 128, 130 Serbs, 54 series, 3, 29, 65, 106, 139, 309 serotonin, 65 services, iv, xiii, 66, 80, 81, 86, 93, 126, 128, 130, 192, 204, 226, 231, 234, 240, 250, 286, 299, 300, 301, 303 settlements, 200, 236 severity, 87, 126, 131, 275 sex, 12, 110, 111, 144, 145, 289, 290 sexual abuse, 12, 15 sexual intercourse, 211 sexuality, 9, 210 sexually abused, 261 shame, 40, 41, 43, 209 shaping, 177, 196 sharing, 235 sheep, 269 shelter, 26, 27 Shiite, xi, 207, 213 shock, 28, 172, 173, 222, 229 shoot, 44, 45, 46, 51, 53 short-term, 12, 14, 15, 139, 166, 199 shoulder, 45, 49 shoulders, 49, 50, 312 siblings, 33 side effects, 15 sign, 56, 218, 245, 273 signs, 41, 99 silver, 37, 45 similarity, 269, 279 sites, 80, 233 skeptics, 66, 263 skills, 249, 250, 252, 271, 303, 314 sleep, 29, 34, 56, 302, 311, 313 smoking, 69, 194, 251 SNS, 175 SOC, 16 sociability, 176 social activities, 80, 172 social attitudes, 297

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Index social behaviour, 176 social class, 178, 181, 215, 217, 233 social consequences, 209 social context, 293 social contract, 297 social desirability, 129 social factors, 64, 102, 126 social integration, 73 social isolation, 226, 231 social justice, 303 social movements, 205, 241 social network, 80, 249, 303 social order, 48, 59 social phobia, 108, 109, 112, 114, 115, 120, 122 social psychology, 138, 200, 235, 253, 296, 297 social relations, 125, 165 social relationships, 125, 165 social sciences, 214 social situations, 108, 209 social skills, 249 social status, 67, 208 social stigmatization, 208 social support, 64, 80, 81, 125, 128, 131, 165, 196, 202, 238, 295, 303 social upheaval, 68 social work, 30, 53 social workers, 30, 53 socialization, xii, 208, 226, 231 social-psychological perspective, 200, 236 socioeconomic, 104, 141, 198, 297 socioeconomic status, 198, 297 sociology, ix, 77, 79 software, 103, 141, 220, 246, 253 soil, 31, 54 solidarity, 36 Somali, 40, 45, 53 Somalia, viii, 17, 18, 20, 23, 24, 25, 26, 29, 30, 33, 34, 39, 40, 41, 42, 43, 44, 45, 47, 53, 54, 60 somatization, 129 sores, 53 sounds, 30 South Africa, 100, 131, 177, 195, 211, 223 spectrum, x, 47, 97, 191, 195, 197 speculation, 126, 277 speech, 3, 34, 41, 271 sperm, 211, 228, 232 spheres, 213, 286 spine, 38 spiritual care, 89, 92, 95, 198, 234, 235, 308 sports, 23 spouse, 131, 172, 203, 209, 239, 251 SPSS, 111, 144, 246, 253 squatter, 200, 236

335

SRIs, 65 stability, 175, 231, 286, 288, 296 stabilize, 70 stages, 52, 183, 197, 215, 221, 222, 229, 232 standard deviation, 293 standard error, 111, 144, 293 standards, 210, 211, 272, 277, 279, 315 statistics, 104, 141, 290 stereotypes, 272 stereotyping, 231 stigma, 41, 43, 126, 212, 226, 231 stigmatization, 208, 209, 226 stomach, 107, 248 storms, 71 strategies, xi, 74, 165, 172, 175, 176, 179, 181, 183, 191, 193, 194, 195, 196, 197, 198, 199, 200, 208, 213, 215, 218, 221, 224, 230, 236, 256, 297, 301 strength, x, xii, 69, 70, 71, 80, 86, 166, 171, 177, 186, 188, 192, 196, 208, 230, 235 stress, 12, 15, 20, 48, 69, 73, 74, 75, 100, 101, 127, 128, 129, 130, 163, 165, 168, 169, 172, 173, 174, 175, 176, 187, 195, 200, 201, 203, 208, 230, 236, 237, 239, 300, 301 stressful events, 66, 176, 197 stressful life events, 87 stressors, 203, 239, 303 strikes, 70 String Theory, 75 stroke, 175 structural dimension, 265 structuring, 85 students, 100, 101, 103, 138, 139, 140, 283, 316 subjective, 79, 80, 81, 84, 177, 196, 203, 239, 282, 283, 294, 295, 305 subjective experience, 282 subjective well-being, 305 subjectivity, 24 substance abuse, 69, 100, 132 substance use, 100, 102, 105, 129, 143, 174 substrates, 130 subtraction, 139 success rate, 174, 212 successful aging, 93 suffering, ix, 18, 43, 47, 60, 63, 64, 67, 70, 77, 82, 83, 89, 202, 212, 237, 267, 268, 271, 309, 310 suicide, viii, 18, 32, 38, 60, 68, 69, 80, 106, 143, 174, 203, 209, 239, 262 suicide rate, 69, 80, 174, 203, 239 summaries, 276, 309 Sunday, 2, 28 sunlight, 258

