Spiritual resources and struggles in coping with medical illness.

Faced with medical illness, many people turn first to their faith for hope, comfort, strength, meaning, a sense of control, social support, and spiritual support. However, for a smaller but significant number of people, medical illnesses can signal the onset of a spiritual struggle that may presage declines in physical and mental health. In this paper, we describe how spirituality represents both a potent resource and a source of struggle for people coping with medical illness. We conclude with some practical suggestions for medical clinicians interested in addressing spirituality with their patients.

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When dealing with medical illness, people can draw upon a variety of spiritual coping resources. (1) People can reframe a negative situation through a spiritual lens as potentially beneficial. For example, an illness can be attributed to God's will or understood as an opportunity to grow spiritually. By seeking spiritual support from God, individuals may find peace and solace or gain a sense of intimacy with the sacred. Individuals can also draw upon the religious support from congregation members and clergy. Finally, when coping with medical illness, individuals may engage in profound spiritual transformations (eg, forgiveness, conversion) in which the sacred becomes a more central organizing value and priority in life. In a meta-analysis of 49 empirical studies including over 13,000 participants, spiritual coping resources were linked with important health benefits. (2)

While medical illness can strengthen an individual's spiritual resolve, it can also shake an individual's most basic assumptions about the world, including spiritual assumptions. Illnesses may elicit questions about the individual's relationship with God, strain relationships with one's religious community, or arouse internal doubts about the individual's own spiritual values and beliefs. Such spiritual crises can produce more distress than even the physical symptoms of medical illnesses because they represent a threat to one's sacred foundation. Empirical studies have shown that spiritual struggles, particularly when unresolved, can lead to declines in health, and even death. For example, in the previously cited meta-analysis, (2) spiritual struggles were associated with various harmful consequences, such as perceived stress, PTSD symptoms, depression, anxiety, guilt, and suicidal tendencies. Furthermore, in a 2-year longitudinal study of religious coping among medically ill hospitalized elderly patients, spiritual struggles at baseline were predictive of greater risk of mortality. (3)

To address spirituality with patients effectively, it is important for healthcare providers to be open to the spiritual dimension. Because patients may be reluctant to raise their spiritual concerns, medical clinicians might broach the topic this way, "Spirituality often influences how people deal with illness. How, if at all, has your spirituality influenced how you have dealt with your medical condition?" Patients could respond to this open-ended question by discussing the potentially helpful and harmful ways they have used spirituality to cope. Second, medical clinicians should support the use of spiritual coping resources. However, clinicians should be careful not to impose their own spiritual values or beliefs (or lack thereof) upon patients. Third, because spiritual struggles can be particularly disconcerting, health care providers may need to normalize spiritual struggles. However, clinicians should also recognize that chronic spiritual struggles increase risk for poorer physical and mental health, particularly if patients get "stuck" there. Medical professionals could help such patients obtain access to other spiritual resources, such as support from clergy or chaplains, spiritual bibliotherapy, or spiritual support groups, to help them work through these issues. Greater sensitivity to the spiritual dimension in patient care can lead to several benefits, including improvements in depressive symptoms, quality of life, satisfaction with aspects of their medical care, and trust in the doctor-patient relationship. (4,5)

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References

1. Pargament KI. The Psychology of Religion and Coping: Theory, Research, Practice. New York, Guilford Press, 1997.

2. Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol 2005;61:461-480.

3. Pargament KI, Koenig HG, Tarakeshwar N, et al. Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study. Arch Intern Med 2001;161:1881-1885.

4. Kristeller JL, Rhodes M, Cripe ID, et al. Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects. Int J Psychiatry Med 2005;35:329-347.

5. Hamilton JL, Levine JP. Neo-Pagan patients' preferences regarding physician discussion of spirituality. Fam Med 2006;38:83-84.

No one can have a peaceful life who thinks too much about lengthening
it.
--Seneca

Kenneth I. Pargament, PhD and Gene G. Ano, PhD

From Bowling Green State University, Bowling Green, OH and from California State University, Long Beach, CA.

Reprint requests to Kenneth I. Pargament, PhD, Department of Psychology, Bowling Green State University, Bowling Green, OH 43403. Email: [e-mail]