336

Index

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Sunni, xi, 171, 178, 179, 184, 185, 186, 187, 188, 189, 190, 192, 193, 207, 213, 214, 215, 216, 222, 225, 226, 227, 228, 232, 234 superego, 262 superiority, 4, 65, 213, 287, 292 supernatural, 68, 195, 213, 284, 294, 295 superstitious, 283 supervision, 90 supervisors, 183, 219 supply, 47, 244 suppressor, 146, 154 surgeons, 53 surgeries, 21 surgery, 9, 69, 214 surging, 136 surprise, 173 survival, 13, 26, 69, 80, 93, 285 survivors, 66, 73, 74, 101, 128, 131 swallowing, 107 sweat, 107 Switzerland, 77, 101 symbolic, 236, 285 symbols, 78 sympathetic, 163, 175, 231, 269, 270 sympathetic nervous system, 163, 175 sympathy, xii, 173, 208 symptom, 126, 261 symptoms, 64, 65, 66, 72, 73, 83, 88, 90, 101, 103, 105, 106, 109, 126, 130, 131, 143, 174, 176, 177, 196, 248, 257, 271 synthesis, 3 systolic blood pressure, 139, 140

T tachycardia, 142, 145, 146, 154, 162 Taiwan, 139, 168 talent, 13 tangible, xii, 243, 249, 251 target population, 104, 141 Taylor series, 111, 144 teachers, 64 teaching, 85, 199, 211, 234, 305, 316 team members, 92, 313 technical assistance, 73 technician, 22 teenagers, 22 telephone, 245 television, 2 temperature, 30, 247 temporal, 101, 125, 130, 211 tension, 36, 72, 209 terminally ill, 95

territory, 57 terrorism, 68 terrorists, 130 testimony, 70, 272, 278 theology, ix, 4, 77, 79 therapeutic approaches, 64, 65 therapeutic benefits, 256 therapeutic relationship, 91, 308 therapists, 65, 72 therapy, 10, 12, 14, 46, 63, 65, 66, 71, 72, 74, 94, 130, 168, 191 thinking, xi, 21, 25, 27, 28, 45, 46, 49, 51, 52, 54, 58, 60, 68, 138, 172, 175, 183, 188, 189, 192, 197, 221, 225, 235, 267, 272, 273, 275, 277, 278 threat, 209, 212 threatened, 225, 261 threatening, 55, 64, 89, 90, 94, 172, 196, 230, 303 threshold, viii, 8, 11 throat, 107 time constraints, 312 time frame, 101, 106 time periods, 188 timing, 191, 196 tin, 107 tinnitus, 15 title, 4, 212 tobacco, 128, 167 torture, 68, 73 trade, 19, 23, 294 trade-off, 294 tradition, 8, 282, 283, 294, 295, 300, 301, 304 traditionalism, 283 traffic, 109 training, xiii, 19, 21, 22, 23, 30, 31, 35, 39, 40, 56, 66, 73, 169, 299, 300, 304, 309, 314, 316 training programs, 314 traits, 3, 38, 71, 99, 128, 137, 209, 256, 269 trajectory, 189, 284 trans, 75, 284 transactional stress, 195, 230 transcendence, 9, 67, 83, 87, 285 transcription, 182, 246 transcripts, 182, 221, 246, 309, 313 transfer, 175 transformation, xi, 5, 67, 132, 172, 196, 285, 305 transformations, 26, 29, 30, 60 transgression, 99, 101, 130 transition, viii, 18, 24, 25, 27, 28, 29, 30, 31, 32, 60, 128, 208 transition to adulthood, 128 transitions, viii, 18, 24, 25, 27, 31, 60, 253, 302 translation, 74 transplant, 201, 237

337

Index transplant recipients, 201, 237 transport, 46 transportation, 244, 250, 252 trauma, vii, viii, ix, 12, 17, 18, 24, 32, 41, 43, 44, 45, 47, 48, 49, 55, 61, 63, 64, 66, 67, 68, 69, 70, 71, 72, 74, 127, 128 traumatic events, 43, 47, 48, 63, 64, 73 traumatic experiences, 31, 66 trees, 55, 56, 259 triage, 55 trial, xiii, 13, 71, 90, 95, 131, 267, 268, 270, 271, 272, 276, 278, 279 triggers, 48 trucks, 29, 36, 45, 55 trust, ix, xi, 18, 21, 39, 48, 60, 63, 65, 70, 71, 72, 137, 187, 208, 223, 224, 226, 230, 260 trusts, 182, 219, 225 trustworthiness, 71, 182 tsunamis, 64 tuberculosis, 53 turkeys, 47 turnover, 244 twins, 68

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U UN, 22, 23, 36, 55 uncertainty, xi, 46, 63, 68, 71, 207, 221, 222, 229, 277 undergraduates, 100 unification, viii, 8, 9, 11, 283 uniform, 29, 41, 43, 57 United Kingdom, 210 United States, v, x, 2, 4, 5, 7, 23, 47, 65, 97, 98, 100, 102, 103, 104, 125, 127, 130, 135, 136, 137, 140, 141, 166, 244, 253, 270, 309, 313 universe, viii, 8, 9, 10, 11, 67, 68, 258, 261 unpredictability, 172

V vagina, 12 validation, 95, 252, 294, 296 validity, 105, 127, 143, 165, 166, 167, 212, 264, 285, 289, 296, 297 values, xi, xii, xiii, 11, 38, 41, 82, 86, 87, 88, 89, 91, 172, 196, 209, 210, 234, 243, 249, 250, 251, 281, 284, 285, 289, 291, 292, 294, 295, 297, 301, 303, 313 variability, 145, 164, 180, 213, 215 variables, xiii, 86, 98, 102, 103, 104, 108, 111, 126, 127, 136, 137, 141, 144, 145, 146, 154, 163, 166,

174, 196, 198, 257, 281, 282, 284, 285, 288, 289, 290, 291, 292, 293, 294 variance, 104, 141, 146, 154 variation, 173, 220 vegetation, 27 vehicles, 30, 35, 50 vein, 70 veterans, 31, 32, 37, 73, 75, 100, 132, 284 victims, 63, 64, 66, 73 Vietnam, 61, 73, 75, 100 Vietnam War, 61 village, 25, 29, 37, 57 violence, 53, 57, 68, 241, 303 violent, 28, 49, 275, 288 violent crime, 275 violent crimes, 275 virus, 45 viscosity, 139 visible, 84 vision, 91 visual perception, 5 voice, 2, 36, 214, 249, 261 volunteerism, xii, 243, 244, 251, 252, 302 vulnerability, 55, 226, 230, 231, 263 vulvodynia, 12

W waking, 106 walking, 27, 29, 41, 54, 59, 248 Wall Street Journal, 70 war, 2, 18, 26, 27, 31, 32, 35, 36, 37, 41, 55, 56, 58, 59, 64 warfare, 31 Washington Post, 70 water, 27, 45, 47, 53, 248, 259, 260, 262 weapons, 46 wear, 41 web, 101 weeping, 57 weight gain, 248 welfare, 73, 252, 289, 301 well-being, xii, 69, 81, 83, 86, 87, 90, 92, 94, 95, 100, 101, 102, 125, 128, 129, 130, 132, 133, 136, 170, 172, 175, 176, 177, 196, 197 198 201, 202, 203, 227, 234, 237, 238, 239 ,243, 244, 248, 251, 253, 301, 305, 308 wellness, 306 wells, 175, 176 Western countries, 78, 203, 239 Western societies, 295 Western-style, 294 whites, 139

338

Index

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William James, 1 wine, 213 winter, 259 wires, 26 wisdom, xi, 12, 13, 15, 60, 184, 208, 223, 224, 283, 285, 301, 302, 303 witnesses, 47, 54, 83 wives, 225, 230 women, x, xi, xii, 51, 52, 53, 54, 55, 57, 58, 83, 101, 103, 130, 171, 172, 173, 174, 177, 178, 180, 181, 184, 185, 186, 188, 189, 190, 191, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 207, 208, 209, 211, 212, 213, 214, 215, 217, 219, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 243, 247, 309 workers, 53, 104, 141 working class, 233 World Health Organization, 86, 174, 210 World War, 23, 31, 32, 38, 42

World War I, 23, 31, 32, 38, 42 World War II, 23, 31, 32, 38, 42 worldview, viii, xi, 8, 11, 47, 49, 172, 176, 195, 223, 283, 285, 292, 294, 295 worry, 35, 36, 106, 107, 176 writing, 180, 183, 271

Y yield, 140 young adults, 104, 141, 296 Yugoslavia, viii, 17, 18, 20, 23, 24, 27, 29, 30, 31, 38, 41, 44, 47, 54, 57

Z Zen, 67, 283